Rahman Azari

Reducing the cost of frequent hospital admissions for congestive heart failure: A randomized trial of a home telecare intervention

Background.The high cost of caring for patients with congestive heart failure (CHF) results primarily from frequent hospital readmissions for exacerbations. Home nurse visits after discharge can reduce readmissions, but the intervention costs are high. Objectives.To compare the effectiveness of three hospital discharge care models for reducing CHF-related readmission charges: 1) home telecare delivered via a 2-way video-conference device with an integrated electronic stethoscope; 2) nurse telephone calls; and 3) usual outpatient care. Research Design. One-year randomized trial. Subjects.English-speaking patients 40 years of age and older with a primary hospital admission diagnosis of CHF. Measures.Our primary outcome was CHF-related readmission charges during a 6-month period after randomization. Secondary outcomes included all-cause readmissions, emergency department (ED) visits, and associated charges. Results.Thirty-seven subjects were randomized: 13 to home telecare, 12 each telephone care and 12 to usual care. Mean CHF-related readmission charges were 86% lower in the telecare group (

The influence of gender on physician practice style.

5850, SD

Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial.

21,094) and 84% lower in the telephone group (

Patient-Centered Care is Associated with Decreased Health Care Utilization

7320, SD

Unmet Expectations for Care and the Patient-physician Relationship

24,440) than in the usual care group (

Ethnic Differences in Use of Complementary and Alternative Medicine at Midlife: Longitudinal Results From SWAN Participants

44,479, SD

Physician practice styles and patient outcomes: differences between family practice and general internal medicine.

121,214). However, the between-group difference was not statistically significant. Both intervention groups had significantly fewer CHF-related ED visits (P = 0.0342) and charges (P = 0.0487) than the usual care group. Trends favoring both interventions were noted for all other utilization outcomes. Conclusions.Substantial reductions in hospital readmissions, emergency visits, and cost of care for patients with CHF might be achieved by widespread deployment of distance technologies to provide posthospitalization monitoring. Home telecare may not offer incremental benefit beyond telephone follow-up and is more expensive.

A Randomized Trial of Telenursing to Reduce Hospitalization for Heart Failure: Patient-Centered Outcomes and Nursing Indicators

As more women enter medicine, intriguing questions arise about how physician gender impacts practice style. To measure this influence in primary care encounters, 118 male and 132 female adult new patients, having no stated preference for a specific physician, were randomly assigned to university hospital primary care residents, and their initial encounters were videotaped. Forty-eight male and 33 female physicians participated. Patient health status was assessed before the visit with the Medical Outcomes Study Short-Form General Health Survey. Physician practice style was evaluated by using the Davis Observation Code to analyze videotapes of each initial visit. Patient satisfaction with medical care was assessed with satisfaction questionnaires. Contrary to prior reports, the difference between male and female physicians in total time spent with patients was small and statistically insignificant, and diminished further when controlling for patient gender and health status. Female physicians, however, were observed to engage in more preventive services and to communicate differently with their patients. These differences in practice style appear to explain partially the observed higher patient satisfaction scores for female physicians. This study underscores the importance of careful measurement and control of potential confounding factors in clarifying the impact of physician gender on practice style.

Patient gender differences in the diagnosis of depression in primary care.

BACKGROUND Many patients with upper gastrointestinal (GI) bleeding have a benign outcome and could receive less intensive and costly care if accurately identified. We sought to determine whether early endoscopy performed shortly after admission in the emergency department could significantly reduce the health care use and costs of caring for patients with nonvariceal upper GI bleeding without adversely affecting the clinical outcome. METHODS All eligible patients with upper GI bleeding and stable vital signs were randomized after admission to undergo endoscopy in 1 to 2 days (control) or early endoscopy in the emergency department. Patients with low-risk findings on early endoscopy were discharged directly from the emergency department. Clinical outcomes and costs were prospectively assessed for 30 days. RESULTS We randomized 110 consecutive stable patients with nonvariceal upper GI bleeding during the 12-month study period. The baseline demographic features, endoscopic findings, and the clinical outcomes were no different between the two groups. However the findings of the early endoscopy allowed us to immediately discharge 26 of 56 (46%) patients randomized to that group. No patient discharged from the emergency department suffered an adverse outcome. The hospital stay (median of 1 day [interquartile range of 0 to 3 days] vs. 2 days [interquartile range of 2 to 3 days], p = 0.0001) and the cost of care (

Request fulfillment in office practice: antecedents and relationship to outcomes.

2068 [interquartile range of