ISSN:0025-7079    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objectives.Tertiary prevention seeks to reduce chronic disease progression and illness-related dysfunction. Using the Aday-Andersen model, we evaluated the impact of predisposing, need, and enabling factors on tertiary prevention, hypothesizing that urban-rural geographic differences in delivery would be detected.Methods.A population-based telephone survey was conducted evaluating six common chronic indicator conditions: arthritis (n= 488), hypertension (n= 414), cardiac disease (n= 185), diabetes mellitus (n= 125), peptic ulcer disease (n= 125), and chronic obstructive pulmonary disease (n= 103). Subjects were 787 (70% women) home-dwelling elderly (age > 65 years) who had one or more of the indicator conditions and who resided in Iowa's 12 most rural and 10 most urban counties. Tertiary prevention measures included counseling for and/or treatment with: influenza and pneumococcal vaccination, smoking cessation, dietary modifications, exercise, drug side effects, chronic disease rehabilitation, aspirin/estrogen for cardiac disease, and foot/eye care for diabetes. Tertiary prevention scores were calculated to compare preventive services across disease categories and to examine relations, in particular, with enabling factors.Results.Education beyond high school, alcohol use, cigarette smoking, and medical specialist use were all significantly greater among urban residents, whereas home services use was greater among rural residents. Respondents with either health maintenance organization or fee-for-service supplemental coverage had higher tertiary prevention scores than respondents without supplemental coverage. After adjustment for the significant effects of the number of diseases, higher income, and place of residence, rural respondents having health maintenance organization supplemental coverage had higher (better) tertiary prevention scores than other respondents.Conclusions.In this community-based study of elderly, enrollment in an health maintenance organization plan, as opposed to a fee-for-service supplement to Medicare, increased tertiary prevention quality for rural but not for urban residents. This study emphasizes that additional research is needed to evaluate the importance of specific types of insurance coverage for preventive services among the elderly.

ISSN:0025-7079    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objectives.The authors describe the relation of provider characteristics to processes, costs, and outcomes of medical care for elderly patients hospitalized for community-acquired pneumonia.Methods.Using Medicare claims data, Medicare beneficiaries discharged from Pennsylvania hospitals during 1990 with community-acquired pneumonia were identified. Claims data were used to ascertain mortality, readmissions, use of procedures and physician consultations, and the costs of care. The relationship of these measures to provider characteristics was analyzed using regression techniques to adjust for patient characteristics, including comorbidity and microbial etiology.Results.Among 22,294 pneumonia episodes studied, 30-day mortality was 17.0%. After adjusting for patient characteristics, 30-day mortality and readmission rates were unrelated to hospital teaching status or urban location or to physician specialty. Use of procedures and physician consultations was more common and costs were 11% higher among patients discharged from teaching hospitals compared with nonteaching hospitals. Similarly, costs were 15% higher at urban hospitals compared with rural hospitals. General internists and medical subspecialists used more procedures and had higher costs than family practitioners.Conclusions.Processes and costs of care for community-acquired pneumonia varied by provider characteristics, but neither mortality nor readmission rates did. These differences cannot be explained by clinical variables in the database. Further studies should determine whether less costly patterns of care for pneumonia, and perhaps other conditions, could replace more costly ones without compromising patient outcomes.

ISSN:0025-7079    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objectives.An understanding of the validity and usefulness of self-reported measures (as distinct from clinically determined measures) of oral health is emerging. These self-reported measures include self-rated oral health (SROH). Three objectives were to: (1) describe self-rated oral health in dentate adults, (2) quantify associations between self-rated oral health and other measures of oral health (oral disease and tissue damage, pain and discomfort, functional limitation, and disadvantage), and (3) assess the construct validity of a model of oral health proposed herein.Methods.The Florida Dental Care Study is a longitudinal study of oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination.Results.The prevalence of self-rated oral health decrements was substantial; approximately one fourth of subjects reported their oral health as only fair or poor. Bivariate and multivariate results provided consistent evidence of the construct validity of the proposed model of oral health. Additionally, the salience of one measure of dental appearance suggests that persons may use esthetic cues when rating their oral health.Conclusions.The proposed multidimensional model of oral health has construct validity. Self-rated oral health is affected by oral disease and tissue damage, oral pain and discomfort, oral functional limitation, and oral disadvantage. These self-reported measures and the proposed model should provide useful information for dental care effectiveness research. General health status has been disaggregated into the "physical" and the "mental;" an additional separation into the "oral" aspects of health seems warranted.

ISSN:0025-7079    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objectives.This study uses the recently developed Network-Episode Model (NEM) to examine the nature and correlates of utilization among Puerto Ricans reporting mental health problems. The NEM highlights two issues: (1) examining the patterns or combinations of lay and formal use that individuals employ and (2) reformulating how the availability and content of social networks influences patterns of care.Methods.Using data from the 1989 Mental Health Care Utilization Among Puerto Ricans Study (probability sample of 1,777 individuals living in low-income areas of the island), the authors focus on the patterns and correlates of use for 365 Puerto Ricans reporting service use for mental health problems in the previous year.Results.A combination of clustering and multinomial logit techniques indicates that there are six unique care patterns. Two patterns include the use of mental health providers and are associated with different contingencies.Conclusions.In general, patterns of use are shaped by age, education, gender, and illness severity. Larger, more supportive networks decrease the use of patterns of care that include formal health care providers, and decrease direct entry into the mental health sector. These results are in line with NEM's predictions for lower class populations and help clarify inconsistencies in previous research on social networks. The implications of this perspective for health services research and treatment are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objectives.Many reports indicate that patients with combined chronic illness and depressive symptomatology have more disability than those with illness alone, which may influence physician visits. Studies suggest that these combined conditions are unevenly accommodated by the delivery system and nonpsychiatric physicians often fail to recognize or treat these symptoms. To address this need, this study aimed to provide further information on combined conditions and report on relations found among arthritis disease symptoms, depression, and disability.Methods.The data was derived from a series of statewide surveys assessing the influence of psychosocial factors on disease course and treatment in a community sample of 277 patients under the care of a rheumatologist. A multivariate model was developed to assess these interrelationships, using measures of symptom severity, depression (CESD), disability (activities of daily living, days of restrictive activities, days in bed), service utilizations, and a few personal and health variables.Results.Even after removing somatic items from the CESD to reduce the risk of inflation due to physical disease, evidence was found for additive impact of depression on one measure of disability, days of restrictive activities. Patients with comorbid conditions also were a high-service utilization group. Very few patients reported receiving help in dealing with emotional problems, suggesting presence of substantial unmet need.Conclusions.Nonpsychiatric physicians need to be aware of the mental health status of chronically ill patients. Although the association between medication use and depression suggests some awareness of the need to treat depression, especially in physically compromised patients, there may be some need to dispense psychological and psychosocial support to those in need.

ISSN:0025-7079    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objectives.The objective of this study was to explore the use of the Clinical Classification for Health Policy Research (CCHPR) as a casemix adjustment method for examining physician practice patterns.Methods.The data source was 2 years of administrative claims from an 86,000 member health maintenance organization in southeastern Michigan. The CCHPR version 2 algorithm, which is in the public domain, was used to assign each claim to one of 260 clinical categories. CCHPR and age-sex categories were used as explanatory variables in multiple linear regression models with approved claims payments in dollars as the outcome variable. Regressions were performed retrospectively for 1994 and 1995, and with 1994 claims' history to predict 1995 utilization. Similar regressions were performed with age-sex categories alone, and also with the ambulatory diagnostic groups.Results.The adjusted R2value of the retrospective regression models for total approved dollars was 0.42 for both study years when CCHPR categories were used. In contrast, age-sex explanatory variables alone achieved an R2of 0.02.Conclusions.The CCHPR method appears to be a promising tool to understand variability in physician resource utilization in managed care.

ISSN:0025-7079    

出版商:OVID    

年代:1998

数据来源: OVID