Health services research
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Health services research · Feb 2020
Effects of opting-out from federal nurse anesthetists' supervision requirements on anesthesiologist work patterns.
To estimate the impact of opting-out from Medicare supervision requirements for certified registered nurse anesthetists (CRNAs) on anesthesiologists' work patterns. ⋯ Anesthesiologists had small but real responses to California's decisions to opt-out of the physician supervision requirement for CRNAs, doing more work in intraoperative care and less outside of the operating room. Total hours worked saw no change.
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Health services research · Dec 2019
Discrimination in the United States: Experiences of black Americans.
To examine experiences of racial discrimination among black adults in the United States, which broadly contribute to their poor health outcomes. ⋯ The extent of reported discrimination across several areas of life suggests a broad pattern of discrimination against blacks in America, beyond isolated experiences. Black-white disparities exist on nearly all dimensions of experiences with public and private institutions, including health care and the police. Evidence of systemic discrimination suggests a need for more active institutional interventions to address racism in policy and practice.
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Health services research · Dec 2019
Gender discrimination in the United States: Experiences of women.
To examine reported experiences of gender discrimination and harassment among US women. ⋯ Results suggest that discrimination and harassment are widely experienced by women across multiple domains of their lives, particularly those who are a racial/ethnic minority or LGBTQ. Further policy and programmatic efforts beyond current legal protections for women are needed to meaningfully reduce these negative experiences, as they impact women's health care and their lives overall.
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Health services research · Oct 2019
A systematic review of the validity and reliability of patient-reported experience measures.
To identify patient-reported experience measures (PREMs), assess their validity and reliability, and assess any bias in the study design of PREM validity and reliability testing. ⋯ Careful consideration should be given when selecting PREMs, particularly as seven of the 10 validity and reliability criteria were not undertaken in ≥50 percent of the PREMs. Testing PREM responsiveness should be prioritized for the application of PREMs where the end user is measuring change over time. Assessing measurement error/agreement of PREMs is important to understand the clinical relevancy of PREM scores used in a health care evaluation capacity.
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Health services research · Oct 2019
Implementation evaluation of academic detailing on naloxone prescribing trends at the United States Veterans Health Administration.
Academic detailing in partnership with the Opioid Overdose Education and Naloxone Distribution (OEND) program was implemented to increase naloxone access for the prevention of opioid overdose mortality in veterans at the U.S. Department of Veterans Affairs (VA). However, implementation was not uniform leading to varying levels of intervention exposure potentially impacting naloxone prescribing. We examined the impact of implementation strength (proportion of providers exposed to academic detailing) at each station on naloxone prescribing from September 2014 to December 2017. ⋯ Our findings highlight the importance of academic detailing's implementation strength on naloxone prescribing. Decision makers must carefully consider the implementation process to achieve the greatest effectiveness from the intervention.