Medical care
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Healthcare systems are investing in end-of-life homecare to reduce acute care use. However, little evidence exists on the timing and amount of homecare services necessary to reduce acute care utilization. ⋯ These results suggest that early homecare admission and increased homecare services will help alleviate the demand for hospital resources at end-of-life.
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To study the reported medical practice of euthanasia in Belgium since implementation of the euthanasia law. ⋯ The frequency of reported euthanasia cases has increased every year since legalization. Euthanasia is most often chosen as a last resort at the end of life by younger patients, patients with cancer, and seldom by nonterminal patients.
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Multicenter Study Comparative Study
Is survival better at hospitals with higher "end-of-life" treatment intensity?
Concern regarding wide variations in spending and intensive care unit use for patients at the end of life hinges on the assumption that such treatment offers little or no survival benefit. ⋯ Admission to higher EOL treatment intensity hospitals is associated with small gains in postadmission survival. The marginal returns to intensity diminish for admission to hospitals above average EOL treatment intensity and wane with time.
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Multicenter Study Comparative Study
Risk adjustment using administrative data-based and survey-derived methods for explaining physician utilization.
The objective of this study was to evaluate an administrative data-based risk adjustment method for predicting physician utilization and the contribution of survey-derived indicators of health status. The results of this study will support the use of administrative data for planning, reimbursement, and assessing equity of physician utilization. ⋯ Administrative data-based measures of morbidity burden are valid and useful indicators of future physician utilization. The survey-derived measures used in this study did not contribute significantly to models on the basis of administrative data-based measures. These findings support the future use of administrative data-based data and Adjusted Clinical Groups for planning, reimbursement, and research.
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Multicenter Study
Association between hospital cardiac management and outcomes for acute myocardial infarction patients.
Randomized trials have shown that medical and interventional therapies improve outcomes for acute myocardial infarction (AMI) patients. The extent to which hospital quality improvement translates into better patient outcomes is unclear. ⋯ Hospitals with higher levels of both medical and interventional management and higher quality initial ED assessment had better outcomes. Readmissions were particularly sensitive to care processes. In the face of the unwarranted variations in outcomes across hospitals, strategies that promote better ED and inpatient management of AMI patients are needed.