ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Pharmaceuticals account for a significant portion of health care costs and are an important target for attempts at cost reductions. While many techniques have been shown effective, most are resource-intensive, have demonstrated fatigue after the intervention is ceased, and have been directed at specific items rather than total charges. The authors designed a computerized program to feed back prescription charges. The intervention is easy to execute, inexpensive, and can be maintained indefinitely. The intervention was performed in a randomized, prospective, controlled trial with the medical residents of a large county hospital. The goal was to reduce total prescribing charges and produce a meaningful financial result. The intervention reduced the mean charge for a prescription by 6.7% (P < 0.025), but with a long latent period and minimal impact on resident knowledge of drug charges. Significant differences were seen only at the end of the study. The program was viewed positively by the residents. The low cost of the intervention yielded a benefit-to-cost ratio in excess of 50:1. Because of computerization and ongoing patient and resident randomization at the study hospital, added costs of this randomized trial in terms of computer time and research assistance were less than $1,000.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Profiles of case mix and related variables were compared for 1,064 Medicaid and 459 non-Medicaid residents of 65 freestanding nursing homes in Colorado in 1980. The results point to substantial case-mix differences, with Medicaid residents typically characterized by fewer and less intense long-term care problems as well as greater independence in functioning (ADLs). Policy impacts of these findings in Colorado have included a legislatively mandated home and community-based care program as well as a more stringent preadmission certification program for Medicaid clients. The method of comparing Medicaid and non-Medicaid case mix in nursing homes appears to have policy relevance for other states as well. Research implications in the areas of measuring severity of long-term care problems and measuring residents' functional abilities apart from services received are also suggested.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

It has traditionally been assumed that obtaining health and illness behavior data by proxy on household members who are not present during the actual interview presents no significant threats to the internal validity of subsequent analyses. Using data on the 78,439 adults interviewed in person or by proxy (about 37% of the total adult sample) as part of the 1978 Health Interview Survey, the authors examine whether the use of proxy respondents alters the results of empirical assessments of the behavioral model of health services utilization or the policy implications that can be derived from it. Two important findings emerge from these analyses. On the one hand, failing to consider explicitly the possibility of a proxy effect (i.e., including a proxy variable in the analyses) does not alter the effect parameters estimated for the behavioral model. On the other hand, failing to consider explicitly the effect of using proxies appears to underestimate slightly physician and hospital contact rates (by 4% and 2%, respectively), as well as the volume of physician utilization. The substantive and policy implications of these findings are discussed, as are two alternative explanations that suggest that proxy-respondents simply use fewer health services either because they are “too busy” or because they are in slightly better health.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

In an empirical study using data from a health center in Sweden, correlation coefficients were computed among nine different measures of continuity of care, five of them visit-based and four individual-based. Generally, the correlations were high. This may be due, in part, to the similar behavior of the measures for people making few visits. The correlations were also quite high, however, when the sample was restricted to people with many visits. Several measures display a significant dependence on utilization level. The results suggest that, for general purposes, the measure COC should be preferred among the individual-based measures and fraction-of-care continuity among the visitbased measures. On grounds of flexibility and ease of interpretation, the authors recommend fraction-of-care measures.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

It is well-documented that ratings of medical care received personally (personal referent) yield more favorable responses than ratings of care received by people in general (general referent). Hence general items are useful in achieving greater variation in responses to satisfaction surveys. However, the validity of general items relative to personal items is being debated currently. It has been hypothesized that bias due to socially desirable response set (SDRS) would be greatest for items with a personal referent. To test this hypothesis, the authors compared both kinds of satisfaction ratings for adults (N = 3,918) who scored high and low on SDRS during Rand's Health Insurance Experiment. Across sites and years of the experiment, the rating item with a personal referent was consistently biased upward for those manifesting SDRS. The rating item with a general referent was not. Further, the correlation between SDRS and the difference between ratings on the personal and general referent items was statistically significant, suggesting that more favorable ratings of medical care received personally compared with ratings of care received by people in general are in part due to SDRS bias. Results are discussed in terms of implications for constructing a valid satisfaction survey.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Between October 30 and November 5, 1980, the Professional Association of Interns and Residents of Ontario called a strike of house staff in Ontario's teaching hospitals. The authors obtained data concerning utilization of laboratory tests and radiology procedures during that period and for the same days 2 weeks before and after the strike. During the strike period, the number of tests performed per patient day decreased by only 8.3%. After accounting for proportional changes in emergency and nonemergency admissions, there was no significant change in the number of tests or relative value units performed per patient day as a result of the strike. These results suggest that the volume of tests performed in teaching hospitals is more likely related to the case mix and severity of illness of patients admitted to these institutions than to a pure “teaching effect.”

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Of the key federal programs that finance in-home services to the elderly, the Medicare program represents the largest and fastest growing. Although Medicare is a federal program, utilization and expenditures for home care vary widely across the states. Building on the work of Feldstein, Scanlon, and others, theory and data are presented that attempt to illuminate reasons why such variations exist. Using program data by state for 1982, nearly three fourths of the variation in home health utilization (R2= 0.72) is explained by seven state characteristics. About three fifths of the variation in expenditures (R2= 0.61) is accounted for by six state factors. Of most explanatory importance are home health agency (HHA) supply, need levels, presence of alternative sources of care, sources of referrals, and state resources. The results suggest the need to give more analytic attention to the impact of the market share of proprietary HHAs in explaining expenditure variations and the effects of total supply on utilization and spending.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Ninety-two general medical outpatients were surveyed with an interview, questionnaires, and a medical record review to investigate the relationships among psychiatric disorder (depression and hypochondriasis), somatic symptoms, medical morbidity, and the utilization of ambulatory medical services. Medical utilization correlated with the number of somatic symptoms reported (r = 0.49, P = 0.0001), depressive symptoms (r = 0.34, P = 0.001), and the number of medical diagnoses in the medical record. Somatic symptoms were not significantly correlated with the number of medical diagnoses, but were related to hypochondriacal attitudes (r = 0.52, P = 0.0001) and depression (r = 0.51, P = 0.0001). In stepwise multiple regressions, the number of medical diagnoses accounted for 33% of the variance in medical utilization. Somatic symptoms were the second most powerful predictor, increasing R2to 0.469. The next best predictors were two hypochondriacal attitudes and the presence of a major psychiatric diagnosis in the medical record. This five-step model explained 56% of the variance. Somatic symptoms are thus powerful determinants of medical utilization, even after controlling for medical morbidity. Depression, disease fear, and bodily preoccupation are also important predictors of utilization. Somatic symptoms are a final common pathway through which emotional disturbance, psychiatric disorder, and organ pathology all express themselves, and which prompt patients to visit doctors.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID