Articles: hospital-emergency-service.
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Circ Cardiovasc Imaging · Jan 2012
Randomized Controlled TrialProvider-directed imaging stress testing reduces health care expenditures in lower-risk chest pain patients presenting to the emergency department.
Among intermediate- to high-risk patients with chest pain, we have shown that a cardiac magnetic resonance (CMR) stress test strategy implemented in an observation unit (OU) reduces 1-year health care costs compared with inpatient care. In this study, we compare 2 OU strategies to determine among lower-risk patients if a mandatory CMR stress test strategy was more effective than a physicians' ability to select a stress test modality. ⋯ URL: http://www.clinicaltrials.gov. Unique identifier: NCT00869245.
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Int J Chron Obstruct Pulmon Dis · Jan 2012
Randomized Controlled Trial Multicenter StudyRandomized trial of pragmatic education for low-risk COPD patients: impact on hospitalizations and emergency department visits.
Most interventions aimed at reducing hospitalizations and emergency department (ED) visits in patients with chronic obstructive pulmonary disease (COPD) have employed resource-intense programs in high-risk individuals. Although COPD is a progressive disease, little is known about the effectiveness of proactive interventions aimed at preventing hospitalizations and ED visits in the much larger population of low-risk (no known COPD-related hospitalizations or ED visits in the prior year) patients, some of whom will eventually become high-risk. ⋯ An educational intervention that is practical for large numbers of low-risk patients with COPD may reduce the rate of breathing-related hospitalizations. Further research that more closely tracks hospitalizations to non-VA facilities is needed to confirm this finding.
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Health Technol Assess · Jan 2012
Randomized Controlled TrialManaging Injuries of the Neck Trial (MINT): a randomised controlled trial of treatments for whiplash injuries.
To examine the clinical effectiveness of a stepped care approach over a 12-month period after an acute whiplash injury; to estimate the costs and cost-effectiveness of each strategy including treatments and subsequent health-care costs; and to gain participants' perspective on experiencing whiplash injury, NHS treatment, and recovery within the context of the Managing Injuries of the Neck Trial (MINT). ⋯ MINT suggests that enhanced psycho-educational interventions in EDs are no more effective than UCA in reducing the burden of acute whiplash injuries. A physiotherapy package provided to people who have persisting symptoms within the first 6 weeks of injury produced additional short-term benefits in neck disability compared with a single physiotherapy advice session. However, from a health-care perspective, the physiotherapy package was not cost-effective at current levels of willingness to pay. Both experimental treatments were associated with increased cost with no discernible gain in health-related quality of life. However, an important benefit of the physiotherapy package was a reduction in work days lost; consequently, the intervention may prove cost-effective at the societal level.
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Randomized Controlled Trial
Targeted crisis resource management training improves performance among randomized nursing and medical students.
In this study designed with adequate statistical power to detect relevant training effects, investigators evaluated Crisis Resource Management (CRM) training during a simulated patient crisis. This study is guided by the Team Effectiveness Conceptual Model by Kozlowski and Ilgen. ⋯ CRM team training and team practice in an environment of high-fidelity simulation and facilitated debriefing have significant effects on team process and team effectiveness. The conceptual framework is potentially adaptable to additional settings and populations for team-related research and education.
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Randomized Controlled Trial Comparative Study
Results of the Medicare Health Support disease-management pilot program.
In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program. ⋯ In this large study, commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care.