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PURPOSE Because limited audit/feedback of health status information has yielded mixed results, we evaluated the effects of a sustained program of audit/feedback on patient health and satisfaction. METHODS We conducted a group-randomized effectiveness trial in which firms within Veterans Administration general internal medicine clinics served as units of(More)
OBJECTIVES To evaluate selected hospice admission practices that could represent barriers to hospice use and the association between these admission practices and organizational characteristics. DESIGN From December 1999 to March 2000, hospices were surveyed about selected admission practices, and their responses were linked to the 1999 California Office(More)
BACKGROUND Nearly 20 years ago it was shown that patients are exposed to unnecessary preoperative testing that is both costly and has associated morbidity. To determine whether such unnecessary testing persists, we performed internal and external surveys to quantify the incidence of unnecessary preoperative testing and to identify strategies for reduction.(More)
BACKGROUND The Veterans Affairs (VA) has made significant investments in care for veterans. However, it is not known whether these investments have produced improvements in end-of-life care in the VA compared to other settings. Therefore, the goal of this study was to compare families' perceptions of end-of-life care among patients who died in VA and non-VA(More)
Empirical evidence suggests that mortality rates for coronary artery bypass graft (CABG) surgery are lower in hospitals that perform a higher volume of the procedure. In recent years, the criteria for CABG surgery have been expanded to include patients with a wide variety of co-morbidities. To address the question of whether the volume-outcome relationship(More)
OBJECTIVE To identify the desired features of end-of-life medical decision making from the perspective of elderly individuals. DESIGN Qualitative study using in-depth interviews and analysis from a phenomenologic perspective. SETTING A senior center and a multilevel retirement community in Los Angeles. PARTICIPANTS Twenty-one elderly informants (mean(More)
BACKGROUND During serious illness, patient preferences regarding life-sustaining treatments play an important role in medical decisions. However, little is known about life-sustaining preference stability in this population or about factors associated with preference change. METHODS We evaluated 2-month cardiopulmonary resuscitation (CPR) preference(More)
OBJECTIVE To present the design and methods of a multisite study of health-related quality of life (HR-QOL) in veterans living with ostomies. RESEARCH DESIGN AND METHODS Veterans from Tucson, Indianapolis, and Los Angeles VA Medical Centers were surveyed using the validated City of Hope ostomy-specific tool (mCOH-QOL-Ostomy) and the SF-36V. Cases(More)
This article explores the ethical issues specific to Health Services Research (HSR) in palliative care, with particular attention to similarities and differences between HSR and institutional quality improvement (QI) initiatives. We focus on the challenges of determining what level of protection is warranted by investigations of health services and programs(More)