ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

In a prospective study we compared the ability of two quality assessment methods—the standard criteria list and the criteria map—to predict the appropriateness of the disposition decision for 421 patients with chest pain who presented to two emergency departments. To evaluate the quality of this decision, each patient was followed at home or in the hospital to determine whether an acute condition requiring hospital admission was present. Among the 169 discharged patients, the map scores of the eight with admissible disease were significantly higher than the score for those without admissible disease (p = 0.02). For the 252 admitted patients, a similar relationship between map score and the admissible disease outcome was observed (p = 0.0001). There was no significant relationship between list score and outcome among either the admitted or the discharged patients. Multivariate logistic analyses confirmed the importance of the map score as a predictor of admissible disease. The map score was superior to the list score and to demographic variables in its ability to correctly classify patients with and without admissible disease. The demonstrated relationship between map score and patient outcome enables the map to be used in a quality assurance system. An institution can ensure that physicians review an enriched sample of the inappropriate discharges and the unjustified admissions by selecting admitted patients with low map scores and discharged patients with high map scores.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This article describes a method for measuring the performance of clinicians treating patients with unilateral inguinal hernia or myocardial infarction. The scoring was based upon the percentage of occasions when appropriate education was given and acute conditions resolved in accordance with clinical expectations. The method was applied to patients of general surgical and general medical firms at two London teaching hospitals in 1972 and 1975. Scores for samples of each diagnosis correlated significantly with subjective evaluations of care by clinicians. Multiple regression was used to identify and weight the patient risk factors (physiological and demographic) significantly associated with lower scores in each disease. Scores of patients with these risks were adjusted upward to compensate for the difficulty of achieving good clinical results when these risks were present. Comparison of firms was based upon adjusted scores. Being older and being single, widowed or divorced were significant in both diseases. High blood pressure and anemia were also significantly associated with lower scores for hernia patients, as were the number of cigarettes smoked for infarction patients. The range of scores was wide in surgical firms in both years. While relatively narrow in the medical firms, scores suggest that there is still scope for improvement in some firms. The authors discuss a plan for using these data to arrive at score standards for each disease which could be used to screen clinical care routinely.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

As health care becomes more differentiated, fewer people receive the majority of their care from a single source. Yet, most methods for assessing health care focus on the care provided by a single facility or group of practitioners. A method is described which tracks individuals through the diffuse medical care “system” and examines the process of care received for complete episodes of care. Through the use of tracer conditions the individual's pathway through the system is followed and the contribution of the various system components (e.g., facilities and providers) is assessed for various functions of care (e.g., screening, diagnosis, treatment), thus pinpointing deficiencies in the process of care. The method is designed to sample systematically from the entire provider and consumer system. Use of this methodology in a variety of settings, including American Indian communities, has proved to be feasible and has uncovered deficiencies in the delivery of health services which might have been overlooked by other approaches. This article describes the assessment method and presents selected results which demonstrate the assessment outputs.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This study analyzes the use of diagnostic studies by community physicians. Data from billing claims for outpatient visits by Medicaid recipients in three northeastern Pennsylvania counties during a 38-month period were studied, including 55,420 visits to 336 physicians. The use of outpatient laboratory tests and roentgenograms was correlated with the personal characteristics of the prescribing physicians. When case mix was controlled, analysis by specialty showed that internists ordered approximately the same number of procedures as family physicians, and both groups ordered more procedures than general practitioners. The number of years since medical school graduation showed a statistically significant inverse relationship with laboratory and radiology use. Public school graduates ordered more laboratory tests than private school graduates, and foreign medical graduates ordered more roentgenograms than domestic graduates. Other variables, including size and location of practice, and osteopathic or medical training, were not significantly related to patterns of use.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The medical record is the source of information for many purposes, including evaluation of the quality of care provided. Despite this reliance on the record, there have been few attempts to validate the recorded content against the verbal content of the interaction between patient and physician. In this study, we compared the record with verbatim transcripts of outpatient visits. Overall, 59 per cent of units of information present in either source were found in the record. Recording was more complete for the chief complaint (92 per cent) and information related to the patient's present illness (71 per cent) than for other medical history (29 per cent). Incomplete recording of elicited information may partially explain the often low levels of performance of recommended care items found in quality-of-care studies. We suggest that more attention be paid to improving communication about tests and therapies to patients.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A 10-item questionnaire was administered to non-elderly persons (N = 4,976) to measure their sophistication or knowledgeability about the medical care delivery system. Such sophistication seems germane to views about the appropriate role consumers might play in decisions affecting resource allocation, especially whether competition or cost-sharing strategies should be pursued or whether certain regulatory strategies are more promising. Analyses of individual items suggest that consumers are knowledgeable about some matters and uninformed about others. If a pro-competitive strategy is pursued, efforts at educating consumers about board certification, staff privileges and other information pertinent to choosing a regular source of care seems warranted. Factor analyses indicated that a substantial amount of the information contained in item responses can be summarized in a multi-item scale score. The reliability and validity of this scale as a measure of patient sophistication was supported.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Numerous proposals for national health insurance (NHI) are before the Congress. This study measures public preferences for three widely debated forms of NHI based on national survey data from 1978. Analyses of the comprehensive, catastrophic and deductible forms of NHI are conducted separately using the multivariate probit technique. Findings suggest that, in general, public preference is greatest for the comprehensive plan and lowest for the catastrophic plan. Supporters of the comprehensive plan tend to be young, Democrats, members of lower socioeconomic groups, nonwhite, residents of the West, Northeast or urban areas, and without extended health insurance coverage. Support for NHI options is associated with political party preference as well as sociodemographic characteristics.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Although pharmacy organizations have been instrumental in the movement to repeal antisubstitution laws, there is evidence that under the current fee-for-service system pharmacists have not exercised their newly obtained prerogatives freely. A previous study has demonstrated that paying pharmacists on a capitation basis for their Medicaid patients effects a highly significant increase in the rate of generic substitution. The present study was conducted to determine whether the pharmacists' newly acquired generic substitution habits “spill over” from Medicaid to non-Medicaid prescriptions as a result of capitation reimbursement. The results indicate that pharmacists who participated in the capitation experiment for the Medicaid drug program significantly increased their rate of generic substitution on non-Medicaid prescriptions. It was concluded that the same pharmacies that increased their substitution rate in the Medicaid program under capitation also increased their substitution rate on non-Medicaid prescriptions. Finally, generic substitutions in both the Medicaid and non-Medicaid studies generally involved the same labelers as well as drugs in the same therapeutic categories and with the same generic classifications.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

We discuss statistical characteristics of AS-SCORE, a recently developed index of illness severity for medical patients. The acronym “AS-SCORE” indicates the five major attributes of the index: age, systems involved, stage of the disease, complications and response to therapy. The reliability of both the four-class system (k= .84) and the additive point scoring system (r = .92) was substantiated by two judges who independently classified and scored 105 records. We also tested the content validity of the four-class system and found that as severity increased there was a concomitant increase in hospital charges, laboratory charges, length of stay, number of consultations and mortality rates. In addition, we performed a regression analysis to determine the relative contributions of each of the attributes to the AS-SCORE value. We describe how we used the AS-SCORE severity of illness index to compare physician practice patterns and we suggest several other potential uses. We conclude that the AS-SCORE index is a reliable, valid and useful prototype method to assess differences in severity of illness for medical patients.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID