摘要:

Terminally ill cancer patients in a Veterans Administration hospital were randomly assigned to receive hospice care. Follow-up evaluation through the time of death revealed no significant differences in anxiety or depression between hospice or control patients, but hospice patients exhibited significantly greater improvement in two of three measures of satisfaction (interpersonal care and involvement in care decisions). Hospice patients' significant others (SOs) showed some decrease in anxiety and greater satisfaction with involvement in care than did control SOs. The differences were attributable in part to hospice staff better meeting SOs' perceived needs.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A quality assessment method using negative indexes of health as a measure of the quality of medical care was applied in a hospital-based primary-care group practice. During a 5-year period, records of 1,147 patients were analyzed. The study led to several observations regarding the use of this method in this setting: 1) The negative indexes of health method encourages physicians to include both primary and secondary preventive measures in their practice of medicine and to see their role as a broad one, from providing good care to individual patients to influencing public policy. 2) Most medical records do not now contain all the data required for use of this method. 3) In cases where this method identifies only a few instances of possibly preventable disease or untimely death, it is impossible to know whether the care is good and the method of evaluation is sensitive, or whether the care is poor and the method is insensitive to deficiencies in care.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Numerous changes in their operating environments have caused many public hospitals to experience serious fiscal deterioration. One increasingly common response to this situation is contracting with private organizations for the provision of total management services. This study examines the effects of these contract management arrangements on the operating performance of public hospitals. Three areas of performance are considered: operating efficiency, service structure, and Medicare/Medicaid case load. Eighty short-term public hospitals operating under contract management in 1980 are compared with 122 traditionally managed public hospitals and 74 hospitals 1-2 years prior to entering contract management. Controlling for a series of hospital and environmental variables, contract managed hospitals display several financial and organizational differences vis a vis the comparison groups. These findings are discussed in terms of their implications for policymakers, hospital managers, and researchers.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Teaching hospitals have higher charges than nonteaching hospitals, and teaching patients within a single institution incur higher charges than do private patients. Teaching hospitals claim that these higher charges are due to caring for patients with more complex illnesses. Critics claim that the increased charges arc primarily related to the hospitals' medical education function. Hospital charges and stay were compared across three physician groups: private patients with a community attending physician, teaching patients with a community attending physician, and teaching patients with a faculty attending physician. Severity of illness differences were controlled for by selecting patients from four Diagnosis Related Groups; refining these groups by surgical codes and age; identifying prehospital and inhospital severity of illness control variables; and omitting death and transfer cases in a second analysis. Least squares regression with logarithmic transformations of the dependent variables revealed that placement of patients on the teaching service with a faculty attending physician led to significantly higher charges as compared with private, nonteaching patients. The patients on the teaching service with a community attending physician did not incur significantly higher charges. It was also revealed that many severity of illness variables predicted a significant amount of variation in hospital charges, even after controlling for diagnostic group and teaching status of the patient.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Determinants of physician utilization were examined using a three-generational sample of Mexican-Americans in San Antonio. A typical version of Andersen's causal behavioral model was moderately successful in predicting physician utilization in the middle and older generations and less successful in the younger generation. Consistent with the literature, need factors (health indicators) tended to affect utilization most directly. The authors also examined whether acculturation into the larger society positively influenced utilization regardless of need, as the literature suggested. While three separate measures of acculturation had no independent effects on physician utilization, acculturation did affect utilization indirectly via the need variables in the middle generation, although these effects were not consistently in the direction of greater utilization. Generational differences in determinants of physician utilization arc discussed particularly in relation to the model's greater relevance for the middle and older generations.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Sociodemographic, health, and health care utilization data on a large representative sample of elderly and multiple logistic regression were used to compare persons making no visits to physicians for 2 years with those making few (one to three) visits but in contact with health practitioners. Results suggest that elderly nonusers are more likely than low users to be single, to have some degree of mental impairment, and to have low educational attainment. Using Cox's proportional hazards model to compare outcomes over the next 7 years, no differences were found in the subsequent hospitalization rate of the two groups, but nonusers were at greater risk of a hospitalization episode of 16+ days and appeared to die sooner than low users. However, they were at no greater risk of poor health outcomes than elderly making four or more physician visits in 2 years. The policy implications of the findings are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The purpose of the study was to determine the basis for nonpsychiatrists' decisions to obtain psychiatric consultations in an emergency department (ED) for patients with transient to moderate psychiatric symptoms. The authors reviewed ED records during July-August 1982 and January-March 1983. Complete data were gathered for 133 of 134 patients with primary or secondary psychiatricdischarge diagnoses and scores on the Global Assessment Scale (CAS) such that most clinicians would not think immediate consultation was required. Information included five sociodemographic variables, psychiatric history, GAS scores, type of interaction with staff, and specificity of medical complaints. Interrater reliability of GAS coding was 81%. A total of 50% of the patients received psychiatric consultations in the ED. Both psychiatric history and GAS scores were associated with consultations (P < 0.001 for both). Using stepwise logistic regression, psychiatric history was more important in predicting consultation (SRR = 3.0, P = 0.001) than was GAS score, which did not enter the model as a significant predictor. Social characteristics also distinguished between patients who received a psychiatric consultation in the ED and patients who did not. It was concluded that nonpsychiatrists base important management decisions on a history of psychiatric treatment for patients with transient to moderate symptoms. Whether this is appropriate needs to be studied.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Care of patients with osteoarthritis is compared for three different types of health service: fee-for-service, prepayment (Kaiser Health Plan), and an experimental service (Midpeninsula Health Service—MHS). While charging fees-forservice, MHS modifies medical practice in defined ways and seeks to involve patients through supervised self-care. Volunteer panels of patients provide the data at 6-month intervals through self-administered questionnaires. This report covers the first 18 months. Health status has not changed. Annualized utilization data, adjusted for age, income, education, pain, disability, disease duration, and prescription drug use, indicate that MHS members have fewer physician visits, fewer diagnostic tests, and-lower antiinflammatory drug use than the other two services. MHS members express satisfaction equal to or greater than other participants. The results suggest that, in addition to modified financial incentives, there is another strategy that is relevant to achieving effective, efficient, and satisfying health care.

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

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID