Articles: hospitals.
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Multicenter Study
A multi-institutional study of care given to patients dying in hospitals. Ethical and practice implications.
Relatively little attention has been paid to how physicians care for dying patients once an initial decision to forgo life-sustaining treatment is made. ⋯ The majority of patients dying at these institutions did so after decisions to limit treatment, but few patients were able to participate in these decisions. Forgoing life-sustaining treatment generally occurred in a sequential manner over several days; the rationale for this stepwise retreat is not, however, clinically or ethically obvious.
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To determine the effect of age on hospital resource use for seriously ill adults, and to explore whether age-related differences in resource use are explained by patients' severity of illness and preferences for life-extending care. ⋯ Compared with similar younger patients, seriously ill older patients receive fewer invasive procedures and hospital care that is less resource-intensive and less costly. This preferential allocation of hospital services to younger patients is not based on differences in patients' severity of illness or general preferences for life-extending care.
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J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. · Aug 1996
Multicenter StudyPredictors of resource utilization for hospitalized patients with Pneumocystis carinii pneumonia (PCP): a summary of effects from the multi-city study of quality of PCP care.
To determine whether patient and hospital characteristics were significantly associated with variations in Pneumocystis carinii (PCP) care and outcomes, we analyzed the use of diagnostic tests, intensive care units (ICUs), anti-PCP medications for persons hospitalized with human immunodeficiency virus (HIV)-related PCP, and hospital discharge status. We conducted retrospective chart reviews of a cohort of 2,174 patients with PCP hospitalized in 1987-1990. ⋯ After we adjusted for differences in this severity of illness, we noted that Medicaid patients, injection drug users (IDUs), and patients treated at VA or county hospitals were significantly less likely than others to have diagnostic bronchoscopies and that persons covered by Medicaid, with a previous diagnosis of acquired immunodeficiency syndrome (AIDS), who did not receive prior zidovudine (AZT) or who received care in a VA hospital had the highest chances of in-hospital death. Insurance and risk group characteristics, severity of illness, and hospital characteristics appear to be the most important determinants of the intensity and timing of medical care and outcomes among patients hospitalized with PCP.
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Gen Hosp Psychiatry · Jul 1996
Multicenter StudyAlcoholism and psychiatric comorbidity in general hospital inpatients.
A substantial psychiatric comorbidity has been observed in alcohol patients from specialized alcoholism and substance abuse treatment centers. However, hardly any results have yet been reported from general hospital inpatients. We report results from a survey of a representative sample of 400 general hospital inpatients (200 medical, 200 surgical) which was carried out not only to assess the prevalence of alcoholism but also the rates of additional psychiatric disorders. ⋯ Of these patients, lifetime alcoholism was associated with 41.3% lifetime psychiatric comorbidity, current alcoholism with 44.4% current comorbidity. Organic brain syndromes were diagnosed predominantly, followed by depressive disorders and phobias. With the exception of the high rate of organic brain disorders, the rates of other comorbid psychiatric disorders in the general hospital seem to resemble those of the general population rather than those from alcoholism treatment facilities.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Does increased access to primary care reduce hospital readmissions? Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission.
For chronically ill patients, readmission to the hospital can be frequent and costly. We studied the effect of an intervention designed to increase access to primary care after discharge from the hospital, with the goals of reducing readmissions and emergency department visits and increasing patients' quality of life and satisfaction with care. ⋯ For veterans discharged from Veterans Affairs hospitals, the primary care intervention we studied increased rather than decreased the rate of rehospitalization, although patients in the intervention group were more satisfied with their care.