Medical care
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Some of the nation's 26 million veterans have two government-financed health care entitlements: Medicare and the Department of Veterans Affairs (VA). The aims of this investigation were to examine trends where Medicare-eligible VA users are initially hospitalized for acute myocardial infarction (AMI) and then to assess rates of cardiac procedure use and mortality for veterans initially admitted to each system of care. ⋯ Medicare-eligible VA users are increasingly hospitalized in Medicare hospitals for AMI. VA users cared for in Medicare hospitals receive more cardiac procedures but have the same survival as VA users cared for in VAMCs. These findings have policy implications for access, quality, and costs in both systems of care.
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To evaluate the psychometric assumptions underlying the construction and scoring of SF-36 scales and summary measures among clinical trial participants with arthritis. ⋯ The SF-36 Health Survey proved to be a psychometrically sound tool for the assessment of the health status of adult participants in clinical trials of arthritis.
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To further validate and assess the reliability and validity of the Trust in Physician Scale. ⋯ The Trust in Physician Scale has desirable psychometric characteristics and demonstrates construct and predictive validity. It appears to be related to, but still distinct from, patient satisfaction with the physician and, thus, provides a valuable additional measure for assessment of the quality of the patient-physician relationship.
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Readmission rates are often proposed as markers for quality of care. However, a consistent link between readmissions and quality has not been established. ⋯ RARs are statistically associated with lower quality of care. However, neither RARs nor other readmissions appear to be useful tools for identifying patients who experience inferior care or for comparing quality among hospitals.
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Prescription medications are being switched to over-the-counter (OTC) status with increasing frequency. Information is limited regarding the impact of OTC availability on the use of prescription forms of those products and on the utilization of health care services. ⋯ The findings of this study suggest that the prescription-to-OTC switch of H2-receptor antagonists reduced the number of prescriptions for those agents dispensed among a population of chronic users of those drugs in a managed care setting without increasing physician visits.