摘要:

&NA;A population‐based approach to monitoring quality of care combining small‐area analysis and outcomes assessment is proposed. While adverse outcomes due to poor surgical technique have long been targeted for quality‐of‐care review, in this study, giving similar attention to adverse outcomes produced by high rates of interventions is proposed. A population‐based approach will strengthen traditional review efforts that currently begin and end at the hospital door. Excluded from these reviews have been questions such as the following: Should the procedure have been performed in the first place? Did the benefits outweigh the risks? Were there other patients not operated on who might have benefited more? Traditional approaches can identify less competent hospitals or practitioners: population‐based approaches can identify the surgical enthusiasts who may pose equal risks to the populations of the areas they serve. Applying a population‐based approach to review of coronary artery bypass graft surgery for Medicare patients in five cities in the United States demonstrates that at least as many deaths could have been prevented by decreasing surgical rates to the U.S. average as by improving the technical quality of care with which the procedure was performed. A similar population‐based analysis of complications (as judged by re‐admissions within 30 days of surgery) associated with hysterectomy across regions of Manitoba, Canada, is presented. In summary, negligent acts in the delivery of health care in institutions are rare and are difficult to detect because medicine is an inexact science and because adverse outcomes are more likely in high‐risk patients, regardless of the quality of care. However, from a population perspective, adverse events are predictable, occur relatively frequently, and are directly related to the frequency of a population's exposure to surgical intervention. Efforts to improve quality of care could be made more effective by including the rates at which populations are exposed to treatments and the technical quality of care delivered.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;The authors evaluated the effect of an educational and feedback intervention on H2‐blocker prescribing patterns and determined, if such effects differed for network‐ versus group‐model health maintenance organization (HMO) physicians and in academic versus nonacademic settings. Physicians were randomized to receive an educational memorandum alone or combined with feedback regarding their individual prescribing behavior. The memo suggested preferred use of an H2‐blocker (cimetidine) that would be less expensive to the HMO. Prescribing was monitored during the 6 months before and after the intervention. The study was undertaken at the primary care practices of a mixed group‐ and network‐model university‐affiliated HMO. Thirty group‐model (at two academic and four nonacademic sites) and 33 network‐model (all in full‐time private practice) primary care physicians participated in the study. The analysis utilized weighted and unweighted analysis of covariance of the change in physicians' cimetidine‐prescribing rates between the baseline and study periods. A significant response to the intervention was noted among academic and nonacademic group‐model HMO physicians, but not among network physicians (adjusted mean absolute prescribing changes of +9.9% and +8.9% versus ‐2.8%,P= .02). There was no difference in prescribing change based on ITYPE of intervention (education versus feedback). The authors conclude that a simple passive educational intervention can be effective at changing group‐model HMO physician behavior.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;Few data are available regarding the performance of the Medical Outcomes Study (MOS) Short‐Form 36‐Item Health Survey (SF‐36) in black patients. In this article, the reliability and validity of the MOS SF‐36 is compared in a population of black patients and white patients with acute chest pain. The MOS SF‐36 was administered to 1,160 patients (31% black) who presented to the emergency department of an urban teaching hospital with acute chest pain from October 1990 to May 1992. In unadjusted analyses, black patients had significantly lower scores compared with white patients for several dimensions of the SF‐36. Correlations among the eight subscales were similar, and the internal consistency of each of the eight subscales was excellent for both groups (Cronbach's coefficient &agr; range .64 to .93). Each subscale had similar clinical and nonclinical correlates in black patients and white patients. In multivariate models, race was not a significant independent correlate of any of the eight subscales. Thus, the MOS SF‐36 had similar reliability and validity in this population of black patients and white patients with acute chest pain who presented to an urban teaching hospital. If these findings are confirmed in other populations, they suggest that results from the MOS SF‐36 may be interpreted similarly in black patients and white patients, after adjusting for clinical and sociodemographic data. Whether these findings are generalizable to other conditions and less acute settings requires further investigation.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;The authors attempted to determine if the self‐reported practices of hospital doctors regarding smoking cessation advice to their patients, would be influenced by the introduction of a scheme in which smokers were routinely identified on admission to hospital and were subsequently mailed letters including cessation advice. The second objective was to assess the relative levels of cessation counselling among different categories of doctors. Five hundred and fifteen doctors from two large public teaching hospitals in Melbourne, Australia participated in the study. Mail‐out cessation advice took place in one hospital (the intervention hospital). In both hospitals, half of the doctors were surveyed 6 weeks before the mailing had commenced, and the remaining half were surveyed 6 months after. There were no significant differences between doctors at the intervention hospital and doctors at the control hospital in the self‐reported advice to patients. Most doctors “encouraged patients to quit whenever possible.” However, this encouragement seemed to be limited to talking to patients about the risks of smoking. Doctors less frequently gave advice concerning how to stop smoking. Compared with other doctors, internists seemed to be the most willing to encourage patients to quit and they reported higher levels of assisting patients to quit. There was no evidence that reminding doctors regularly that their patients were receiving mailed cessation advice significantly increased or decreased doctor's reporting smoking cessation activities with their patients. Internists are more involved in smoking cessation counselling than other ITYPEs of doctors.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;In this study, the authors attempted to determine if physician board participation enhances or impairs the operational performance of a hospital. Two theories—managerialism and agency theory—are compared to determine if participation on the hospital board by inside (i.e., medical staff) and outside physicians provides informational advantages (managerialism) or poses the threat for opportunism (agency theory). Using hospital operating margin to measure hospital performance for a 4‐year period (1985‐1988), the findings indicate that boards with inside physician (medical staff) participation had significantly better performance than those without such physician participation. Supportive of the managerialist perspective, the findings strongly suggest that medical staff board participation can enhance operational performance. Implications of physician‐hospital relations for future hospital strategies as well as health care reform issues are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;In this article, the methodology used by the Health Care Financing Administration in the 1992 release of 1990 mortality statistics is described, and the performance of one outlier hospital is evaluated as a case study. The study hospital is compared to all other hospitals, and to a smaller cohort of 200‐to‐299‐bed minor teaching hospitals, in terms of predicted and observed mortality rates and mortality model determinants. Proportionately more patients treated in the study hospital were women and had cerebrovascular degeneration or chronic renal disease; fewer patients had cardiovascular disease. Substantially more patients from this hospital were transfers from a skilled nursing facility. Fewer patients were admitted through the emergency department. Although patients tended to be more seriously ill overall compared with other hospitals in the country, observed mortality rates were still higher than predicted. Possible explanations for the discrepancy were coding inconsistencies, inability to control adequately for the severity of illness of transfers from skilled nursing facilities, or quality of care problems.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;The United States Agency for Health Care Policy and Research brought together representatives from each of the Patient Outcomes Research Teams (PORTs) as the Inter‐PORT Meta‐Analysis Work Group. The purpose of the meeting was to discuss a wide range of problems the panel had encountered in the area of meta‐analysis. Several actual problems were presented, and tentative solutions to those problems were given. The PORTs had to consider issues such as quality assessment, survival analysis, rare events, sensitivity and specificity, and random effects models. The solutions presented represent the methods used by several researchers who are active in the area of meta‐analysis.

ISSN:0025-7079    

出版商:OVID    

年代:1995

数据来源: OVID