Health services research
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Health services research · Dec 2004
To prevent, react, and rebuild: health research and the prevention of genocide.
To develop an approach to the primary prevention of genocide, based on established public health-based violence prevention methods derived from a variety of high-risk settings. ⋯ Our analysis suggests that genocide is one of the most pressing threats to the health of populations in the twenty-first century. Recent advances in the public health discipline of violence prevention provide a blueprint for approaches to primary genocide prevention based on epidemiological methods.
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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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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 · 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
Competing values of emergency department performance: balancing multiple stakeholder perspectives.
To describe the performance interests of multiple stakeholders associated with the management and delivery of emergency department (ED) care, and to develop a performance framework and set of indicators that reflect these interests. ⋯ Emergency department performance interests are not homogeneous across stakeholder groups, and evaluating performance from the perspective of any one stakeholder group will result in unbalanced assessments. Community-based stakeholders, a group frequently excluded from commenting on ED performance, provide important insights into ED performance related to the external environment and the broader continuum of care.