摘要:

In an academic general medicine clinic, we performed a randomized, controlled trial to compare (1) the effects of supplying monthly feedback reports of compliance with preventive care protocols by 135 internal medicine house staff with (2) the effects of specific reminders given to them at the time of patient visits. The protocols were randomly divided into two groups, A and B, and half the house staff were given feedback for Group A and half for Group B. Thus, each group served as a control for the other. Each feedback group was also randomly assigned to receive reminders for either Group A or B protocols. House staff receiving feedback more often complied with fecal occult blood testing, mammography, pneumococcal vaccination, use of metronidazole, and combined Group A and B protocols than did controls (P < 0.01). There was also significantly more compliance with the same protocols by house staff receiving reminders, but the increase for fecal occult blood testing, pneumococcal vaccination, and combined Group A protocols was twice that seen in physicians given feedback alone. In addition, reminders alone increased compliance with oral calcium supplementation. Overall compliance with the preventive care protocols was low: 10-15% in physicians receiving neither feedback nor reminders, increasing to 15-30% in those receiving reminders. Physician compliance with suggested preventive care protocols can be increased by both delayed feedback and immediate reminders, but reminders have a greater effect.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Determinants of physician utilization were examined among three groups of ethnic elderly, Vietnamese, Portuguese, and Hispanic, living in Santa Clara, California. Andersen and Newman's1behavioral model provided a framework for the analysis. Univariate analysis described and compared the three groups in terms of predisposing, enabling, and need factors as well as factors related to ethnicity such as language and language of the physician. Least squares regression compared the predictors of utilization for the samples. The results showed that need is the common determinant of physician care but that the definition of need varies with ethnicity. The samples had similar rates of chronic illnesses and made equal physician visits, but the needs and factors predicting utilization differed. Contrasts were found between groups in the role of marital status on utilization. For the Portuguese, being married was a significant predictor; while for the Hispanics, being unmarried was significant. The most important predictor for the Vietnamese was satisfaction with their medical care, a factor that was not significant for the other samples. This may indicate that the physician's role transcends that of being just a health care provider for this population. The results suggest that ethnicity is not necessarily a barrier to care but that providers must be sensitive to the cultural diversities of patients and the effects they can have on utilization

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Analysis of the National Medical Care Utilization and Expenditure Survey indicates that the poor/near-poor with continuous Medicaid coverage had almost double the probability of use of ambulatory mental health care compared with the poor/near-poor not enrolled in Medicaid. The higher probability of use reflects the impact of increased financial accessibility to needed mental health services and may also be influenced by an associated demand for social services provided by organized mental health settings in addition to clinical services. Intensity of use per user was not significantly different between Medicaid- and non-Medicaid-enrolled poor/near-poor, but the percent paid out of pocket was substantially lower for those continuously in Medicaid.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Evaluation of a long-term care patient classification instrument in use in the Veterans Administration revealed that the levels of functional ability used in such instruments can influence their abilities to explain use of nursing time and reliability between raters. Specifically, a three-level scale that combines patients who require supervision with those who require help does not explain use of LPN and nurse's aide personal care time as well as does a four-level scale or a three-level scale that combines patients who require supervision with those who are independent. These findings should be considered in designing and applying patient assessment instruments.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

In this paper we examine the relationship between inpatient length of stay and the patient's type of health insurance. The data consist of discharges in seven diagnosis-related groups (DRGs) from community hospitals in Minneapolis and St. Paul during 1982. After controlling for the effects of the patient's age, sex, medical condition, and severity of illness, as well as the hospital's size, teaching and ownership status, and average annual occupancy rate, we must reject the null hypothesis that the patient's type of health plan is unrelated to inpatient length of stay in Twin Cities community hospitals. We find that, in most cases, patients in prepaid group practices and independent practice associations exhibit significantly shorter lengths of stay than similar patients in Blue Cross and commercial health insurance plans, while Medicare and Medicaid patients exhibit significantly longer lengths of stay than those of similar commercially insured patients

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A natural movement away from traditional first-dollar health care benefits to coverage with cost-sharing features was studied among employer groups covered by Blue Cross and Blue Shield of North Carolina. The groups choosing the new benefits were atypical: they had a record of high rates of hospitalization. The new benefits were successful in shifting part of the financial burden away from the employer and, additionally, the groups collectively experienced a decline in inpatient utilization in excess of the decrease noted among controls. Despite the overall decline in utilization, their days/1000 remained in excess of the control groups in the year following the benefit change. Not every group experienced a utilization decline. Participants in counties with traditionally low levels of utilization did not experience a further decline.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This study reports the results of a household survey of 495 Medicaid clients eligible under the Aid to Families with Dependent Children program in Monroe County, New York. The purpose of the study has been to examine the views and to anticipate the health care choices/decisions of Medicaid clients prior to their enrollment in a new, county-wide Medicaid-managed care program. The findings indicate significant ethnic differentials among the Medicaid poor, both in the choice of care source and in the reasons offered for that choice. Forty percent of those interviewed would like to change to a new source of care, but less than 13% can actually be expected to change. Private practice arrangements were the preferred source of care, yet distance to such sources appears to represent a major stumbling block to access. This study suggests that the managedcare approach being offered in Monroe County may offer the Medicaid eligibles a new stigma-free way of affiliating with a health care provider. This is being recognized by those surveyed as an important element. The study demonstrates that the choices made by the Medicaid recipients are perfectly rational given the recipients' knowledge of Medicaid and the health care system, and the general conditions in which they find themselves. These findings have important implications for the move of Medicaid programs from the fee-for-service to the managed-care/HMO system.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Selected issues regarding the application of the kappa statistic in assessing the reliability of measures to classify patients are discussed. Data are used to illustrate how the methods used to estimate reliability can influence the resulting coefficient. Suggestions for a more comprehensive approach to the study of the psychometric properties of measures of patient classification are then offered.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Fifty ambulatory upper respiratory tract infection patients were studied to evaluate the nature of their illness concerns and explore the relationship between these concerns and subsequent recovery. Thirty-four patients still had URIrelated symptoms 1 week after their medical visit, whereas 16 were asymptomatic. In general, asymptomatic patients could not be distinguished from symptomatic patients in terms of demographic variables, symptom type or duration, initial level of health concerns, physician findings, culture results, or therapy. Further, both groups exhibited surprisingly high levels of initial concern. Asymptomatic patients had a significantly greater reduction in these concerns shortly after their visit than the symptomatic group (P < 0.01). Asymptomatic patients also reported more benefit from discussion of their concerns (P < 0.01) and more satisfaction with this aspect of their care than the symptomatic group (P < 0.001). The notion of illness concerns appears to be a concept worthy of clinical consideration and further investigation.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Many Medicaid policy changes occurred in recent years including those resulting from the Omnibus Budget Reconciliation Act of 1981 and the Tax Equity and Fiscal Responsibility Act of 1982. At the same time, the supply of providers increased and the health care market became more competitive. This paper presents evidence about how these developments are affecting pediatricians' participation in state Medicaid programs. Surveys conducted in 1978 (N = 814) and 1983 (N = 791) indicate that the proportion participating declined only slightly from 85.1% to 82.0%. The average Medicaid case load of participants remained at 15%, although extent of participation of individual pediatricians fluctuated. Previous research demonstrates that physicians' Medicaid participation is affected by reimbursement level, administrative complexity, and generosity of eligibility and benefits. Our data confirm these influences. However, the longitudinal design of the analyses reported here also captures shifts in the relative influence of these factors. The influence of policy factors has diminished over time, while the influence of changes in physician supply has increased. Increased physician supply, however, is associated with decreased Medicaid participation. Thus, diminished access to pediatric care for low-income children may result from recent changes in Medicaid and in the broader health care environment.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID