Journal of evaluation in clinical practice
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To investigate whether patients are prioritized for joint replacement surgery on the basis of severity of osteoarthritis, pain and physical functioning. ⋯ With the expected increase in demand for joint replacement, there needs to be a re-examination of assessment procedures of patients listed for joint replacement. The use of measurement tools to assess symptoms such as pain and physical function would be one way forward.
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Although courses in acupuncture are increasingly available to doctors, little is known about educational outcomes, or the impact on doctor practices. We sought to characterize doctors who seek acupuncture training, and describe acupuncture practice and referral patterns after training. ⋯ Among doctors enrolling in an acupuncture training programme, half encountered barriers that prevented use in clinical practice. Those who did use acupuncture found it to be helpful for treatment of pain. Given the expanding pool of doctors trained in acupuncture in the USA, outcomes research is needed to further evaluate medical acupuncture practice.
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Safer care is a strategic priority for health care organizations worldwide. Yet, the measurement and evaluation of key processes and outcomes associated with safer care remains challenging, even with existing performance measurement indicators. The multi-national Quality Indicator Project (QI Project) data are analysed to [1] document the patterns of safety indicators used between 1999 and 2006 among hospitals in Asia, Europe and the USA; and [2] to identify trends in using both organization-level and patient-level data in hospital performance improvement. ⋯ Traditional performance measures continue to assist hospitals in identifying crucial aspects of safety in the delivery of care. Building on the findings of a previous study, there are emerging trends in the type of measures used in hospitals in Asia, Europe and the USA pursuing the improvement of overall performance. The increasing use of patient-level data specifically, in tandem with organizational level indicators, may signal the continuum of measurement strategies, now still predominantly in the USA but anticipated to be adopted both in Europe and Asia.
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Limited data exist to estimate the use of electronic health records (EHRs) in ambulatory care practices in the United States. ⋯ Overall, fewer than 1 in 5 medical practices in Massachusetts have an EHR. Even among adopters, though, doctor usage of EHR functions varied considerably by functionality and across practices. Many clinicians are not actively using functionalities that are necessary to improve health care quality and patient safety. Furthermore, among practices that do not have EHRs, more than half have no plan for adoption. Inadequate funding remains an important barrier to EHR adoption in ambulatory care practices in the United States.