ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To test the hypothesis that the ability of physicians to speak the same language as asthmatic patients promotes patient compliance and the use of scheduled office appointments in preference to emergency services, the charts of 96 Spanish-speaking patients with asthma were reviewed. Of these patients, 65 were cared for by seven Spanish-speaking bilingual physicians and 31 were cared for by 23 non-Spanish speaking physicians. Compared with patients with language concordant physicians, patients with language discordant physicians were only slightly more likely to omit medication, to miss office appointments, and to make at least one emergency room visit. Subgroup analysis showed that, with extended follow-up, patients cared for by a language discordant physician were more likely to omit medication (rate ratio: 3.24;P=0.08), more likely to miss office appointments (rate ratio: 3.06;P=0.01), and were slightly more likely to make an emergency room visit (rate ratio: 2.07;P=0.12) than patients with language concordant physicians. Cox regression analyses taking account of differences in follow-up time, age, gender, pay-status, and severity of disease confirmed these findings. These data suggest that patient compliance and more cost-effective use of ambulatory care services may be associated with the ability of physicians to speak the same language as their patients.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The Commission on Professional and Hospital Activities (CPHA) developed the Risk-Adjusted Mortality Index (RAMI), a method for comparing hospital death rates using existing abstract or billing data. The method is comprehensive insofar as it includes all payers and all types of cases except neonates. RAMI was designed to differentiate among admissions on the basis of the patient characteristics that increase or reduce the risk of dying in the hospital. Using a large national data base, risk factors were determined empirically within each of 310 clusters based on diagnosis-related groups (DRGs). The model was very effective at predicting risk-adjusted outcomes, with a correlation of 0.98 between actual and predicted deaths in a sample of 300 hospitals. RAMI appears to be a powerful tool for using existing data to monitor changes over time in hospital death rates.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This article examines use of prescription and over-the-counter drugs among a linear probability sample of ambulatory elderly. As previous research has shown, health status indicators are better predictors of use of prescription than nonprescription medications. The analysis suggests that self-medication with over-the-counter drugs may be a first step in illness behavior, rather than a substitute for physician consultation. These preparations are used most frequently for symptoms that the elderly person interprets as nonthreatening; persons concerned about their health are more likely to consult a physician.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Recent debates over health policy have tended to be between procompetitive solutions and proregulatory ones. This dichotomy, however, seems to be less descriptive of the policy debate over ways to improve nursing home quality. This article argues that a more useful distinction may be between adequacyand incentive-oriented policies. The nursing home industry and others have argued that the financial and physical resources at the disposal of nursing homes have been inadequate to produce acceptable quality levels. Whether quality requires more resources is tested using the 1983 Iowa Outcome Oriented Survey, but none of the quality measures constructed from these data were significantly associated with higher average costs. On the other hand, nonprofit nursing homes, nursing homes with more professional workers (nurses), and nursing homes that cater to private patients have incentives that may motivate them to provide better quality. These factors were often significantly associated with a variety of the quality measures, suggesting that policies based on incentives may be more effective than adequacy-oriented policies.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The effects on compliance of clinical and telephone intervention, based on the Health Belief Model (HBM), were investigated for 842 Emergency Department (ED) patients. The influence of mediating variables on compliance was also examined. Compliance was defined operationally as follow-through on a recommended referral originating in the ED. The study design was a 2 X 2 X11 factorial design, in which the first factor was the HBM clinical intervention, the second was the HBM telephone intervention, and the third was the type of presenting problem. Patients were randomly assigned to one of four intervention groups, with all nursing care, interventions, and follow-up telephone calls being done by the research nurse. The HBM clinical, telephone, and combination clinical/telephone interventions were strongly associated with increased compliance in the 11 presenting problems. Availability of child care, knowledge of presenting problem, nature and duration of the illness, and demographic variables (such as age of the patient) were also related to compliance

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The costs to an insurer of a 10-year maternal serum alpha-feto protein (MSAFP) screening program were subtracted from future medical care costs avoided by the insurer (benefits) to examine whether such a program would be cost-justified from the perspective of a managed health care system (i.e., result in net costs ≥ 0). The analysis considered MSAFF screening for neural tube defects (NTDs) alone and then was repeated to consider screening for both NTDs and Down's syndrome. Using a 5% discount rate for future dollars, the costs to the insurer of a screening program for NTDs alone over 10 years exceeded costs avoided by $10.00 per person screened. Adding screening for Down's syndrome using the same MSAFP test increased the net cost by $22.00 to a total of -$32.00 per screenee. The estimate of the cost to the insurer was sensitive to assumptions regarding the costs of medical care avoided, the expense of MSAFP, the proportion of screened women requiring a genetic amniocentesis, and the cost of that procedure. The conclusion that screening would not result in a cost savings to the insurer was not changed by reasonable assumptions regarding 1) the appropriate discount rate; 2) the costs of MSAFP; 3) the costs of genetic amniocentesis; 4) the sensitivity of MSAFP; 5) the proportion of the population requiring genetic amniocentesis; and 6) the costs of 10 years of medical care for someone affected by Down's syndrome or an NTD. Other analyses suggested that screening for NTDs or Down's syndrome would be cost-justified when viewed from the perspective of society. The present work suggests this conclusion does not hold when the perspective of the insurer is taken because avoided costs of care realized by society exceed those realized by the insurer.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This article probes the relationship between use of ambulatory mental health services and the persistence of mental problems. The analysis focuses on the difficulties in obtaining empirical estimates of the relationship between usage and persistence. A two-step estimator is used to take into account unobserved determinants of both usage and mental health status. This estimator is compared with a single equation model and a two-stage least-squares estimator. The study makes use of a community survey designed to estimate the prevalence of major mental disorders over a 12-month period. The survey consisted of three waves of interviews over the study year. The results indicate a significant decrease in the likelihood of mental problems persisting when treatment is received

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Over the past 20 years, investigators have been refining the connection between behavioral practices, popularly known as health habits, and health status. Repeated study has demonstrated that the number of healthful practices, regardless of which ones are adopted, provides a reliable predictor of mortality. Few studies, however, have questioned the validity of summing such diverse practices as smoking and physical activity together to form a single practice score. The purpose of this study was to raise some questions about this widely adopted scoring procedure and to reassess the problems connected with its use. Data are drawn from the Texas Behavioral Risk Factor Survey of 1982. The approach contrasts practice profiles formed from all possible combination of practices, representing full information about them, and the scores produced by collapsing practices onto a single dimension. Special attention is given to the meaningfulness of the information lost in the scoring process and to the implications this may have for the health practice-to-health status relationship

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID