Bmc Health Serv Res
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Bmc Health Serv Res · Jan 2015
Race/ethnicity, and Americans' perceptions and experiences of over- and under-use of care: a cross-sectional study.
Despite widespread documentation of racial/ethnic disparities in care (predominantly under-use of needed care), differences in population-wide attitudes or experiences about under- or overuse (care where harms may outweigh potential benefits) of care are not well understood. We examined whether race/ethnicity is associated with perceptions or experiences of overuse or underuse. ⋯ Over- and underuse of medical care are important problems for many Americans, and experiences vary by race/ethnicity. Clinician communication and educational campaigns about appropriateness of care may need tailoring for varying population groups.
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Bmc Health Serv Res · Jan 2015
Minimum volume standards in German hospitals: do they get along with procedure centralization? A retrospective longitudinal data analysis.
Compliance with minimum volume standards for specific procedures serves as a criterion for high-quality patient care. International experiences report a centralization of the respective procedures. In Germany, minimum volume standards for hospitals were introduced in 2004 for 5 procedures (complex esophageal and pancreatic interventions; liver, kidney and stem cell transplantations), in 2006 total knee replacement was added. This study explores whether any centralization is discernible for these procedures in Germany. ⋯ For the purpose of further centralization of interventions it will be necessary to first analyze and then appropriately address the reasons for non-compliance from the hospital and patient perspective.
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Bmc Health Serv Res · Jan 2015
Searching for success: Development of a combined patient-reported-outcome ("PRO") criterion for operationalizing success in multi-modal pain therapy.
There is a need for a way to measure success in multi-modal pain therapy that researchers and clinicians can agree upon. According to developments in health services research, operationalizing success should take patient-reported outcomes into account. We will present a success criterion for pain therapy that combines different patient-reported variables and includes validity measures. The usable criterion should be part of a statistically significant and satisfactory model identifying predictors of successful pain therapy. ⋯ It is possible to develop a feasible success criterion that combines several variables and includes patient-reported outcomes ("PROs") with routine data that can be used in a predictor analysis in multi-modal pain therapy. The criterion was based on basic constructs used in pain therapy and used widespread validated self-rating instruments. Thus, it should be easy to transfer this criterion to other institutions.
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Bmc Health Serv Res · Jan 2015
No longer 'flying blind': how access has changed emergency mental health care in rural and remote emergency departments, a qualitative study.
Mental health presentations are considered to be a difficult aspect of emergency care. Although emergency department (ED) staff is qualified to provide emergency mental health care, for some, such presentations pose a challenge to their training, confidence, and time. Providing access to relevant and responsive specialist mental health care can influence care and management for these patients. The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telepsychiatry program that was established to improve access to specialist emergency mental health care across rural and remote western NSW, Australia. ⋯ MHEC-RAP has not only provided access to specialist mental health care for local ED providers, but it has changed their practice and perspective. MHEC-RAP could be adapted for implementation elsewhere. Provider experience confirms that the program is accessible and offers insights to those considering how to establish an emergency telepyschiatry service in other settings.
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Bmc Health Serv Res · Jan 2015
Women with comorbid substance dependence and psychiatric disorders in Sweden: a longitudinal study of hospital care utilization and costs.
Substance use disorders are regarded as one of the most prevalent, deadly and costly of health problems. Research has consistently found that the prevalence of other psychiatric disorders among those with substance related disorders is substantial. Combined, these disorders lead to considerable disability and health years lost worldwide as well as extraordinary societal costs. Relatively little of the literature on substance dependence and its impact on healthcare utilization and associated costs has focused specifically on chronic drug users, adolescents or women. In addition, the research that has been conducted relies largely on self-reported data and does not provide long-term estimates of hospital care utilization. The purpose of this study is to describe the long-term (24-32 year) healthcare utilization and it's associated costs for a nationally representative cohort of chronic substance abusing women (adults and adolescents) remanded to compulsory care between 1997-2000 (index episode). As such, this is the first study investigating healthcare costs for women in compulsory treatment in Sweden. ⋯ Women placed in compulsory care use more hospital resources than that of the general Swedish population and when compared to international research of hospital care use and substance abuse. Direct hospital costs vary greatly over the life course. Effective services can have significant economic benefit.