Health services research
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Health services research · Oct 2007
Comparative StudyMortality of Department of Veterans Affairs patients undergoing coronary revascularization in private sector hospitals.
A limitation of studies comparing outcomes of Veterans Affairs (VA) and private sector hospitals is uncertainty about the methods of accounting for risk factors in VA populations. This study estimates whether use of VA services is a marker for increased risk by comparing outcomes of VA users and other patients undergoing coronary revascularization in private sector hospitals. ⋯ A small difference in risk-adjusted outcomes for VA users and nonusers undergoing revascularization in private sector hospitals was found. This difference reflects unmeasured severity in VA users undergoing revascularization in private sector hospitals.
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Health services research · Aug 2007
Comparative StudyDo hospitals provide lower quality care on weekends?
To examine the effect of a weekend hospitalization on the timing and incidence of intensive cardiac procedures, and on subsequent expenditures, mortality and readmission rates for Medicare patients hospitalized with acute myocardial infarction (AMI). ⋯ Weekend hospitalization leads to delayed provision of intensive procedures and elevated 1-year mortality for elderly AMI patients. The existence of measurable differences in treatments raises questions regarding the efficacy of a single input regulation (e.g., mandated nurse staffing ratios) in enhancing the quality of weekend care. My results suggest that targeted financial incentives might be a more cost-effective policy response than broad regulation aimed at improving quality.
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Health services research · Aug 2007
Effects of the State Children's Health Insurance Program on access to dental care and use of dental services.
To provide national estimates of implementation effects of the State Children's Health Insurance Program (SCHIP) on dental care access and use for low-income children. ⋯ Consistent results from two analytical approaches provide evidence that SCHIP implementation significantly reduced financial barriers for dental care for low-income children in the U.S. Low-income children enrolled in SCHIP or Medicaid had substantially increased use of dental care than the uninsured.
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Health services research · Aug 2007
Hospice care: what services do patients and their families receive?
To determine the degree to which patients and families enrolled with hospice received services across key categories of palliative care, the extent of hospice-level variability in services delivered, and changes over time in services delivered. ⋯ Hospice care for patients and families varies substantially across hospices. Whereas some hospices provide services across the key categories of palliative care, other hospices do not provide this breadth of services. Greater understanding of the causes of variation in service delivery as well as its impact on patient and family outcomes and satisfaction with end-of-life care is a critical subject for future research. Changes in Medicare's reimbursement policies may help hospices increase the range of services provided to patients and families.