摘要:

While nonpsychiatrist physicians account for the majority of prescriptions written for psychotropic drugs, little is known about the quality of their drug management strategy. We studied this issue using data from 16 academic internal medicine group practices. Data on treatment, abstracted from medical records, were compared to criteria for quality care. Eighteen percent of patients used minor tranquilizers or antidepressants. The only individual factor independently associated with use of minor tranquilizers was mental health status. Nonwhites were less likely than whites to be diagnosed as depressed or receive antidepressants, even after controlling for baseline mental and physical health status. Mental and physical health status were also independently associated with antidepressant drug use. Quality of care was low for formulating a treatment plan for either drug group and for follow-up plans for antidepressants. Documentation of an adequate treatment plan for minor tranquilizers was poorest for patients who visited a house staff or nonphysician rather than a faculty member. For antidepressants, the patients with the poorest general health status tended to have the best documentation of treatment plans.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This article summarizes the results of 41 independent studies containing correlates of objectively measured provider behaviors in medical encounters. Provider behaviors were grouped a priori into the process categories of information giving, questions, competence, partnership building, and socioemotional behavior. Total amount of communication was also included. All correlations between variables within these categories and external variables (patient outcome variables or patient and provider background variables) were extracted. The most frequently occurring outcome variables were satisfaction, recall, and compliance, and the most frequently occurring background variables were the patient's gender, age, and social class. Average correlations and combined significance levels were calculated for each combination of process category and external variable. Results showed significant relations of small to moderate average magnitude between these external variables and almost all of the provider behavior categories. A theory of provider-patient reciprocation is proposed to account for the pattern of results.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

An interest in using nosocomial infection rates as an outcome measure to reflect quality of care in hospitals prompted us to consider factors in addition to quality that influence these rates. Approximately one third of nosocomial infections are potentially preventable, and changes in this “preventable” stratum of infections should reflect variations in quality. However, it will be necessary to identify those potentially preventable infections by calculating rates which are adjusted for intrinsic patient risk. Five other factors necessary for nosocomial infection rates to be a valid and reliable indicator of quality include identification of critical indicators (e.g., types of infection) and sampling schemes that most accurately reflect variations in quality; adoption of standardized, objective definitions of site-specific nosocomial infections; adoption of universal denominators across institutions; development of a monitoring system to assess compliance with surveillance and reporting procedures; and the adoption of more standardized training for infection control practitioners.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This study analyzed the early effects of the Medicare Prospective Payment System (PPS) on the likelihood of hospital’s discharging Medicare beneficiaries to skilled nursing facilities (SNFs), intermediate care facilities (ICFs), and home health agencies. It also examined length of stay before transfer. Discharge abstract data on patients in five DRG groups were studied. Data were obtained from 501 hospitals for the third quarters of 1980, 1983, 1984, and 1985. Multinomial logit and ordinary least squares regression techniques were employed.After controlling for hospital and patient characteristics, including severity of illness, it was found that the probability of transfer increased substantially in virtually all DRGs and discharge destinations studied. This was particularly true for patients with stroke, pneumonia, and major joint and hip procedure.The analysis reveals that PPS increased the rate of discharges to subacute facilities. This effect was stronger for transfer to SNFs than to ICFs and home health agencies. Further, the impact of PPS on transfers was greater in 1985 than in 1984. Lengths of stay before transfer tended to decline in almost all DRGs and destinations examined. However, the effects of PPS on lengths of stay of transferred patients were not statistically significant at conventional levels. The results suggest that payment experiments with broader forms of bundled services are in order, as are experiments with hospital acute-subacute swing beds.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A multifaceted intervention was hypothesized to increase postdischarge ambulatory contacts and to reduce nonelective readmissions. Patients (N=1,001) discharged from the general medicine service were stratified by risk for nonelective readmission and randomized to the control or intervention group. Intervention patients received phone calls from nurses, mailings of appointment reminders and lists of early warning signs, and prompt rescheduling of visit failures. Patients were followed for 6 months, and the results were computed in units per patient per month. The intervention group had 10.4% more total office contacts (0.53 vs 0.48, P=0.005) than the control group. Although the intervention group had 7.6% fewer nonelective readmission days (0.85 vs 0.92), this was not statistically significant (P=0.5). Patients in the intervention group at high risk (N=181) had 28.1% more office visits (0.73 vs 0.57, P<0.01) and 31.9% fewer nonelective readmission days (1.13 vs 1.66), but this was also not statistically significant (P=0.06). Thus, the intervention significantly increased postdischarge contacts, primarily in high-risk patients, but failed to reduce the incidence of nonelective readmission days significantly.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A 14-item, self-administered, multidimensional, functional social support questionnaire was designed and evaluated on 401 patients attending a family medicine clinic. Patients were selected from randomized time-frame sampling blocks during regular office hours. The population was predominantly white, female, married, and under age 45. Eleven items remained after test-retest reliability was assessed over a 1- to 4-week follow-up period. Factor analysis and item remainder analysis reduced the remaining 11 items to a brief and easy-to-complete two-scale, eight-item functional social support instrument. Construct validity, concurrent validity, and discriminant validity are demonstrated for the two scales (confidant support—five items and affective support —three items). Factor analysis and correlations with other measures of social support suggest that the three remaining items (visits, instrumental support, and praise) are distinct entities that may need further study.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID