JAMA : the journal of the American Medical Association
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To analyze whether elderly patients who are black or from poor neighborhoods receive worse hospital care than other patients, taking account of hospital effects and using validated measures of quality of care. ⋯ Quality of hospital care for insured Medicare patients in influenced both by the patient's race and financial characteristics and by the hospital type in which the patient receives care.
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Comparative Study
Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs.
To examine whether blacks admitted to Veterans Affairs Medical Centers (VAMCs) with an acute myocardial infarction (AMI) are less likely than whites to undergo cardiac catheterization or coronary revascularization procedures and to determine the impact of these differences on patient survival. ⋯ In a health care system designed to provide equivalent availability of care to all eligible patients, blacks received substantially fewer cardiac procedures after AMI than whites. Despite undergoing fewer interventional procedures, blacks had better short-term and equivalent intermediate survival rates compared with whites.
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The demand for medical services such as critical care is likely to often exceed supply. In the setting of these constraining conditions, institutions and individual providers of critical care must use some moral framework for distributing the available resources efficiently and equitably. ⋯ Patients who are not expected to benefit from intensive care, such as those with imminently fatal illnesses or permanent unconsciousness, should not be placed in the intensive care unit. Hospitals should assign individuals the responsibility of intensive care triage, and a committee should oversee the performance of this responsibility to facilitate the most efficient and equitable use of intensive care.
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To assess risk factors for high-grade cervical dysplasia among southwestern Hispanic and non-Hispanic white women. ⋯ The strongest risk factor associated with high-grade cervical dysplasia among clinic attendees was HPV infection. Although most of the risk factors we examined showed similar associations for dysplasia for both ethnic groups, our data suggest that several different risk factors may be relevant to the development of cervical dysplasia in Hispanics compared with non-Hispanic whites who attend the same clinics.