Medical care
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Although hospice use may be increasing among heart failure patients, its association with both cost and intensity of care in this population has not been well examined. ⋯ Despite lower rates of hospitalization, ICU days, and invasive procedures, hospice care was not associated with reduced expenditures in heart failure. Financial savings related to reduced intensive medical care seems to be offset by the expenditures related to hospice care itself.
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Significant racial disparities have been reported regarding nursing home residents' use of hospital and hospice care at the end of life (EOL). ⋯ Differential use of feeding tubes, do-not-resuscitate and do-not-hospitalize orders lead to racial differences in in-hospital death and hospice use. The remaining disparities are primarily due to overall EOL care practices in predominately black facilities, not to differential hospitalization and hospice-referral patterns within facilities.
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To examine longitudinal changes in Medicare-eligible veterans' reliance on the Department of Veterans Affairs (VA) healthcare system for primary and specialty care over 4 years. ⋯ Reliance on VA primary and specialty care among VA primary care patients decreased substantially over time, particularly for specialty care. Increasing use of non-VA services may complicate VA's implementation of patient-centered medical home models and performance measurement.
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Logistic regression models that incorporated age, sex, and indicator variables for the Johns Hopkins' Aggregated Diagnosis Groups (ADGs) categories have been shown to accurately predict all-cause mortality in adults. ⋯ The MRS combined values for a person's age, sex, and the John Hopkins ADGs to accurately predict 1-year mortality in adults. The ADG Score is a weighted score representing the presence or absence of the 32 ADG diagnosis groups. These scores will facilitate health services researchers conducting risk adjustment using administrative health care databases.
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Understanding provider perceptions of and experiences with order entry and order checks (drug alerts) in an electronic prescribing system may help improve medication safety technology. ⋯ Computerized provider order entry and related order checks are perceived to improve prescribing safety; however, provider entry of some relevant information into the appropriate electronic fields may not be optimal.