摘要:

The purpose of this study is to group hospital-based home care (HBHC) patients homogeneously by their characteristics with respect to cost of care to develop alternative case mix methods for management and reimbursement (allocation) purposes. Six Veterans Affairs (VA) HBHC programs in Fiscal Year (FY) 1986 that maximized patient, program, and regional variation were selected, all of which agreed to participate. All HBHC patients active in each program on October 1,1987, in addition to all new admissions through September 30,1988 (FY88), comprised the sample of 874 unique patients. Statistical methods include the use of classification and regression trees (CART software: Statistical Software; Lafayette, CA), analysis of variance, and multiple linear regression techniques. The resulting algorithm is a three-factor model that explains 20% of the cost variance (R2= 20%, with a cross validation R2of 12%). Similar classifications such as the RUG-II, which is utilized for VA nursing home and intermediate care, the VA outpatient resource allocation model, and the RUG-HHC, utilized in some states for reimbursing home health care in the private sector, explained less of the cost variance and, therefore, are less adequate for VA home care resource allocation.

ISSN:0025-7079    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The effects of sociodemographic factors on health service use among people with human immunodeficiency virus (HIV) infection are assessed. Data are from a survey of 939 clients of the Robert Wood Johnson Foundation's AIDS Health Services Program in nine communities across the country. Dependent variables are the number of outpatient visits, use of the emergency room, and whether the respondent had been admitted as an inpatient. In the 3 months before the interview, the sample averaged 7.46 outpatient physician/clinic visits: 35.9% reported an emergency room visit, and 29.9% had been hospitalized. The data suggested differential patterns of health service use, such that those who are white, male, and non-intravenous drug users have higher rates of outpatient clinic/physician use, whereas those who are nonwhite, female, and intravenous drug users have higher rates of emergency room use. Whether these observed differences are attributable to the system's response to different socioeconomic groups, or to differences in individual orientations toward use of medical care is discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This study examines utilization of physician services using a sample of 17,110 children younger than 18 years from the Child Health Supplement to the 1988 National Health Interview Survey on Child Health. Although children averaged 3 contacts with physicians, 21% of children did not use physician services and 7% had 10 or more contacts and accounted for 37% of all contacts for children during 1988. Age and ethnicity of the child; family income, health insurance status, size, and area of residence; and mother's educational attainment were important sociodemographic correlates of low usage. In contrast, demographic and socioeconomic characteristics were found to be only modest predictors of high usage. Children's health characteristics, especially number of childhood health conditions, were highly predictive of both high and low physician services usage. Compared with children who had no reported conditions, children with multiple conditions were eight times as likely to be high users and were only a fourth as likely to be low users. Implications of these results are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This study examines the determinants of area-level variation in Medicare home health use in 1985 for the entire United States, using data from Medicare Home Health Bills, the Medicare/Medicaid Automated Certification System, the Medicare Provider Analysis and Review Files, and other sources. Weighted two-stage least squares regression was used to analyze variation in the number of home health users per 1,000 enrollees and the average number of visits received per user. The data were aggregated to the Metropolitan Statistical Area and the rural part of the state, resulting in 343 units of analysis. According to the study's results, higher proportions of Medicare enrollees use home health services in areas with fewer nursing home beds per enrollee, higher hospital discharge rates, and shorter mean lengths of stay, higher Medicare reimbursement ceilings for skilled nursing home health visits, and more home health agencies per enrollee. Other things being equal, beneficiaries in New England are 40% more likely to use home health services than their counterparts in other regions with similar climates. The average number of visits received by home health users appears to be higher in areas where there are more agencies per enrollee and a higher share of agencies that are proprietary. There also appear to be large regional differences in the number of visits received per user. Our results imply that constrained access to nursing home beds is leading to higher levels of Medicare home health use and that there may be further savings from the substitution of home health services for hospital days. The study shows that Medicare reimbursement ceilings may constrain use and that access may be a problem for beneficiaries in areas with fewer agencies per enrollee. This study also points to significant regional variation in the proportion of beneficiaries who use home health services, even with controls for many different explanatory variables. Overall, our results suggest the possibility of serious limitations in access to Medicare home health services.

ISSN:0025-7079    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This study examines the degree to which patient characteristics predict physicians' ad hoc decisions regarding acceptance of Medicare assignment. The study is based on a random sample of Medicare Part B enrollees living independently in the Salem, Oregon metropolitan area. Beneficiary characteristics and beneficiary reports of physician behavior are obtained from an hour long face-to-face survey. The findings show that patient characteristics are significant predictors of physician behavior. Those respondents with poor health, no supplementary coverage to Medicare Part B, and who are more sensitive to the cost of health care are significantly more likely to report that their physician accepts assignment than are respondents without these characteristics. Policy and research implications are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Among a sample of 119 distressed high-utilizers of primary care, 45% of patients evaluated by a psychiatrist as needing antidepressant treatment had been treated in the year before the examination. However, only 11% of the patients needing antidepressants had received adequate dosage and duration of pharmacotherapy. In the year following the intervention, study patients whose physicians were advised regarding treatment during a psychiatric consultation were more likely to receive antidepressant medications (52.7%) relative to a randomized control group (36.1%). However, the intervention did not significantly increase the provision of adequate antidepressant therapy (37.1% vs 27.9%). Among study patients using antidepressants, patient characteristics did not differentiate patients who received adequate dosage and duration of antidepressant medications from those who did not. Analysis of data on the duration of antidepressant therapy for all health maintenance organization enrollees initiating use of antidepressants showed that only 20% of patients who had been given prescriptions for first-generation antidepressants (amitriptyline, imipramine, or doxepin) filled four or more prescriptions in the following six months, compared to 34% of patients who had prescriptions for newer antidepressants (nortriptyline, desipramine, trazodone and fluoxetine). Experimental research evaluating whether these newer medications (with more favorable side effect profiles) improve adherence, and thereby patient outcome, is needed.

ISSN:0025-7079    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This study examines whether patient outcomes are affected by changes in volume over time within hospitals and whether such effects are consistent with cross-sectional results previously reported in the literature. Investigating the existence of volume-outcome relationships longitudinally for specific groups of patients relates directly to the policy issue of whether, and how, specific inpatient services should be regionalized. The analysis uses up to 8 years of observations from a national sample of nearly 500 community hospitals. Outcomes are measured as inhospital mortality adjusted for case severity. Instrumental variables techniques are used to test and control for the possibility of selective referral. The results suggest that higher volume leads to better outcomes for certain groups of patients. Among the groups studied here, increases in volume lowered adjusted mortality rates for acute myocardial infarction, hernia repair, and respiratory distress syndrome in neonates; correlations were observed between volume and outcome for coronary artery bypass grafts, which seemed to be due primarily to referral patterns; and, no significant findings were found for hip replacements. In general, the effects of volume on outcome appear to be larger when estimated from longitudinal, rather than cross-sectional, data.

ISSN:0025-7079    

出版商:OVID    

年代:1992

数据来源: OVID