摘要:

The differential utilization of screening mammography by racial/ethnic groups was examined through 35-minute bilingual, random digit dialed telephone interviews with 1,057 women over age 35 years. Results showed that 71% of hispanic women had never had a mammogram and that only 27% over age 50 years had had one in the year before the survey. White and black women over the age of 50 years were being screened more frequently with 34% of white women and 36% of black women having had a mammogram in the prior year. More than half of the hispanic women over age 50 years had never had a mammogram. Analyses showed that the most important variable that predicted whether women of all racial groups had a mammogram, at any time or within the last year, was whether their doctors had discussed mammography with them. The discussion did not need to be lengthy or complex. Hispanic women, however, were less likely to have physicians who discussed screening with them even though these women reported that they were just as motivated as other women to get a mammogram if their doctor referred them. Suggestions for what primary care physicians can do to increase mammography rates, especially among hispanic women, are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This study reports on the analysis of audiotapes of 537 adult, chronic disease patients and their 127 physicians (101 men and 26 women) in a variety of primary care practice settings to explore differences attributable to the effects of the patient's and the physician's sex on the process of communication during medical visits. Compared to male physicians, women conducted longer medical visits (22.9 vs 20.3 minutes; F(1,515) = 7.9, P < .005), with substantially more talk F(1,518) = 19.5, P < .000. Differences were especially evident during the history segment of the visit when female physicians talked 40% more than male physicians (F (1,518) = 20.1, P < .000) and when patients of female physicians talked 58% more than male physicians' patients (F(1,448)= 24.4, P < .000). Compared to male physicians, female physicians engaged in more positive talk, partnership-building, question-asking, and information-giving. Similarly, when with female compared to male physicians, patients engaged in more positive talk, more partnership-building, question-asking, and information-giving related to both biomedical and psychosocial topics.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This study uses a new database containing clinical risk factors for cardiac surgery to investigate the relationship between surgical volume (hospital and surgeon) and inhospital mortality rate for all patients receiving coronary artery bypass surgery in New York State in 1989. Also, hospitals with significantly higher and lower mortality rates than expected on the basis of patient preoperative risk factors are identified. The results demonstrate that both annual surgeon volume and annual hospital volume are significantly (inversely) related to mortality rate. The 36% of all coronary bypass operations performed in hospitals with annual bypass volumes of 700 or more by surgeons with annual bypass volumes of 180 or more had a risk-adjusted mortality rate of 2.67% in comparison to a risk-adjusted mortality rate of 4.29% for other bypass operations. Furthermore, low surgical volumes were a major contributor to the outlier status of four of the five hospitals with significantly higher mortality rates than expected.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The Health Care Financing Administration (HCFA) uses information from hospital bills, such as age, sex, and diagnoses, to estimate statistical models for the probability, or risk, of death during and after hospital stays. The average risk estimates (expected death rates) are compared with the actual death rates to identify potentially poor quality of care. However, the methods have been criticized as inadequate and an often cited reason is the failure to incorporate risk factors for mortality that are known from clinical research. This hypothesis was tested using a stratified, random sample of 41,963 Medicare patients in 84 hospitals. Many clinical measurements were abstracted for testing as possible risk factors, and a few (26) were identified as useful predictors of death using logistic regression. The estimated regressions accounted for 39% of the variation in mortality, a standard severity classification accounted for 29%, and a relatively simple classification of patients into 17 groups, based on diagnoses, accounted for 17%. The logistic regressions yielded more accurate estimated mortality rates than the severity classification, which in turn was superior to the estimation methods used by HCFA. The HCFA methods were found to be biased in identifying outlier hospitals and this bias can be removed or ameliorated by using clinical risk factors to predict mortality. It is possible to estimate the risk of death more accurately using clinical risk factors and to measure the quality of care.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Responses to episodes of musculoskeletal illness, musculoskeletal injury, and respiratory illness are examined separately. Data are from a 1-year longitudinal study of the illness experiences of 885 Medicare recipients. Unlike studies examining aggregate use of medical services, this study examines both episodes for which medical care was sought and episodes for which no medical care was sought. Both factors associated with the decision to seek medical care for each type of episode and the illness response patterns associated with whether medical care is sought are analyzed. The three types of episode have different characteristics and profiles of illness response. Perceived seriousness and duration of the episode are the best predictors of physician visits for all episode types. However, the relative effect of predisposing and need variables on the decision to seek medical care is greatest for musculoskeletal illness episodes. These data also bear on the relationship between self-care, informal care, and the use of formal medical care. Use of nonprescription medications is shown to substitute for medical care in a significant number of illness episodes. Lay consultation and restricted activity are often linked with physician visits; however, they cannot be assumed to precede care seeking. The analytic strategy of examining responses to specific types of episodes suggests that both characteristics of the person and characteristics of the illness affect how people respond to illnesses and that the relative importance of each type of characteristic is specific to each illness type. Implications of these findings for health education are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID