Medical care
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Surgical site infections (SSIs) following vascular surgery have high morbidity and costs, and are increasingly tracked as hospital quality measures. ⋯ Claims-based surveillance offers a standardized and objective methodology that can be used to improve SSI surveillance and to validate hospitals' publicly reported data.
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To describe the previously unexamined association between admissions to hospital with chronic disease and changes in all-cause health service utilization over time. ⋯ Cardinal events represent an important reference point to understand the impact of chronic disease on health service utilization. Events that herald such a marked transition in health service demand have not been previously described.
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To examine the relationship between age and all-cause hospital utilization in the years preceding and following a diagnosis in hospital of heart failure, type 2 diabetes, or chronic obstructive pulmonary disease (COPD). ⋯ Longitudinal analysis of utilization around cardinal events overcomes the confounding effect of differences in chronic disease rates between age groups, avoiding a source of ecologic bias that erroneously attributes increasing utilization in individuals with chronic disease to age. Programs designed to reduce hospital demand in patients with chronic disease should possibly focus on younger, rather than older, individuals.
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Higher proportions of BSN-educated nurses were associated with improved outcomes in hospital-level studies. A recent Institute of Medicine report calls for increasing the proportion of BSN-educated nurses to 80% by 2020. Patient-level evidence of cost and quality implications of the 80% BSN threshold is needed for a business case to support these efforts. ⋯ A combined approach of increasing the hospital-level BSN proportion to 80% and assuring a high BSN dose through individual patient-level staffing assignments is needed to achieve projected quality and costs benefits.
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This commentary builds on work examining the impacts of racism on health to identify parallels and intersections with regard to able-ism and health. The "Cliff Analogy" framework for distinguishing between five levels of health intervention is used to sort the Healthy People 2020 goals on Disability and Health along an array from medical care to addressing the social determinants of equity. Parallels between racism and able-ism as systems of power, similarities and differences between "race" and disability status as axes of inequity, intersections of "race" and disability status in individuals and in communities, and the promise of convergent strength between the anti-racism community and the disability rights community are highlighted. With health equity defined as assurance of the conditions for optimal health for all people, it is noted that achieving health equity requires valuing all individuals and populations equally, recognizing and rectifying historical injustices, and providing resources according to need.