ContextIn response to concerns about the quality of care in US hospitals, the Centers for Medicare & Medicaid Services began measuring hospital performance and reporting this performance on their Web site, Hospital Compare. It is unknown whether these process performance measures are related to hospital-level outcomes.ObjectiveTo determine whether quality measured with the process measures used in Hospital Compare are correlated with and predictive of hospitals' risk-adjusted mortality rates.Design, Setting, and ParticipantsCross-sectional study of hospital care between January 1 and December 31, 2004, for acute myocardial infarction, heart failure, and pneumonia at acute care hospitals in the United States included on the Hospital Compare Web site. Ten process performance measures included in Hospital Compare were compared with hospital risk-adjusted mortality rates, which were measured using Medicare Part A claims data.Main Outcome MeasuresCondition-specific inpatient, 30-day, and 1-year risk-adjusted mortality rates.ResultsA total of 3657 acute care hospitals were included in the study based on their performance as reported in Hospital Compare. Across all acute myocardial infarction performance measures, the absolute reduction in risk-adjusted mortality rates between hospitals performing in the 25th percentile vs those performing in the 75th percentile was 0.005 for inpatient mortality, 0.006 for 30-day mortality, and 0.012 for 1-year mortality (P<.001 for each comparison). For the heart failure performance measures, the absolute mortality reduction was smaller, ranging from 0.001 for inpatient mortality (P = .03) to 0.002 for 1-year mortality (P = .08). For the pneumonia performance measures, the absolute reduction in mortality ranged from 0.001 for 30-day mortality (P = .05) to 0.005 for inpatient mortality (P<.001). Differences in mortality rates for hospitals performing in the 75th percentile on all measures within a condition vs those performing lower than the 25th percentile on all reported measures for acute myocardial infarction ranged between 0.008 (P = .06) and 0.018 (P = .008). For pneumonia, the effects ranged between 0.003 (P = .09) and 0.014 (P<.001); for heart failure, the effects ranged between −0.013 (P = .06) and −0.038 (P = .45).ConclusionsHospital performance measures predict small differences in hospital risk-adjusted mortality rates. Efforts should be made to develop performance measures that are tightly linked to patient outcomes.

https://jamanetwork.com/journals/jama/articlepdf/204523/joc60163_2694_2702.pdf

Relationship Between Medicare’s Hospital Compare Performance Measures and Mortality Rates

Background: There are costs and benefits for people with psychiatric disorders to decide to disclose publicly these disorders. Aims: The gay and lesbian community has struggled with the same tension and their discoveries about coming out may prove useful for the disclosure concerns of persons with mental illness. Methods: Lessons learned about coming out by the gay and lesbian community include a variety of models that map the stages for successfully coming out; e.g., identity confusion, comparison, identify acceptance, immersion, and identity synthesis. Navigating these stages requires consideration of the costs and benefits of disclosure; we review some of these including social avoidance and disapproval as key costs and improved psychological well-being and interpersonal relations as benefits. Conclusions: The paper ends with a review of levels of disclosure for people who opt to come out. Declaration of interest: This paper was made possible in part by MH62198-01 from the National Institute of Mental ...

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Stigma and disclosure: Implications for coming out of the closet

ContextWe originally described the hospitalist model of inpatient care in 1996;
since then, the model has experienced tremendous growth. This growth has important
clinical, financial, educational, and policy implications.ObjectivesTo review data regarding the effect of hospitalists on resource use,
quality of care, satisfaction, and teaching; and to analyze the impact of
hospitalists on the health care system and frame key issues facing the movement.Data Sources and Study SelectionWe searched MEDLINE, BIOSIS, EMBASE, and the Cochrane Library from 1996
to September 2001 for studies comparing hospitalist care with an appropriate
control group in terms of resource use, quality, or satisfaction outcomes.Data ExtractionWe extracted information regarding study design, nature of hospitalist
and control groups, analytical strategies, and key outcomes.Data SynthesisMost studies found that implementation of hospitalist programs was associated
with significant reductions in resource use, usually measured as hospital
costs (average decrease, 13.4%) or average length of stay (average decrease,
16.6%). The few studies that failed to demonstrate reductions usually used
atypical control groups. Although several studies found improved outcomes,
such as inpatient mortality and readmission rates, these results were inconsistent.
Patient satisfaction was generally preserved, while limited data supported
positive effects on teaching. Although concerns about inpatient-outpatient
information transfer remain, recent physician surveys indicate general acceptance
of the model.ConclusionsEmpirical research supports the premise that hospitalists improve inpatient
efficiency without harmful effects on quality or patient satisfaction. Education
may be improved. In part catalyzed by these data, the clinical use of hospitalists
is growing rapidly, and hospitalists are also assuming prominent roles as
teachers, researchers, and quality leaders. The hospitalist field has now
achieved many of the attributes of traditional medical specialties and seems
destined to continue to grow.

葉子高橋

Papers

World Report ニューヨーク

葉子 高橋

Papers

World Report ニューヨーク

葉子高橋