ISSN:0025-7079    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Patient education has been shown to affect physician performance profiles. It is not known whether census-derived measures of patient socioeconomic status (SES) show comparable effects.Objective.The objective of this study was to compare the effects on physician profiles for patient satisfaction and physical and mental health of adjustment for patient SES derived from patient addresses geocoded to the census block group level, zip codes, and patient education.Design.This was a cross-sectional survey of patients in physician practices.Setting.Subjects came from adult primary care practices in western New York.Participants.A random sample of 100 primary care physicians and 50 consecutive patients seen by each physician participated in the study .Measurements.Independent variables were census-derived (block group and zip code) patient SES and patient-reported education. The outcomes were physician ranks for patient satisfaction (Patient Satisfaction Questionnaire) and physical and mental health status (SF-12).Results.In empirical Bayes models that adjusted for patient age, age squared, gender, insurance, and case mix, both the census-derived measures (block group and zip code) of SES and education had similar effects on each of the physician profiles.Conclusions.The results suggest that SES derived from either patient addresses geocoded to the census block group level or zip codes may offer a convenient alternative to individually collected SES when adjusting physician profiles for the socioeconomic characteristics of physicians’ practices. The relative ease of using zip codes compared with geocoded addresses and loss of information associated with incomplete matching during geocoding suggest that zip code–derived SES may be preferable.

ISSN:0025-7079    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Little is known about the extent to which consumers have specific problems with their managed care organizations (MCOs) or whether these problems differ by type of MCO.Objective.To estimate the prevalence at which consumers in managed care report specific problems and to assess whether rates in preferred provider organizations (PPOs), independent practice association (IPA)/network health maintenance organizations (HMOs), and staff/group HMOs differ.Design.Random probability sample of insured adults weighted to reflect the underlying population in California. A computer-assisted telephone interview survey was conducted in September 1997. Logistic regression models estimate the adjusted odds of reporting each problem in the last year in IPA/network HMOs versus PPOs, IPA/network HMOs versus staff/group HMOs, and staff/group HMOs versus PPOs.Subjects.One thousand two hundred one insured adults who had resided in California for ≥12 months.Measures.Prevalence of 11 consumer problems in MCOs.Results.Forty-two percent of adult Californians in managed care in our sample reported ≥1 problem with their MCO in the last year. Adjusted odds that adults in IPA/network or staff/group HMOs reported delays in getting needed care, not receiving the most appropriate or needed care, and being forced to change doctors were higher than for adults in PPOs. Adjusted odds that adults in IPA/network HMOs reported difficulty getting a referral to a specialist and difficulty selecting a doctor or hospital were higher than for adults in PPOs and staff/group HMOs. Adjusted odds that adults in staff/group HMOs reported misunderstandings over benefits and coverage; important benefits not covered; and problems with claims, billing, or payments were lower than for adults in PPOs and IPA/network HMOs. Adjusted odds that consumers in HMOs in our sample reported any problem with their health plan was higher for those in IPA/network HMOs compared with staff/group HMOs. No differences were seen by MCO type in the rates at which consumers reported being denied care or treatment, forced to change medications, or language and communication barriers.Conclusions.Rates at which consumers report problems with managed care and the kinds of problems they report differ significantly across different types of MCOs. These findings have important implications for federal and state policy for consumer protections in managed care.

ISSN:0025-7079    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objective.To examine differences by physician gender in the identification and treatment of childhood psychosocial problems.Design.Survey of patients (n = 19,963) and physicians (n = 366) in primary care offices in 2 large, practice-based research networks. Multivariate regressions were used to control for patient, physician, and visit characteristics, with a correction for the clustered sample.Subjects.Children ages 4 to 15 years seen consecutively for nonemergent care.Measures.Physician report of attitudes, training, practice factors, and identification and treatment of psychosocial problems. Parental report of demographics and behavioral symptoms.Results.Compared with male physicians, female physicians were less likely to view care for psychosocial problems as burdensome. They were more likely to see children who were female, younger, black or Hispanic, in single-parent households, enrolled in public or managed health plans, and with physical health limitations. Children seen by male physicians had higher symptom counts. Male physicians were more likely to report having primary care responsibility for their patient and that parents agree with their care plan. Female physicians spent more time with patients. After controlling for these differences, female physicians did not differ from male physicians in identification or treatment of childhood psychosocial problems.Conclusions.Male and female physicians see different kinds of children for different visit purposes and have different kinds of relationships with their patients. After controlling for these factors, management of childhood psychosocial problems does not differ by physician gender. Improving management of psychosocial conditions depends on identifying modifiable factors that affect diagnosis and treatment; our work suggests that characteristics of the practice environment, physician-patient relationship, and patient self-selection deserve more research.

ISSN:0025-7079    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Many elderly inpatients have substance use disorders; recent treatment guidelines suggest that they should receive regular outpatient mental health care after discharge from hospital.Objective.The prevalence, predictors, and outcomes of outpatient mental health care obtained by elderly Medicare patients with substance use disorders were examined.Research Design.A longitudinal prospective follow-up was performed.Subjects.Data from Medicare Provider Analysis and Review Record and Part B Medicare Annual Data were used to identify elderly inpatients with substance use disorders (n = 4,961) and determine their outpatient mental health care 4 years following hospital discharge.Results.Only 12% to 17% of surviving elderly substance abuse patients received outpatient mental health care in each of 4 years after discharge. Cumulatively over 4 years, approximately 18% of surviving patients obtained diagnostic/evaluative mental health services, 22% obtained psychotherapy, and 9% received medication management. Of patients who obtained outpatient mental health care, 57% made 10 or fewer outpatient mental health visits over the entire 4 years. Younger, nonblack, and female patients were more likely to obtain mental health outpatient care, as were patients with prior substance-related hospitalizations, dual diagnoses, and fewer medical conditions. Prompt outpatient mental health care was predictively associated with higher likelihood of mental health readmissions and, among patients with drug disorders, lower mortality.Conclusion.Very few elderly Medicare substance abuse patients obtain outpatient mental health care, perhaps because of health or economic barriers.

ISSN:0025-7079    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Abortion is one of the most common surgical procedures performed on women in the United States, and its safety has been demonstrated. Little research has focused, however, on women’s reports and ratings of the service.Objectives.This study explored the association of demographic factors, medical outcomes, and client ratings of service dimensions with global satisfaction.Research Design.For this cross-sectional study, permission to access clinic medical records was obtained. Surveys were distributed after the procedure, with instructions to return by mail.Subjects.Study subjects were 797 women who underwent an outpatient surgical abortion at 1 of 2 New England health centers in 1996 and 1997.Measures.Demographic data, pregnancy history, and information on the procedure were collected from medical records. Survey items measured reports of access, medical outcomes, and satisfaction ratings with service domains.Results.Women with positive ratings of staff sensitivity and of the counseling process and information received and those who had the procedure at a younger gestational age were less likely to report that care could be better. Although very few women reported a medical complication, this was associated with agreement that care could have been better, as was reporting agreement that the wait between the preexamination visit and the procedure was too long.Conclusions.Satisfaction with abortion services is high. Education and counseling play very important roles. Survey items could routinely be used to monitor services.

ISSN:0025-7079    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Having missing data complicates the statistical analysis of health-related quality-of-life (HRQOL) data and, depending on the extent and nature of missing data, can introduce significant bias in treatment comparisons.Objective.We evaluated the bias associated with 4 different imputation methods for estimating physical health status (PHS) scores missing as a result of mortality.Methods.A simulation study was conducted in which we systematically varied mortality rates from 0% to 30% and change in PHS scores from −20 to 20 on a 100-point scale for a 2-group clinical trial with follow-up over 18 months. The 4 imputation methods were last value carried forward (LVCF), arbitrary substitution (ARBSUB), empirical Bayes (BAYES), and within-subject modeling (WSMOD). Pseudo–root mean square residuals (RMSRs) and differences between true and estimated slopes were used to evaluate how well the imputation methods reproduced the true characteristics of the simulated population data.Results.ARBSUB and BAYES methods have the smallest RMSRs compared with LVCF and WSMOD across all mortality rates. As the rate of missing data resulting from mortality increased, all imputation techniques deviated more from population data. The BAYES technique was best at reproducing group slopes in cases with differential mortality rates or when mortality rates exceeded 15%. WSMOD and LVCF significantly underestimated changes in PHS.Conclusions.The different imputation methods produced comparable results when there were few missing data. The BAYES approach most closely estimated true population differences and change in PHS regardless of missing data rates. These findings are limited to physical health and functioning measures.

ISSN:0025-7079    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objective.The objective of this work was to develop a psychometrically sound questionnaire for measuring the on-the-job impact of chronic health problems and/or treatment (“work limitations”).Research Design.Three pilot studies (focus groups, cognitive interviews, and an alternate forms test) generated candidate items, dimensions, and response scales. Two field trials tested the psychometric performance of the questionnaire (studies 1 and 2). To test recall error, study 1 subjects were randomly assigned to 2 different questionnaire groups, a questionnaire with a 4-week reporting period completed once or a 2-week version completed twice. Responses were compared with data from concurrent work limitation diaries (the gold standard). To test construct validity, we compared questionnaire scores of patients with those of healthy job-matched control subjects. Study 2 was a cross-sectional mail survey testing scale reliability and construct validity.Subjects.The study subjects were employed individuals (18–64 years of age) from several chronic condition groups (study 1, n = 48; study 2, n = 121) and, in study 1, 17 healthy matched control subjects.Measures.Study 1 included the assigned questionnaires and weekly diaries. Study 2 included the new questionnaire, SF-36, and work productivity loss items.Results.In study 1, questionnaire responses were consistent with diary data but were most highly correlated with the most recent week. Patients had significantly higher (worse) limitation scores than control subjects. In study 2, 4 scales from a 25-item questionnaire achieved Cronbach alphas of ≥0.90 and correlated with health status and self-reported work productivity in the hypothesized manner (P≤0.05).Conclusions.With 25 items, 4 dimensions (limitations handling time, physical, mental-interpersonal, and output demands), and a 2-week reporting period, the Work Limitations Questionnaire demonstrated high reliability and validity.

ISSN:0025-7079    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.While the adjusted clinical group (ACG) system has been extensively validated in the United States, its use in other developed nations has been limited. This article examines the performance of the system in 2 Canadian provinces and assesses the extent to which ACGs can account for same-year and next-year health care expenditures.Methods.The study population included all residents of Manitoba and British Columbia who were continuously enrolled in the provincial health plans from April 1, 1995, to March 31, 1997. ACGs were assigned through diagnoses from fee-for-service physician claims and hospital separation records. “Physician” costs were calculated from the fee-for-service tariffs, and for Manitobans, “total” costs were also computed by combining physician and hospital costs. Linear regression was used to examine the ability of the ACG system to explain variation in individual costs (truncated at the 99th percentile).Results.The British Columbia and Manitoba data were generally acceptable, with fewer than 2% rejected diagnoses. Higher costs were associated with both the accumulation of morbidities and their relative severity. For physician costs, the ACG system explained ∼50% and ∼25% of the variation in same-year and next-year truncated costs, respectively. For total costs, the system explained ∼40% and ∼14% of these respective costs.Conclusions.The application of ACGs in Canada is feasible using existing data. The ability of the ACG system to explain variation in costs is similar to that found in US health systems. While application of ACGs in Canada shows promise, further research is required to examine how closely they reflect population morbidity burdens and health care needs.

ISSN:0025-7079    

出版商:OVID    

年代:2001

数据来源: OVID