摘要:

Health planning agencies have long had a need for local area data on issues such as health status, utilization, and preventive care. Synthetic estimation and regression techniques have been advanced for use in adjusting national or regional data from the NCHS Health Interview Survey (HIS) to the local area based on demographic and other pertinent variables. To evaluate the accuracy and utility of these techniques for local health planning, estimates of certain key HIS variables were obtained from a telephone survey of 2,500 randomly selected households located in the Central Maryland Health Systems Agency (CMHSA). This paper presents results of the comparison between these telephone estimates and the corresponding estimates derived from the national HIS. The techniques are evaluated on the basis of data generally available to local planning agencies.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This study examines the cost-effectiveness of returning previously ill neonates to community hospitals after treatment in a tertiary center, a concept known as “back-transport.” The authors compared the charges for medical care during convalescence of a group of back-transported infants (BT infants; n = 20) with a similar group of infants who remained in a tertiary center for convalescence (NT infants; n = 20). The total charges for convalescent care (inpatient plus transport charges) for 20 representative BT infants was $(61,840, compared with $68,240 for 20 matched NT infants, an average savings of $320 per BT infant. The average daily bed charge and charges for laboratory tests and medications were significantly less for BT infants compared with NT infants, and these reductions offset the transport charges for BT infants. The authors conclude that back transport decreases the charges for medical care for most infants. Therefore, the decision to back-transport an individual infant usually can be based on factors other than cost.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The authors examined the effect of after-hours telephone access to physicians and physician access to computerized medical records on hospitalizations and emergency room (ER) visits in an inner-city, adult, general medicine clinic. Patients were randomly assigned to a control (C) and two study groups (S1 and S2). Patients in study groups S1 and S2 had after-hours telephone access to physicians. Computerized medical records were accessible to physicians only for callers in study group S2. During the initial 18 months of study, only 7.6% of eligible patients called the after-hours service, a rate of 6 calls/1,000 patients/ month (200 calls/1,849 patients/18 months). Repeated promotion of the service was subsequently undertaken, and 19.4% of the patients used the service during the final 12 months of study, a rate of 24.1 calls/1,000 patients/month (467 calls/1,616 patients/12 months). There were no significant differences in hospitalizations or ER visits among the control and two study groups.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This article presents a series of models for explaining hospital utilization. The models belong to the multinomial logit class, which relate the probability of hospital selection to factors that include travel time between patients and hospitals, hospital attractiveness factors, physician characteristics, and patient characteristics. Separate models for different population groups (sex, age, socioeconomic classes) and medical services (general medicine, obstetrics, pediatrics, psychiatry, and general surgery) are estimated and compared with the general hospital model. The results, which are based on an extensive data base and new estimation procedures, are superior to those of past studies. A number of differences between utilization patterns for the various populations are also observed.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

As part of the Washington State Dental Auxiliaries Project, a 42-item measure of patient satisfaction with dental care was developed. The measure is comprised of 13 subscales: dentist–patient relations, technical quality of care, access, patient waiting time, cost, facilities, availability, continuity, pain, auxiliaries performing expanded duties, staff–patient relations, staff technical quality of care, and office atmosphere. The measure was developed from a set of 52 items included in a questionnaire administered to the patients of private dental practices in Washington state. Usable questionnaires were returned by 30.8percnt; of patients receiving questionnaires in 1979, 40.1% in 1980, and 34.0% in 1981. Factor analysis plus categorization of items by a panel of professionals were used initially to group items into subscales. Contribution to internal consistency was the final criterion for an item's inclusion in a subscale. Internal consistency of subscales ranged from 0.44 to 0.80. The concurrent validity of subscales was assessed by relating patient satisfaction to characteristics of the dental practices. The following statistically significant relationships between subscales and criterion variables were observed: dentist–patient relations and percent of patients seen by the dentist; access and number of weeks appointments must be booked in advance; patient waiting time and actual patient waiting time; continuity of care and percent of patients seen by the dentist; auxiliaries performing expanded duties and delegation to auxiliaries; and staff technical quality and percent of hygienist restorations with satisfactory quality. Each relationship was in the expected direction.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Understanding the role primary care physicians play in the recognition and management of mental disorder among their patients is a research topic that has assumed considerable importance because of the high prevalence combined with low recognition of mental morbidity in primary care settings. Patient characteristics that influence diagnostic patterns have been one important focus of this research. This paper presents data from a study in two primary care departments in a large comprehensive health care clinic in central Wisconsin. During a 3-month period, 1,452 attenders at these clinics were assessed using a brief psychiatric screening scale, and special study forms were completed by the primary care clinicians. Consistent with previous research, reason for visit, psychiatric symptoms, and prior knowledge of the patient arc significant predictors of physician diagnosis of mental disorder. Additionally, pattern of physician practice, as represented by differences between the two types of clinics, was a strong predictor of both diagnosis and treatment. The lack of significant effects of sex and previous medical utilization is contrary to previous research.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The authors compared the continuity of care that family physicians, general internists, and medical subspecialists provided to their adult primary care patients. The 40 study physicians came from large, private multispecialty practices in the San Francisco Bay Area. The three physician types did not differ significantly in the degree of continuity provided, measured by the proportion of total visits to a patient's primary provider (usual provider continuity (UPC) score). Each type provided approximately 80% of its primary care patients' visits. In contrast, the continuity scores of individual physicians ranged widely, from 57% to 98%. Proxy measures of case mix and physician expertise were found to be associated with differing UPC scores. A more detailed exploration of the subspecialists revealed that the lowest levels of continuity were afforded patients with high utilization rates who did not carry a diagnosis in their primary physician's area of subspecialty expertise. The “generalist versus subspecialist” debate assumes that a physician's training background is a major determinant of the quality of primary care delivered. This was not true in this study for the provision of one aspect of quality, a high level of continuity. If factors other than specialty or subspecialty designation are generally found to be the important determinants of continuity, isolated changes in the proportion of physicians receiving generalist versus subspecialty training may have relatively little impact on the level of continuity afforded adult medical patients.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

To replicate an earlier study and explore associations between verbal behaviors in patient–physician interactions and outcomes of care, 102 visits to a medicine walk-in clinic were tape-recorded, transcribed, and coded according to the Verbal Response Mode (VRM) system. Questionnaires given before and after the clinic visit and telephone interviews 1 week and 4 weeks after the visit were used to measure patient satisfaction, compliance, and change in symptoms. Data were collected on patients' sociodemographic characteristics, illness characteristics, and health beliefs. Two verbal exchanges were examined: in the medical history, thePatient Expositionexchange, which was measured as the frequency with which patients make statements about their illnesses in their own words; and in the conclusion, thePhysician Explanationexchange, which was measured as the percentage of physician statements that are factual. These verbal indexes showed correlations with patient satisfaction, thus replicating the earlier study, but no significant correlations with compliance. Analysis of variance showed that the association between verbal exchanges and patient satisfaction remained after controlling for physician differences and for patient age, education, and belief in the controllability of the illness.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The effect of initiation, termination, and reinitiation of consultant clinical pharmacist services of drug regimen review and physician communication on patient drug use in a 72-bed geriatric long-term care facility was assessed at five points in time: initiation, termination, reinitiation, then 3 months and 3 years after reinitiation of services. Both times when the consultant was retained, drug use was cut almost in half (46.1% and 42.7%, respectively), with essentially the same number of established diagnoses per patient at each point in time. Conversely, before the consultant services were initiated, and when the consultants services were terminated, drug use was twice as great as when consultant pharmacist was retained. Regularly scheduled drugs increased 59%, and pro re nata (prn) drug increased 200% during the period between the termination and reinitiation of consultant services. There was also a lower admission, discharge, and death rate as well as higher hospitalization rate when the consultant was retained. It appears that the consultant clinical pharmacist has an impact on drug cost in long-term care facilities that is reversed when drug regimen review is removed and renewed when services are reinitiated.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID