摘要:

Regional differences in hospital utilization are quite substantial, especially between the East Coast and West Coast. To determine whether or not differences in the socioeconomic composition of regional populations explain observed regional differences in hospital utilization, the authors assessed patterns of utilization for a sample of 18,660 New York City residents, 18,881 Los Angeles residents, 10,921 persons living in Northeastern Standard Metropolitan Statistical Areas (SMSAs) and 13,475 persons living in Western SMSAs. The results showed that the New York–Los Angeles difference in hospital days of care decreased from 43% to 22% after adjusting for differences in seven distinct socioeconomic characteristics of the two populations. The Northeastern–Western difference decreased from 18% to -6% (i.e., the Western rate exceeded the Eastern rate after adjustment). Adjusting for differences in socioeconomic characteristics of the local populations affected regional differences in admission rates more than differences in lengths of stay. In the case of New York City, the study also showed that the presence of an unusual number of very long hospital episodes (51 or more days) also is an important explanation of New York's high average stay. The difficulty of identifying posthospital placements for patients needing extended care is thought to cause these long stays in New York City.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Utilizing national data on patient care provided by family practitioners, general internists, and subspecialists in internal medicine, this study examines the complexity of care provided by generalist physicians versus subspecialty physicians on a disease-specific basis. Limiting the analysis to “principal care” provided by office-based physicians, the study finds the complexity of care provided by cardiologists for heart disease and by endocrinologists for diabetes mellitus to be somewhat greater than that provided by family practitioners and general internists, though the magnitude of the differences is not large. For chronic obstructive pulmonary disease, however, pulmonary disease specialists are shown to provide care that is substantially more complex than that provided by their generalist colleagues. For all diseases and specialties, hospital care is substantially more complex than ambulatory care.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This paper explores the merits of two methods that extract the decision models of experts to serve as a decision support mechanism for staffing. One method has experts make judgments about hypothetical cases and the other has experts decompose the decision into criteria weighting and scaling. Staffing models were developed for each method using nurses who work in neonatology wards in two large hospitals. The four decision models were used to predict the demands for nursing time in both hospitals, which were compared with anexpost factoassessment of needs to validate the models. To measure transportability, the author used the model developed in one site to predict nursing hours for the other site. Both methods were found to be acceptable when applied at the site where they were developed. However, the ability to transport either model was negligible, suggesting that universal protocols for staffing do not exist.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A 9-year follow-up study of a national probability sample (n = 865) of foreign medical graduates (FMGs) and United States medical graduates (USMGs) who were house officers in United States hospitals in 1973-1974 reveals that more than three fourths of the alien FMGs were located in the United States in 1983. FMGs were distributed disproportionately across United States census regions (P < 0.001), specialty areas (P = 0.071), and type of position (P = 0.059). Neither the switching of specialty areas nor the changing among United States census regions was significantly different for FMGs and USMGs. Census regions with net gains of FMGs over the 9-year period included the Pacific, South Atlantic, and West South Central regions, areas with either proportionately higher 1973-1974 USMG concentrations or net USMG gains. The results suggest a gradual assimilation of FMGs into the American medical system from an initial position different than that of USMGs

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Improving pregnancy outcomes for low-income women has been a longstanding Medicaid objective, yet exceptionally low Medicaid participation rates for private practice obstetrician-gynecologists (OB-GYNs) suggest that access to maternity care may be particularly limited. Using a national sample of more than 2,800 office-based physicians, the authors analyzed the factors influencing the Medicaid participation decision of physicians in three specialties: OB-GYN, pediatrics, and general surgery. Regression results suggest that OB-GYNs are equally, or even more, sensitive to Medicaid reimbursement and program administration characteristics. Higher Medicaid fees definitely raise OB-GYN participation rates, for instance. OB-GYNs are also more willing to participate in those states where Medicaid programs are more generous in their eligibility requirements and where administrative red tape is less onerous.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

In this study the authors compare the patterns of referral to alcoholism treatment from two neighborhoods adjacent to a public mental health facility. The areas are alike in terms of socioeconomic status, but they differ in their racial composition and social organization. They hypothesized that referrals to alcoholism treatment originate from self, family, and friends in the organized neighborhood and from police and social service agencies in the unorganized area. Results support the following conclusions: 1) self, family, and friends account for the majority of referrals to alcoholism treatment from both an organized neighborhood and an unorganized area; 2) race and sex explain more variation in referral to alcoholism treatment than does neighborhood social organization; and 3) white female patients are more likely to be institutionally referred than any other group.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This article reviews the procedures for developing a multiattribute health index for use in population health studies and program evaluations. The development of such indexes involves two steps: 1) the creation of a multiattribute health state classification system; and 2) the mapping of the system into a single metric scale. The system must be relevant for its intended use and as concise as possible. Because a limit exists in the number of attributes that can be included in the system while maintaining reliable measurement, there may be a trade-off between specificity of detail and breadth of coverage. When mapping the system into a scale of cardinal values, five issues arise: 1) the selection of a scaling technique; 2) the use of mathematic models to quantify health; 3) the selection of anchor points; 4) the selection of raters; and 5) the identification of factors that influence raters' judgments. The article reviews the procedures that are used, discusses the issues that arise, and proposes some solutions for the development of multiattribute health indexes.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID