Medical care
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Despite the availability of effective treatments for posttraumatic stress reactions after serious physical injuries, many sufferers do not use mental health services. Attempts to understand the factors that facilitate mental health service use have often focused on patient-related factors without assessing provider behavior. ⋯ Findings highlight the importance of physician referral in facilitating access to mental health services for trauma injury survivors.
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Health care utilization among decedents is increasingly used as a measure of health care efficiency, but decedent-based measures may be biased estimates of care received by "dying" patients. ⋯ Hospitals' end-of-life intensity varies in the use of specific life-sustaining treatments that are somewhat emblematic of aggressive end-of-life care. End-of-life intensity is a relatively stable hospital attribute that is robust to multiple measurement approaches.
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Elevation in prepregnancy body mass index (BMI) has been linked to a host of perinatal complications, but increases in charges or costs associated with obesity during pregnancy have not been quantified. ⋯ Although these hospitalizations represent a relatively small sample of all obese pregnant women, diagnosed obesity seems to contribute heavily to increased costs among pregnant women. Further studies are needed to identify reasons increased health care costs of caring for women with obesity during pregnancy besides increased cesarean section. These data may encourage insurers to provide fiscal incentives to prevent complications of obesity during pregnancy.
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Comparative Study
Healthcare utilization in community-acquired pneumonia episodes of care: a comparison across the continuum of managed care.
Compare healthcare utilization and total payments for community-acquired pneumonia (CAP) episodes-of-care among 5 health plan designs spanning the continuum of managed care. ⋯ As previously shown among other patient populations and conditions, PPO episodes of CAP are associated with greater total payments due in large part to increased resource utilization among the episodes of lowest severity.
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Pay-for-performance programs typically rate hospitals using a composite summary score in which process measures are weighted by the total number of treatment opportunities. Alternative methods that weight process measures according to how hospitals organize care and the range for possible improvement may be more closely related to patient outcomes. ⋯ In-hospital cardiac care is organized by clinical and administrative processes of care. Pay-for-performance schemes that incentivize hospitals to focus on administrative process measures may be associated with decreased adherence to clinical processes. A pay-for-performance scheme that acknowledges these factors may be associated with improved inpatient mortality.