Articles: outcome-assessment-health-care.
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Co-existent or comorbid diseases are appreciated as prognostic factors in studies of quality and effectiveness of care when mortality is the end point. The need to measure and adjust for comorbidity in studies of postoperative hospital complications or long-term recovery from surgery has not been documented. In this study, we determined the impact of co-existent disease on post-operative complications and 1-year health-related quality of life in patients hospitalized for a total hip replacement. ⋯ After controlling for gender, age, education, and marital status, ICED remained a significant predictor of functional status at 1 year. Furthermore, differences among hospitals in functional outcomes disappeared when the ICED was included in the model to adjust for patient characteristics at the time of surgery. A measure of co-existent disease was crucial in explaining differences among hospitals in recovery from total hip replacement patients.
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The Los Angeles County-University of Southern California (LAC-USC) Medical Center, a level I trauma center, has experienced a rapidly increasing incidence of gunshot wounds (GSWs). We sought to enumerate the annual monetary costs and medical consequences of thoracoabdominal gunshot wounds in the epicenter of urban violence. A consecutive series of patients admitted from September 1, 1989 to August 31, 1990 was studied. ⋯ Annual medical cost of all admissions including rehabilitation, however, could be as great as $12 million for the Medical Center and $53 million for the County of Los Angeles. Thirty percent of patients had MediCal insurance. Payment could not be recovered from another 57% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Palliative medicine · Jan 1993
Validity of the support team assessment schedule: do staffs' ratings reflect those made by patients or their families?
This study aimed to assess the validity of the Support Team Assessment Schedule (STAS), a measure of the outcome of palliative care, through comparisons with the views of patients and family members. STAS ratings completed by two support teams were compared with (1) patients' ratings and (2) family member/carer ratings of seven (of the total 17 STAS) items, collected by independent interviewers. Of 183 patients referred to the teams, 84 (46%) were interviewed and 99 (54%) could not be contacted. ⋯ Team ratings were usually closer to those of the patients than to those of the family member; a team rating often lay between the patient's and family member's rating. The STAS is a measure of professional assessment which is independent from, although based on, the patient and family. The results support the validity of STAS as a measure of the outcome of palliative care from the perspective of a palliative care team.
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Clin Intensive Care · Jan 1993
A tool to measure the change in health status of selected adult patients before and after intensive care.
If the effect of intensive care on the patient is to be fully assessed then the health status of patients before and after admission to ICU must be measured. The validity of a simplified system which can also use relatives, where necessary, as informants on the patients' pre-morbid health status has been evaluated. In a District General Hospital Intensive Care Unit a questionnaire based survey of 85 patients admitted over a period of eight months used a new specially-designed instrument and compared this with the Functional Limitations Profile (FLP) and the Perceived Quality of Life instrument (PQL). ⋯ At six months post ICU discharge, 49 patients completed the follow-up questionnaires, 12 patients had died and three were too confused to co-operate. Twenty-one patients (25%) were lost to follow-up. At one year post ICU discharge, 43 patients completed the follow-up questionnaires, one other patient had died and three still remained confused.(ABSTRACT TRUNCATED AT 250 WORDS)