Journal of general internal medicine
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To determine patient and provider characteristics associated with increased risk of nondetection of mental health problems by primary care physicians. ⋯ Patients' race, gender, and coexisting medical conditions affected physician awareness of mental health problems. Strategies to improve detection of mental health problems among African Americans, Hispanics, and men should be explored and evaluated.
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To determine if type of hospital ownership is associated with preventable adverse events. ⋯ Patients in for-profit and minor teaching or nonteaching government-owned hospitals were more likely to suffer several types of preventable adverse events. Further research is needed to determine how these events could be prevented.
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Multicenter Study
Patients' perceptions of physicians' recommendations for comfort care differ by patient age and gender.
To determine patient characteristics associated with patient and proxy perceptions of physicians' recommendations for life-prolonging care versus comfort care, and with acceptance of such recommendations. ⋯ Among patients with advanced illness, perceived comfort care recommendations were related to patient age and gender, raising concern about possible gender and age bias in physicians' recommendations. Although all patients and proxies gave significant decision-making authority to physicians, older individuals were more likely to give physicians decision-making authority, making them more vulnerable to possible physician bias.
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Multicenter Study Comparative Study
The impact of leaving against medical advice on hospital resource utilization.
To assess the effect of hospital discharge against medical advice (AMA) on the interpretation of charges and length of stay attributable to alcoholism. ⋯ Discharge AMA affects the interpretation of the relation between alcoholism and utilization. The ARD-attributable utilization was greater when analyses adjusted for or excluded AMA cases. Not accounting for leaving AMA resulted in an underestimation of the impact of alcoholism on resource utilization.
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Multicenter Study Comparative Study Clinical Trial
Racial differences in the utilization of oral anticoagulant therapy in heart failure: a study of elderly hospitalized patients.
To assess racial differences in the use of oral anticoagulant therapy for patients with heart failure, we conducted a cohort study of 30 hospitals in northeast Ohio. For 12,911 Medicare enrollees consecutively admitted in 1992 through 1994 with heart failure, crude and adjusted odds of being on oral anticoagulation were determined. The crude and adjusted odds of being African Americans on oral anticoagulant therapy relative to whites were 0.57 (95% confidence interval 0.47-0.69) and 0.55 (95% confidence interval 0. 45-0.67), respectively. African-Americans with heart failure were much less likely than whites to receive oral anticoagulant therapy, even after adjusting for other variables associated with anticoagulant use.