Journal of general internal medicine
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Prior literature suggests that blacks are more likely to be discharged against medical advice (DAMA). ⋯ Disparities in DAMA affecting minority patients in general hospitals are largely accounted for by individual and hospital socio-economic factors. The absence of any adjusted disparity affecting blacks, and the protective effect observed for Hispanics and other minorities suggest that individual discrimination and poor communication are not primary determinants of DAMA, but where patients are admitted does contribute to disparities in DAMA.
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Despite the importance of lifelong learning as an element of professionalism, no psychometrically sound instrument is available for its assessment among physicians. ⋯ Empirical evidence supports the validity and reliability of the JSPLL.
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Evaluating the quality of care provided by individual primary care physicians (PCPs) may be limited by failing to know which patients the PCP feels personally responsible for. ⋯ Nearly one-third of patients seen were considered "Not My Patient" by the PCP, although this proportion varied widely. We developed and validated a simple model to link specific patients and PCPs. Such efforts may help effectively target interventions to improve primary care quality.
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Comparative Study
The burden of obesity among a national probability sample of veterans.
Few national data exist about the prevalence of obesity and the resulting health burden among veterans. ⋯ Veterans who receive care at the VA have higher rates of overweight and obesity than the general population. At present, less than half of VA medical centers have weight management programs. As the largest integrated U.S. health system, the VA has a unique opportunity to respond to the epidemic of obesity.
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Comparative Study
Impact of health literacy on socioeconomic and racial differences in health in an elderly population.
Differences in health literacy levels by race and education are widely hypothesized to contribute to health disparities, but there is little direct evidence. ⋯ We found that health literacy explained a small to moderate fraction of the differences in health status and, to a lesser degree, receipt of vaccinations that would normally be attributed to educational attainment and/or race if literacy was not considered.