摘要:

This study examined the feasibility of using routinely collected information on patients enrolled in home health care to predict their subsequent use of services. Data were gathered from 1,984 episodes of care randomly sampled from home health care agencies of the Virginia Health Department. Age, sex, Medicare and Medicaid enrollment, referral source, medical diagnosis, and prognosis were used to predict the total number of visits, the duration of enrollment, and the intensity of service. Since the data were originally gathered to study the effects of the implementation of diagnosis-related groups (DRGs) on home health services, half of the patients were enrolled before and half after the implementation of DRGs. Using multiple linear regression analysis, significant amounts of variance in each measure of home health care utilization were explained by the predictor variables (R2= 0.04 to 0.10). For example, after controlling for other predictor variables, age 75 years or older predicted longer durations of enrollment and lower intensities of service as compared with other age groups(P < 0.05),and four of 14 diagnosis categories predicted at least one measure of utilization (P < 0.05). Medicaid enrollment predicted longer durations of enrollment and lower intensities of service in home health care (P < 0.05) in the post–DRG but not the pre–DRG period. These results demonstrate the value of routinely collected information in predicting the use of home health services. To develop more accurate estimates of needs for home health services for particular groups of patients, additional information on chronic functional impairments, informal caregiving, and the chronicity of needs may be useful.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

In this report the data from medical history questionnaires, screening examinations, insurance claims, and a face–to–face physician interview were used to examine the quality of ambulatory care received for 17 chronic conditions by a general population of 5986 adults (≤65) and children (≤14) enrolled in the RAND Health Insurance Experiment. Subjects in six U.S. sites were randomly assigned to insurance plans that were free or that required cost sharing, or in one site to an HMO. Quality–of–care criteria—both process (what was done to patients) and outcome (what happened to them)—were developed. Overall, 81% of outcome criteria and 62% of process criteria were met. Physicians interviewed patients with selected conditions at the Experiment's end to evaluate care. They suggested that approximately 70% of patients should have their current therapy changed, but only 30% of patients would obtain more than minor improvement from such a change. Clinically meaningful plan differences in quality of care were observed only for the process criteria dealing with the need for a visit (free plan compliance 59%; cost sharing compliance 52%). Quality of care for the poor was slightly worse than for the nonpoor and persons randomized to an HMO had slightly better overall quality of care than those in the fee–for–service system. Substantial improvements in the quality of the process of care could be made, but impact on outcome may be small. Results of the analysis suggest the need for development of clinical models to test the relationship between specific process criteria and improvements in outcome.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The objective of this research was to devise a survey instrument specifically applicable to prepaid health care plans that could accurately predict whether patients would disenroll from their current plan because of dissatisfaction when given the opportunity to do so. A “prequestionnaire” was sent to all employees at a southwestern university whose employee benefit package included the option of selecting one of several health maintenance organizations (HMOs) as a source of health care. The prequestionnaire included 90 variables reported in the literature as related to patient satisfaction. The prequestionnaire was mailed two months before “open enrollment,” the time at which subjects would have the opportunity, if desired, to change HMOs. After open enrollment, a “postquestionnaire” was sent to the same subjects, asking whether or not they did change plans during open enrollment. There were 2,365 respondents enrolled in HMOs who formed the study population. Of these, 189 (8.0%) changed HMOs during open enrollment. Discriminant function analysis was used to identify prequestionnaire variables which were predictive that subjects had changed plans; 10 variables were identified. They were combined into a survey instrument, which can be scored to predict an individual subject's probability of changing plans.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Health care insurance claims were used to track costs associated with hypertension for an employed population. Employees were classified as hypertensive (n = 373), high normal (n = 363), or normotensive (n = 2,411) on the basis of hypertension screening done at the worksite. Claims activity was monitored for the three groups during a three–year period, including periods before, during, and after the screening done at the worksite. The average amount claimed per employee was significantly higher for the hypertensives as compared with the normotensives or high normals, even after adjustment for age, race, sex, salary, marital status, and duration of insurance coverage. There was no significant difference in the average amount claimed per employee between high normals and normotensives. The health care costs for hypertensives are estimated to be about 80% more than those for normotensives. Hospital, physicians, and nursing care accounts for about 50 percentage points of this increment while the remaining 30 percentage points derive from drug costs.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Physician mental work load is an important variable intervening between work demands imposed on physicians and physician performance. A brief instrument was developed to measure the mental work load experienced during a clinic session in internal medicine ambulatory care hospital clinics. The instrument covered six dimensions of mental work load: performance, time load, mental effort, physical effort, psychologic stress, and difficulty. Cronbach's alpha reliability coefficient for the instrument was 0.83. The instrument exhibited construct validity. As hypothesized, mental work load was found to be positively associated with number of patients seen and with fatigue, and mental work load was inversely associated with physician satisfaction with the patient care they provided and with their self–rating of the quality of care they provided. The importance of measuring physician mental work load is discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID