摘要:

Post efforts in assessment of the quality of maternity care have been analyzed in order to develop an evaluation framework that will have utility and applicability beyond a specific program, population, or health discipline. Presently available evaluation approaches have focused attention on either “high risk” populations or upon women experiencing a complicated pregnancy or delivery. Quality has been defined as the extent to which normative or empirically derived standards of obstetrical care have hcen applied.An alternative approach is suggested which conceives of the pregnancy as a normal physiological event but with the potentiality of either causing or exacerbating social or health problems. Maternity- care quality is viewed as die application of those necessary health and health-related services that are required to safeguard the health of (lie mother and offspring, minimize the noxious consequences of pre-existing or concurrent health hazards or conditions, and upgrade the health and social functioning of those women who require it. Additionally, the system of services should be functionally organized to optimize care.Indicators of quality are suggested which incorporate structural, process, and outcome variables, and which link medical and consumer criteria in a comprehensive community level approach to quality assessment.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Physician and practice characteristics were reviewed in relation to the quality of the doctor-patient relationship in primary medical care. This relationship was defined in terms of communication between physicians and patients, patient satisfaction with care, and physician awareness of patient concerns.The study subjects were mothers of infants and pregnant women, identified from the offices of a random sample of primary care physicians in a single community. The patients of 49 physicians, 363 pregnant women and the mothers of 523 infants were the subjects of the study. When controlled for patient characteristics, communication was better for pediatricians with mothers of infants and for obstetricians with pregnant women as compared with other physicians. Mothers of infants were more highly satisfied with care provided by residency-trained physicians; pregnant women were more satisfied with non-Board certified physicians. Physician awareness of patient concerns presented a mixed pattern of associations with several physician and practice characteristics. These findings suggest that physician credentials are not consistently associated with the three identified dimensions of the doctor-patient relationship.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

In the present study, an adaptive social systems model is developed and utilized to examine the dynamic properties of a health services delivery system. The model employs a Markov chain as a structure for analyzing the utilization of physician services both inside and outside of a prepaid plan. Four system states are defined, namely, no use, inside use, outside use, and both inside and outside use of physician services. Subscribers are considered to be in one of these states on each episode of illness. Transition probabilities are estimated from data collected from a sample of subscribers to a university health plan using a regression approach that permits a heterogeneous population to be examined within a Markovian framework.This framework is used to examine factors that account for differences in utilization patterns among individual subscribers and to examine overtime changes in the transition probabilities resulting from population shifts on specific demographic and health-related attributes. Based on the assumption that individual subscribers rather than the population as a whole follow a Markov process, the k-step transition matrix is constructed for the heterogeneous subscriber population and is used to examine the long-run effects of particular utilization patterns on the functioning of the prepaid plan.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Health care utilization studies often reach conflicting conclusions about the appropriate measures of utilization and the relationships between such measures and the explanatory variables. The purpose of this paper is to demonstrate why such ambiguities exist, provide empirical tests of different models, and suggest an appropriate analytical framework. A household survey of a rural California community was used to collect both family and individual data on utilization, “need,” accessibility, attitudes, and demographics. A number of possible utilization models are presented, each containing alternative sets of dependent and independent variables. Multiple regression analysis is applied to each model, providing considerable insight into the roles of specific independent variables in explaining alternative utilization measures. The omission of certain variables, such as health status (or “need”), can result in an incorrect interpretation of the results.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

A major focus of efforts to monitor and control health care expenditures has centered on factors related to hospital length of stay. Age, in particular, is usually assumed to be an important correlate of hospital length of stay, especially when diagnosis and hospital variables are also taken into account. In an analysis of data representative of medicaid cases in 23 large New York City hospitals during 1972, these effects turn out to be less clear-cut than generally assumed. Although the first-order coefficients of length of stay regressed on age and the rank order correlation of the means are statistically significant, such wide differences in length of stay within age groups remain as to reduce the substantive impact of the observed findings. This same pattern of wide variations within age groups persists even when diagnosis is controlled by use of up to 80 covariant groups. In over half the 80 diagnostic categories, no significant age effects was found.When the age analysis is repeated using 23 hospitals as the covariants, estimated age effects differed between institutions, and a similar pattern of large within-group variation was observed. These findings are interpreted as a caveat to health care researchers who might otherwise plan overly sophisticated utilization review systems.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Increased costs of malpractice insurance and physician fear of involvement in malpractice suits have been suggested as inhibiting greater employment and utilization of allied health personnel in physicians' offices, since physicians are liable for acts of negligence by their employees. However, data obtained from a survey conducted by the American Medical Association in 1971 suggest that malpractice insurance expenses vary within only a relatively narrow range with the number of allied health personnel employed by physicians. Thus, malpractice insurance expense per sc is probably not a significant factor in influencing physicians' decisions to hire aides. On the other hand, nonpecuniary aspects of the malpractice situation may still be an important deterrent to greater employment of allied health personnel.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID