摘要:

Recent reports document that US hospitals vary considerably, notably by ownership, in the number of acquired immunodeficiency syndrome (AIDS) patients they treat. Still, little is known about other types of hospital response to human immunodeficiency virus (HIV) and AIDS and the relative strength of ownership as a determining factor. With annual survey data from the American Hospital Association the authors examine the formal adoption of HIV-related services among urban US hospitals at the turn of the decade. Descriptive analyses of 2 years of data (1988 and 1991) are presented. A multivariate logistic regression analysis, conducted on the 1991 data, tests for unique ownership effects on the likelihood that hospitals are heavy investors in HIV-related care. Patterns of service adoption for 1991 strongly resemble those for 1988. Nearly three fourths of urban US hospitals offer general inpatient AIDS care, and over half provide HIV testing. Few urban hospitals offer outpatient services; even fewer operate AIDS units. A substantial minority report no formal adoption of HIV-related services. For-profit hospitals stand out as least likely to formally adopt these HIV-related services. Those adopting a comprehensive set of HIV-related services typically are public or secular, not-for-profit in ownership, large, affiliated with a medical school, and high volume users of Medicaid funding. The logistic regression analysis suggests that public ownership is a key determinant of greater service investment, even after controlling for other explanatory factors. This study appears to mirror a familiar pattern of hospital response to undercompensated care in the United States.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Chronic illnesses make up the majority of health problems in North America. Many chronically ill persons adjust over time to their illnesses; however, there remains a small but important group of those less adjusted, who are concentrated in specialty clinics and are high users of health care resources. This randomized clinical trial investigated the impact of health promotion interventions in the form of problem-solving counseling or phone support that augmented conventional clinic medical care. Chronically ill, poorly adjusted outpatients (n = 293) attending clinics were randomly assigned to receive additional problem-solving counseling, phone call support, or neither. Psychosocial adjustment to illness, utilization, and expenditures of health services were the main outcomes measured. There were no overall significant differences between groups in their change in psychosocial adjustment and expenditures for health and social care. However, interaction analyses (P< 0.05) gave an indication of who might benefit from these interventions. Those who lived alone and infrequently used problem-solving behaviors to cope with their illness significantly improved their adjustment to illness and had fewer health service expenditures if they received problem-solving counseling. Supportive telephone calls were most effective for those who lived with someone and frequently used problem-solving coping behaviors. These findings suggest that health promotion services should be targeted to outpatients described by specific social support and coping characteristics.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Monitoring risk-adjusted outcomes is the centerpiece of efforts to ensure health care quality. Because data collection is expensive, questions arise concerning what information is essential to adjust for risk. This investigation used retrospective analysis of existing, computerized clinical databases containing laboratory test results, information on chronic coexisting conditions, and nursing evaluations of functional status to predict in-hospital mortality. We studied persons admitted to one tertiary teaching hospital between 1987 and 1992 for cerebrovascular disease or pneumonia. Predictive models for each of the conditions were developed using logistic regression; the results were validated with split samples. We compared the predictive value of the nursing functional status assessments and the clinical laboratory data. For each study condition, the functional status data had as much prognostic information as the laboratory data. Specifically, a nurse's report that a patient required total assistance for bathing was the best single predictor of in-hospital mortality in the models for patients with either cerebrovascular disease or pneumonia. If hospitals admit patients with different levels of functional impairment, it is important to account for these differences before comparing outcomes across facilities. Assessments of functional status are a simple, inexpensive measure that may have considerable value.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This article explores various methodological issues of patient utility measurement in two randomized controlled clinical trials involving 85 patients with fibromyalgia and 144 with ankylosing spondylitis. In both trials one baseline and two follow-up measurements of the patients' preferences for their own health state and several hypothetical states were performed using the rating scale and the standard gamble methods.It was confirmed that standard gamble scores are consistently higher than rating scale scores for both the experienced and the hypothetical states. The 3-month test-retest reliability for hypothetical states measured by intraclass correlation coefficients ranged from 0.24 to 0.33 for the rating scale and from 0.43 to 0.70 for the standard gamble. Although the reproducibility is not high, the group mean scores are fairly stable over time. Mean standard gamble scores tend to differ depending on the way the measurements are undertaken. Utilities elicited with chained gambles were significantly higher than utilities elicited with basic reference gambles. At the individual level some inconsistent responses occurred. However, more than 70% of these fell within the bounds of the measurement error, which ranged from 0.11 to 0.13 on the standard gamble (0–1 scale) and from 8 to 10 on the rating scale (0–100 scale). The large number of negative utilities for the severe hypothetical state, which was used as an anchor point in the chained gambles, and the magnitude of these negative utilities (down to −19) calls for intensified research efforts to handle these responses in utility calculations.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Equity in health care provision is an important policy goal in Norway. This article addresses equality in the services provided by primary care physicians. These services are the responsibility of local government financed mainly through public funding. Patient fees are low. The local government system results in geographical variation in the number of physicians relative to local health demands. The authors present the hypothesis that this generates inequalities in health care utilization. The system of government finance is based on the assumption that utilization of health services is independent of patient income. Therefore, variation in income is expected to have only a small impact on utilization. The authors estimate a demand model by combining extensive micro data with aggregate data on municipal supply. There is very little relationship between indicators of access and health care utilization. The estimated income elasticities approximate zero, supporting the argument that equality in utilization has been achieved. However, the authors results also raise the question of whether equality has been achieved at the cost of limiting supply of services for people who could afford to consume more, or to pay for services of higher quality.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Assessing the appropriateness of hospital utilization in the United Kingdom may yield practical solutions to problems faced by both purchasers and providers of health care in the National Health Service. It is, however, essential that such assessment is based on a method that is both valid and reliable—in particular, valid in the context in which it is applied. Whereas American methods for the assessment of appropriateness have been shown to be valid in the United States, it is pertinent to question whether the application of such methods to the National Health Service also is valid given the different circumstances, both cultural and financial, under which health care is provided. A study of the appropriateness of admission and hospital stay for a sample of admissions to a large acute hospital in the United Kingdom was carried out, and the assessment of appropriateness was made using the Intensity-Severity-Discharge Review System with Adult criteria (ISD-A). The validity and reliability of using the ISD-A for assessing hospital utilization in the United Kingdom was evaluated. The ISD-A was found to have high reliability and to be valid for assessing appropriateness in the United Kingdom when a full range of alternative forms of care are presumed to be available. It was not found to be valid currently, therefore, for routine assessment of hospital utilization within the National Health Service, when alternatives often are not available.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID