The American journal of managed care
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To describe variations in the structure of anticoagulation clinic (ACC) care within the Veterans Health Administration (VA) and to identify structures of care that are associated with better site-level anticoagulation control. ⋯ We found substantial variation in guideline-targeted organizational and management features of ACC care within the VA. However, no single feature was associated with better anticoagulation control. Current guidelines for organizing an ACC may have limited relevance for improving patient outcomes.
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Randomized Controlled Trial
A multimodal blood pressure control intervention in 3 healthcare systems.
To determine if a multimodal intervention composed of patient education, home blood pressure (BP) monitoring, BP measurement reporting to an interactive voice response (IVR) phone system, and clinical pharmacist follow-up improves BP control compared with usual care. ⋯ A multimodal intervention of patient education, home BP monitoring, BP measurement reporting to an IVR system, and clinical pharmacist follow-up achieved greater reductions in BP compared with usual care.
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To determine whether patterns of electronic health record (EHR) adoption and “meaningful use” vary between high-, intermediate-, and low-quality US hospitals. ⋯ We found higher rates of adoption of key EHR functions among high-quality hospitals, suggesting that high quality and EHR adoption may be linked. Most low-quality hospitals without EHR functions reported no plans to implement them, pointing to challenges faced by policy makers in achieving widespread EHR adoption while simultaneously improving quality of care.
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To determine pneumonia admission care components that are most affected by emergency department (ED) crowding. ⋯ Despite compliance with mandated ratios of nurses to patients, the time from antibiotic ordering to administration (a nursing task) was prolonged with higher ED volumes, as were throughput measures. Targeting these may expedite treatment under crowded ED conditions.
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To estimate the relationship between electronic medical record (EMR) use and efficiency of utilization and provider productivity during visits to US office-based physicians. ⋯ EMR use had a mixed association with efficiency and productivity during office visits. EMRs may improve provider productivity, especially during visits for a new problem and routine chronic care.