Geographic variation in access to care--the relationship with quality.

Institute for Healthcare Improvement, Cambridge, MA, USA.
New England Journal of Medicine (Impact Factor: 51.66). 06/2012; 367(1):3-6. DOI: 10.1056/NEJMp1204516
Source: PubMed

ABSTRACT Three decades of research focused predominantly on costs and the use of services among Medicare beneficiaries has repeatedly found wide regional variations in health care experiences and health system performance.(1) Much less attention has been paid to variations in access to care and their associated implications for quality of care and health outcomes. Our recent Commonwealth Fund report, "Rising to the Challenge: Results from a Scorecard on Local Health System Performance,"(2) shows that when we look beyond state averages, there are staggeringly wide gaps in people's ability to gain access to care in different communities around the country. We also . . .

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The volume-outcome relationship is supposed to be stronger in high risk, low volume procedures. The aim of this systematic review is to examine the available literature on the effects of hospital and surgeon volume, specialization and regionalization on the outcomes of the Norwood procedure.
    BMC Pediatrics 08/2014; 14(1):198. · 1.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective was to assess the feasibility of delivering a group treatment to improve emotional regulation via videoconferencing to individuals with traumatic brain injury (TBI). A pre-post feasibility study was undertaken. Seven individuals with TBI were recruited at a brain injury research centre in an urban medical centre. The main measures were therapist assessment of session-by-session progress and feasibility, Difficulties in Emotion Regulation Scale (DERS), Brain Injury Rehabilitation Trust Regulation of Emotions Questionnaire (BREQ), Satisfaction with Therapy and Therapist Scale (STTS), and exit interview. Attendance across sessions and participants was over 90%. Adequate skill acquisition and ease of use of the technology were demonstrated. Self-reported satisfaction with treatment was high. Participants noted several benefits in terms of the treatment delivery modality. There was no change is self-reported emotional dysregulation. This is the first study to report the use of videoconferencing for the delivery of group treatment to individuals with TBI. The exceptional compliance and self-reported satisfaction suggest that this treatment delivery option could be a viable alternative for increasing access to healthcare in this population. The findings of the study supported the development of a large clinical trial to assess treatment effectiveness.
    Neuropsychological Rehabilitation 05/2014; · 2.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In Italy, rigorous studies obtained with specific and validated questionnaires that explore the impact of exclusion diets on health-related quality of life (HRQoL) in children with food allergies are lacking. In this cross-sectional study, we wished to validate the Italian version of a disease-specific quality of life questionnaire, and assess the impact of exclusion diets on the HRQoL in a cohort of Italian children with IgE-mediated food allergies. Children on an exclusion diet for >=1 food were enrolled consecutively, and their parents completed the validated Italian version of the Food Allergy Quality of Life Questionnaire--Parent Form (FAQLQ-PF) and Food Allergy Independent Measure (FAIM). Ninety-six parents of children aged 0--12 years answered the FAQLQ--PF. The validity of the construct of the questionnaire was assessed by correlation between the FAQLQ--PF and FAIM--PF (r = 0.85). The Italian version of the FAQLQ had good internal consistency (Cronbach's alpha >0.70). Factors that mainly influenced the HRQoL were older age, severity of food allergy, and the duration of the cow milk-exclusion diet. The FAQLQ--PF, validated in Italian, is a reliable instrument. Worse QoL scores were observed among older children, those with severe systemic reactions, and those with a prolonged cow milk-free diet. It is very important to consider the QoL assessment as an integral part of food-allergy management. These results emphasize the need to administer exclusion diets only for the necessary time and the importance of assessment of the HRQoL in these patients.
    BMC Pediatrics 12/2013; 13(1):203. · 1.98 Impact Factor

Full-text (2 Sources)

Available from
May 20, 2014