ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

On October 1, 1983, Medicare began paying general hospitals by a prospective payment system based on DRGs. Psychiatric settings are exempted automatically or by request. By January 1985, however, a decision is required on how to integrate psychiatric settings into this system. This article provides an empirical analysis of the current DHHS DRGs categories for mental disorders. Current mental disorder DRGs and alternate DRGs examined here explain less than 3-12% of the variation in psychiatric length of stay. This is in contrast to 30-50% explained variation for other disorders. Alternatives and policy implications are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Although the programs are of increasing popularity, little has been published on the effects of discharging maternity patients early from the hospital. In particular, there is almost no evidence to date to prove that these programs actually achieve two objectives for which they were designed; to reduce occupancy pressure on maternity beds and to lower hospital costs. Evaluation of the early stages of a relatively small and flexible maternity early discharge program in Alberta, Canada suggests that the program is effective in reducing length of stay in the hospital and hospital costs, but there is little evidence that it is actually used to reduce pressure on bed space in the maternity unit.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Issues that arise in the development of methods for measuring adequacy of physician performance (MAPP) are discussed. The comparative content validity, scorability, cost, and acceptability of four MAPP strategies are assessed using a sample of clinic-based physicians treating 30 patients with chronic obstructive pulmonary disease (COPD). Criteria for adequate care are contained in a “criteria map.” No one of the four methods (physician interview, patient interview, videotaped observation, and chart audit) was best at capturing all aspects of the management of COPD. The relative content validity of a method depended on the aspect of care evaluated. The interviews provided the broadest range of information and the chart audit the most limited. The patient interview yielded the largest proportion of encounters upon which physician performance could be scored, although specific criteria map subscales were differentially scorable depending on the method used. Relative cost and acceptability are also discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Four evaluations of ambulatory medical care tasks were developed for use in quality assurance. The evaluations used medical records data and explicit criteria incorporating branching logic. They were implemented in eight general medicine provider groups in two teaching hospitals and six related health centers. Agreement with criteria among 316 provider responses to questionnaires varied from 57% to 100%. The percentage of cases with one or more variation from evaluation criteria, confirmed on peer review to have a deficiency in care, ranged by task from 6% to 42%, with substantial variation between sites. Physician reviewers from each site varied in leniency. Numbers of actions taken to correct deficiencies ranged by site and task from zero to six. Multisite evaluations revealed differences in performance and efforts to improve that are not apparent when each site conducts its own evaluations. More uniformly effective and impartial quality assurance is needed to correct some important deficiencies in care observed in this study.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Preferences for degree of involvement in health care of 47 low-income, inner city, outpatient diabetic patients were measured by the Health Opinion Survey (HOS). These scores were compared with those of three normative groups of college students. Significant differences were found between the samples on each HOS subscale and the total HOS (allPvalues < 0.001). Implications of these differences for health care providers are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Despite the apparent success of health maintenance organizations (HMOs) in lowering the costs of health care, they have been criticized for other reasons, including the lack of doctor-patient continuity in the patient's having a regular doctor. Consistent with previous research, HMO members sampled from Los Angeles County (N = 190) were less likely to identify with a regular doctor than comparable fee-for-service (FFS) subscribers (N = 653) (P < 0.001). When differences in this variable were not controlled statistically, HMO members reported higher rates of physician visits, but only for acute respiratory problems (P < 0.05). It was not until differences in having a regular doctor were taken into account that HMO members were found to report higher rates of use for all symptoms (P < 0.05) as well as for digestive problems (P < 0.10). These findings suggest the importance of taking physician-patient continuity into account when comparing utilization rates across health plans. Additionally, few differences were found in reports of morbidity, although HMO members were less likely to report cold symptoms during this 1-year survey than comparable FFS subscribers (P < 0.05).

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The dependability of medical billing diagnostic information was evaluated using a rating scale developed by Studney and Hakstian. Generalizability theory offers a comprehensive and flexible framework for analyzing problems associated with measures derived from multiple raters. The medical record and billing system diagnostic information from 45 patient encounters were rated according to similarity and value by three physician judges on two occasions. Data were analyzed using a three-way ANOVA design with levels of judges (3), occasions (2), and encounters (45). Examination of variance components and associated generalizability indicated that the judges and occasions factors or the interaction with occasions and other factors contributed little variance. The greatest proportion of variance was attributable to interindividual differences among the encounters and the interaction of judges and encounters. This investigation illustrates the application of a relatively new approach to practical measurement problems, generalizability theory.

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