摘要:

The authors prospectively evaluated the usefulness of 12 preoperative tests (including blood type and screen) ordered selectively according to clinical status and importance of scheduled surgery. Two methods of assessing usefulness of tests were used, taking into account not simply their abnormality yield, but also their impact on patient care during the entire hospitalization: first, usefulness was assessed by anesthetists involved in care; second, usefulness was assessed by an automated analysis of specific clinical situations in which tests were a priori considered useful. In 3,866 patients 15,920 tests were performed; 30% of performed tests were abnormal. As a consequence of test results, surgery was delayed or cancelled in 19 patients and modified in 1, and a treatment was instituted or anesthetic management influenced in 347 (9%). Blood component therapy was instituted in 652 patients (17%). Anesthetists and automated analysis found at least one preoperative test useful in 931 patients (24%) and 890 patients (23%), respectively, whereas on a per-test basis 17% and 9% of tests were found useful. The discrepancy in usefulness assessment was mainly due to differences in evaluation of the usefulness of normal results. This study shows that the usefulness of selectively ordered preoperative tests may be high, but better criteria for their indications are needed, because tests other than those recommended by protocol were found useful.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

More than 1.5 billion prescriptions were dispensed from retail pharmacies in 1984 at a consumer cost of $18.4 billion. The number of prescriptions dispensed in 1984 equaled the previous record set in 1973. Over 40% of 1984 prescriptions were for four therapeutic classes: cardiovascular drugs, anti-infectives, psychotherapeutic drugs, and diuretics. Prescriptions for cardiovascular drugs and diuretics increased substantially from 1975 to 1984, while prescriptions for psychotherapeutic drugs decreased. Outpatient use of systemic antiinfectives remained fairly stable over the 10-year period. Trends in the use of specific drug categories within these broad therapeutic classes were variable, as were patient age and sex distributions.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

There are two conceptual problems with the study of the utilization of ambulatory care: 1) a problem of definition and 2) a problem of measurement. Large multivariate studies conceptualize utilization in a straightforward and static manner that is reflected in the way they measure utilization: as a sum of the number of visits to physicians over a period of time. However, utilization can be construed as a process occurring through time. The object of an analysis of utilization is to examine the causes of the changes in the levels of utilization patients undergo from one period to the next. In this paper, a Markovian model for studying utilization as a process is set up, using data on utilization from a sample of 2,149 patients from Montreal (1981). Results show that the effect of age and sex on utilization is not structured in the same way when using a Markovian model as when using a traditional model, where utilization is measured by the number of visits in one period. Thus, the results of large multivariate studies are most probably biased.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The present Medicare Diagnosis Related Group (DRG) classification system contains 95 DRG pairs, where one DRG of the pair contains patients within a distinct diagnostic category who are under 70 years of age with no comorbidities or complications (CCs). The other DRG of the pair contains patients in the same diagnostic category who are over 69 or who have CCs. This study examines whether it is appropriate for reimbursement purposes to group those patients who are 70 years of age or older but have no CCs with patients who have CCs. Our findings show that age alone, in the absence of CCs, increases length of stay and cost of care only slightly. In fact, using only CCs as a classification variable reduces the within-group variance more than the present classification based on both age and CCs. Therefore, it is inappropriate to group Medicare patients who are older than 70 years of age without CCs with Medicare patients who have CCs.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The growth of dental health services over the past 15 years has produced several issues in dentistry. Because economic markets are the cornerstone of dental delivery in the US, informed responses to these issues require a thorough understanding of dental-care markets. The empirical literature is reviewed to examine the structure of dental markets, to assess the major determinants of market equilibrium, and to examine the social and health consequences of dental-care markets. Results reveal that while dental markets are imperfectly competitive, it is unclear whether prices exceed competitive levels. Little is known about the effects of dental markets on public oral health and society. Future research is proposed in two broad areas: 1) updating early studies conducted when few Americans had dental insurance benefits; and 2) path-breaking research to advance our knowledge of dental-care markets in particular and medical-care markets in general.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In this study the existing forms and amounts of cost-sharing in the Republic of Serbia (Yugoslavia) are analyzed. The level of cost-sharing is ranked according to the number and type of services involved and the relative importance with which they are viewed within the overall health-care policy of Yugoslavia. The “self-managing community of interest of health care,” administratively coincident with the district, is taken as the unit of observation. Until recently, these bodies independently decided whether to introduce cost-sharing as well as the rate of cost-sharing. Therefore, the implementation of this health-policy measure differed among the districts generating inequality within health-care system. The results of simple and multiple correlation indicate that poorer districts with fewer health resources and lower levels of consumption introduced cost-sharing for more services, attempting to provide additional resources for financing of the health-care system. The multiple linear-regression model shows that population/physician ratio and the use of primary care physicians' services are the significant indicators of health-care expenditures in this territory. Considering the current economic situation in Yugoslavia and the level of development of the health-care system, the results of this cross-sectional study imply that cost-containment in health care can be achieved in a more equitable and effective manner by controlling supply of health services than by limiting demands.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The growing literature on multihospital systems (MHS) has concentrated on assessing system performance without a concurrent examination of the assumptions related to the conditions under which hospitals and systems affiliate with each other. Using a net present-value framework the current study develops and tests a model that explains the entry patterns of hospitals into multihospital systems. Specifically, we assess the role of the hospital's market, management activity, and mission compatibility with the system as predisposing conditions of MHS affiliation. The model is tested on a sample of 306 affiliated and 918 nonaffiliated hospitals under conditions of market equilibrium and disequilibrium, and for hospital entry into both non-profit and investor-owned multihospital systems. Results suggest that the relative impact of market factors, hospital management characteristics, and mission compatibility on MHS entry will vary systematically as a function of assumptions about the hospital's market and the type of system with which the hospital affiliates.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In this secondary analysis of data from the National Hospice Study (NHS), a new measure, quality of death (QOD), was developed by weighting reports of cancer patients' last 3 days of life by what patients wanted their last 3 days to be like. Using analysis of covariance, the QOD scores were higher for terminally ill patients in hospices (either home-care [HC] or hospital-based [HB]) than similar patients who received conventional care (CC). The results are discussed in terms of verification of the hospice philosophy and other uses for a quality of death measure.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The delivery of ambulatory mental health and general health services to persons with phobias (unweighted n=1,689) and without phobias during a 6-month period are examined. The phobics were part of a larger study of 18,572 subjects, drawn as a representative sample of the population in five locations, as part of the Epidemiologic Catchment Area Program (ECA). Among phobic conditions, agoraphobia most often leads to use of services related to emotional problems, especially in the specialty mental health sector. There were no significant differences between male and female subjects in their use of the various sectors for a mental health reason. The highest age group of agoraphobics that used health services most often was 25-44 years old, and the group that used them least often was 65 years and older. Agoraphobics with four or more symptoms of panic use services in higher proportions than agoraphobics with zero to three panic symptoms. The authors observe that a very large proportion of phobics report seeking no help from any source.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The purpose of this study was to describe the content of prenatal care in the United States over time. Secondary data sources were reviewed and selected data were analyzed, mainly in the last two decades. Data reviewed included special surveys from the National Center for Health Statistics, advice given by professional organizations, obstetric textbooks, commercial advertisements in obstetric journals, and occasional surveys. The data suggest that American prenatal care has emphasized screening for biomedical problems, while health education and support functions have been less central. It appears that some prenatal practices from earlier years, such as strict weight-gain restriction, wide use of diuretics and some other drugs, use of x-ray, have been harmful.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID