Medical care
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Practice guidelines rarely consider comorbid illness, and resulting overuse of health services may increase costs without conferring benefit. ⋯ The payoff time framework may identify patients for whom particular clinical guidelines are unlikely to confer benefit, and has the potential to decrease unnecessary health care.
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Comorbidity measures are necessary to describe patient populations and adjust for confounding. In direct comparisons, studies have found the Elixhauser comorbidity system to be statistically slightly superior to the Charlson comorbidity system at adjusting for comorbidity. However, the Elixhauser classification system requires 30 binary variables, making its use for reporting and analysis of comorbidity cumbersome. ⋯ When analyzing administrative data, the Elixhauser comorbidity system can be condensed to a single numeric score that summarizes disease burden and is adequately discriminative for death in hospital.
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Patient misunderstanding of prescription drug label instructions is a leading cause of medication errors. Among Latino patients, limited English proficiency is a major barrier to comprehension of medication instructions. ⋯ The majority of pharmacies surveyed offered limited or no translation services. Lack of translation services is not isolated to rural areas or locations with a marginal Latino population. Spanish-speaking patients encounter barriers to acquiring instructions that support the safe and effective use of medications.
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Bariatric surgery is one of the fastest growing hospital procedures, but with a 40% complication rate in 2001. Between 2001 and 2005 bariatric surgeries grew by 113%. Our objective is to examine how 6-month complications improved between 2001 and 2006, using a nationwide, population-based sample. DATA/DESIGN: We examined insurance claims in 2001-2002 and 2005-2006 for 9582 bariatric surgeries, at 652 hospitals, among a population of 16 million non-elderly people. Outcomes and costs were risk-adjusted using multivariate regression methods with hospital fixed effects. ⋯ Improvements in bariatric outcomes and costs were due to a mix of within-hospital volume increases, a move to a laparoscopic technique, and an increase in banding without bypass.