Medical care
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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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Patients' trust in their health care providers may affect their satisfaction and health outcomes. Despite the potential importance of trust, there are few studies of its correlates using objective measures of physician behavior during encounters with patients. ⋯ Physician verbal behavior during an SP encounter is associated with trust reported by SPs and patients. Research is needed to determine whether interventions designed to enhance physicians' exploration patients' experiences of disease and illness improves trust. Key Words: physician-patient relationship, patient-centered care, trust, physician behavior
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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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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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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.