摘要:

In this study, the nature of practicing physicians' "frustrating" visits was explored and a guide to help physicians identify problems in communicating with patients was developed. The study included 1,076 practicing physicians who attended a voluntary workshop on physician-patient communication. The physicians were from multiple specialties and diverse work settings geographically dispersed throughout the United States. The method included development of a preliminary item pool (descriptions of frustrating patients and occasions) by experienced physicians and teachers of medical communication, additions/deletions/revisions of items within the pool, empirical analyses to reduce redundancy and group-like items, and construct validation of the final 25-item questionnaire. Factor analysis was used to identify subscales. Physicians most often attributed communication problems to the patient rather than to their own limitations. Seven types of communication problems (subscales) were identified, including: 1) lack of trust/agreement, 2) too many problems, 3) feeling distressed, 4) lack of understanding, 5) lack of adherence, 6) demanding/controlling patient, and 7) special problems. Primary care physicians reported greater problems than specialists on four subscales. Physicians practicing in health maintenance organizations reported greater problems than physicians in fee-for-service practice on five subscales. Seven sources of frustration physicians experience in their work with patients were identified. Understanding these frustrations will allow physicians to reflect on their own experiences and potentially improve the quality of their patient visits.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Early evaluations of the Medicare prospective payment reforms found them very effective in reducing hospital utilization. In this study, the author investigated whether the reforms remained effective throughout the first decade of implementation. Seasonal autoregressive-integrated-moving average (ARIMA) models with intervention components were applied to age-specific national time series of hospital admissions, average length of stay, inpatient days, and adjusted inpatient days. Three alternative regulatory impact patterns were tested using quarterly data collected by theNational Hospital Panel Surveyspanning the period 1970:1 to 1992:1 (n = 89). The reimbursement reforms seem to have reduced hospital admissions, average length of stay and patient days during fiscal years 1983–1984, but significant readjustmentsrelative to projected levelsoccurred for all four utilization measures during fiscal years 1985–1986. Similar, yet less pronounced readjustments, were found in the analysis of non-Medicare time series suggesting regulatory spill-over effects. Sicker patients and hospital diversification efforts are two plausible reasons for the relative increase in hospital utilization during 1985–1986. The Medicare reimbursement reforms appear to remain effective in reducing hospital utilization, but at a reduced rate.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In this study, a hierarchical case-mix model was developed for grouping Medicare home health beneficiaries homogeneously, based on the allowed charges for their home care. Based on information from a two-page form from 2,830 clients from ten states and using the classification and regression trees method, a four-component model was developed that yielded 11 case-mix groups and explained 22% of the variance for the test sample of 1,929 clients. The four components are rehabilitation, special care, skilled-nurse monitoring, and paralysis; each are categorized as present or absent. The range of mean-allowed charges for the 11 groups in the total sample was $473 to $2,562 with a mean of $847. Of the six groups with mean charges above $1,000, none exceeded 5.2% of clients; thus, the high-cost groups are relatively rare.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This study assessed the pattern of utilization of mammography among 2,880 inner-city minority women 40 years of age or older who received ongoing primary care services during 1988 or 1989 at four practice sites operated by a health department (two sites), Health Maintenance Organization (HMO), and private hospital. Mammography referral could be documented for 23% to 32% of age eligible women and completed mammograms for 15% to 26%. Among women without a mammogram, 85% had never been referred while 15% were referred but unable to complete the procedure. In multiple logistic regression analysis, factors associated with mammography include age less than 70 years, presence of a breast cancer risk factor and more frequent clinic visits. Mammography was somewhat more frequent at the HMO and hospital clinic than at the health department, but this relationship varied with the women's previous visit and mammography experience. At sites serving uninsured women, mammography use was not associated with the presence or absence of health insurance. It is concluded that the underutilization of mammography is a substantial barrier to the early detection of breast cancer in each of the three different health care organizations studied, and that interventions to improve breast cancer control should focus upon facilitating physician referral practices.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In this study, trends in hospital use were identified in Japanese cities. Data for all inpatient care in May 1985 (9,555 patients) and in May 1988 (11,205 patients) paid for by National Health Insurance in 12 cities in Osaka Prefecture were analyzed. The main factor affecting differences in inpatient days per insured person of all ages (hospital use) among the cities were differences in hospital use by long-stay patients aged 70 years or older, which depended not on inpatient days per patient but on the rate of hospital admission. The main factor affecting change in mean hospital use from May 1985 to May 1988 seemed to be an increase in hospital use by long-stay patients 70 years or age or older, which did not depend on increases in the rate of hospital admission, but did depend on the number of insured persons 70 years of age or older. Calculation showed that an increase of 13 long-stay patients 70 years of age or older for 10,000 insured persons 70 years of age or older per year was to have accounted for about 40% of the increase in hospital use by all patients. If the trend for increasing hospital use in Japan is to be altered, the first step might be the careful planning for this comparatively small increase in long-stay elderly patients by promotion of a non-hospital-based care system.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Previous studies have demonstrated that functional status is a significant predictor of resource utilization for rehabilitation patients. Before implementing a prospective payment system (PPS) for rehabilitation, it is important to first: 1) develop an underlying conceptual framework of rehabilitation resource use; and 2) understand how the role of functional status may vary by rehabilitation condition. In this study, a theoretical model of rehabilitation is presented that proposes relationships between patient and provider characteristics, rehabilitation treatment, costs, and clinical outcomes of rehabilitation. Also presented are regression analyses based on this model for a key outcome of rehabilitation, change in functional status, for nine rehabilitation conditions using variables that minimize adverse incentives by providers in selecting patients for admission to rehabilitation. The change-in-functional-status model explained the most variance for back injury, cardiopulmonary, and arthritis, and less variance for stroke, spinal cord injury, and neurologic impairment. The significant predictors of change in functional status varied by condition. Results support the use of functional status measurements in a PPS for rehabilitation services, the need to refine the measurement of functional status, and the use of condition-specific activities of daily living (ADL) items to include in summary indices.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

To select patients for early discharge planning, a randomized clinical trial evaluated a protocol that used risk factors identified upon hospital admission. The goal of the study was to determine if intervention with high-risk patients could reduce the need for hospital admission or skilled care. Of 13,255 patients screened, 835 study participants were identified as "at risk" for frequent health care resource use. Half of the high-risk patients were randomly assigned to the experimental group (n=417) and received discharge planning from day 3 of their hospital stay, while the control group (n=418) received discharge planning only if there was a written physician request. Those patients receiving early, systematic discharge planning experienced an increased likelihood of successful return to home after hospital admission and a decreased chance of unscheduled readmission for the 9-month study period. Length of the index hospital stay was not affected by early planning, however. The major clinical implication is the potential for discharge planners to decrease the need for, and use of, health care resources after hospital admission.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID