A cluster-randomized trial to improve stroke care in hospitals.

Objective: We evaluated the effect of performance feedback on acute ischemic stroke care quality in Minnesota hospitals.

Methods: A cluster-randomized controlled trial design with hospital as the unit of randomization was used. Care quality was defined as adherence to 10 performance measures grouped into acute, in-hospital, and discharge care.

Blood pressure management in acute ischemic stroke.

Data from the Project for Improvement of Stroke Care Management in Minnesota were used to characterize provider practice in the management of hypertension in hospitalized acute ischemic stroke patients in relation to guidelines from the American Stroke Association (ASA) and the European Stroke Initiative (EUSI). Among 1181 patients, 129 received as-needed medication in direct response to elevated blood pressure in the first 24 hours after admission. Of these 129, 56% were overtreated according to ASA guidelines and 24% by EUSI guidelines.

The influence of cost containment strategies and physicians' financial arrangements on patients' trust and satisfaction.

Concerns have been raised about the potential for negative effects of health plans' cost containment strategies on the patient-physician relationship. We surveyed Minnesota patients with diabetes or hypertension (N = 595) and their physicians (N = 389) to assess the associations of gatekeeping, utilization profiling, and financial arrangements with patients' trust in and satisfaction with their physician. We found that patients of physicians exposed to various cost containment strategies were generally not less trusting in or less satisfied with their physicians than other patients.

Relationship of diabetes-specific knowledge to self-management activities, ambulatory preventive care, and metabolic outcomes.

Background: Educational interventions increase diabetes patients' knowledge and self-care activities, but their impact on the use of health services to prevent diabetes complications is unclear. We sought to determine the relationship of patients' diabetes-specific knowledge with self-management behaviors, use of ambulatory preventive care, and metabolic outcomes.

Methods: We surveyed 670 adults with diabetes from three managed care plans to assess diabetes knowledge (using an eight-item scale) and self-management activities.

The influence of physicians' practice management strategies and financial arrangements on quality of care among patients with diabetes.

Context: Health care organizations use many strategies to influence physician behavior and the care delivered, but the effect of such strategies on quality is not known.

Objective: We sought to assess the influence of practice management strategies and financial arrangements on the quality of diabetes care.

Design: This was a retrospective cohort study including medical record reviews and a physician survey.