Evaluation & the health professions
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This article reviews the different ways in which quality-of-life assessment has been applied to and has affected health care research and practice. A schema that describes the steps involved in the ongoing challenge of improving health outcomes is used to structure the review. ⋯ The benefit of quality-of-life assessment has been demonstrated in a number of these areas (e.g., in identifying problems and evaluating treatments). Its role in other applications (e.g., in clinical practice to assess patients' needs) shows great promise and requires additional evaluation.
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State governments are experimenting with a variety of innovative approaches to the current tort system for medical malpractice liability. One such approach is to apply the concept of no-fault liability to medical practice. ⋯ The author concludes that the concept of no-fault compensation for medical malpractice is a promising remedy. However, it is a medicine that will require more testing before it can be pronounced a cure for the disease that plagues the current system.
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Review Comparative Study
Gender and hospital resource use. Unexpected differences.
Several recent studies have explored gender differences in medical care that are not attributable to clinical characteristics. At an 880-bed teaching hospital between July 1987 and June 1990, we studied the importance of gender on two measures of hospital care: length of stay and ancillary service use. The latter was measured on a relative value unit (RVU) scale, based on an estimation of direct cost dollars. ⋯ This RVU difference dissolved when intensive care unit (ICU) stays were eliminated; men were 1.13 times more likely (95% confidence interval 1.07 to 1.19) to be placed in the ICU. Being married shortened length of stay and women were less likely to be married (51% vs. 68%; p < 0.001), but even within marital status subgroups women remained in the hospital longer than men. Whether this longer length of stay and less technologically intensive care for women reflects a difference in illness severity or physician gender bias requires further study.