摘要:

The evidence is substantial that comprehensive, HMO-type prepayment plans can significantly reduce hospitalization rates. Yet it remains unclear which factors contribute to this phenomenon. This study focuses on organizational characteristics of four plans with different hospitalization experiences. Regular medical staff review and frequent use of second opinions and economies of scale achieved by providing care at one well-equipped, large health center appear to have the largest impact. However, such organizational advantages can easily be wiped out by adverse self-selection of patients during openenrollment periods. Evidence of selection based on predictable high obstetrical and newborn care costs is presented.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The study determined the separate and joint effects of 1) physician specialty, 2) type of medical school attended, 3) time in practice, 4) type of ambulatory care setting, and 5) type of hospital on the quality of physician performance in patient care. The sample consisted of 454 physicians in 18 specialty categories. Multiple Classification Analysis was used to determine the effects of these predictors on the quality of physician performance. The study found that the organization of hospital care had a large independent effect, but that the other four predictors had relatively small effects on the quality of physician performance. The findings imply that the organization of the setting in which care is provided has more influence than the education and training that physicians had attained. All five predictors together explained 20 per cent of the variance. Methodological suggestions were made to improve the explanatory power of the variables, and various pragmatic implications for medical care administrators were presented.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

This study was conducted to determine whether implementation of a specific formalized concurrent utilization review system which involved malting a prior determination of length of stay had any more effect on average length of stay than continuance of a utilization review method not involving assignment of such a target date. The system studied was the Pre-Discharge Utilization Review (PDUR) program used for Medicaid patients in Pennsylvania. Analysis was conducted using discharge abstracts for Medicaid patients under age 65 who were discharged with one of 14 common diagnoses for certain Allegheny County hospitals in 1972 and 1973. Comparisons were made for each individual diagnosis to control for possible differences in case mix. Results indicate that there was no general reduction in length of stay which could be attributed to the PDUR program.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

This study relates components of care, including patient characteristics, degree of initial morbidity, and process of care, to patient outcomes. One hundred twenty-two adults who were being treated for congestive heart failure by a sample of physicians in Fort Wayne, Indiana were studied. Data were obtained on the patients' personal characteristics; degree of illness at the beginning of the six-month study period; process measures (physician awareness, communication, medication use, therapeutic management, patient satisfaction, and utilization of services); and level of activity and symptoms at the end of the study period. These components were quantified and subjected to correlation and regression analysis. The largest and most significant predictors of outcome status were measures of initial disease status. Process variables were strongly and significantly associated with outcome only in a group of patients who were minimally symptomatic initially. The lack of an overall association between process of medical care and patient outcome cannot be generalized beyond these patients with congestive heart failure. A similar approach of dissection, quantification, and analysis of components of care, however, can be used to explore a possible relationship in other conditions and care delivery settings.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Faced with constantly increasing costs for the provision of laboratory services to Medicaid recipients, the New York City Department of Health last year attempted to implement a program to fundamentally restructure the organizational patterns and financing mechanisms of New York City's clinical laboratory industry. The program, based on competitive bidding, gave one laboratory in each of New York's five boroughs exclusive rights to process Medicaid lab samples and replaced presently existing fee-for-service reimbursement mechanisms with a unique system combining unit pricing and capitation.This paper outlines the principal provisions of the City's proposed contract, analyzes the underlying motivations of the City's decision, and describes the reactions of the existing laboratory service delivery system. In addition, the generic problems of implementing effective administrative techniques for cost and quality control of laboratory services are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID