摘要:

To determine the convergent validity of four methods of physician assessment—physician interview, patient interview, chart audit, and videotaped observation—these methods were compared for their ability to detect medication regimens prescribed for patients with chronic obstructive pulmonary disease (COPD). Comparisons of data from the four methods revealed substantial discrepancies among them. In fact, the methods were in full accord only 36% of the time in detecting theophylline prescription, and even less often for the other COPD medications. According to physician interview, 78% of patients were on theophylline; chart audit revealed 62% of patients were on the medication; videotaped observation, 69%; and only 59% of patients reported themselves to be on theophylline. An iterative analysis, applied to determine which method most accurately captures data, revealed that reports from physician interviews were the most precise source of data. Although the order of merit was much the same for each of the drugs studied, there were some differences in levels of sensitivity across drugs. Specificities were consistently high for all drugs and all methods.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Laboratory tests are responsible for a large percentage of health care expenses in the United States. In a retrospective study of the outpatient test ordering by residents for hypertensive patients between the years 1980 and 1986 at the Department of Family Medicine at the Medical University of South Carolina, we found great variability in laboratory test ordering as well as an association between personality as measured by the Myers-Briggs Type Indicator (MBTI) and test ordering. Introverts ordered more than extroverts, and intuitives ordered more than sensors. This association was confirmed by a multiple regression analysis controlling for potential confounders of test ordering, such as severity of disease, the presence of coexisting diabetes mellitus, the demographic characteristics of the patient population, and the number of initial evaluations for hypertension. Elucidation of a relationship between resident personality and laboratory test ordering has important implications for planning intervention strategies to reduce excessive laboratory test ordering in ambulatory care.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This article reports the results of a regression-based cohort analysis of physician utilization rates among eight 4-year cohorts of elderly Americans over an 8-year period. Data on 99, 445 noninstitutionalized individuals aged 56–95 were taken from the pooled 1972–73, 1976–77, and 1980–81 Health Interview Surveys. The parameters of the behavioral model of health services utilization were then estimated separately for each cohort within each pooled survey. The partial unstandardized regression coefficients obtained were used to construct standard cohort tables, which were then visually and statistically compared to identify any changes due to aging, period, or cohort effects. The findings suggest that the declining rate of physician utilization among the oldest-old results from an accelerated decreased response to health-related limitations in activity. Six plausible explanations for this changing response are considered.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Sixty nursing homes were randomly allocated to receive or not to receive a quality assurance intervention. The experimental intervention included the use of predeveloped quality assurance packages, the services of a quality assurance consultant, and the process of working through the quality assurance cycle with one of two principal indicator conditions. Two prevalent health problems, hazardous mobility and constipation, were selected as the principal indicator conditions. To detect co-intervention, one of two hidden secondary indicator conditions (potential skin breakdown and urinary incontinence) was assessed in each facility. In the control nursing homes, both the principal and secondary indicator conditions were hidden from staff. The care for 1,525 residents was examined before and after the intervention using a retrospective record review initiated for the study purposes. Improvement in management of the principal conditions, hazardous mobility and constipation, was greater in the experimental group (P< 0.03 andP< 0.005, respectively). Neither group changed its management of the hidden conditions. Behavior change was achieved using quality assurance-linked interventions. Further research should focus on refining quality assurance interventions that provide staff education and motivational strategies.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A randomized controlled trial was conducted to assess efficacy and cost of sustained home nursing care for patients with chronic lung disease. Three hundred one patients were randomly assigned to a respiratory home care group (RHC) that received care from respiratory home care nurses, a standard home care group (SHC) that received care from regular home care nurses, or an office care group (OC) that received whatever care they needed except for home care. Patients were followed for 1 year. At the end of the study year, there was no difference in survival, pulmonary function, or everyday functioning among the three groups. Average annual cost of care for all study patients was $7,647 (1981–82 dollars). The average annual health care costs for patients in the RHC group was $9,768; for those in the SHC group, $8,058; and for those in the OC group, $5,051 (P= 6.45, df = 2/298,P= 0.02). These results suggest that the current policy of limited coverage of home nursing services by Medicare and other third-party payers may be appropriate.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To determine the effect of a self-care communication-based health education program on ambulatory care utilization, a prospective, randomized, controlled trial was conducted with a Medicare population within a health maintenance organization. A statistically significant decrease of 15% in total medical visits was found in the experimental group as compared with a control. Although not evident in the control, a statistically significant decrease in the ratio of follow-up visits from pre-entry to postentry was realized in the experimental group. Medical-visit decreases resulted in a savings of $36.65 per household in the experimental group for a benefit-cost ratio of 2.19 saved for every dollar spent on intervention. These results demonstrate that a health education program can reduce utilization while having no known negative impact on the quality of health.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The number of female veterans has more than doubled in the last 15 years, and this growth is expected to continue. This study examines the current utilization of both overall and Veterans Administration (VA) health care services by female veterans. Current utilization is studied as a set of contact decisions: whether or not to utilize any inpatient, VA inpatient, any outpatient, and VA outpatient services. Probit regression is used to estimate these dichotomous choices. Results indicate that health status and some demographic variables are significantly related to the use of all four types of care. In addition, use of other VA benefits, the absence of private insurance coverage, and low income are predictors of use of the VA.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The cost of obstetric care delivered in a cooperative care unit was compared with the cost for similar patients treated in a traditional inpatient maternity unit. The study sample contained 1,683 consecutive patients representing 23 diagnosis categories. The analysis indicates that cooperative care patients had significantly lower total hospital costs. This cost savings persisted even when we controlled for case severity. The only exception was for the obstetric patient requiring intra-abdominal surgery. For fiscal year 1986, hospital cost savings for the 576 patients who used the cooperative care unit was $80,640 or approximately $105,000 in total patient charges. The majority of the savings came from a reduction in routine nursing services that are directly attributable to the cooperative care unit. We conclude that cooperative care can be an economically feasible alternative for most obstetric patients.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Using data from a survey of internists, family and general practitioners, and obstetricians and gynecologists, and of women in Maryland, this article examines congruence between physicians' recommendations and women's Papanicolaou (Pap) testing behavior. Both the specialty of the physicians and the age of the women are considered. The majority of all three physician specialties recommended annual Pap tests for all their patients. However, the internists and family or general practitioners were less likely to recommend annual Pap smears for their elderly patients than for their younger patients. Obstetrician-gynecologists were consistently more likely than the other specialties to recommend zannual Pap tests, to send postcards to their patients reminding them to come in for Pap tests, and to view themselves as successful in inducing their patients to come in for routine Pap testing. Both the physicians and the women reported that elderly women were less likely than younger women to receive care from obstetrician-gynecologists. Women's reported Pap testing behavior indicated that they received Pap tests with far less frequency than the physicians recommended. Older age was related to less frequent Pap testing, while having a visit with an obstetrician-gynecologist was related to increased frequency. Findings indicate the need for education of physicians about methods of improving women's attendance for Pap testing and of women about the importance of routine Pap testing.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We evaluated the usefulness of commonly ordered routine admission laboratory tests in 301 patients admitted consecutively to the internal medicine wards of a university teaching hospital. Using a consensus analysis approach, three Department of Medicine faculty members reviewed the charts of admitted patients to determine the impact of the test results on patient care. The evaluated tests were the urinalysis, hematocrit, white blood cell count, platelet count, six-factor automated multiple analysis (serum sodium, potassium, chloride, bicarbonate, glucose, and blood urea nitrogen), prothrombin time, partial thromboplastin time, chest x-ray, and electrocardiogram. Forty-five percent of the 3,684 tests were ordered for patients without recognizable medical indications. Twelve percent of these routine tests were abnormal, 5% led to additional laboratory testing, but only 0.5% led to change in the treatment of patients. We conclude that the impact of routine admission laboratory testing on patient care is very small and that there is little justification for ordering tests solely because of hospital admission.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID