The American journal of managed care
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Inferior total knee arthroplasty (TKA) outcomes are reported in minority populations. Standardized TKA pathways improve outcomes but have not been studied extensively in minority populations. This study evaluated the impact of TKA pathway standardization at an urban teaching hospital that predominantly treats minority patients. ⋯ Compared with nonpathway patients, standardized TKA pathway patients had shorter LOS, decreased PCA use, increased discharge to home, fewer blood transfusions, and higher postoperative hemoglobin, with no difference in total incidence of complication.
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Patient-centered care, defined as "providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions," is advocated by clinicians and professional organizations and is part of a composite criterion for augmented reimbursement for various health care settings, including patient-centered medical homes. Despite general agreement that patient-centered care is a good idea and worthy of incentivization, patient-centered care is difficult to assess accurately, scalably, and feasibly. ⋯ One potential marker of this discordance is persistent lack of control of a comorbid condition that is easily controllable by existing therapies and where existing therapies are sufficiently diverse to be compatible with a wide range of patient preferences (eg, stage 1 hypertension, type 2 diabetes with glycated hemoglobin < 8.5%). We outline how this approach may be tested, validated, and harmonized with existing quality improvement activities.
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Observational Study
Properties of the overall hospital Star Ratings and consumer choice.
To examine characteristics of the CMS Overall Hospital Quality Star Ratings related to their use by consumers for choosing hospitals. ⋯ Hospitals' overall scores clustered in the middle of the potential distribution of scores; no hospitals were either best at everything or worst at everything. The Star Ratings did not predict hospital quality scores for separate quality measures related to specific medical conditions or health care needs. These 2 observations suggest that the Star Ratings are of limited value to consumers choosing hospitals for specific care needs.