Abstract:
OBJECTIVES:To compare open heart surgery services provided by public and private hospitals in Catalonia (Spain) according to case mix, procedures undergone and surgical mortality. METHODS:Data on all adult patients undergoing open heart surgery procedures were collected prospectively in a sample of public and privately owned centres for a 6.5-month period in 1994. Sociodemographic, clinical and procedural variables were collected. A predictive model stratifying patients according to their surgical mortality risk was used to adjust for differences in case mix between providers. RESULTS:Included were 1287 open heart surgery procedures. Public and private patients differed significantly in terms of gender, clinical history (e.g. hypertension, pulmonary disease, recent infarction) and procedural variables (e.g. reoperation, type of intervention). There were also statistically significant differences related to educational level, with better educated patients more likely to be treated in private centres. Crude surgical mortality rates differed between providers, although public centres operated on higher-risk patients. After adjusting for differences in case mix, the association between the type of provider and surgical mortality was not statistically significant (odds ratio 1.68; 95% CI from 0.94 to 3.0). CONCLUSIONS:Although crude mortality rates differ between public and private providers, there is a significant trend towards higher surgical risk in public centres. After adjusting for surgical risk, differences between types of provider decreased and were no longer statistically significant. The importance of other social and health-related factors, such as educational level, may explain differences between providers in their patients' surgical risk and in their performance in open heart surgery.
journal_name
J Health Serv Res Policyjournal_title
Journal of health services research & policyauthors
Pons J,Moreno V,Borras J,Espinas J,Almazan C,Granados Adoi
10.1177/135581969900400204subject
Has Abstractpub_date
1999-04-01 00:00:00pages
73-8issue
2eissn
1355-8196issn
1758-1060journal_volume
4pub_type
杂志文章abstract:OBJECTIVES:The nine NIHR CLAHRCs are collaborations between universities and local NHS organizations that seek to improve patient outcomes through the conduct and application of applied health research. The theoretical and practical context within which the CLAHRCs were set up was characterized by a considerable degree...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819613499903
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abstract:OBJECTIVE:Limited resources mean that decision-makers must set priorities among competing opportunities. Programme budgeting and marginal analysis (PBMA) is an economic approach that focuses on optimizing benefits with available resources. Accountability for reasonableness (A4R) is an ethics approach that focuses on en...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581906775094280
更新日期:2006-01-01 00:00:00
abstract::Health services researchers have an important role to play in helping health care systems around the world provide high quality, affordable services. However, gaps between the best evidence and current practice suggest that researchers need to work in new ways. The production of research that meets the needs and prior...
journal_title:Journal of health services research & policy
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journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581960000500408
更新日期:2000-10-01 00:00:00
abstract:OBJECTIVES:This paper focuses upon health status, need for care, and use of health care from 1994/95 to 2000/01 in the Canadian foreign-born population. METHODS:Using Statistics Canada's longitudinal National Population Health Survey, descriptive and survival analyses are used to explore immigrant health status and he...
journal_title:Journal of health services research & policy
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abstract::Diagnosis-related groups are widespread across Europe and they are meant to be a central instrument to improve the activity and efficiency of hospitals. However, there are many examples of diagnosis-related groups having adverse effects which are difficult to control and which endanger the goals of health care systems...
journal_title:Journal of health services research & policy
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更新日期:2016-01-01 00:00:00
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journal_title:Journal of health services research & policy
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更新日期:2004-10-01 00:00:00
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journal_title:Journal of health services research & policy
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doi:10.1258/135581906778476490
更新日期:2006-10-01 00:00:00
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journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
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更新日期:2004-01-01 00:00:00
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journal_title:Journal of health services research & policy
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更新日期:2016-07-01 00:00:00
abstract:OBJECTIVES:To understand the challenges and opportunities associated with the introduction of assistant practitioner (AP) roles supporting the work of ward-based registered nurses (RNs) in National Health Service (NHS) acute hospital trusts in England. METHODS:Three case studies of NHS acute hospital trusts. This pape...
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更新日期:2011-04-01 00:00:00
abstract:OBJECTIVES:Increasingly health care performance data are being disseminated in the form of 'league tables' of health care providers, with the implication that such publication helps purchasers select the better providers, and spurs providers into improvements. This paper examines progress to date. METHODS:Three stages...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1177/135581969800300111
更新日期:1998-01-01 00:00:00
abstract:OBJECTIVES:To evaluate the effect of a risk factor checklist and training video for general practitioners in reducing inter-practice variation and improving the appropriateness of referrals (assessed by their positive predictive value or PPV) of patients with suspected otitis media with effusion (OME or 'glue ear') to ...
journal_title:Journal of health services research & policy
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1258/1355819011927387
更新日期:2001-07-01 00:00:00
abstract:OBJECTIVE:To evaluate how UK maternity unit protocols conformed to national recommendations for preventing early-onset neonatal Group B Streptococcal (GBS) disease. METHODS:In December 2005, all UK obstetric maternity units were contacted and asked to provide a copy of their protocol on preventing GBS disease. Informa...
journal_title:Journal of health services research & policy
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doi:10.1258/jhsrp.2007.007144
更新日期:2008-04-01 00:00:00
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doi:10.1177/135581969700200107
更新日期:1997-01-01 00:00:00
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journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1258/jhsrp.2010.009129
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVE:Poor people receive shorter consultations in general practice than more affluent people. Our aim was to study the two reasons generally advanced for this for patients consulting with mental health problems: people of low socioeconomic status (SES) demand shorter consultations or they tend to match with practi...
journal_title:Journal of health services research & policy
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doi:10.1258/jhsrp.2009.009034
更新日期:2010-04-01 00:00:00
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更新日期:2015-07-01 00:00:00
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journal_title:Journal of health services research & policy
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doi:10.1258/135581906776318956
更新日期:2006-04-01 00:00:00
abstract::Evidence-based medicine (EBM) and evidence-based decision-making (EBDM) were intended to revolutionize health care and health policy. Thus far they have not. A great deal of research has demonstrated the persistent ubiquity of error in health care, wide and unjustifiable variations in practice and the minimal impact o...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581907781543094
更新日期:2007-07-01 00:00:00
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journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2008.008055
更新日期:2008-07-01 00:00:00
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journal_title:Journal of health services research & policy
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更新日期:2013-10-01 00:00:00
abstract:OBJECTIVES:to determine the extent and nature of the decisions individuals are asked to make as in-patients, and whether doctors, nurses, other health care practitioners, and housekeepers engaged in routine (non-emergency) medical assessments, investigations and treatments, or acts of personal care observe the Referenc...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2010.009148
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVES:To conduct an economic evaluation comparing a traditional antenatal visiting schedule (traditional care) with a reduced schedule of visits (new style care) for women at low risk of complications. METHODS:Economic evaluation using the results of a randomised controlled trial, the Antenatal Care Project. This...
journal_title:Journal of health services research & policy
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2000-04-01 00:00:00
abstract:OBJECTIVE:Our aim was to evaluate whether the involvement of health care managers in research projects improves the quality and relevance of research, and whether collaboration builds capacity in the managerial community. METHODS:The NIHR Service Delivery and Organization Management Fellowship programme supports the d...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2011.011099
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVES:To test the effects of adding text messages to weekly email communications on recipients' total physical activity (leisure-time; workplace; domestic and garden; and active transportation) in employees of universities and colleges in the UK. METHODS:A randomised trial with two study groups (email only or ema...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,随机对照试验
doi:10.1177/1355819613478001
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVES:To examine the influence of the English National Health Service (NHS) South and West (S&W) region Development and Evaluation Committee (DEC) technology appraisal reports on purchasing and clinical decisions in the S&W and elsewhere in the NHS, and to estimate the cost of the DEC process. METHODS:Two postal ...
journal_title:Journal of health services research & policy
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更新日期:2003-01-01 00:00:00
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journal_title:Journal of health services research & policy
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更新日期:2003-04-01 00:00:00
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journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1177/1355819613483126
更新日期:2013-10-01 00:00:00