Arch Intern Med
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Medicare currently pays for "indirect costs" of medical education to support the higher costs of care in teaching hospitals. To investigate whether indirect costs are higher earlier in the training year when house officers might be less efficient--the "July phenomenon"--we compared utilization by 1251 patients hospitalized during July and August with 1338 patients hospitalized during April and May from 1982 through 1984 at Brigham and Women's Hospital, Boston, Mass. ⋯ Using analysis of covariance to correct for age, sex, diagnosis related group, urgency of admission, temporal change, and mortality, we found no differences in length of stay, total charges, or categories of ancillary charges. These results suggest that there is no substantial increase in the cost of care early in the training year; there was no evidence of a "July phenomenon."
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Hypertension was evaluated longitudinally in a nationally representative sample of the US population. This study, based on the data from the National Health and Nutrition Examination Survey NHANES I Epidemiologic Follow-up Study, analyzed changes in blood pressure and frequency of treatment, hypertension incidence, and ten-year survival of the cohort relative to hypertension status at baseline. Higher prevalence rates for each older age group, especially in women, as previously reported on data from community studies were confirmed. ⋯ Incidence rates for blacks were at least twice the rates for whites for almost every age-sex group. Decreased survival in older hypertensive men probably explained the higher prevalence in older women. Treatment and location of measurement in clinic or household must be major considerations in the calculation of incident cases.