Medical care
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The importance of teams for improving quality of care has received increased attention. We examine both the correlates of self-assessed or perceived team effectiveness and its consequences for actually making changes to improve care for people with chronic illness. STUDY SETTING AND METHODS: Data were obtained from 40 teams participating in the national evaluation of the Improving Chronic Illness Care Program. Based on current theory and literature, measures were derived of organizational culture, a focus on patient satisfaction, presence of a team champion, team composition, perceived team effectiveness, and the actual number and depth of changes made to improve chronic illness care. ⋯ The data suggest the importance of developing effective teams for improving the quality of care for patients with chronic illness.
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Administrative data play a central role in health care. Inaccuracies in such data are costly to health systems, they obscure health research, and they affect the quality of patient care. ⋯ Although more research is needed to evaluate the cause of inaccuracies and the relative contributions of patient, provider, and system level effects, it appears that significant inaccuracies in administrative data are common. Interventions aimed at correcting these errors appear feasible.
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Comparative Study
Which organizational characteristics are associated with increased management of depression using antidepressants in US nursing homes?
There is universal agreement that organizational characteristics of nursing facilities can and do influence the quality of care and resident outcomes. ⋯ Facilities that are required to be more fiscally conservative, be it larger facilities with fewer private pay patients or for profit facilities, have lower rates of pharmacologic treatment. Resource and structural characteristics influence the type of antidepressant being prescribed; resident characteristics may not be the over-riding factor in prescribing.
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Comparative Study
Changes in usual source of care and perceptions of health care access, quality, and use.
We sought to evaluate the extent of changes in usual source of care and associations with perceived health care access, quality, and use. ⋯ Persons who experience a change in usual source of care more closely resemble persons who have no usual source in perceptions of access and quality but resemble persons who have a continuous usual source in use. Although we cannot determine whether the change in usual source caused these variations in perceived access, quality, and use, these data suggest that there are important and unrecognized differences in interactions with the health system among individuals who report a usual source of care at a single point in time.
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The objective of this study was to estimate the association between socioeconomic status (SES) and outcome for admissions to intensive care. ⋯ There is a SES gradient for hospital mortality in elective surgical admissions that is not explained by differences in case mix or the withdrawal of active treatment. Further research is required to establish if this finding can be explained by unmeasured differences in health status at admission to an intensive-care unit or differences in care and to establish the potential impact these results may have on interpreting comparative surgical performance data.