ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The central purpose of an ambulatory care information system is to communicate information to the practitioner to facilitate clinical decision making. The clinical decision can be considered the dependent output variable in a process in which the information system, the patient, clinician characteristics and the environment are the independent input variables. Evaluation methodologies must consider these relationships. Approaches using patient outcomes are problematic because of the indirect relationship between the information system and patient outcomes, which limits both sensitivity and validity. A process measure technique that focuses on the clinical decision directly as the measure of output could be appropriate if it represented a generic sampling of clinical decisions made in ambulatory care. A new method under development based on an information theory concept may be more widely applicable than currently available methods.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This study investigates the reliability of the Manitoba Health Services Commission data bank from a variety of perspectives. Emphasizing diagnostic and surgical procedures, the research focuses on those areas in which problems exist and in which the data can be relied upon. Computerized comparisons are stressed, since they can provide cost-effective checks on data quality. One key to performing reliability studies inexpensively is finding information recorded independently: by separate individuals or organizations, at two different times, or in two or more data files. When a particular event has certain logical implications vis-à-vis another, inconsistencies can be located. Face sheet information and data on the performance of major surgical procedures were found to be reliably recorded in the Manitoba data bank. Collapsing ICD-8 diagnoses from medical claims into several categories proved much better than relying upon individual diagnoses. Problems in working with the data included difficulty in distinguishing between closely related surgical procedures and the underreporting of inhospital consultations and nonsurgical procedures.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A randomly selected sample of Iowa physicians was surveyed using a selfadministered mail questionnaire that measured the relative importance of prescribing criteria as well as selected physician and practice characteristics. Based on a response rate of 68.3 per cent, it was found that the physicians' criteria for selection of a drug to prescribe could be reduced to two groups. The first group is used to select the generic drug or therapeutic class and is of primary concern to the physicians. Those criteria used in specifying a brand of drug product are of lesser importance to physicians and constitute the second group. It was further discovered that physicians could be segregated into two distinct segments based on the importance of the prescribing criteria. It was not possible, however, to explain the composition of the groups using the physician and practice characteristics measured.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Four similar teams of physicians associated with similar inpatient units and randomly assigned patients were used to study the effect of providing physicians with cost information about their use of lab tests and x-rays. Two teams received information about lab test costs, and two teams received x-ray test costs. Test usage fell during the experimental conditions and continued to fall after the experimental period ended in teams in which there was an interested leader.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This research evaluated the effects of providing physicians with information about the prices of diagnostic tests on their subsequent test-ordering behavior. The study population consisted of 36 second- and third-year residents and 23 clinical faculty in three family practice centers affiliated with the Department of Family Medicine at Wayne State University School of Medicine, Detroit, Michigan. Study participants were asked to review four case studies, each describing a patient with ambiguous symptoms, and to indicate on an attached test order form the tests they would order for each patient. Subjects were randomly assigned either to a group that received test order forms on which the prices of diagnostic tests were printed (price-information group) or to a group that received test order forms with no prices indicated (control group). The study results show that for each of the four cases, the average number of diagnostic tests ordered was significantly lower in the price-information group than in the control group. Our findings also show an average reduction in the cumulative cost of tests ordered per patient of 31.1 per cent related to the provision of price information. The feasibility of regularly providing physicians with price information is discussed and reviewed in light of other approaches that have been developed to modify physician behavior in ordering diagnositc tests.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A questionnaire containing 11 patient management problems was completed by 495 physicians and medical students at an American and a Canadian medical school. Respondents indicated whether they would order a particular diagnostic test in each case, given five different prices for the test. Approximately 25 per cent of attending staff and a higher proportion of residents, interns and clerks responded that they would order the test depending on its price. Approximately 50 per cent of attending staff and smaller proportions of residents, interns and clerks indicated that they would not order the test even if there were no price. Respondents in Montreal were more likely than those in Philadelphia to select a price-sensitive response, the reverse of the expected tendency. Since some tests may be ordered on the basis of price, education of physicians regarding the price of diagnostic tests may alter their use of these services, but a large proportion of tests are ordered because of clinically absolute reasons, which may be insensitive to price.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Data from a national survey of veterans are analyzed to determine how age, income, health insurance and service-connected disability influence the veteran's choice of Veterans Administration (VA) hospitalization. Log-linear analysis is used to provide a model that expresses in numerically quantifiable terms (odds and odds ratios) the effects of these factors on the choice of VA hospitalization. Moreover, the multivariate nature of the analysis provides the opportunity for assessing the magnitude of these effects simultaneously in the presence of all other effects. The final model shows that age and health insurance act independently of each other and of all other factors. The effect of income is modified by service-connected disability status and vice versa; this interaction of two factors is probably due to VA hospital care eligibility criteria. Overall, the single most important factor affecting a veteran's choice of hospitalization is health insurance; veterans without health insurance have nearly five times greater odds of going to VA hospitals than do those with health insurance—regardless of age, income or service-connected disability status.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The purpose of this study was to determine the level of satisfaction with maternity care and whether satisfaction was related to the patterns of communication between caretakers and patient and to specific clinical procedures used during labor and delivery. Data, gathered in a statewide survey, indicated widespread satisfaction with prenatal, labor and delivery care. Level of satisfaction was related to both the quality of communication and the fulfillment of preferences about the management of labor and delivery. There was a general consensus among respondents about the desirability of childbirth coaches, controlled breathing and relaxation techniques, and freedom to move around and the undesirability of medication rendering one unconscious for delivery. There was considerable variation in desire concerning medication during labor, use of a fetal monitor, presence of family members and choice of atmosphere. The implications for alternatives in maternity care are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Specialized ambulatory geriatric care remains an understudied topic. This article analyzes the organization of one special clinic that was established in an apartment block of elderly housing. The findings indicate that as the number of nurse practitioners and case workers' visits rose steadily during the first four years of the clinic's existence, visits to the clinic physicians declined by approximately one visit per client per year. The clinic population utilized less inpatient hospital care than other nonusing residents, and less than other residents of similar age in Connecticut. There was reduced usage of intermediate nursing home care (as opposed to skilled nursing care). Hence, how geriatric ambulatory care is delivered affects institutionalization. In the interests of general well-being and economy, more attention should be paid to this extramural phase of medical care of the elderly.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID