Medical care
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Evidence suggests that over 90% of pediatric splenic injuries can be successfully managed nonoperatively. Although pediatric hospitals have rapidly adopted nonoperative management, variability exists among other types of hospitals. ⋯ For-profit hospitals seem to be trailing not-for-profit hospitals in the adoption of spleen-conserving management practices. The cost of caring for a child with a splenic injury also seems greater at for-profit hospitals, regardless of management path (ie, splenectomy vs. nonoperative management).
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Depression is associated with poor chronic illness outcomes, but it is unknown whether depression influences the quality of communication during the clinical encounter. We investigated whether diabetes patients with depressive symptoms, compared with those without depressive symptoms, report worse clinician-patient communication, and which domains of communication are most affected. ⋯ Diabetes patients with severe depressive symptoms are more likely than those without depressive symptoms to report suboptimal clinician-patient communication across multiple domains of communication, especially those that involve more interactive and "patient-centered" communication. Further investigation of this relationship may uncover explanatory mechanisms and help guide interventions for improving care for both conditions.
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Comparative Study
Identifying in-hospital venous thromboembolism (VTE): a comparison of claims-based approaches with the Rochester Epidemiology Project VTE cohort.
Efforts to identify hospital-acquired complications from claims data by applying exclusion rules to discharge diagnosis codes exhibit low positive predictive value (PPV). The PPV improves when a variable is added to each secondary diagnosis to indicate whether the condition was "present-on-admission" (POA) or "hospital-acquired". Such indicator variables will soon be required for Medicare reimbursement. No estimates are available, however, of the proportion of hospital-acquired complications that are missed (sensitivity) using either exclusion rules or indicator variables. We estimated sensitivity, specificity, PPV, and negative predictive value (NPV) of claims-based approaches using the Rochester Epidemiology Project (REP) venous thromboembolism (VTE) cohort as a "gold standard." ⋯ Utility and accuracy of claims data for identifying hospital-acquired conditions, including POA indicator variables, requires close attention be paid by clinicians and coders to what is being recorded.
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Service quality deficiencies are common in health care. However, little is known about the relationship between service quality and the occurrence of adverse events and medical errors. We hypothesized that patients who reported poor service quality were at increased risk of experiencing adverse events and medical errors. ⋯ Patient-reported service quality deficiencies were associated with adverse events and medical errors. Patients who report service quality incidents may help to identify patient safety hazards.