Medical care
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Comparative Study
Differences in hospice use between black and white patients during the period 1992 through 2000.
We examined differences in hospice use rates among blacks and whites and investigated trends in racial differences in hospice patients during the period 1992 through 2000. We tested differences in length of hospice survival from hospice enrollment to death between black and white patients during this period. ⋯ Hospice use rates significantly increased for both whites and black patients. Black patients had lower hospice use rates than white patients from 1992 to 1994, but not from 1996 to 2000, which may reflect the diffusion of hospice care to black patients with the rapid growth in hospice programs. Despite differences in patient characteristics, the length of hospice survival was similar among both groups. Future research is needed to assess whether racial disparities exist in quality of hospice care.
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The VA's integrated electronic medical record makes it possible to create a "virtual" cohort of veterans with and without HIV infection to monitor trends in utilization, toxicity, and outcomes. ⋯ In the HAART era, HIV-related codes are sufficient for identifying HIV-infected subjects from administrative data when patients with a single outpatient code are excluded. A large cohort of HIV-infected subjects and matched comparators can be identified from existing VA administrative datasets.
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Bariatric surgery is one of the fastest growing hospital procedures. Our objective is to examine the safety outcomes and utilization of resources in the 6 months after bariatric surgery using a nationwide, population-based sample. DATA/DESIGN: We examine insurance claims for 2522 bariatric surgeries, at 308 hospitals, among a population of 5.6 million nonelderly people covered by large employers in the 2001-2002 MarketScan data. Outcomes and costs were risk-adjusted using multivariate regression methods. ⋯ In contrast to current bariatric studies, which report a 20% in-hospital complication rate, we find a significantly higher complication rate over the 6 months after surgery, resulting in costly readmissions and emergency room visits. Thus, a clear way to reduce the costs and improve outcomes of bariatric surgery is to address the high rate of postoperative complications.
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Comparative Study
Administrative versus clinical data for coronary artery bypass graft surgery report cards: the view from California.
The objective of this study was to compare the performance of a risk model for isolated coronary artery bypass graft (CABG) surgery based on administrative data with that of a clinical risk model in predicting mortality and identifying hospital performance outliers. ⋯ Unique properties of the California administrative data, including the ability to distinguish acute preoperative risk factors from complications of surgery, permitted construction of an administrative risk model that predicts mortality on par with most published clinical models. Despite this, the administrative model identified slightly different hospital outliers, which may indicate somewhat biased assessments of hospital patient risk.
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Conventional wisdom suggests high-quality care for most patients with hip fractures is surgical fixation within 24 hours to reduce mortality and complications, although there is little evidence to support this standard. ⋯ The timing of surgical fixation of hip fracture was not associated with early mortality in carefully adjusted analyses, and the use of "surgery within 24 hours" as a measure of high quality care may be inappropriate.