摘要:

Questions have been increasingly raised about the value of performing right heart catheterization. A preliminary analysis done in 1992 revealed significant interhospital variation in the frequency of the procedure among Medicare Part A and Medicaid patients in New York State, and it also suggested that the procedure was being performed routinely in some hospitals. In 1993, IPRO initiated a cooperative health care quality improvement program involving the state's 53 catheterization laboratories. As a result of this educational intervention, the rate of bilateral catheterization among Medicare Part A patients fell from 89/100,000 beneficiaries in 1992 to 65/100,000 in 1996, and the overall percentage of catheterized Medicare patients undergoing bilateral catheterization fell from 30.5% in 1992 to 17.4%. A major question was whether a corresponding decrease had occurred among ambulatory patients (Medicare Part B). To determine the answer, the Medicare Part B database was analyzed for the identical period of time. It was found that the percentage of ambulatory Medicare patients who underwent bilateral catheterization at the 53 laboratories fell from 37.6% in 1992 to 17.0% in 1996, paralleling the decline observed among inpatients. The results of this quality improvement study show that an educational intervention directed at inpatient practice patterns can have a similar impact on outpatient patterns.

ISSN:0148-9917    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The need to develop reliable and valid measures of patient satisfaction in ambulatory care settings is underscored by the rapid growth and changes in this health care arena as well as the requirement to monitor and gauge quality of care. The purpose of this article is to provide evidence for the reliability and validity of patient satisfaction questionnaires designed specifically for three points of care across the ambulatory care continuum. These points are outpatient testing and physical therapy services, outpatient surgery, and home health care. The present effort represents an evaluation of revised questionnaires for the first two points and an initial assessment of the psychometric properties of the questionnaire for the third. The present results support the internal reliability and construct validity of each questionnaire. In addition, differences were found on select facility characteristics based on each questionnaire.

ISSN:0148-9917    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The study described in this article explored the relationships between primary care physician characteristics and patterns of managed care affiliation in a single region. Secondary data sources were used to investigate the affiliations of all primary care physicians in King County, Washington (Seattle and environs) with 29 managed care products in 1996. Descriptive findings indicate that specialty, board certification, and experience all are associated with the managed care affiliations held by physicians. Differences between managed care product provider lists suggest that there are different strategies for the design and management of provider networks.

ISSN:0148-9917    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The Episode Classification System is intended to perform two tasks. First, it will be a prospective capitation risk adjuster and predict future health care costs. It will do this by assigning each individual a single capitation risk adjustment category based on an analysis of the medical history and of health care services rendered during a specific period of time. Second, the Episode Classification System will create retrospective severity adjusted Episodes of Illness or Episodes of Care. These latter Episodes will provide a framework for relating patient characteristics to the amount, type, and duration of services provided during the treatment of a specific disease. These Episodes will give users the ability to understand past costs and the risk of mortality. As such they will form the basis for provider profiling by allowing users to analyze a complete clinical episode.

ISSN:0148-9917    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The purpose of this study is to identify groups of care episodes that involve pneumologic and cardiologic problems and that exhibit homogeneous patterns of frequentation and diagnostic test consumption in an ambulatory consulting room. A 1-year prospective study of care content was done, and the episodes were retrospectively analyzed 2 years later. Data were collected in an ambulatory cardiologic and pneumologic consulting room in Spain. Nonlinear principal components analysis was applied before cluster analysis. Five typologies with a homogeneous pattern of resource consumption were obtained: three related to acute episodes of care and two to chronic ones.

ISSN:0148-9917    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1999

数据来源: OVID