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Authors: Brach C, and Fraser I.
Title: Reducing Disparities through Cultural Competent Health Care: An Analysis of the Business Case.
Publication: Quality Management in Health Care 10(4):15-28.
Date: 2002
Abstract: The persistence of racial and ethnic disparities in health care access, quality, and outcomes has prompted considerable interest in increasing the cultural competence of health care, both as an end in its own right and as a potential means to reduce disparities. Health care organizations have financial incentives to become culturally competent, but limitations inherent in these incentives must be overcome if cultural competence is to become widespread.
Availability: AHRQ Publication No. 02-R081 is available from the AHRQ Publications Clearinghouse.

Authors: Spector W., Mukamel D.
Title: Nursing home administrators' perceptions of competition and strategic responses.
Publication: Long Term Care Interface 2001 Mar;2(3):37-41.
Date: 2001
Abstract: This paper presents findings from a 1999 mailed survey of nursing home administrators in New York State, designed to elicit their perceptions of competition in the nursing home market and their strategic plans to cope with changing market conditions. Results show that administrators think that nursing home markets have become more competitive and expect this trend to continue. They perceive differences in the way individual customers choose nursing homes versus the way MCOs and hospitals make such choices. They believe that individual consumers place a higher value on quality of life factors, while aggregate purchasers rate price and the availability of complex sub-acute services higher. Strategic responses by nursing homes varied by ownership type.

Authors: Palmer CS, Zhan C, Elixhauser A, et al.
Title: Economic assessment of the Community-Acquired Pneumonia. Intervention Trial Employing Levofloxacin.
Publication: Clinical Therapeutics 22(2):250-64.
Date: 2000
Abstract: The purpose of this study was to assess use of critical pathway designed to manage community-acquired pneumonia more efficiently than its management with conventional therapy. Economic outcomes were assessed in conjunction with a cluster-design, randomized, controlled trial. Nineteen participating Canadian hospitals were randomized to implement the critical pathway (n=9) or conventional therapy (n=10). The critical pathway included a clinical prediction rule to guide the admission decision, treatment with levofloxacin, and practice guidelines. Patient data on medical resource use, lost productivity, and quality of life were collected prospectively for more than 6 weeks after treatment. Costs were calculated from government, health care system, and societal perspectives, with imputation of missing outpatient costs and the costs of lost productivity when necessary. Bootstrapping was used to identify 95 percent CIs for the total cost per patient. The analysis included all eligible patients in the critical pathway (n=716) and conventional therapy (n=1027) arms. There were fewer hospital admissions in the critical pathway arm than in the conventional therapy arm, both overall (46.5 percent vs 62.2 percent; P=0.01) and in low risk patients (33.2 percent vs 46.8 percent; P< 0.001). Compared with conventional therapy, hospitals in the critical pathway arm had 1.6 fewer bed days per patient managed (P=0.05) and used fewer inpatient medical resources. The two study arms had similar outpatient, readmission, and lost-productivity costs, and similar quality-of-life outcomes. The critical pathway produced cost savings from all three perspectives that ranged from $457 and $994 per patient. The critical pathway employing levofloxacin resulted in cost savings compared with conventional therapy and did not compromise health outcomes.

Authors: Shikiar R, Halpern MT, McGann M, Palmer CS, Seidlin M.
Title: The relation of patient satisfaction with treatment of otitis externa to clinical outcomes: Development of an instrument.
Publication: Clinical Therapeutics 21(6):1091-104.
Date: 1999
Abstract: This survey was undertaken to develop a short, comprehensive measure of patient satisfaction with pharmacologic treatment for otitis externa and to assess the relationships between satisfaction, disease symptoms, and medication side effects. Our results demonstrate that patient satisfaction with otic medication can be assessed across various aspects of satisfaction and that it is correlated with reported disease symptoms and medication side effects. This type of multifaceted assessment may help physicians select between medications with different side-effect profiles and administration schedules.

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