摘要:

The importance of measuring health outcomes such as functional status and quality of life has increased with the greater emphasis on efficiency and on judgements of clinical effectiveness of therapies for patients with chronic disease. One measure of health status, the quality of well-being (QWB), has received significant attention as a health policy model because it quantifies health on a scale ranging from “zero” (death) to “one” (optimal health). The scale is based on weights (values) that were derived by having several thousand individuals in the general population rate scenarios in which a patient is described in terms of mobility, physical activity, social activity, and major symptom or problem. The present study was undertaken to determine if a disease-specific population composed of patients with moderate and moderately severe rheumatoid arthritis who were participating in a national multicenter trial of a new oral therapeutic agent, would rank scenarios similarly to the general population sample. In this study, close agreement was found between the weights obtained from the general population sample and the weights obtained from the sample of rheumatoid arthritic patients (R.= 0.937). The investigators believe that the study supports the use of the original general population weights and suggest that the index may be used for populations with a specific condition as well as for general populations.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Sixty-eight interviews of hospitalized patients by freshmen medical students were examined for common response patterns. Response profiles were constructed for each medical student and subjected to cluster analysis. Four common response patterns were identified: Questioning Facilitators, Declaring Facilitators, Elaborators, and Prompters. The four patterns are distinguished by the different balance they strike between directing the interview and remaining responsive to the patient. Limitations of the study and its practical implications are also considered.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The effect upon patient satisfaction of a reorganization of a traditional medical clinic into a group practice model was examined in a controlled trial in which both patients and physicians were randomized. The group practice model, unlike the traditional clinic, provided decentralized registration, 5 days/week clinic coverage, and night/weekend phone coverage. Residents worked in small groups with an attending physician, a nurse practitioner, and a receptionist. This reorganization resulted in a substantial decrease in charges and utilization for patients in the experimental group. A panel of 302 patients was interviewed prior to the reorganization and 1 year later. Patients in the experimental groups perceived improvements in access to their physicians as well as decreases in clinic waiting time and decreases in the lag time between requesting and obtaining an appointment. General health perceptions and other satisfaction measures were unchanged. The authors conclude that a group practice organization can result in decreased patient charges without substantially altering patient satisfaction.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Three city data sources (CDSs)—police reports, ambulance reports, and medical examiner (ME) logs—were evaluated for their usefulness in epidemiologic studies of trauma. The CDSs were employed to identify all cases of penetrating injury to the chest and/or abdomen severe enough to require care in a medical institution during 1979 and 1980 in Baltimore city. The percent of cases identified by source was: police, 66.8%; ambulance, 47.9%; ME, 16.6%; police plus ambulance, 89.4%; police plus ME, 82.9%; and ambulance plus ME, 50.1%. Hospital admissions to six study hospitals due to chest and/or abdomen penetrating injury were located and matched to the CDS reports: 89.2% of the hospitalized cases were reported in one or more CDS, and 34.7% of the cases identified by one or more CDS could not be located in the hospital records. Using hospital records as the standard, each source was determined to have the following completeness of case reporting: police, 66.2%; ambulance, 72.9%; and ME, 92.2%. The authors conclude that existing CDSs should be used with caution, and that the usefulness of data from multiple sources far outweighs that from any single source.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This article analyzes the labor market-related effects of informal care provision in the National Hospice Study on the individual providing this care. The results indicate that voluntary providers of patient care who were employed at the onset of the care-giving episode experienced considerable loss of earnings. These losses were partly caused by the fact that over one-fourth of initially employed caregivers left the labor force because of care obligations. This exit probability increased with the caregiver's age and female gender, and decreased with the caregiver's reported annual family income. Of the caregivers who continued in paid employment during the informal care episode, 60% reported losses of income because of care-related increased absenteeism from work. These two types of income loss are quantified using an indirect valuation method. This quantification indicates that some of the cost savings which have been attributed to the home-centered hospice modality in the National Hospice Study may have resulted from the shifting of costs from the formal health care sector to the informal care sector.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Different components of drug knowledge (i.e., knowledge of the drug purpose, regimen, action if a dose is missed, and common side effects) were examined in 187 ambulatory cardiovascular patients in order to determine whether the components were similar enough to be considered interchangeable in representing drug knowledge. Patients and physicians were interviewed in a family practice setting and their responses compared for each cardiovascular drug the patient was taking. Scores were highest for knowledge of the drug regimen and purpose, fewer patients were correct about the appropriate action if a dose were missed, and only a small number could accurately identify common side effects associated with their drug therapy. The comparison of patient responses to each of the knowledge measures indicated that there was little consistency in response across the various types of knowledge. The differences in the measures were supported further by regression equations that showed different relationships between a set of independent variables and knowledge of drug purpose and regimen, respectively. The study findings suggest that a partial explanation for inconsistencies of research about drug knowledge may be the way this concept is measured.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Four randomly selected nursing groups were assigned to three experimental groups and one control group to test the relative impact of three experimental nursing schedules, using a before-after design. The three experimental treatments were (1) straight shifts; (2) regular schedule but with unlimited requests for changes; and (3) individual station-designed schedules. Before treatment, score differences between the experimental and control groups were limited to one of 36 highly reliable scales specifically constructed and pretested to gauge effects of scheduling. This single difference was judged not to be significantly related to experimental outcomes. Because of a poor job market situation, retention was not affected significantly by any of the three treatments, but root causes of turnover were. Results of the experiment showed that individual station-designed schedules triggered the most changes that favor retention. In contrast, the other two treatments unexpectedly increased nurses' own sense of marketability and reduced teamwork among nurses. Reasons accounting for the results are discussed in the text.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Research on adverse outcomes following common surgical procedures has suggested the importance of hospital and surgeon variables. Policy directions depend on which factors are important in influencing patient outcomes and what sorts of policies are feasible. Focusing on where a given procedure is performed highlights a concern for centralization; emphasizing who should perform a particular operation implies physician certification. Finally, monitoring involves identifying particular hospitals that appear to have relatively poor (or relatively good) results.This paper analyzes patient, surgeon, and hospital characteristics associated with serious postdischarge complications of hysterectomy, cholecystectomy, and prostatectomy in patients age 25 and over in Manitoba, Canada, following surgery during 1974 through 1976. The three procedures differ markedly in the ease of prediction of the probability of complications and in the predictive importance of patient, hospital, and physician variables. The predictors worked fairly well for cholecystectomy, somewhat less well for hysterectomy, and not well at all for prostatectomy. Hospital variables were not generally important in the multiple logistic regressions. After controlling for case mix and type of surgery, physician surgical experience was found to account for relatively large differences (almost two to one) in the probability of patient complications following cholecystectomy.Cholecystectomy might be a candidate for certification because of the epidemiology of the operation. As of the mid-1970s, a substantial proportion of the cholecystectomies were being performed by physicians with comparatively little ongoing experience with this type of procedure. Moreover, a monitoring perspective identified one hospital with a significantly higher postcholecystectomy complication rate, even after physician experience was taken into account.Both identifying which procedures should be attended to and focusing on problems following surgery are important beyond Manitoba and highly relevant to such American requirements as Peer Review Organizations. Methods of increasing the efficiency of using claims data for quality assurance studies are outlined.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID