ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A national cohort of 44 rural satellite health centers originally staffed by nurse practitioners (NPs) and physician assistants (PAs) was studied in 1975 and resurveyed in 1979 and in 1984 to examine the viability of this type of health-care delivery organization during a period of significant growth in the nation's physician supply. Twelve of these practices had ceased to function, although eight have been replaced by physician practices. Of the remaining 32, 14 have physicians on their staffs and 18 remain staffed only by NPs and PAs. Those centers staffed by physicians experience greater patient utilization, charge more for office visits, have larger budgets, and generate more of their budgets from fees for services and therefore appear to be more organizationally stable than centers staffed only by NPs and PAs. Although broader studies are needed for substantiation, these findings suggest that the period when NP/PA-staffed satellite health centers were important organizations for delivering care to previously underserved rural communities may be ending.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The study assessed the psychometric properties of the Medical Communication Behavior System. This observation system records time spent by the physicians and patients on specific behaviors in the categories of informational, relational, and negative situation behaviors by using hand-held electronic devices. The study included observations of 101 genetic counseling sessions and also assessed the outcome measures of patient knowledge and satisfaction. In addition, 41 of the sessions were rated using the Roter Interactional Analysis System, and 20 additional control subjects completed the post-counseling information without being observed to examine the effects of recording the session. Results showed good interobserver reliability, and evidence of concurrent, construct, and predictive validity. No differences were found between the observed and unobserved groups of any of the outcome measures.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A factorial design randomized controlled trial to test several clinically feasible strategies primary-care practitioners may use in routine practice to increase patient participation in occult blood testing for colorectal cancer is reported. Three compliance-enhancing intervention strategies (physician/nurse talk, and/or reminder postcard, and/or reminder phone call) were introduced. Patient health beliefs were examined as compliance predictors. High compliance levels were seen in all intervention groups, with a mean of 89% compared with 68% in controls. An interactive talk by the physician or nurse increased compliance by 12-13%. The reminder postcard was the most effective single intervention. It increased compliance by 24-25%, achieving 92.7% overall compliance, and appeared to be cost-effective. Patient health beliefs were of minimal value in predicting compliance in this study.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We studied the effect of physician specialization and board certification on costs and outcome of health care for a group of 213 patients with chronic lung disease followed prospectively for a year. Linear, semilogarithmic, and logistic regressions were used to control for differences in pulmonary function, functional ability, and sociodemographic characteristics. The cost of health services during the year was estimated from the total charges incurred. Patients' pulmonary function, functional ability, number of medical conditions, and insurance status were significant predictors of total cost. Combinations of these variables were important determinants of institutional days, outcome health status, and survival. Physician specialization and board certification were not significant descriptors of total costs or outcomes, although large variances limited the power of these findings. We conclude that differences in characteristics of primary care physicians do not appear to affect significantly the total cost or outcome of care for patients with moderate to severe chronic lung disease.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Factors associated with the utilization of medical care by Hispanic, black Non-Hispanic, and white Non-Hispanic children were analyzed using multivariate regression techniques on a Health Interview Survey sample. The findings indicate that Medicaid coverage was the sharpest enhancer of entry into care for Hispanics and blacks, contributing significantly to the amount of physician visits. While financial factors seemed more influential determinants of physician contacts for minorities, perceived health needs appeared to be important contributors to entry into health care for white children. Such differences reveal that important racial-ethnic disparities persist with respect to physician utilization among children. Improved insurance coverage for Hispanics, particularly children of Mexican origin, is suggested as an important intervention to facilitate access for this population.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

In view of the relatively high cost and mortality associated with hospitalization, 1,989 inpatients of family physicians and internists were compared with regard to length of stay, charges generated, charges generated per day, disposition (home, death, or other), number and type of diagnoses, and number of procedures. There were no interspecialty differences in mean length of stay (9 days), charges generated ($3,604), charges per day ($475), number of procedures done or disposition (79% went home, 9.5% died, and 11.5% had other placements). There were interspecialty differences in the type of diagnoses coded (chi-square = 52,P< 0.0001); family physicians tended to assign fewer diagnoses than internists (mean 3.08 versus 3.43,P< 0.0001). Review of a random sample of 50 charts of patients admitted to family physicians and a matched sample of charts of patients admitted to internists did not reveal any differences in either severity of illness on admission or rate of readmission. Multivariate adjustment for differences in case mix did not affect the direction or significance of the main findings. Similar findings were obtained whether using the hospital admission or the physician as the unit of analysis. The results are discussed in the context of related investigations in the ambulatory setting.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The authors compared the effects of age, sex, socioeconomic status, and mental and physical health status on the use of outpatient mental health services in one well-established health maintenance organization (HMO) and in fee-for-service plans. In the Seattle site of the Rand Health Insurance Study (HIS), families were randomly assigned to HMO or fee-for-service coverage. Adults incur much greater expense for outpatient mental health services than children in both an HMO and a fee-for-service plan with identical coverage (i.e., free care). However, the difference in use between adults and children is significantly greater for the fee-for-service plan than the HMO (P< 0.01). Similarly, education has significantly greater effects on use for the fee-for-service than the HMO plan. Increased income has a significant negative effect on use in both the HMO and fee-for-service plans. Mental and physical health status have similar large effects on use in both fee-for-service and HMO plans.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

In settings where an itemized hospital bill is not generated, estimation of hospitalization charges for research or administrative purposes can be a laborious task. This article examines the extent to which the number of hospital days spent outside an intensive care unit (ICU), number of days in an ICU, number of laboratory tests performed, number of x-rays, and number of surgeries can be used in a multiple regression equation to impute inpatient charges for a sample of 103 hospitalizations at a Veterans Administration hospital. These predictor variables, all of which are readily ascertained in a brief medical record review, accounted for about 97% of the variance in imputed hospital charges. The bootstrap method was applied for validation of the prediction equation. Application of the method described here may be of value to researchers concerned with hospital charge estimation in non-fee-for-service settings.

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