ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

This study provides empiric confirmation of the widely held belief that coronary artery bypass graft (CABG) surgery has become quicker over time as clinical and organizational improvements diffuse across hospitals. Based on a two-stage cluster sample of 74 hospitals performing CABG surgery in 1984, data on skin-to-skin procedure and pump times were analyzed for 2,784 Medicare- eligible cases over the 1972-84 period. Using multivariate regression analysis to adjust for patient characteristics and number of grafts, we found that CABG skin-to-skin times fell an average of 36.5% during the first 12 years of hospital experience while cardiopulmonary pump times fell 28.2%. Rates of decline averaged 4.5-5.4% annually initially, but tapered off to 1.5% by the twelfth year of experience. Extrapolating over a 20-year period, gains in skinto- skin times are projected to reach 42%, resulting in nearly a halving of surgical times. Our findings have implications both for physician reimbursement and patient outcomes. Medicare CABG prevailing fees do not reflect these gains in efficiency and could be reduced substantially. Alternatively, efficient, high-volume hospitals could be identified for inclusion in a Medicare “CABG PPO” so that society might share in the productivity gains. Finally, recent research showing better outcomes in high-volume institutions may be partially explained by their shorter procedure times, which should reduce operative complications.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

In order to better understand patient differences in question asking and other information-seeking behaviors when communicating with doctors, 106 rehabilitation medicine patients were studied. Sociodemographic data, attitude measures, interview data and tape recordings of doctor-patient encounters revealed that patients desired information about a wide range of medical topics but did not engage in many information-seeking behaviors when communicating with doctors. While desiring information, patients regarded doctors as the appropriate persons to make medical decisions. Regression analyses indicated that patient information-seeking behaviors were more directly associated with situational variables (length of interaction, diagnosis, reason for visit) than with patient attitudes or sociodemographic characteristics. Patient attitudes influenced patient information-seeking behaviors only for patients with interactions lasting at least 19 minutes, indicating that a longer interaction may be necessary for patient attitudes regarding desire for information and participation in medical decisions to manifest themselves in information-seeking communication behavior.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Two annual cost-containment educational programs, featuring involvement of respected senior physicians, lectures, comparative feedback, chart reviews, and small group discussions, were designed to reduce interns’ generated costs in a private and a VA university hospital affiliated with Northwestern University Medical School. To evaluate the impact of this randomized educational intervention, hospital data on inpatient charges and length of stay (LOS) were collected for 12 common medical diagnoses and adjusted by the Severity of Illness Index. Interns who were randomized to the program were found to have significantly lower per patient costs and LOS than control group interns at both hospitals. These reductions in resource use and LOS were not associated with differences in patients’ residual impairment on discharge, the incidence of inpatient complications, or the percentage of deaths and readmissions within 30 days. Our results suggest that the current hospital cost-containment environment may be far more conducive to physician cost-containment education than indicated by the earlier literature.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

It was conjectured that a small group of chronically ill in tertiary ambulatory clinics consume a large amount of health resources and that, from the perspective of the patient, psychosocial rather than disease variables would most explain their health service utilization and subsequent cost. New referrals with a chronic illness (N = 215) to one of three clinics (oncology, rheumatology, and gastroenterology) consented to participate in a subsequent trial of a psychosocial intervention designed to promote their adjustment to illness and, conceivably, to reduce their health service utilization. At baseline an inventory to describe the disease, treatment, functional capacity, prognosis, and socioeconomic situation of consenting subjects was completed. In addition, subjects completed the Psychosocial Adjustment to Illness Inventory (PAIS-SR), the Family Assessment Device (FAD), the Meaning of Illness Questionnaire (MIQ), and a Health Service Utilization Inventory designed to assess direct and indirect costs of health resources. These data were entered into a concurrent analytic survey design. Participating subjects represented a more socioeconomically advantaged and better-adjusted group of chronically ill patients compared with others referred to the tertiary clinics. They were representative of all new referrals in their use of the majority of health services. However, once hospitalized, participating subjects stayed longer and used specialists less. There was no important relationship between disease severity or prognosis and any type of service utilization, including hospitalization. Because the strongest correlate of all types of health services consumed was psychosocial adjustment to illness (r= 0.28 to 0.33), patients were partitioned into one of three categories of adjustment to illness: good, fair, and poor. The total annual cost per patient was $23,883, if poorly adjusted, compared with $9,791 if well adjusted. If cash transfers (benefits paid by different types of insurance) are added, the average 1987 annual cost per poorly adjusted subject was $31,291 per patient, compared with $13,771 for a patient well adjusted to the illness. There was a statistically significant and economically important linear gradient in 1987 treatment costs per category of adjustment. The possible economic implications for psychosocial intervention are highlighted.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

This study reports the effects of a voluntary Medicaid case-management demonstration on the primary care provided to young children by office-based physicians. The MDs who participated were reimbursed at rates higher than the regular Medicaid fee schedule, either through augmented fees for specific services or through monthly capitation payments. Using the Medicaid Management Information System (MMIS) claims data, we compared the rates at which children in the experimental program and children in the regular Medicaid program were seen by a physician during a one-year period. The majority of experimental children received regular and frequent care from primary care physicians during the demonstration. After controlling for race and prior utilization differences, we found that augmented fee-for-service children received more primary care from office-based physicians than children in the regular Medicaid program. Capitation children received at least the same amount of primary care as children in the regular Medicaid program. We interpret our data to mean that capitation payment, untied to the delivery of services, does not necessarily reduce access to primary care and that higher fees for physicians who treat children may, in fact, increase access.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The classic Health Belief Model (HBM) was adapted to explain children’s expected medicine use for five common health problems. To evaluate this Children’s Health Belief Model (CHBM), 270 urban preadolescents, stratified by socioeconomic status, grade level, and sex, and their primary caretakers (93% mothers) were individually interviewed. Analyses were performed in two steps. First, regression analysis evaluated the influence of the child’s primary caretaker on the child’s expected medicine use; Individual differences in children’s motivations, perceived benefits and threats, and expectations to take medicines were partially explained by caretakers’ perceptions of these children. Second, path analysis evaluated hypothesized causal relationships in the CHBM, accounting for 63% of the adjusted variance in children’s expected medicine use. Two readiness factors, perceived severity of illness and perceived benefit of taking medicines, had the highest path coefficients, with illness concern and perceived vulnerability to illness accounting for a smaller, but significant, portion of the variance. Cognitive/Affective variables, notably children’s health locus of control, contributed to indirect paths between demographic and readiness factors. The CHBM appears to be a promising model for studying the development of children’s health beliefs and expectations.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID