Arch Intern Med
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Under increasing pressure to provide more efficient, higher-quality care, the Department of Veterans Affairs (VA) is expanding primary care and implementing other managed care techniques. To assess the magnitude of performance improvement possible in the VA and to investigate potential barriers to implementation of new techniques, we compared a VA facility with similar managed care organizations on specific managed care performance benchmarks. METHODS AND DATA COLLECTION: Detailed case studies of a large VA medical center and a large capitated multispecialty group practice in the same region were carried out. Various qualitative and quantitative data were collected between October 1, 1994, and September 30, 1997. Unstructured and semistructured interviews, participant and direct observations, document review, electronic data abstractions, and patient surveys were used to collect the data. ⋯ On many dimensions the VA did not compare favorably with the efficiency or lower utilization of the capitated managed care practice. Part of the reason must be attributed to the VA's multiple missions, which include teaching and research; another reason is the VA's role to be a service provider to all eligible veterans regardless of sociodemographic or health characteristics. Whether these differences are also caused by different case mix, or differences in socioeconomic status of patients, surprisingly is not well understood. This hampers future efforts to use managed care techniques to improve the operation of the VA.
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Hypertension is prevalent in the elderly, but an information gap remains regarding the old, frail, individuals with complex conditions living in long-term care. ⋯ Among very old, frail hypertensive patients living in nursing homes, the pattern of treatment seems not to follow recommended guidelines; age, functional status, and comorbidity appear to be important determinants of treatment choice.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of ondansetron and prochlorperazine for the prevention of postoperative nausea and vomiting after total hip replacement or total knee replacement procedures: a randomized, double-blind, comparative trial.
Limited data are available on the efficacy of ondansetron hydrochloride compared with prochlorperazine maleate for the treatment of postoperative nausea and vomiting (PONV). ⋯ Prochlorperazine is associated with superior efficacy and significant cost savings compared with ondansetron for the prevention of PONV in patients undergoing total hip and total knee replacement procedures.