Medical care
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We sought to examine the extent to which reported barriers to health care services differ between American Indians (AIs) and non-Hispanic Whites (Whites). ⋯ Although individuals have enrolled in health care programs and have access to care, barriers to using these services remain. Significant differences between AIs and Whites involve issues of trust, respect, and discrimination. Providers must address barriers experienced by AIs to improve accessibility, acceptability, and quality of care for AI health care consumers.
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Controversy exists regarding whether and how physicians should address religion/spirituality (R/S) with patients. ⋯ Differences in physicians' religious and spiritual characteristics are associated with differing attitudes and behaviors regarding R/S in the clinical encounter. Discussions of the appropriateness of addressing R/S matters in the clinical encounter will need to grapple with these deeply rooted differences among physicians.
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The substantial racial and ethnic disparities in access to and use of health services are well documented. A number of studies highlight factors such as health insurance coverage and socioeconomic differences that explain some of the differences between groups, but much remains unexplained. We build on this previous research by incorporating additional factors such as attitudes about health care and neighborhood characteristics, as well as separately analyzing different Hispanic subgroups. ⋯ Researchers and policymakers may need to broaden the scope of factors they consider as barriers to access if the goal of eliminating disparities in health care is to be achieved.
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Risk adjustment is central to the generation of health outcome report cards. It is unclear, however, whether risk adjustment should be based on standard logistic regression, fixed-effects or random-effects modeling. ⋯ Shrinkage estimators based on random-effects models are slightly more conservative in identifying quality outliers compared with the traditional approach based on fixed-effects modeling and standard regression. Explicitly modeling surgeon provider effect (fixed-effects and random-effects models) did not significantly alter the distribution of quality outliers when compared with standard logistic regression (which does not model provider effect). Compared with the standard parametric approach, the use of a bootstrap approach to construct 95% confidence interval around the O/E ratio resulted in more providers being identified as quality outliers.
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Randomized Controlled Trial
Modeling the impact of enhanced depression treatment on workplace functioning and costs: a cost-benefit approach.
The impact of depression on the workplace has been widely observed in studies examining absenteeism and reduced productivity during days at work. However, there is little scientific evidence about whether depression interventions are cost-beneficial to employers. ⋯ Many employers will receive a potentially significant ROI from depression treatment models that improve absenteeism and productivity at work.