Journal of general internal medicine
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Fluid resuscitation is a widely used intervention that is mandated in the management of sepsis. While its use can be life-saving, its overuse is associated with harm. Despite this, the best means of assessing a need for fluid resuscitation in an acute medical setting is unclear. ⋯ While fluid resuscitation is considered a key part of the management of sepsis, evidence to support fluid assessment in awake adults is lacking. This review has highlighted a number of research recommendations that should be addressed as a matter of urgency if patient harm is to be avoided.
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Clinical decision-making relies heavily on making a correct diagnosis. Clinicians have a responsibility to understand the full spectrum of the diagnostic information conveyed by a physical exam finding, laboratory test result, or imaging. ⋯ This approach can lead to waste of important diagnostic information and substandard clinical decision-making. The aim of this paper is to demonstrate the role of ROC curves in developing a more comprehensive understanding of diagnostic information portrayed by continuous tests to augment clinical decision-making.
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Observational Study
Real-time Feedback in Pay-for-Performance: Does More Information Lead to Improvement?
Pay-for-performance (P4P) has been used expansively to improve quality of care delivered by physicians. However, to what extent P4P works through the provision of information versus financial incentives is poorly understood. ⋯ More frequent provision of information, provided in real-time, was insufficient to improve physician performance in an existing P4P program with high baseline performance. Results suggest that electronic registries may not themselves drive performance improvement. Future work should consider testing information feedback enhancements with financial incentives.
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Since 2017, four states have successfully adopted the Medicaid expansion through ballot initiative. We analyze how states could potentially use ballot initiatives to implement these programs. ⋯ Amongst those states, there are challenges that limit the development, scope, and implementation of an initiative. Whether a state adopts the Medicaid expansion has important implications for health care providers.