Medical care
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Although patients readmitted to intensive care units (ICUs) typically have poor outcomes, ICU readmission rates have not been studied as a measure of hospital performance. ⋯ ICU patients who were subsequently readmitted have a higher risk of death and longer LOS after adjusting for severity of illness. However, readmission rates were not associated with severity-adjusted mortality or LOS. Those data indicate that ICU readmission may capture other aspects of hospital performance and may be complementary to these measures.
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Comparative Study
Cost as a study outcome: sensitivity of study conclusions to the method of estimating cost.
The analyses presented here are intended to provide empirical guidance to two questions faced by researchers performing clinical trials which include a cost component: Which health care services should we track? Should we use facility specific costs or national average costs for individual services in estimating total costs? ⋯ Ideally all health care costs should be included in the analysis. When this is not feasible, one should determine utilization and cost for the intervention itself, costly services (usually hospital, nursing home, and clinic care), and lower cost services that are likely to be affected by the intervention. Sensitivity analysis should be performed to determine if different methods of costing (eg, facility specific versus national costs) materially affect the conclusions of the study.
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Many internal medicine physicians report both primary and secondary specialties in the American Medical Association (AMA) Physician Masterfile. Usually, those represent combinations of general internal medicine and medical subspecialty practice. Whether reported specialty combinations can be used to assess the contribution of specialists to primary care is unknown. ⋯ Aggregate estimates of the availability of primary care in the US could be adjusted by taking into account the primary and secondary specialties reported by internal medicine physicians in the AMA Physician Masterfile.
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Rural health care workforce forecasting has not included adjustments for predictable changes in practice patterns, such as the introduction of practice guidelines. ⋯ The implementation of practice guidelines could result in an increased need for rural health care physicians or other providers. That increase, caused by guideline implementation, should be accounted for in future rural health care workforce predictions.
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To estimate the impact of insurance status on inpatient resource use after adjusting for health upon admission and site of care. ⋯ Inpatient resource use is affected by both the hospital in which care is received and the type of patient admitted. Failure to control for unmeasured differences across hospitals is likely to overstate the impact of insurance substantially.