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Social Determinants of Treatment Response

Socioeconomic status is consistently linked to population health and specifically to the finding that there is decreasing health associated with decreasing social position. Despite the substantial literature, an analogous literature that is focused on clinical practice, and especially consideration of the individual, is almost nonexistent. Even in the absence of these data, physicians routinely incorporate […]

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The Frequency of Unnecessary Testing in Hospitalized Patients

Testing is an important part of medicine across all specialties and settings. As a result, the volume of testing is enormous, with an estimated 4-5 billion tests performed in the United States each year.1 Unnecessary laboratory testing and diagnostic imaging is believed to be common. Studies looking at testing of patients have found 40%-60% of tests […]

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Implications of Medicare’s Value-Based Payment Initiative for Specialty Health Systems

Despite the current uncertainty about the direction of health care reform in the United States, the Centers for Medicare and Medicaid Services (CMS) appears poised to transition from standard fee-for-service reimbursement to value-based payments in the coming years. These new models, which were codified in the Medicare Access and CHIP [Children's Health Insurance Program] Reauthorization […]

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Advance Directives in Hospice Healthcare Providers: A Clinical Challenge

On a daily basis, healthcare providers, especially those dealing with terminally ill patients, such as hospice workers, witness how advance directives help ensure the wishes of patients. They also witness the deleterious consequences when patients fail to document the care they desire at their end of life. To the best of our knowledge there are […]

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Denying International Medical Graduates Entry to the United States: A Loss at Both Ends

A resident colleague of ours at the Cleveland Clinic was recently deported soon after entering the United States. This was in conjunction with the executive orders at that time that barred individuals from selected countries to enter the United States, whereas suggesting “extreme vetting” for the others. She had traveled to spend vacation time with […]

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