摘要:

Four hundred eighty-four physicians were surveyed on the number of new procedures they adopted during a 1-year period. Clear differences were found among specialties. A simultaneous statistical analysis of factors affecting the adoption of new procedures yielded a number of additional significant relationships. Up to an age of approximately 50 years, age has an increasing impact on the number of new procedures adopted by physicians. Beyond that age, it has a decreasing effect. Board certified physicians tend to adopt more new procedures than physicians who are not board certified. Among those physicians in nonurban locations, those in solo practice adopt significantly fewer procedures than those in other practice modes. The implications of these findings for such issues as the rising costs of health care and physician reimbursement systems are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Substantial differences in the use of pediatric medical resources reinforce the need for identifying and understanding factors that influence the use of medical services for children. This research assesses the simultaneous impact of sociodemographic characteristics, health attitudes and beliefs, psychologic distress, social stressors, and social networks on the use of pediatric acute care services during a 12-month period. Using a prospective longitudinal study design, data were obtained on 513 children and their families enrolled in a prepaid group practice. Linear modeling results showed that health attitudes and social networks were important predictors of acute care utilization in addition to child's age, birth order, baseline health status, and ethnic group. The authors were able to show significant effects for network size, dispersion, and tendency to use one's network members. Individuals with large nondispersed networks are more likely to use pediatric health services, apparently due to the transmission of the networks' pro-medical care health beliefs. Also the tendency to call on network members modifies an individual's propensity to seek care for minor pediatric medical problems and can make a difference by as much as 1.6 visits per year per child for acute care episodes.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

It is well known that the costs of care at health maintenance organizations (HMOs) at any point in time have been lower than in the fee-for-service sector, but how costs have changed in each of these sectors has been less well-documented. The only previous study, which examined the HMO experience during the 1960s and early 1970s, found that HMO and fee-for service costs rose at approximately the same rate. The present study, which extends this analysis to the period 1976-1981, also demonstrates that HMO costs increased at a rate not detectably different from that in the fee-forservice sector. These results are consistent with the earlier conclusions that HMOs cause a once-and-for-all reduction in cost. They also indicate that the public has been willing to pay for much of the increased costs of modern medical technology.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A model of the drug prescribing process, which incorporates prescribers' personal values about treatment outcomes and beliefs about treatment effects, was tested under actual clinical conditions. Forty physicians were given two fictional case histories and six disguised case histories of patients whom they had recently treated for hypertension or maturity-onset diabetes mellitus. The physicians completed questionnaires based on each case history that measured 1) the beliefs about the probability that seven treatment-related outcomes would result from the prescribing of several alternative treatments and 2) the values placed on each outcome. The physicians were also asked, in an open-ended question, how they would treat the patient described in the case. The 40 physicians proposed 172 drug treatments that corresponded to treatment alternatives for which beliefs about treatment effects had been measured. The model correctly predicted 1) prescribing intent in 81% of hypertension cases and in 87% of the diabetes cases and 2) actual prescribing in 76% of hypertension cases and in 70% of the diabetes cases, significantly more than would be expected at random (P<0.01). The prescribing model appears useful for predicting drug choices for the outpatient treatment of hypertension and diabetes by resident physicians.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Patients in the most prevalent DRGs in a Medical Intensive Care Unit (MICU) were compared with their counterparts who received only routine hospital care on adjusted total hospital costs and length of stay. Costs for both groups were compared with estimated DRG payments under an allpayer system. For patients in three DRGs, measures of severity of illness were examined as predictors of costs. Significant differences between MICU and routine care patients were found in 10 of 13 DRGs studied; intensive care costs were substantially above overall payment rates. The severity of illness measures varied widely in their correlation with costs, depending on DRG and whether the patients were MICU or routine care. These apparent differences in accounting costs may result in hospital decisions to restrict the number of MICU beds. Severity of illness adjustments to DRGs might produce more equitable payments. The most useful measure of severity may differ, however, depending on DRG.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The effects of financial coverage, education, race, age, and marital status on the start of prenatal care was studied in this analysis of 85,000 live births that occurred in New York City in 1981. Log-linear models were selected for the three variables prenatal care, coverage, and education after the data had been partitioned by race, age, and marital status. An overall model for the six variables was also selected to determine the relationship between race, age, and marital status and the three principal variables named above. Late or no prenatal care was found to be associated with Medicaid and an education of less than 12 years. For the most part, the association of race and age with late or no prenatal care was mediated by coverage and education. Hispanics, blacks, and teenagers who experienced greater odds of incomplete education and Medicaid insurance experienced greater odds of late or no prenatal care.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Anti-inflammatory/analgesic drugs account for a large proportion of prescriptions and prescribing costs, particularly for ambulatory patients. Although aspirin is highly effective, 95% of anti-inflammatory/analgesic prescriptions have been for the newer, more expensive alternatives. Recently two newer aspirin formulations were made available on our hospital's formulary. Subsequently aspirin prescribing rose from 5% to 14.5% (P<0.0005), and mean pharmacy costs for anti-inflammatory analgesics fell 5.9% over a 7-month period (P<0.025). This decline in costs interrupted a historic trend toward increased prescription costs and was accomplished with minimal effort or hospital resources. Increased availability and familiarity with these newer aspirin formulations may substantially reduce costs for the health care system.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This study identifies and analyzes factors under a hospital's control that can affect its market share. The study, utilizing the Multiplicative Competitive Interaction model, specifically focuses on determining the market share for each hospital within a geographic area, as opposed to the total demand for hospital services within an area. The results indicate that the effect of the number of physician affiliations on hospital patient share is statistically significant. The article investigates the variables that affect the level of physician affiliation. Besides physician affiliation, hospital location, a PROFILE factor based on a composite of a number of variables, and the proportion of affiliated physicians who are not affiliated elsewhere have a significant impact on each hospital's market share. The variables examined resulted in an R2=0.901 for individual hospital patient market share.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The article describes the development of methods to use live simulated patients for assessment of quality of care of primary physicians. Methods used to train patients and achieve undetected entry into physicians' practices are described. The study demonstrated that patients can be entered into practices with a low rate of detection (13%) and that they are able to recall the details of the encounter with a high degree of reliability.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID