Health services research
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Health services research · Dec 2002
Multicenter StudyError reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project.
To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. ⋯ Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.
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Health services research · Oct 2002
Whom should we profile? Examining diabetes care practice variation among primary care providers, provider groups, and health care facilities.
To evaluate the amount of variation in diabetes practice patterns at the primary care provider (PCP), provider group, and facility level, and to examine the reliability of diabetes care profiles constructed using electronic databases. ⋯ little of the variation in many currently measured diabetes care practices is attributable to PCPs and, unless panel sizes are large, PCP profiling will be inaccurate. If profiling is to improve quality, it may be best to focus on examining facility-level performance variations and on developing indicators that promote specific, high-priority clinical actions.
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Health services research · Oct 2002
An approach to forecasting health expenditures, with application to the U.S. Medicare system.
To quantify uncertainty in forecasts of health expenditures. ⋯ History is a valuable guide for quantifying our uncertainty about future health expenditures. The probabilistic model we present has several advantages over the high-low scenario approach to forecasting. It indicates great uncertainty about future Medicare expenditures relative to GDP.
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To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom generation ages. ⋯ To meet the long-term care needs of Baby Boomers, social and public policy changes must begin soon. Meeting the financial and social service burdens of growing numbers of elders will not be a daunting task if necessary changes are made now rather than when Baby Boomers actually need long-term care.
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Health services research · Aug 2002
Diagnostic cost groups (DCGs) and concurrent utilization among patients with substance abuse disorders.
To assess the performance of Diagnostic Cost Groups (DCGs) in explaining variation in concurrent utilization for a defined subgroup, patients with substance abuse (SA) disorders, within the Department of Veterans Affairs (VA). ⋯ Modifying the DCG/HCC model with additional markers for SA modestly improved homogeneity and model prediction. Because considerable variation still remained after modeling, we conclude that health care systems should evaluate "off-the-shelf" risk adjustment systems before applying them to their own populations.