Medical care
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Comparative Study
Differences among the elderly in the treatment costs of colorectal cancer: how important is race?
Medical expenditures adjusted for price differences are a barometer of total resources devoted to patient care and thus may reflect treatment differentials. ⋯ African American CRC patients cost more than their white counterparts, but adjusted differences were nonsignificant and trivial. Several nonracial cost differences were considerably larger (but not all statistically significant), and suggest that future research pay more attention to these characteristics.
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Hospitals are under pressure to increase revenue and lower costs, and at the same time, they face dramatic variation in clinical demand. ⋯ Hospitals that operate at or over capacity may experience heightened rates of patient safety events and might consider re-engineering the structures of care to respond better during periods of high stress.
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We sought to test whether variations across regions in end-of-life (EOL) treatment intensity are associated with regional differences in patient preferences for EOL care. ⋯ Medicare beneficiaries generally prefer treatment focused on palliation rather than life-extension. Differences in preferences are unlikely to explain regional variations in EOL spending.
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One of the PROMIS (Patient-Reported Outcome Measurement Information System) network's primary goals is the development of a comprehensive item bank for patient-reported outcomes of chronic diseases. For its first set of item banks, PROMIS chose to focus on pain, fatigue, emotional distress, physical function, and social function. An essential step for the development of an item pool is the identification, evaluation, and revision of extant questionnaire items for the core item pool. ⋯ Focus groups were used to confirm domain definitions and to identify new areas of item development for future PROMIS item banks. Cognitive interviews were used to examine individual items. Items successfully screened through this process were sent to field testing and will be subjected to innovative scale construction procedures.
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Constructing and evaluating item pools that measure a single domain of health-related quality of life (HRQOL) is one of the fundamental objectives of the Patient Reported Outcome Measurement and Information System (PROMIS) project. The initial focus of PROMIS is on 5 HRQOL domains: physical function, fatigue, pain, emotional distress, and social/role participation. Analysis of related, available data can inform construction of these new banks. ⋯ The 15 physical functioning items provide reasonably good fit to a unidimensional item response theory model that provides satisfactory coverage of the lower levels of physical functioning but does not provide very much information at higher levels of functioning.