摘要:

A strategy is described in which explicit patient care criteria are used to measure the continuity of the health problem solving process. Prevalent diseases arc selected to represent the work load of the health system. Continuity is defined in terms of rates of transition between the major clinical elements: screening, the definitive diagnostic evaluation, treatment, and follow-up evaluation. Results define critical dropout patterns and promote constructive assessment of the health care system. Sample data from the Indian Health Service are presented and discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The Joint Committee on Quality Assurance developed and validated by expert opinion a list of criteria for each of seven areas of ambulatory child health care: well-child supervision in four age ranges: birth to 1 year, 1 through 5 years, 6 through 12 years, and 13 through 18 years; and three diseases: bronchial asthma, tonsillopharyngitis, and urinary tract infection in the female.Each physician was scored on a list of criteria for each of the seven areas. The relationship among the areas was studied by correlating the scores on these criteria. The degrees of the relationships among the seven areas of care, and the reliability of each list of criteria are reported.All relationships were positive. Various age ranges of health supervision were more strongly related to one another than to any of the diseases. Individual diseases were more strongly related to one another than to health supervision. Reliabilities of each list ranged from .74 to .95.All correlations between areas were positive and, except for health supervision (birth to one year) with the three diseases, significant (p < .01). These high correlations would imply a great deal of homogeneity among health care areas of ambulatory child health care.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Correlations among ten diagnostic categories of hospital care physician performance measures are reported. Using measures of conformance to predetermined criteria for optimal performance, mean scores of individual physician performances within diagnostic categories were calculated and correlated. Measurement reliability estimates were computed and it was suggested that a minimum of four cases in each diagnostic category he used for measurement of performance on the individual physician level of analysis. There appeared to he homogeneity of performance measures among some but not all diagnoses studied. This finding reinforces the need to examine interdiagnostic correlations before attempting to measure overall individual physician performance by combining measures from separate diagnostic categories.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Previous studies from this institution have shown extreme variation in laboratory and x-ray use among comparably trained physicians caring for similar patients. In addition, essentially no correlation (r = -.13) existed between a physician's lab use profile and subjective estimates of clinical competence. This study compares variations in lab use with both clinical productivity and outcome of care. Costs of lab tests of 149 long-term ambulatory hypertensive patients cared for by 13 faculty internists during one year were computed. Variation in mean annual lab costs per patient among the internists was great (range, $8-$161; standard deviation, $42). Outcomes of care were estimated using hypertension as an indicator condition. The physicians were scored according to percentage of hypertensive patients with systolic and diastolic pressures below specified levels. Correlation between lab use profiles and outcomes was negative (r = -.42) but not significant. Clinical productivity was estimated by two methods: adjusted panel size and subjective estimates of efficiency by the clinic administrator. Correlations between lab use behavior and each estimate of productivity were negligible (.13 and -.16 respectively).These data indicate that in this setting there is no positive association between a physician's frequency of lab use and either clinical productivity or outcomes of care.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

In the decision theory model of medical diagnosis and treatment, optimal choice of diagnostic tests requires accurate estimation of the probability that a given test will be positive. We assessed the ability of physicians to estimate the probability that a specific test (cholecystography) would be positive.For 102 patients, the predicted number of gallstone cases, 35.8, was significantly greater than the observed number, 15 (p < 0.001), even though 13 of the 15 observed cases were patients with previous radiographic evidence of gallstones. The ovcrcstimation of probability of positive tests casts doubt on the correctness of decisions regarding selection of diagnostic tests when these decisions are derived from probability estimates based on intuition or expert opinion.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A system for the Medical Review of nursing home patients has been fully operational in the state of Rhode Island since 1973. This study examines recommendations as to the appropriate level of care required by each of 1,309 skilled nursing patients reviewed during the system's first full year of operation and relates these recommendations to a number of other factors, including patient and facility characteristics.Variables measuring patient medical condition and need for skilled nursing care correlated strongly with level of care recommendations made by the team of professional reviewers. In addition, facility licensing status emerged as a significant influence in the decision-making process concerning appropriate level of care assignments. Skilled nursing patients in multi-level (SN/ICF) facilities were much more likely to be recommended for less intensive, intermediate levels of nursing care than were patients residing in single-level (SN) facilities. This relationship persisted after controlling for variations in patient characteristics, but was strongest among those patients for whom the need for continued SN care seemed most dubious.The authors conclude that 1) the relationship can be attributed to a reluctance on the part of the review team to physically relocate aged patients, and 2) long-term care patients with complexly intertwining medical and social needs might be most appropriately placed in facilities which offer a spectrum of services and multiple levels of care.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

An experimental drug utilization review program was developed for a health maintenance organization (HMO). The objectives of the program were to develop and implement an ongoing mechanism for reviewing drug use using criteria based on the scientific literature, and to evaluate the effect of the drug use review program on physician prescribing patterns. Seven therapeutic categories of drugs, accounting for over 65 per cent of prescribing, were selected and criteria developed for their use. The drug use review procedure is described briefly.The evaluation of the drug use review program is based on a comparison of rates of prescription use for specific therapeutic categories before and after the criteria were developed and approved. As an example, data for the anti-histamine therapeutic category are presented. Criteria for prescribing antihistamines suggested restricting use of combination cold preparations and refraining from antihistamine use in viral upper respiratory tract infections. After the criteria were adopted, prescribing of antihistamines for viral URIs declined, particularly in pediatrics. In general, prescribing of combination antihistamine preparations did not change; where one combination preparation was deleted from the formulary, prescribers appeared to substitute another combination preparation.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The Professional Standards Review Organizations (PSROs) mandated by the Social Security Act aim to monitor and control hospital utilization by publicly funded patients, particularly those whose care is paid for by Medicare and Medicaid. One question to ask is, if PSROs prove successful in reducing suspected overutilization by public patients, would the principal private third parties, Blue Cross and commercial insurance plans, benefit by applying those techniques to their patients, as well. Data are presented from the Chicago Hospital Discharge Study, which was conducted in February, 1970, before PSRO activities were undertaken. They show that average length of stay for Medicaid patients is not consistently different from that for patients who pay by other means. Therefore, it is argued that, if it proves successful as applied to Medicaid patients, private third parties might benefit by using the PSRO mechanism to try to monitor and control the stays of their patients, as well.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID