Medical care
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The quality of nursing home care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor is the impact of special care units (SCUs) for dementia for residents at the end stage of this disease. ⋯ Residence in an SCU is associated with some, but not all, markers of better quality end-of-life care among nursing home residents with advanced dementia.
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Pervasive poverty and high uninsurance rates in the US-Mexico border region coupled with rising US health care costs and the availability of alternatives to formal US health services-both in the United States and Mexico-have resulted in widespread use of alternatives to formal US health care. ⋯ Increasing access to US health services may require greater effort and resources in border communities given the availability of substitutes for formal health care services in this region.
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Policymakers are exploring ways to reduce readmission rates. Much attention has been given to readmissions for conditions such as heart failure, acute myocardial infarction, and pneumonia, but little attention has been given to readmissions of patients with injury-related index admissions. ⋯ This study expands evidence for the influence of injury characteristics on readmission rates. It also provides evidence about hospital experiences that affect readmissions. These findings suggest that a focus on preventing complications during the hospital stay may help reduce hospital-specific readmissions for patients with injury-related conditions. It also suggests that a strategy to reduce readmission rates should not only focus on hospitals but also nursing homes and home health care.
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The complexity of health information often exceeds patients' skills to understand and use it. ⋯ This study provides support for reliability and validity of the CAHPS Item Set for Addressing Health Literacy. These items can serve to assess whether healthcare providers have communicated effectively with their patients and as a tool for quality improvement.
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There is a need for reliable and valid measures of cultural competence (CC) from the patient's perspective. ⋯ The CAHPS CC 26-item set demonstrates adequate measurement properties and can be used as a supplemental item set to the CAHPS Clinician and Group Surveys in assessing culturally competent care from the patient's perspective.