Medical care
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Comparative Study
A spurious correlation between hospital mortality and complication rates: the importance of severity adjustment.
When two outcome measures, such as mortality and complication rates, are intended to measure the same underlying quantity (in this case hospital quality of care), one expects they will be highly correlated. In addition, as data quality improves, one expects the correlation will increase. The authors show that these expectations are, in a significant way, mistaken. ⋯ Before claims of construct validity can be made, investigators must show that correlations between outcomes purporting to measure quality of care are sustained after adequate correction for severity. Most importantly, it should be recognized that inadequately controlled confounding variables may lead to a spurious high correlation between an accepted and a new outcome measure, and a false sense of adequate construct validity.
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The authors assess the feasibility of using retrospective, indication-specific patient surveys to conduct hospital outcomes research in Germany. Surgical outcome and patient satisfaction were examined in patients who underwent common elective surgical procedures. ⋯ The use of retrospective, indication-specific patient surveys constitutes a time-efficient, cost-effective, and patient-focused option for the systematic acquisition and evaluation of health outcomes in Germany. This methodology holds promise for international and domestic efforts to demonstrate the consequences of restructuring activities in the inpatient sector.
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The author highlights changes in hospital utilization that have occurred in association with restructuring of Ontario hospitals. The basic features of the epidemiology of hospital utilization described link the analysis of the organizational and structural components of hospitals with a more comprehensive evaluation of the impacts of their restructuring and have implications for international comparative studies. ⋯ International comparisons of the epidemiology of hospital utilization and the impact of hospital restructuring will require the use of multiple data sources and the development of shared evaluative frameworks. Health data systems in Canada support the assessment of the broader impacts of hospital restructuring and offer a framework for developing research projects that can provide useful information on these important changes in health-care policy.
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Comparative Study
Competition, ownership, and access to hospital services. Evidence from psychiatric hospitals.
This article examines the impact of increasing competition among hospitals on access to inpatient services and preexisting differences in access between nonprofit and for-profit facilities. It tests theoretical propositions that suggest that nonprofit and for-profit hospitals will respond in different ways and to differing degrees to changing competitive pressures. ⋯ The interaction of ownership and competition explains some seemingly inconsistent finding in the literature and points to the complexity of relying on ownership-based policies to protect access in an increasingly competitive health-care system.
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The authors sought to identify associations between critical care nurses' self-reported participation in euthanasia, their social and professional characteristics, and their attitudes toward end-of-life care. ⋯ These results help explain why some US critical care nurses engaged in euthanasia despite legal and professional prohibitions against it. Because critical care nurses may have a special understanding of the needs of critically ill patients, these results may indicate that current guidelines for end-of-life care are inadequate.