Medical care
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Multicenter Study
Patient and visit characteristics related to physicians' participatory decision-making style. Results from the Medical Outcomes Study.
This article identifies the characteristics of patients and office visits associated with decreased mutual decision-making between physicians and patients. In the baseline cross-sectional survey of the Medical Outcomes Study we measured specific patient characteristics hypothesized to influence participatory decision-making (PDM) styles of physicians. We related these characteristics to the PDM style scores for their physicians. ⋯ We have identified seven patient and visit characteristics that maximize or compromise the effectiveness of interpersonal care. Recognizing those at risk for suboptimal interpersonal care may be a first step in improving the management of chronic disease. Key words: participatory decision-making style; interpersonal care; doctor-patient communication.
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The Department of Veterans Affairs (VA) operates one of the largest health care systems in the nation; more than 2.5 million veterans receive care annually. Among the special foci of care within VA is the Dental Service. The Department of Veterans Affairs Dental Service is the largest dental care system in the nation and the largest hospital-based dental care system in the world, receiving more than 1.2 million visits annually. ⋯ The goal of the VA Dental Service is to become veterans' first choice for dental care. Information needed by VA to best respond to the needs of veterans include the following: (1) reasons for why eligible veterans do not use VA dental care; (2) veterans' oral health needs; (3) definition of optimum care and whether it varies as a person moves from functional independence to dependence; (4) whether VA is providing the most cost-efficient care possible and is best utilizing allied health professions; and (5) whether this care is best provided in a hospital setting. Modifications of data gathering systems are required as a first step to providing the needed information.
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Health services research (HSR) in the Department of Veterans Affairs (VA) is one way in which to study the oral health care delivered to aging veterans and to ensure the most effective and efficient methods of meeting their oral health needs. This article details the current resources and infrastructure within VA dentistry that could be used to support a dental HSR agenda, followed by recommendations for improvements. The Department of Veterans Affairs' current situation regarding dental HSR is as follows: Dental health services research within VA needs expansion. ⋯ Develop dental HSR training programs modeled after the Career Development Program, Dental-Geriatric Fellowship, and Dentist-Scientist Programs that will permit VA to become a leader in dental HSR training. Develop mechanisms to ensure adequate and sustained funding for dental HSR projects. Ensure that dissemination techniques are effective and result in improvements in operational effectiveness and quality of care.
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The randomized controlled clinical trial is an increasingly used method in health services research. Analysis of methodology is needed to accelerate practical implementation of trial results, select trials for meta-analysis, and improve trial quality in health services research. The objectives of this study are to explore the methodology of health services research trials, create and validate a streamlined quality evaluation tool, and identify frequent quality defects and confounding effects on quality. ⋯ There was a positive correlation between the overall quality and year of publication (R = 0.21, P < 0.05). The authors conclude that the new quality evaluation tool leads to replicable results and there is an urgent need to improve several study characteristics of clinical trials. In comparison to drug trials, site selection, randomization, and blinding often require different approaches in health services research.
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Comparative Study
Surgical trends in the treatment of diseases of the lumbar spine in Utah's Medicare population, 1984 to 1990.
Chronic low back pain is a major source of disability in this country. The rate of surgical treatment for back disorders varies between small geographic areas in the northeastern United States. A statewide database was utilized to determine rate of surgery for mechanical low back problems in Utah's Medicare population from 1984 to 1990. ⋯ There was no significant correlation between the number of surgeons performing back surgery and the rate of surgery. The variation and increase in back surgery rates in Utah's Medicare population are likely related to changes in the use of surgery for treatment of spinal stenosis and not to an increase in the number of back surgeons. Further investigation is needed to understand better the reasons for the observed increase in back surgery rates.