摘要:

The Health Care Financing Administration (HCFA) plans to use the Uniform Clinical Data Set System (UCDSS) to collect data on hospitalized Medicare patients. This study examined the value of UCDSS data for creating severity of illness measures. UCDSS data were obtained from a study hospital and from a national data set for patients with pneumonia (n = 528) and stroke (n = 565). Models to predict length of stay or an adverse event were derived for each condition using HCFA claims data alone, UCDSS data alone, and UCDSS data supplemented with additional information also abstracted from charts. The models were derived from one set of patients and validated on another. The R2for predicting length of stay in the validation data for the UCDSS model was 0.29 for pneumonia and 0.19 for stroke compared to R2values from the claims model of 0.09 for stroke and 0.06 for pneumonia. UCDSS models also were better than claims models for predicting adverse events. The best UCDSS models includedInternational Classification of Diseases, Ninth Revision, Clinical Modification(ICD-9-CM) codes and other information requiring clinical judgment, and were improved by adding more information on patient functional status. Some findings were more strongly associated with outcome for the study hospital than for the national data. These results suggest that UCDSS models will predict outcome much better than the claims based models currently used by HCFA for the analysis of hospitalization-related mortality; more functional status information should be added to UCDSS; and despite an extensive objective database, the most predictive UCDSS models require clinician-assigned diagnostic codes.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We examined patterns of ambulatory care in the year before diagnosis of acquired immune deficiency syndrome (AIDS) for 5,720 persons infected with human immunodeficiency virus (HIV) who were continuously enrolled in the New York State Medicaid program and diagnosed in 1984–90. For 3,175 persons followed ≥ 6 months after AIDS, we also examined the change between the year before AIDS diagnosis and the 6 months afterward in the predominant provider who was seen most frequently and at least twice. Approximately 75% of the population had a predominant provider identified. Of this group, 43% of the patients had a generalist as their predominant provider before AIDS diagnosis, falling to only 25% after diagnosis. The proportion with an AIDS specialist predominant provider increased from 22% before AIDS diagnosis to 39% afterward (P< 0.001). Patients with a generalist predominant provider before AIDS diagnosis had higher odds of switching providers and of hospitalization after AIDS diagnosis than patients with an AIDS specialist predominant provider. If generalists are to be encouraged to manage patients with advanced HIV disease, a better understanding of factors contributing to these outcomes is needed.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We analyzed switches between prepaid and fee-for-service health care plans among depressed outpatients in the longitudinal part of the Medical Outcomes Study. Patients of mental health specialists in fee-for-service plans had the lowest adjusted rate of plan switching (8.1%), compared to fee-for-service general medical patients (13.5%) and prepaid patients of both types of providers (10.1% to 11.7%). Although there were no substantial differences in initial sickness by payment system among enrolled patients, differing switching rates by provider specialty and payment system indicated biased selection over time. In addition, we found that married, nonwhite, and wealthier individuals were significantly more likely to leave fee-for-service than prepaid care plans. We analyzed whether system switching had an effect on patient satisfaction and outcomes. None of the results were highly significant, but the power of the data to analyze this issue was limited. Nevertheless, it appears that patients switching from prepaid to fee-for-service may be at risk for poorer functioning outcomes, although there was no similar effect on mental health status.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

One of the most frequently used health status measures consists of a single item that asks respondents to rate their overall health as excellent, good, fair, or poor. This study identified the conceptual domain that is assessed by this self-rated health measure. Findings from 158 in-depth interviews revealed that the same frame of reference is not used by all respondents in answering this question. Some study participants think about specific health problems when asked to rate their health, whereas others think in terms of either general physical functioning or health behaviors. The data further revealed that the specific referents that are used vary by age. In addition, more tentative findings suggest that the use of specific referents may also vary by education and race. Finally, the results suggest that certain referents may not be related to closed-ended health ratings in predictable ways.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Medicare has adopted a physician fee schedule that places emphasis on measuring physicians' work. We assessed the construct validity of self-reported work scores for 11 selected medical services performed by 44 internists in two large group practices. These physicians' work scores correlated highly with their ratings of time, physical and mental effort, and stress required to produce the services. Eighty-five percent of the variance in total work scores could be explained by the dimensions of work. Time was the most important input, but mental effort also was important for internists. We also found that physicians may reduce the total work required to produce two services for a patient if they provided those services in one visit, rather than in separate visits. Savings occurred for service pairs in which the physician could reduce his or her own time. Our findings imply that the Medicare fee schedule pays internists mainly for the time and mental effort required to produce medical services. They also underscore the importance to physicians of saving time by providing two services during the same patient visit.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Health locus of control (HLC) has been used to operationalize general health motivation. This study was undertaken to evaluate the internal consistency and construct validity of Tinsley and Holtgrave's Parent Health Belief Scales (PHBS) as a measure of maternal HLC toward their children's health. Five hundred mothers (71% of eligible consecutive admissions) of newborns admitted to the normal newborn nursery of a large municipal teaching hospital were interviewed 24 to 72 hours after delivery. Principal components factor analysis of the PHBS did not support the originally hypothesized three-dimensional factor structure of the PHBS. In addition, the original subscales did not have adequate internal consistency reliability. Further assessment of construct validity by comparison with maternal preventive health behaviors showed some evidence of construct validity for the scales when compared with breastfeeding behavior. When the three items written as reverse-coded Internality items are not reversed, a reliable seven-item Externality scale emerges which contains items originally thought to represent all three dimensions of HLC.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID