ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This paper describes the development of risk-adjusted mortality indices (RAMI) using 1985 MEDPAR data from 657 hospitals. The RAMI methodology is adopted from the Commission on Professional and Hospital Activities, however both inhospital and post-discharge deaths are counted within time windows that vary by clinical condition. Five different RAMI measures (expected deaths/observed deaths) are developed, compared, and aggregated into various hospital characteristic strata. These measures vary by which discharge is held responsible for deaths within a time window, and whether or not inhospital deaths that occur beyond the time window are included. The RAMIs using varying time windows are compared with the RAMIs based upon inhospital deaths only. The inhospital RAMI was higher for the nonteaching hospitals (.95) as compared with the major and minor teaching institutions (.91 and .89). The RAMIs using the varying time windows, on the other hand, tend to be higher for the teaching institutions (e.g., 1.07 for major teaching hospitals; 0.99 for nonteaching hospitals).

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Interest in health-related quality of life (HRQOL) is burgeoning and there has been a proliferation of self-report measures of HRQOL. However, only two instruments available for measuring HRQOL have been calibrated using empirically derived preferences; both are long and complex. This study tested a brief survey designed to concurrently assess HRQOL and preferences for different HRQOL states. Multitrait-multimethod (MTMM) analysis was used to evaluate the construct validity of the survey in a convenience sample of 116 persons. Two methods were used to assess six aspects of HRQOL: general health perceptions, meaningful activities, outlook on life, physical suffering, self-care activities, and social relationships. HRQOL preferences were assessed using two methods similar to those used for self-reports, as well as one additional method. The construct validity of self-reported HRQOL was supported. On the other hand, substantial method variance and little valid trait variance was observed for the HRQOL preferences. Results are discussed in terms of their implications for evaluating and measuring HRQOL and related preferences.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Malignant neoplasms confer a special significance to the relationship between terminally ill patients and their immediate environment and directly influence the patient's place of death. This study analyzed the factors that influenced the place of death of cancer patients in Majorca (Balearic Islands, Spain). A survey was carried out among 335 surviving relatives who acted as primary care-givers. Information from interviews and data from medical records showed that 46% of the deaths occurred at home. The patients' place of residence (two of three patients from rural areas died at home and two of three patients from urban areas died in the hospital) and their sociocultural level (a higher proportion of deaths occurred in the hospital among patients of lower socioeconomic levels) were the family and social factors that had the greatest influence in determining the place of death. The opinions of those interviewed, the majority of whom were women (female/male ratio, 3.5:1), as to the admission and discharge of the deceased from the hospital and the impact on the family of the patient's death were analyzed. There were marked differences in the overall perception of the terminal phase of illness in hospital-centered and home-centered groups. The relatives of those who died at home were significantly less distressed.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This article describes the process utilized to develop criteria for appropriately ordering five ancillary services frequently performed in hospitals: 1) arterial blood gases, 2) electrocardiograms (ECGs), 3) serum electrolytes, 4) chest x-rays, and 5) complete blood counts (CBCs). The development of each set of criteria involved an initial consultant, a panel of six additional regional expert consultants, and three national reviewers. Each criteria set was developed through a process involving seven steps: 1) an initial working draft, 2) revisions at an initial meeting of the regional experts, 3) revisions at a second meeting of the regional experts, 4) written comments from the regional experts, 5) written comments from national reviewers, 6) additional written comments from regional experts, and 7) application of the criteria to cases in a community hospital. The change in item content was measured between steps and agreement with individual items was measured at steps 2, 3, and 4. The results indicate that appreciable change in content occurred with each step except step 4. Agreement started fairly high and was over 90% by step 4. The discussion considers the utility of each developmental step, factors affecting the utility of the criteria, the extent to which the. results can be generalized, and the need for more research to identify optimal processes for the development of criteria to evaluate quality of care.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The objective of this study was to examine the effects of hearing impairment on the utilization of physician and hospital services in the U.S. adult population. Andersen's behavioral model of health services utilization served as the conceptual framework for the study, and data used for the analyses were taken from two years (1971, 1977) of the Health Interview Survey. Hearing impaired persons used significantly more physician services than hearing persons. Hearing impairment had no effect on the number of hospitals days used but had a significant, positive effect on hospital contact and hospital episodes. In addition, neither the type nor the severity of the impairment had a consistent effect on utilization. These findings were consistent for both years of study data. The study's findings, implications, and suggestions for future research are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Using data from the community based RAND Health Insurance Experiment, the effect of cost-sharing versus free care on the use of office-based medical care in children was examined. Children from families on cost-sharing plans had a 22 percent lower probability (P< 0.005) of having an episode of care during the study year. Both the number of episodes of care and total charges for outpatient professional services were 30 percent lower (P< 0.005) with cost-sharing. cost-sharing reduced average charges for medical services by 30 percent (P< 0.01) and pathology charges by 45 percent (P< 0.005). cost-sharing reduced medical services received by 26 percent (P< 0.05) and pathology services received by 43 percent (P< 0.05) but did not have a significant effect on either the price for medical services or pathology services. It was concluded that there is a large difference between cost-sharing insurance plans and free care in the demand for office-based medical care in children. Cost-sharing results in children receiving fewer services, not lower priced services.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This study examines the intravenous use of two thrombolytic agents [streptokinase (SK) and tissue plasminogen activator (tPA)] in the acute phase of myocardial infarction (MI). These two agents have very different costs and offer an excellent opportunity to study both the impact of economic factors on clinical decisionmaking and the potential for cost savings by limiting the use of expensive new therapeutic agents. A nationwide survey of the 5,792 acute care general hospitals listed in the American Hospital Association's 1988 data file was responded to by 2,651 hospitals (46%) and revealed that 2,384 of these responding hospitals (90%) were using thrombolytic therapy. For 2,200 of these 2,384 hospitals (92%), the respondent was a physician who primarily used one of the two drugs. Eight hundred eighty-six of these 2,200 physicians (40%) primarily used SK while 1,314 (60%) primarily used tPA. SK users were more concentrated in federal public hospitals (69% used SK) than in nonfederal public hospitals (47% used SK), and were least concentrated in private hospitals (36% used SK). There was no difference between the rate of SK vs tPA use in investor-owned and not-for-profit private hospitals. SK users most often (62%) cited various economic factors as the reason for their choice. The users of tPA primarily (73%) cited clinical preferability as the reason for their choice even though trials are still ongoing to see which drug is preferable. Several multivariate analyses shed light upon the association between choice of thrombolytic agent and various additional physician and hospital characteristics. These data clearly indicate that while new therapies are rapidly implemented by the medical community, considerations of cost have a substantial impact upon the pattern of implementation and reflect a desire to implement cost savings in the use of new drugs.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

While Preferred Provider Organizations (PPOs) are designed to contain the costs of health care, they may not be able to do so if sicker individuals opt not to use PPO providers. This study examined how level of mental health status and prior use of mental health services affected the decision to use or not use PPO providers for mental health care for employees enrolled in fee-for-service plans with a PPO option. Data were obtained from an employee survey and claims data on three large employee groups. It was not possible to examine effects of sickliness on the intent to select PPO providers for mental health care directly because about one half of employees could not identify who they would visit for mental health care or even how they would select a provider for such care. The intent to use PPO or non-PPO providers for general medical care, however, was not significantly associated with mental health status when other factors were controlled. Furthermore, among persons who used mental health services after implementation of the PPO option, those who had previously visited providers who were to become part of the PPO panel tended to stay with PPO providers, while those who previously visited providers who were not to enter the PPO panel subsequently selected away from PPO providers for mental health care. This pattern of results suggests that established individual patient-provider relationships, rather than sickliness, determined the selection of PPO versus non-PPO providers for mental health care for employees enrolled in these optional PPO fee-for-service plans.

ISSN:0025-7079    

出版商:OVID    

年代:1991

数据来源: OVID