Medical care
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Few studies have described patterns and determinants of health services utilization (HSU) in chronic pain (CP) subjects. We aimed to describe these, in particular, regarding medical consultations (MCs), diagnostic tests (DTs), pain medicines (PMs) and nonpharmacologic treatment methods (NTM) utilization. ⋯ The main drivers behind HSU are pain severity, psychological distress, and socio-economic determinants. An important set of benchmarks are presented regarding HSU in CP subjects, comprising useful tools for public health policy and decision-making. Results presented may suggest possible inequalities in the access to NTM, and interventions to improve access are encouraged. Moreover, possible indirect evidence of imaging DT overuse is presented, and it is recommended that their use in CP subjects should more closely follow existing guidelines.
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Public reporting on quality aims to help patients select better hospitals. However, individual quality measures are suboptimal in identifying superior and inferior hospitals based on outcome performance. ⋯ Composite measures of quality for HF, AMI, and PNA performed better than existing measures at explaining variation in future mortality and predicting future high and low performers.
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Reducing readmissions is a national priority, but many hospitals lack practical tools to identify patients at increased risk of unplanned readmission. ⋯ Clinicians can use the RI to help target hospital programs and supports to patients at highest risk of readmission.
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National attention is increasingly focused on hospital readmissions. Little prior research has examined readmissions among patients who are homeless. ⋯ Patients who were homeless had strikingly high 30-day hospital readmission rates. These findings suggest the urgent need for further research and interventions to improve postdischarge care for patients who are homeless.
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Mixed methods research has emerged alongside qualitative and quantitative approaches as an important tool for health services researchers. Despite growing interest, among health services researchers, in using mixed methods designs, little has been done to identify the procedural aspects of doing so. ⋯ "Mixing" in mixed methods is more than just the combination of 2 independent components of the quantitative and qualitative data. The use of "mixing" procedure in health services research involves the integration, connection, and embedding of these 2 data components.