Journal of general internal medicine
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Barriers to healthcare are common in the USA and may result in worse outcomes among hospital survivors of an acute coronary syndrome (ACS). ⋯ Absence of an established usual source of care and inconsistent transportation availability were associated with a higher risk for dying after an ACS. Patients with these barriers to follow-up care may benefit from more intensive follow-up and support.
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The transition to later-life caregiving roles, especially for couples caring for each other, can be rife with ambiguity. The incident discordance in spousal perceptions of one another's role and its relationship to mental health outcomes have not been well-described. ⋯ Findings suggest that spousal agreement about the amount of care given and received varies broadly and is an important consideration for primary care providers who counsel these patients day-to-day. Furthermore, agreement appears to predict mental health and relationship outcomes and should be further evaluated in this growing population of mid-to-late life adults emerging into caregiving.
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There is a lack of comprehensive view of the association between acute exacerbation of COPD (AECOPD) and the risk of acute cardiovascular events. ⋯ AECOPD was associated with increased 30-day and 1-year incidences of acute cardiovascular event.
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The Chronic Care Model (CCM) has been endorsed by experts to reduce disparities in chronic disease outcomes but benefits may be slow to appear in low-income populations. ⋯ After adopting the CCM for primarily Hispanic patients with DM, SBP control increased significantly despite treatment with fewer HTN drugs. Yet improvement took 3-4 years, suggesting that financial rewards for using the CCM to achieve improved clinical outcomes for low-income, minority patients may be delayed.
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Studying diagnostic error at the population level requires an understanding of how diagnoses change over time. ⋯ Diagnostic discordance commonly occurred during inter-hospital transfers and was associated with increased inpatient mortality. Health information exchange adoption was associated with decreased discordance and improved patient outcomes.