Health services research
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Health services research · Dec 2004
The impact of diabetes on workforce participation: results from a national household sample.
Diabetes is a highly prevalent condition that results in substantial morbidity and premature mortality. We investigated how diabetes-associated mortality, disability, early retirement, and work absenteeism impacts workforce participation. ⋯ In the U.S. population of adults born between 1931 and 1941, diabetes is associated with a profound negative impact on economic productivity. By 1992, an estimated 60 billion US dollars in lost productivity was associated with diabetes; additional annual losses averaged 7.3 billion US dollars over the next eight years, totaling about 120 billion US dollars by the year 2000. Given the rising prevalence of diabetes, these costs are likely to increase substantially unless countered by better public health or medical interventions.
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To validate physicians' self-reported intentions to leave clinical practice and the American Medical Association (AMA) Masterfile practice status variable as measures of physician attrition, and to determine predictors of intention to leave, and actual departure from, clinical practice. ⋯ Our findings call into question the accuracy of both AMA Masterfile data and physicians' self-reported intentions to leave as measures of physician attrition from clinical practice. Research using these measures should be interpreted with caution. Self-reported intention to leave practice may be more of a proxy for dissatisfaction than an accurate predictor of actual behavior.
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Health services research · Oct 2004
Availability of safety net providers and access to care of uninsured persons.
To understand how proximity to safety net clinics and hospitals affects a variety of measures of access to care and service use by uninsured persons. ⋯ Closer proximity to the safety net increases access to care for uninsured persons. However, the improvements in access to care are relatively small compared with similar measures of access to care for insured persons. Modest expansion of the safety net is unlikely to provide a full substitute for insurance coverage expansions.
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Health services research · Aug 2004
Comparative StudyQuality of care for patients with type 2 diabetes mellitus in the Netherlands and the United States: a comparison of two quality improvement programs.
To assess differences in diabetes care and patient outcomes by comparing two multifaceted quality improvement programs in two different countries, and to increase knowledge of effective elements of such programs. ⋯ Following implementation of guidelines and organizational improvement efforts, change occurred primarily in the process outcomes, rather than in the patient outcomes. Although much effort was put into improving process and patient outcomes, both complex programs still showed only moderate effects.
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Health services research · Aug 2004
Hospice use by Hispanic and non-Hispanic white cancer decedents.
To investigate rates of hospice use between Hispanic and non-Hispanic white Medicare beneficiaries diagnosed with cancer using data from a large, population-based study. ⋯ Our findings indicate similar rates of hospice use for Hispanics and non-Hispanic whites diagnosed with one of the four leading cancers. Additional studies from other national registries may be necessary to confirm these findings.