Medical care
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The goals of this study were to examine the relationship of patient assessments of hospital care with patient and hospital characteristics. In addition, the authors sought to assess relationships between patient assessments and other patient-derived measures of care (eg, how much they were helped by the hospitalization and amount of pain experienced). ⋯ Although hospital scores differed according to several patient and hospital characteristics, the magnitude of the associations was relatively small. The findings suggest that, with respect to obstetric care, patient assessments may represent a robust measure that can be applied to diverse hospitals and patient casemix.
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This study used discrete-time survival analysis to estimate the tenure of primary care physicians in Community Health Centers (CHCs), to identify the changing risk of leaving Community Health Center employment as time passes, and to identify factors associated with a physician's likelihood of remaining in a Community Health Center. Because of dramatic differences in physician career trajectories, much of the focus was on differences between physicians with and without National Health Service Corps obligations. ⋯ The study demonstrates the value of discrete-time survival analysis in addressing questions related to the tenure of primary care physicians in Community Health Centers, making it possible to use data from physicians whose Community Health Center careers began before or ended after a give measurement window. Second, the study measured primary care physician tenure, providing center directors with a yard-stick against which to compare their own center's performance. Finally, the data provided some help in trying to explain differences in the propensity to stay or leave employment in Community Health Centers.
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The authors determined whether standardized hospital mortality rates varied for six common medical diagnoses. ⋯ Standardized hospital mortality rates varied for six diagnoses that likely are managed by similar practitioners. Although variability may be decreased by restricting analyses to hospitals with large volumes, the findings indicate that for many hospitals, diagnosis-specific mortality rates may be an inconsistent measure of hospital quality, even when data are aggregated for multiple years.
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Randomized Controlled Trial Clinical Trial
A randomized controlled trial of a drug use review intervention for sedative hypnotic medications.
Drug use review is used by both the public and private sector to influence prescribing behavior and patient drug use. Past interventions mailed to prescribers have had mixed results. The objective was to evaluate the effect of a one-time, mailed intervention on subsequent use of sedative hypnotic medication. ⋯ The intervention achieved a statistically significant decrease in targeted drug use, and the amount of reduction is likely to have decreased the risk of fractures associated with benzodiazepine use. This study adds to the recent evidence that mailed drug use review interventions can have a desirable impact on patient drug use.
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The authors describe the relation of provider characteristics to processes, costs, and outcomes of medical care for elderly patients hospitalized for community-acquired pneumonia. ⋯ Processes and costs of care for community-acquired pneumonia varied by provider characteristics, but neither mortality nor readmission rates did. These differences cannot be explained by clinical variables in the database. Further studies should determine whether less costly patterns of care for pneumonia, and perhaps other conditions, could replace more costly ones without compromising patient outcomes.