Articles: outcome-assessment-health-care.
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Multicenter Study
A regional evaluation of variation in low-severity hospital admissions.
Determine patient and hospital-level variation in proportions of low-severity admissions. ⋯ Rates of low-severity admissions for congestive heart failure and pneumonia varied across hospitals and were higher among nonwhite and poorly insured patients. Although the current study does not identify causes of this variability, possible explanations include differences in access to ambulatory services, decisions to admit patients for clinical indications unrelated to the risk of hospital mortality, and variability in admission practices of individual physicians and hospitals. The development of protocols for ambulatory management of low-severity patients and improvement of access to outpatient care would most likely decrease the utilization of more costly hospital services.
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Acta Neurol. Scand. · Jun 1997
Multicenter Study Clinical TrialSurgical treatment for epilepsy: a retrospective Swedish multicenter study.
The characteristics of patients suffering from drug resistant epilepsy, including the results of the preoperative evaluation and epilepsy surgery were retrospectively analyzed in a Swedish multicenter 10-year cohort of children and adults. Altogether 152 patients (65 children and 87 adults) treated during the period 1980-1990 in three epilepsy centers were included and followed-up 2 years after surgery. Median age at onset of seizures was 4 years for the children and 12 years for the adults. ⋯ Another 25% of the patients had a more than 50% reduction of seizure frequency. In the postoperative non seizure free group of patients there was a negative correlation between decrease in weighted seizure severity and decrease in seizure frequency. This finding stresses the need for including other parameters than seizure frequency when evaluating the outcome of epilepsy surgery.
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Intensive care medicine · Mar 1997
Multicenter StudyQuality of life 6 months after intensive care: results of a prospective multicenter study using a generic health status scale and a satisfaction scale.
To assess the quality of life of intensive care survivors 6 months after discharge. ⋯ Quality of life measured with a health-related quality of life scale and a satisfaction scale 6 months after an ICU stay depended on the admission diagnosis. Different dimensions of quality of life were variably affected.
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Critical care medicine · Aug 1996
Multicenter Study Comparative StudyComparative assessment of pediatric intensive care in Moscow, the Russian Federation: a prospective, multicenter study.
Comparative assessment of pediatric intensive care. ⋯ We provided a quantitative description and assessment of pediatric intensive care in Moscow. Moderate efficiency may reflect a low threshold for ICU admission due to poor nurse/patient ratios on the wards. Effectiveness in the low- and medium-risk strata is below standard, as compared with a Western reference population. Excess mortality was concentrated in the low- and medium-risk strata, and can only partially be explained by the inclusion of co-morbidity. Future analysis should focus on specific treatment protocols, protocol adherence, and the determination of infectious and therapeutic complications.
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Intensive care medicine · Jun 1996
Multicenter Study Comparative StudyApplication of the APACHE III prognostic system in Brazilian intensive care units: a prospective multicenter study.
To compare patients and their outcomes at ten Brazilian intensive care units (ICUs) with those reported from the United States. ⋯ The APACHE III prognostic system was a good discriminator of hospital mortality for ICU admissions at 10 Brazilian ICUs. There was substantial and significant variation, however, in SMRs among the Brazilian ICUs, which suggests that further evaluations of international differences in intensive care using a common risk assessment system should be performed and factors associated with variations in risk-adjusted mortality scrutinized.