Outcomes Assessment and Health Care Reform

Argues for the use of outcomes assessment in measuring cost-effectiveness and quality to capture the overall impact of multi-dimensional treatment strategies and to identify healthcare systems that both adopt appropriate technologies and perform well

Is Less Better? Greater Efficiency With Fewer Resources Expended

Summarizes an analysis of Medicare spending to assess the relative efficiency of healthcare providers in managing patients with severe chronic illnesses in California. Highlights the need to redesign the payment system to improve healthcare efficiency

Regional and Racial Variation in Health Care Among Medicare Beneficiaries

Focuses on variations in healthcare delivery and outcomes among and within hospital service areas, in addition to racial and geographic disparities, as measured by five indicators. Discusses variations in spending and considers implications for reform

Disparities in Health and Health Care Among Medicare Beneficiaries

Compares disparities in treatments and health outcomes -- diabetes-related leg amputations, mammograms, diabetes management, primary care, and hospitalization rates -- by race/ethnicity and state or region

Hospital and Physician Capacity Update

Offers an alternative view of healthcare costs by examining trends in hospital capacity and healthcare labor across regions. Outlines how effective management of healthcare capacity would enable affordable quality care that meets patient needs and wants

The Revolving Door: A Report on U.S. Hospital Readmissions

The U.S. health care system suffers from a chronic malady -- the revolving door syndrome at its hospitals. It is so bad that the federal government says one in five elderly patients is back in the hospital within 30 days of leaving.Some return trips are predictable elements of a treatment plan. Others are unplanned but difficult to prevent: patients go home, new and unexpected problems arise, and they require an immediate trip back to the hospital.But many of these readmissions can and should be prevented. They are the result of a fragmented system of care that too often leaves discharged patients to their own devices, unable to follow instructions they didn't understand, and not taking medications or getting the necessary follow-up care.The federal government has pegged the cost of readmissions for Medicare patients alone at $26 billion annually, and says more than$17 billion of it pays for return trips that need not happen if patients get the right care. This is one reason the Centers for Medicare & Medicaid Services has identified avoidable readmissions as one of the leading problems facing the U.S. health care system and now penalizes hospitals with high rates of readmissions for their heart failure, heart attack, and pneumonia patients. This report is being released in conjunction with the Robert Wood John Foundation's Care About Your Care initiative, which is devoted to improving care transitions when people leave the hospital. It looks at the issue of readmissions in two ways: by the numbers and through the eyes of the people who live them

Compound nuclear decay and the liquid to vapor phase transition: a physical picture

Analyses of multifragmentation in terms of the Fisher droplet model (FDM) and the associated construction of a nuclear phase diagram bring forth the problem of the actual existence of the nuclear vapor phase and the meaning of its associated pressure. We present here a physical picture of fragment production from excited nuclei that solves this problem and establishes the relationship between the FDM and the standard compound nucleus decay rate for rare particles emitted in first-chance decay. The compound thermal emission picture is formally equivalent to a FDM-like equilibrium description and avoids the problem of the vapor while also explaining the observation of Boltzmann-like distribution of emission times. In this picture a simple Fermi gas thermometric relation is naturally justified and verified in the fragment yields and time scales. Low energy compound nucleus fragment yields scale according to the FDM and lead to an estimate of the infinite symmetric nuclear matter critical temperature between 18 and 27 MeV depending on the choice of the surface energy coefficient of nuclear matter.Comment: Five page two column pages, four figures, submitted to Phys. Rev.

Trends and Regional Variation in Hip, Knee and Shoulder Replacement

Analyzes patterns in underuse or overuse of joint replacements among Medicare beneficiaries by geographic regions and race/ethnicity. Explores underlying factors and highlights the need for physician and patient education and shared decision making

Trends and Variation in End-of-Life Care for Medicare Beneficiaries With Severe Chronic Illness

Provides an updated analysis of regional and hospital variations in end-of-life care for Medicare beneficiaries with chronic illnesses, including percentage of hospital deaths, days in intensive care units, and physician labor per patient