ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Physician involvement with uninsured patients is a topic of increasing policy interest. In the past, data limitations have hindered analysis of factors influencing physician contact with uninsured patients. This article attempts to bridge this gap in the health services research literature. Using a nationally representative sample of nonfederal patient care physicians, the study revealed marked variations in physician involvement with uninsured patients by specialty class, employment status, and other practice characteristics. Pediatricians and general practitioners had roughly comparable involvement with uninsured patients, while internists and surgeons were significantly less involved. Self-employed physicians generally participated less in caring for uninsured patients than did employed physicians. While definitive evidence that people without coverage face serious access problems is not provided, such a conclusion is certainly consistent with the results of this study. Indeed, the proportion of the average physician’s patients who are uninsured is substantially below current estimates of the proportion of the general population that is uninsured.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Because many raters are generally involved in the implementation of a patient classification system, interrater reliability is always a concern in the development and use of such a system. In this article, a case example is used to demonstrate a prototype for identifying measurement error introduced at each step in the classification process (assessment, creating summary item responses, and use of these responses for categorization) and to illustrate how this identification may lead to error reduction strategies. The methods of analyses included percent agreement, Kappa, and visual inspection of contingency tables displaying interrater responses to assessment items, summary items, and the placement category. The extent to which raters followed instructions was analyzed by comparing their responses with computer-generated responses across the classification steps. In addition, raters were interviewed regarding their use of the system.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

An evaluation of a community-based prenatal care program for teens compared 180 adolescent clients with a sample of adolescents matched on age and year of delivery who received care through a traditional prenatal care program at a university medical center. Evaluation criteria describing the process of receiving care were the mean number of prenatal visits, nonscheduled outpatient visits, nonstress tests, ultrasounds, and inpatient days during pregnancy. The two programs were significantly different as measured by these criteria. Outcome criteria included gestational age, birthweight, the percentage of infants requiring neonatal intensive care, and the percentage of clients with maternal complications. A multivariate analysis snowed no statistically significant differences in these outcomes. The average cost of resources consumed during prenatal care for the study group was 41% that of controls.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Although access to health services has improved considerably in the past two decades, there is growing concern about the locus of health care for the poor and ethnic minorities. In urban areas, in particular, the use of hospital outpatient departments and emergency rooms by the indigent has been increasing. This article examines the determinants of regular source of care and illuminates the ethnicity-poverty-health care nexus. The data set analyzed includes blacks, Mexicans, Puerto Ricans, and non-Hispanic whites residing in poverty areas in Chicago, IL. Multinomial logit analysis is used to estimate the likelihood of having a particular kind of regular source of care. The findings demonstrated considerable ethnic group differences. In particular, blacks tend to utilize hospital facilities as a result of past constraints and their current dependence on public insurance programs. Mexicans are the least likely to have a regular source of care due to social and cultural barriers such as language, migration status, and low community participation. The implications of social isolation associated with poverty are also examined and discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The information needs of a group of patients taking antihypertensive medication were assessed with special emphasis on the influence of perceived symptoms of high blood pressure and adverse drug effects. All patients of a hypertension clinic currently on antihypertensive medication were included in the study. The response rate to the questionnaire was 85%. Of the 623 patients included, only 31% expressed satisfaction with the amount of information received on adverse effects of their antihypertensive drugs. Patients younger than 50 years explicitly expressed a need for information more often than those older than 64. There were no differences in the expressed information needs between men and women. The reported experience of symptoms related to high blood pressure and adverse drug effects was more common among younger patients than among the elderly. Of those who experienced both adverse drug effects and symptoms, 57% expressed a need for more information, whereas only 30% of those who had no such experiences expressed a need for more information on adverse drug effects. It was concluded that there is a substantial need for more information on adverse drug effects, especially among those who have experienced adverse drug effects or some symptoms of hypertension.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In October 1988, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) introduced a prospective payment system based on diagnostic- related groups (DRGs) to pay for substance abuse services. These services were initially excluded from the new payment system because of concerns that a DRG-based system may have a large and poorly understood financial impact on individual hospitals. This report assesses the performance of a DRG system in explaining variation in costs at the individual patient level and evaluates how well this payment system predicts resource use across hospitals. Overall, the substance abuse DRGs explained only 4.2% of the total variance in charges. It was found that the Medicare DRG-based system had to be modified to reflect the characteristics of the younger CHAMPUS population by splitting DRG 435 to account for the increased costliness of beneficiaries younger than 21 years. In addition, the study revealed substantial variation in the impact of the DRG system on hospital revenue. These differences largely reflected significant differences between general and specialty hospitals.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID