Medical care
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Specialized stroke unit care improves outcome in stroke patients. However, it is uncertain whether the units should be placed in a neurological or non-neurological (eg, internal medicine or geriatric) setting. ⋯ Except for early antiplatelet therapy and early computed tomographic scan or magnetic resonance imaging, the medical setting was not associated with differences in processes of acute stroke care and patient outcome. No medical setting related differences were found according to comorbidity, although indications of a worse outcome in patients with moderate comorbidity in neurological settings warrant further investigation.
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Studies suggest that a business case for improving nurse staffing can be made to increase registered nurse (RN) skill mix without changing total licensed nursing hours. It is unclear whether a business case for increasing RN skill mix can be justified equally among patients of varying health needs. This study evaluated whether nursing hours per patient day (HPPD) and skill mix are associated with higher inpatient care costs within acute medical/surgical inpatient units using data from the Veterans Health Administration. ⋯ The association of nurse staffing level with costs per admission differed for medical versus surgical admissions.
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Heart failure patient mortality rates are a focus of hospital quality assessment. This study examines whether comprehensive use of diagnoses identified as present on admission improves methods for comparing hospital mortality rates. ⋯ More comprehensive use of diagnoses identified as present on admission improves the performance of mortality risk adjustment methods, and these improvements meaningfully change the results of hospital mortality rate comparisons.
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Multicenter Study Comparative Study
Impact of perceived discrimination in healthcare on patient-provider communication.
The impact of patients' perceptions of discrimination in healthcare on patient-provider interactions is unknown. ⋯ Perceptions of past racism and classism in healthcare settings may negatively impact the affective tone of subsequent patient-provider communication.
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Language discordance between patient and physician is associated with worse patient self-reported healthcare quality. As Hispanic patients have low rates of cardiovascular and cancer screening, we sought to determine whether patient-physician language concordance was associated with differences in rates of screening. ⋯ This study finds that Spanish-speaking patients cared for by language-concordant PCPs were not more likely to receive recommended screening for cardiovascular risk factors and cancer. Furthermore, language concordance was associated with lower likelihood colorectal cancer screening. Further research is needed to examine which conditions are optimal to improve cardiovascular and cancer screening for Spanish-speaking patients, particularly for colorectal cancer, which has a low rate of screening.