Medical care
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Randomized Controlled Trial Multicenter Study
A randomized trial of telephonic counseling plus walking for depressed diabetes patients.
Patients with diabetes and depression often have self-management needs that require between-visit support. This study evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients' management of depressive symptoms, physical activity levels, and diabetes-related outcomes. ⋯ This program of telephone-delivered CBT combined with a pedometer-based walking program did not improve A1c values, but significantly decreased patients' blood pressure, increased physical activity, and decreased depressive symptoms. The intervention also improved patients' functioning and quality of life.
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Interhospital transfer of patients is a routine part of the care at community hospitals, but the current process may lead to suboptimal patient outcomes. A microlevel analysis of the processes of patient transfer has not earlier been carried out. ⋯ The patient transfer process is often cumbersome, varies by condition, and may not be focused on optimizing patient outcomes. Development of a more fluid transfer infrastructure may aid in implementing policies such as selective referral and regionalization.
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Government regulation is intended to enhance quality, safety, fairness, or competition in the regulated industry. Such regulation entails both direct and indirect costs. ⋯ This study for the first time places a price tag on the regulation of quality in nursing homes. It offers an order of magnitude on the costs to the industry of complying with the current set of standards and given the current level of enforcement. Complementary studies of the benefits that these regulations entail are needed to gain a comprehensive assessment of the effect of the regulation.
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There is inconclusive evidence that nursing home caregiver staffing characteristics influence quality of care. In this research, the relationship of caregiver staffing levels, turnover, agency use, and professional staff mix with quality is further examined using a longitudinal analysis to overcome weaknesses of earlier research. ⋯ With longitudinal information and quarterly staffing information, we are able to show that for many nursing homes improving staffing characteristics will improve quality of care.
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Research suggests that racial/ethnic concordance (matching) between patients and physicians improves quality of care for minority patients by reducing discrimination in the clinical encounter. ⋯ Given that physician race is a more powerful predictor of preventive screening than patient-physician concordance, minority patients may receive some guideline-recommended care at lower rates in concordant pairs. Addressing physician education and training to ensure practice that is consistent with preventive care guidelines may be important. Forms of discrimination in the clinical encounter thought to be modified by concordance do not appear to drive disparities in these outcomes.