摘要:

The authors determined the sensitivity of estimates of the use and cost of outpatient mental health care to two methods effects: the definition of a mental health visit and strategies for allocating mental health care costs. They use data from the Rand Health Insurance Study, which has a random sample of the nonaged noninstitutionalized civilian population in six United States sites. Estimates of the use of mental health specialists are insensitive to alternative methods. However, estimates of the use and cost of the mental health care delivered by nonpsychiatrist physicians (e.g., internists) are quite sensitive to methods effects. Nevertheless, the cost of care from nonpsychiatrist physicians is so low that the total cost of outpatient mental health care is not meaningfully affected by methods effects.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The use of a surrogate Sickness Impact Profile (SIP) score was investigated in a sample of 66 chronically or terminally ill homebound patients and their caretakers. Statistically significant differences in category scores (P< 0.05) were found in only two categories. Profile analysis revealed no systematic differences between patient and caretaker responses, and agreement was generally quite high. Agreement of a surrogate SIP was somewhat lower if the patient was suffering from a terminal condition, if the patient had lower educational attainment, or if the caretaker did not live in the same household as the patient. Agreement did not appear to be affected by a diagnosis of a neurologic or psychiatric condition, by the patient's age or degree of dysfunction, or by the relationship of the caretaker to the patient. Overall, the results of the study are encouraging with regard to use of surrogate SIP total and dimension scores for group-level analysis of chronically ill patients if the surrogate is a family member who is closely involved in the patient's care.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Respondents' reports of outpatient medical care use in the preceeding year are compared with actual utilization. The authors examine the predictors of the discrepancy between reported and actual utilizaton as well as the extent to which reporting error biases models of utilization behavior. The average reporting error in this study is relatively small, but the impact of biased reporting on prediction models can be substantial.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The role of respondents' values in their evaluation of and satisfaction with medical care was explored in four health education settings. Two hundred and twenty-seven nursing, medical, and health psychology students completed a forced-choice instrument designed to measure their value preferences for technical quality of care, psychosocial concern, courtesy, and mutual participation style of interacting in a medical visit. They subsequently watched a standardized 14-minute videotape of a simulated physician-patient interaction and evaluated the physician's behavior from the patient point of view on the four dimensions using two popular methods for assessing patient satisfaction. Respondents' ratings of the medical encounter were more often significantly influenced by their values when the more subjective satisfaction measure was considered. In addition, respondents who valued technical quality more highly were more satisfied with the other three dimensions of physician behavior, while respondents who more highly valued psychosocial concerns were less satisfied with these three dimensions. Ratings of satisfaction with technical quality were not affected by respondents' values. The importance of these findings in assessing patient satisfaction is discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Broken appointments have been a major problem at the Anthony L. Jordan Health Center since it opened in 1968. In an earlier 6-month study of broken appointments at the center the authors found 48% of pediatric appointments and 43% of medicine appointments to be broken. Daily broken appointment rates were correlated between the two departments and were associated with day and time scheduled and with certain weather conditions. Specifically, highest broken appointment rates were noted for Mondays, for afternoon and evening hours, and for days with precipitation.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The neonatal risk score of Hobel et al. was evaluated as a measure of neonatal morbidity in a sample of 1,600 singleton infants born alive at two institutions. The score was evaluated for internal consistency, the appropriateness of weight assigned to factors, criterion validity, and conformity to the negative binomial distribution. The results are encouraging for the use of the score as a measure of neonatal morbidity. It appears internally consistent. All risk factors occur with some frequency with at least one other and, in most instances, with several others. With one exception, all factors distinguish infants with high and low scores. The neonatal score, defined by a weighted score and by the number of factors, is highly correlated with length of infant stay in the nursery. Correlations are higher for scores of events measured after birth than for scores of events measured directly at birth. The authors recommend that the number of risk factors be used in preference to the weighted neonatal score since it conforms to the negative binomial distribution and is simpler to calculate. The potential uses of a quantitative, comprehensive measure of neonatal morbidity are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This article addresses several questions about the effect of disenrollment on the start-up phenomenon in health maintenance organizations that were raised in a recent exchange of articles and comments in this journal. The results show that disenrollees, like continuous enrollees, go through a start-up phase of utilization that decreases over duration of membership to a stable lower level. The study also differentiates between voluntary and involuntary disenrollees, both of which go through start-ups. The different characteristics of the start-ups of both groups of disenrollees are contrasted with those of continuous enrollees. The implications of these findings for planners and administrators are discussed, and a future research agenda is recommended.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Current legislative proposals to increase competition among private insurers assume that people are or can be well-informed about their insurance coverage. Evidence from the National Medical Care Expenditure Survey shows that among the population 65 years of age and older knowledge about health insurance coverage is substantial but generally lower than in the population younger than 65 years of age. Multivariate analysis is used to identify factors associated with high and low levels of knowledge. Although correct knowledge of coverage of particular services is highly associated with current experience of health problems, with use of these health services, and with the cost for private insurance, overall knowledge is lowest among some groups at high risk of serious illness, in particular, the old, nonwhites, and persons enrolled in Medicare but without Medicaid or private insurance supplements.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Black children make substantially less use of health services than do their white counterparts, despite their demonstrably poorer health status. This relationship is true regardless of income. Various authors have suggested that such differences are due to system-related barriers to access to care by black children. Alternatively, others have noted that blacks have cultural patterns related to health and illness, and these culturally determined beliefs and behaviors may account for the observed differences. The present study compared use of health services by black and white children within a system of care that has sought to decrease barriers to access to care by black children. Within this system, black and white children used health services in a similar fashion, suggesting that system-related factors that assure equity of access to health services may be more important than client-related cultural factors, or that these cultural factors may be overcome.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

To investigate admissions from nursing homes to a medical intensive care unit (ICU), the authors detailed the major interventions, costs, and outcomes for such patients (n = 67) over a 3-year period and then compared them with those for ICU patients receiving home care or visiting nurse services (240 patients) before admission and all others older than 65 years of age (949 patients). These three groups comprised 37% of total ICU admissions. In contrast to younger patients admitted primarily with acute ischemic heart disease, nursing home patients were more likely to be admitted with cardiopulmonary arrest, infection, and gastrointestinal bleeding. Major interventions of intubation and mechanical ventilation were most frequent for nursing home patients, but total hospital charges differed little among the groups. In-hospital mortality for the nursing home group (28%) was significantly higher than for the home care group (7%) and others older than 65 years of age (7%). Cumulative mortality for the nursing home group reached 66% by 8 months, versus 32% and 26% in the other groups, respectively.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID