Journal of general internal medicine
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Nursing resources, such as staffing ratios and skill mix, vary across hospitals. Better nursing resources have been linked to better patient outcomes but are assumed to increase costs. The value of investments in nursing resources, in terms of clinical benefits relative to costs, is unclear. ⋯ Medicare beneficiaries with common medical conditions admitted to hospitals with better nursing resources experienced more favorable outcomes at almost no difference in cost.
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Both patients and surrogate decision-makers experience decisional conflict when making a major medical treatment decision with life or death implications. The relationship between health literacy and decisional conflict while making a major medical treatment decision is not understood. ⋯ The need to make major treatment decisions is likely to increase and making decisions on someone else's behalf appeared to be especially difficult. Improving communication to encourage patient and family engagement in the decision-making conversation, particularly for individuals with limited health literacy, may be helpful.
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Cash prices for prescription drugs vary among community pharmacies in the USA. GoodRx is a discount platform that provides coupons for use in community pharmacies without a membership requirement. Analytical pharmacy is a new type of pharmacy that tests drugs before dispensing to verify medication quality. ⋯ GoodRx-discounted cash prices of generic CV medications were significantly lower than undiscounted cash prices at supermarket, mass merchandiser, and national chain pharmacies. Analytical pharmacy cash prices too were significantly lower than traditional pharmacy undiscounted cash prices. GoodRx-discounted prices for brand-name CV medications did not differ significantly from undiscounted cash prices and between pharmacy types.
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Implementation of evidence-based practices often requires tailoring implementation strategies to local contextual factors, including available resources, expertise, and cultural norms. Using an exemplar case, we describe how health systems engineering methods can be used to understand system-level variation that must be accounted for prior to broad implementation. ⋯ Tools from health systems engineering can be used to identify key work flow process steps, variations in how those steps are executed, and influential contextual factors. This process and the associated assessment tool may facilitate broader implementation tailoring.