Medical care
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Emergency department (ED) crowding has been identified as a major threat to public health. ⋯ Measures indicating crowded ED conditions were not predictive of mortality after case-mix adjustment. The first half-day of boarding added to admission LOS rather than substituted for it. Our findings support the use of boarding time as a measure of ED crowding based on robust prediction of admission LOS. Interpretation of measures based on other patient ED transit times may be limited to the timeliness of care.
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Patients with sickle cell disease (SCD) can suffer frequent hospital admissions for painful vasoocclusive crises. Hydroxyurea was approved by the FDA in 1998 to decrease the morbidity of SCD, but nationwide hospitalizations for SCD in the United States since 1998 have not been evaluated. We hypothesized that the availability of hydroxyurea for SCD would be associated with a decrease in hospitalizations for SCD over time. ⋯ Between 1998 and 2008, there was not a steady decrease in hospitalization rates for the population of SCD in the United States. On the contrary, there was a decline in length-of-stay in hospital over this time. Hydroxyurea underuse is well documented. Efforts to increase hydroxyurea use may help to reduce hospitalization rates.
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Randomized Controlled Trial Multicenter Study Comparative Study
Use of interactive voice response to improve colorectal cancer screening.
Only 63% of the US population aged 50-75 years is adherent with recommended colorectal cancer (CRC) screening guidelines. Efforts are needed to increase screening for CRC. ⋯ Our analysis provides "real-world" evidence that IVR is effective when delivered by a commercial health plan, and may be a useful tool for increasing adherence to screening guidelines among patients outside an integrated care practice.
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Because of small sample sizes and low event rates, risk-adjusted surgical outcomes often do not meet reliability benchmarks for distinguishing hospital performance. Nonetheless, it is unclear whether these measures may still be useful for predicting future hospital surgical performance. ⋯ Even at very low reliability levels, risk-adjusted outcome measures may distinguish best and worst hospitals' surgical performance. This study suggests that commonly accepted reliability thresholds may be too high, especially in the context of selective referral.
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Previous research has demonstrated that patients undergoing elective surgery on the weekend had an adjusted risk of 30-day mortality that was significantly higher than that of patients operated upon during the week. The generalizability of this association and effect size is unknown. ⋯ Similar to previous studies in distinct health care systems, patients in Ontario undergoing elective surgery on the weekend experienced an increased risk of 30-day postoperative mortality. Mechanisms underlying this effect require further study.