Effective clinical practice : ECP
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Randomized Controlled Trial Multicenter Study Clinical Trial
Enhanced access to primary care for patients with congestive heart failure. Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission.
To determine whether enhanced access to primary care affects the diagnostic evaluation, pharmacologic management, or health outcomes of patients hospitalized with congestive heart failure (CHF). ⋯ Compliance with recommended CHF testing and treatment guidelines was equally high in both study groups. Enhanced access to primary care did not improve patients' self-reported health status and was associated with more frequent hospitalizations.
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Comparative Study
Medical versus surgical treatment for low back pain: evidence and clinical practice.
Although low back pain is one of the most common health problems, it is still difficult to choose between surgical and medical treatment. ⋯ The literature comparing the efficacy of surgical and medical treatment for low back pain is limited. Not surprisingly, the use of surgery for low back pain varies widely across the United States. To establish clinical consensus, we need better evidence about the efficacy of surgery.
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Many patients are admitted to acute-care hospitals when their medical needs might be more appropriately met in an extended-care facility (ECF). ⋯ For selected patients, direct admission to an ECF seems to be feasible, safe, and acceptable. A randomized, clinical trial is needed to fully assess the safety and cost implications of direct ECF admission.
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To design and implement the Lovelace Diabetes EPISODES OF CARE program in a managed care setting. This program is intended to address the complex needs of patients with type 2 diabetes mellitus by using specific physician-provider and patient interventions. ⋯ An integrated health care delivery system with a comprehensive, diabetes disease management program can substantially improve outcomes.
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To determine the effect of a multifaceted program of support on the ability of primary care teams to deliver population-based diabetes care. ⋯ Providing support to primary care teams in several key areas has made a population-based approach to diabetes care a practical reality in the setting of a staff model HMO. It may be an important mechanism for improving standards of care for many diabetic patients.