摘要:

This study investigates the relationship between chronic poor health and school outcomes among children. A simultaneous three-stage least squares model is estimated in which achievement and attendance are endogenous variables. The hypothesis that particular health characteristics are associated with differences in individual school outcomes is confirmed. For example, attendance is affected most by illnesses likely to interfere with school or peer interactions or difficulty doing only strenuous activity. Achievement is lowered by moderate to severe psychologic problems. Including attendance as an endogenous variable increases its significance. Other socioeconomic and school variables, such as mother working, marital status and special schooling, are included in the model. Policy implications are suggested.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A method was developed and tested to analyze the efficiency of medical care using each patient's length of hospital stay (LOS) and comparing these LOS with patients with similar diagnoses, ages, and operative conditions. The method assigns a percentile score to each discharged patient's LOS in comparison with the group of patients in the referent population with the same medical condition. A percentile score calculated in this way removes the effect of case mix and intensity of service from each patient's LOS, and allows the efficiency of medical care to be analyzed. This method was applied to patients who were discharged from a secure unit of a general hospital that serves the tertiary medical needs of patients from the state's correctional system. The LOS for our patients on average corresponded to the 60th percentile for the LOS in other patients with comparable ages and medical conditions. This difference was significantly greater than an expected value of 50.0 (P < 0.01). The LOS of patients discharged from each specialty service were examined. Two services were identified, in which an increased LOS represented a difference in the practice patterns of physicians in these specialties, in comparison with those of other physicians in this area. An application of the method described in this report should enable hospitals to identify units or services where patients are managed inefficiently and to guide the need for managerial intervention.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The relative homogeneity of medical, surgical, and psychiatric diagnosisrelated groups (DRGs) are examined. Using data from the State of Maryland and the Health Care Financing Administration we studied the amount of variation in resource utilization within the DRGs. The estimated coefficients of variation of resource utilization for the surgical DRGs were found to be significantly smaller than those estimated for both medical and psychiatric DRGs. The authors were unable to reject the hypothesis that the coefficients of variation for medical and psychiatric DRGs were different. These results suggest that hospitals are at substantial but equal risk under a DRG-based payment system for both medical and psychiatric DRGs.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

In 1977, the American Heart Association recommended that patients with mitral valve prolapse (MVP) and mitral insufficiency receive antibiotic prophylaxis prior to procedures that place them at risk for bacterial endocarditis. To study how clinicians conformed to this recommendation, the authors selected 126 patients with MVP admitted to a University Medical Center in 1978, the year following the official policy. Overall, only 47 patients (37%) had the antibiotic prophylaxis recommended. Furthermore, information that might have increased the certainty of diagnosis of MVP or the likelihood of mitral insufficiency did not influence the physician's decision: symptoms, previous history, procedures, sex, evidence for mitral insufficiency, other serious illnesses, or the use of cardiac medications. However, patients seen in consultation by a cardiologist were much more likely to have prophylaxis recommended (P < 0.05). It was concluded that the application of an official policy about prophylaxis for a condition such as MVP, where the risks are uncertain, is likely to be guided by other factors, such as the opinions of local experts.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A set of 15 self-administered case histories were developed, each consisting of a short case followed by a standard format on which desired tests were checked. After pilot testing the case histories within a group of doctors, the authors selected the ten cases with the highest item-total correlations that also provided a broad clinical spectrum. Using a different group of 19 doctors, test-ordering on the questionnaire was compared with actual test-ordering in clinical practice. Questionnaire test-ordering did not reflect practice behavior; in fact, the relationship tended to be inverse (r = -0.43: P < 0.10). Adjusting for casemix variation by including only those practice cases with diagnoses similar to questionnaire cases did not improve its performance (r = -0.50: P < 0.05). These findings suggest that test-ordering on case history questionnaires may not reflect actual practice behavior. Conclusions about test-ordering behavior and management strategies to alter it should not be based on results from questionnaires that have not been validated against actual practice.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The present study compares patient satisfaction scores with job satisfaction scores of the physicians providing their care in 16 general internal medicine teaching hospital group practices. Practice sites with more satisfied patients were also more likely to have more satisfied housestaff and faculty physicians. Additionally, higher satisfaction scores for both physician groups and patients were consistently associated with a greater percentage of patients experiencing continuity of care, lower patient no-show rates, more efficient use of ancillary staff in providing direct patient care, and more reasonable charges for a routine follow-up visit. These findings suggest that improving physician and patient satisfaction may have economic as well as psychological and social benefits.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

In studies of the effectiveness of health care organizations, the job satisfaction level of professional staff is often viewed as an “outcome,” since providing a climate that satisfies participants' needs is one aspect of organizational effectiveness. Staff satisfaction, however, has not been linked with outcomes associated with clients. In this article, the authors examine the relationship between the aggregate job satisfaction level of nursing staff in 77 family planning clinics and two client outcomes: 1) the aggregate satisfaction level of teenage clients with contraceptive services obtained in the clinic, and 2) the subsequent rate of client compliance with contraceptive prescriptions. Among the variables studied in testing an organizational-level model, it is found that the job satisfaction level of nursing staff is the strongest determinant of the aggregate satisfaction level of clients; client satisfaction level, in turn, predicts the rate of clients' subsequent contraceptive compliance. Staff satisfaction has a noteworthy indirect effect on compliance through client satisfaction. Compliance, however, appears to be more susceptible to variations in clinic structure than to variations in staff satisfaction levels. Implications of these findings for studies of effectiveness of health services and for management of health care organizations are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This study examines the impact of hospital participation in multi-institutional arrangements on formal relationships between hospital governing boards and chief executive officers (CEOs) and between governing boards and hospital medical staffs. Hypotheses are derived from Mintzberg's general theory of organizational design and are tested using combined data from three American Hospital Association Surveys of nonfederal, short-term hospitals. Analysis results provide considerable support for the study hypotheses. CEOs were found in general to have more formal influence in decisionmaking but also were more likely to be held accountable for performance standards in those hospitals that are part of multi-institutional arrangements. In addition, analyses using both 1976 and 1982 survey data indicate that hospital participation in multi-institutional arrangements is associated with lower levels of formal involvement of the medical staff in institutional decisionmaking. Relationships, for the most part, remain unchanged after the introduction of statistical controls for hospital size. One important issue raised by these findings is the possible impact on hospital performance of less participation by medical staff in the governance of hospitals whose boards are either responsible for multiple hospitals or accountable to higher organizational authority.

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