摘要:

Using a nearly complete set of hospital discharge abstracts for Michigan in 1980, the authors offer evidence that the shifts in diagnostic and procedure coding (from HICDA-2 to ICD-9-CM) and associated class definitions may have affected both estimates of surgical/nonsurgical use rates and expected lengths of stay of operated versus nonoperated patients as defined using Commission on Professional and Hospital Activities length-of-stay texts.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A model for improving physician prescribing that utilizes computerized feedback was studied in a family medicine residency practice. Resident and faculty physicians were stratified by level of experience and randomized into two groups. For 9 months the experimental group received monthly printouts identifying drugs they had prescribed by brand name with estimates of cost savings that might have been realized by prescribing generic drugs. The control group received no feedback. Prescription monitoring of both groups continued for 12 months after all feedback had ceased. Median weighted rates of generic prescribing for the experimental physicians were 14% for the baseline, 67% for the feedback, and 54% for the follow-up periods. Rates for the control physicians for the three periods were 32%, 37% and 31%, respectively. The increase in generic prescribing by physicians in the experimental group was significantly greater than for control physicians (P= 0.01). The feedback model improved rates of generic prescribing but should be evaluated for broader areas of physician prescribing.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The authors developed a model that relates survival from myocardial infarction or cardiac arrest to four classes of interactive variables describing the rural community, the patient, Emergency Medical Service (EMS) system inputs, and EMS system process in caring for the suspected cardiac patient. Using data from 92 EMS systems in three geographically distinct and physically dissimilar regions, the authors found a consistent and significant relationship between the probability of patient survival and cardiac disease severity, age, sex, the presence of a life-threatening arrhythmia, health care resources available to the EMS system, citizen-initiated cardiopulmonary resuscitation, EMS response time, and the presence of a paramedic on the ambulance responding to the call. The model affords the opportunity to enumerate those factors with the greatest influence on cardiac survival within the community and to test expected increases in survival gained through incremental changes in these factors.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The authors report on a controlled examination of the effects of mental health intervention on the use of medical services in a health maintenance organization. Thirty-six patients were randomly assigned, after initial evaluation, either to begin immediately short-term (15 weekly session) group therapy or for those same 15 weeks to remain on a waiting list. The results seemed to indicate that both patients treated immediately and patients who were wait-listed reduced their medical utilization. Wait-list patients, however, appeared to reduce health care usemorethan immediate-treatment patients. Further, examination of the patterns of health care use showed that wait-listed patients were more likely to have changed their patterns of utilization than immediate-treatment patients. These findings, which must be interpreted cautiously because of the small number of subjects, appear to support the results of other studies that indicate that those patients with the least mental health intervention appear to have the greatest reductions in medical utilization.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Because cohort methods are insensitive in detecting rare outcomes, the authors used the more sensitive case-control technique to investigate whether pediatricians or nonpediatric generalists are better able to recognize severe acute illness or to avoid preventable complications. We selected “indicator” outcomes for four types of common acute illness and enrolled patients who had contacted a physician more than 24 hours prior to an index emergency room visit for the same illness. Cases (N = 103) were patients with adverse outcomes, i.e. potentially preventable complications or delayed diagnosis, treatment, or referral. Controls (N = 103) were those with acceptable outcomes (uncomplicated illness or prompt diagnosis, treatment, or referral) and were matched according to age, SES, and illness type. The overall results indicate no evidence of better care by pediatricians: prior contract with a pediatrician was associated with an estimated relative risk (ω) of adverse outcome of 1.32 (95% confidence interval, 0.76-2.29). Within the two largest illness categories (gastroenteritis and pneumonia-respiratory), the results were similar: ω = 1.16 (0.68-1.99) and 2.23 (0.82-6.04), respectively. Potential confounders were controlled for by multiple logistic regression analysis, but ω remained virtually unchanged. Nor were the findings altered by elimination of outliers or restriction of “contact” to office visits only. The authors conclude that study pediatricians and generalists provide equivalent acute illness care to children and that the case-control method provides a feasible and highly suitable approach to the study of the quality of medical care.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The authors compared four different continuity-of-care measures recently suggested in the literature. First, an analytic comparison is made and useful inequalities are derived. Then the continuity indexes are applied to an extensive data material from a Swedish ambulatory care center. The four indexes give fairly similar results, and the basic finding is the substantially higher index values for elderly patients. Finally, computed index values are compared with what could be expected under a scheme of random assignment of patients to doctors

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The authors developed and tested a model of two dimensions of physicians' behavior in counseling patients about four health habits (smoking, weight control, alcohol consumption, and regular exercise). The two dimensions are the indications for routine counseling and the aggressiveness of counseling style. To test these dimensions, a questionnaire was administered to a random sample of members of a Western County Medical Society in 1978. The response rate was 76%. Indications and Aggressiveness subscales were developed for each habit. Reliability and discriminant validity for all subscales was excellent. Descriptive results were consistent with expectations, e.g., physicians counseled more about smoking and weight control than about alcohol and exercise. The results support the dimensions and suggest that the questionnaire will be useful for future research on counseling behavior.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This article reports on the introduction of a cost-sharing health care plan to the United Mine Workers. The authors discuss the data base and analyze the impact of the program on the use of health care, the probability of a hospital admission, hospital expenditures and length of stay, the demand for physician services, and the probability of seeing a physician. Hospital admissions and hospital expenditures per stay decreased, as did the probability of seeing a physician. It is suggested that these behavioral adjustments to cost sharing are fairly rapid and long lasting.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Effects of financial arrangement and organizational setting on the socioeconomic aspects of four health care delivery systems are assessed. Analysis of variance tests are used to analyze differences between group and solo fee-forservice practices, prepaid group practices, and independent practice associations. Solo fee-for-service physicians tended to be older, to be non-board-certified, to prefer autonomy over earnings, and to have more patient visits, longer hours, and shorter waits for an appointment. Prepaid group physicians tended to be younger, to prefer a specific practice location and predictable schedule, to have lower incomes and expenses coupled with fewer patient visits, shorter work weeks, and longer patient waiting times. If current trends continue, new physicians may develop practice arrangements combining elements of fee-for-service and prepayment.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This paper reports a concurrent self-report study of 2,456 office encounters with physicians and/or physician assistants (PAs) in 16 primary care, private practices in Florida. Initial patient assignment to either a physician or PA varies according to demographic and visit-specific characteristics. Patients who are male, younger than 65 years, new patients, seeking help for acute problems, and those who are “walk-in” or “work-in” patients are more likely to be assigned to a PA. Among frequently performed procedures, physicians are more likely to perform the partial histories, partial physicals, and pelvic examinations, as well as counsel patients on diet and psychosocial problems. PAs are more likely to perform the complete physical examinations, record vital signs, conduct diagnostic tests, and perform therapeutic procedures (administer injections, change dressings, etc.). Most tasks performed by PAs receive supervision through chart review raiher than direct oversight. The typical patient visit in a practice employing a PA involves the receipt of services from only one provider. Approximately 50% of patient services are performed by physicians only, while 35% of the services are performed solely by PAs, and 15% are performed by both. Most patients have received care from both the physician and the PA.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID