BACKGROUND The distribution of malpractice claims among physicians is not well understood. If claim-prone physicians account for a substantial share of all claims, the ability to reliably identify them at an early stage could guide efforts to improve care. METHODS Using data from the National Practitioner Data Bank, we analyzed 66,426 claims paid against 54,099 physicians from 2005 through 20...

BACKGROUND Projections of physician shortages, an aging population, and insurance expansions have increased interest in expanding the number of primary care nurse practitioners (PCNPs) in the United States. Although information about the number and distribution of nurse practitioners is known, there is little information about the practice characteristics of PCNPs. The purpose of this study was...

PURPOSE To assess the impact of 2005 and 2006 reductions in chemotherapy reimbursement, mandated in the Medicare Modernization Act, on patterns of chemotherapy receipt in the last 14 days of life. PATIENTS AND METHODS Included in the study were Medicare beneficiaries dying with poor-prognosis cancer from 2003 to 2007. We compared pre- and postreform probability and frequency of chemotherapy r...

In an interesting article Wieteke van Dijk and colleagues argue that societal developments and values influence the practice of medicine, and thus can result in both medicalisation and overdiagnosis. They provide a convincing argument that overdiagnosis emerges in a social context and that it has socially constructed implications. However, they fail to show that overdiagnosis per se is socially...

BACKGROUND Reducing rates of rehospitalization has attracted attention from policymakers as a way to improve quality of care and reduce costs. However, we have limited information on the frequency and patterns of rehospitalization in the United States to aid in planning the necessary changes. METHODS We analyzed Medicare claims data from 2003-2004 to describe the patterns of rehospitalization...

BACKGROUND A survey was conducted of 26 physician offices and the County Health Department to determine the quality of vaccine storage. METHODS All refrigerators were examined for secure electrical supply, firmly shut door, storage of inappropriate items, and expired vaccines. A maximum-minimum thermometer was then placed in the middle of the storage area for 24 hours, and temperatures were r...

This section has surveyed characteristics of the health service systems in Denmark, Scotland, West Germany, and the United States. Certain characteristics in each country are likely to increase hospital utilization. In the United States the characteristics include economic incentives to physicians and patients for hospital use and the high percent of physicians in specialty practices. In Denmar...