Journal of general internal medicine
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Although experts recommend that healthcare organizations create forums for honest dialogue about race, there is little insight into the physician perspectives that may influence these conversations across the healthcare workforce. ⋯ Creating a healthcare work environment that successfully supports diversity is as important as recruiting diversity across the workforce. Developing constructive ways to discuss race and race relations among colleagues in the workplace is a key step towards creating a supportive environment for employees and patients from all backgrounds.
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Opportunistic screening using hemoglobin A1c (HbA1c) may improve detection of undiagnosed diabetes but remains controversial. ⋯ Risk stratification improves the predictive validity of HbA1c in screening for undiagnosed diabetes in the US population. Although opportunistic screening with HbA1c would improve detection of undiagnosed diabetes, cost-effectiveness studies are needed before implementation of specific screening strategies using HbA1c.
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Patient safety indicators (PSIs) are screening tools that use administrative data to identify potential complications of care and are being increasingly used as measures of hospital safety. It is unknown whether PSIs are related to standard quality metrics. ⋯ With the exception of failure to rescue, we found poor or inverse relationships between PSIs and other measures of healthcare quality. Whether the lack of relationship is due to the limitations of the PSIs is unknown, but suggests that PSIs need further validation before they are employed broadly.
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Limited community-based data describe weight change after diabetes diagnosis. ⋯ A small-but-substantial group of patients had a mean weight trajectory that included a clinically significant weight loss. Weight-loss trajectories were strongly associated with better glycemic control when compared to weight gain. Patients with certain characteristics may need more support for weight loss.
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Significant racial and ethnic differences along several dimensions of patients'experiences with hospital care have been previously documented. However, the relationship between these differences and possible differences in processes of care has not been well described. ⋯ Our findings suggest that hospitals should pursue hiring a culturally diverse work force and should collect racial and ethnically specific data about satisfaction with care including satisfaction with availability of social workers and interpreters.