ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Comprehensive data on 3,579 patients in Baltimore nursing homes were collected by trained teams of reliable observers. The data included an implicit judgment about the level of care (LOC) deemed most appropriate for each patient. Two different approaches were used to fit the patient data to the LOC judgments: Several versions of an algorithm adapted from a utilization review scheme based on simple clinical criteria and a series of mathematical equations based on logistic regression were each tested. In the case of the latter, each equation was derived from a random half of the data and tested on the remaining half.Both approaches yielded comparable results. The best variation of the algorithm correctly identified 71 per cent of patients needing skilled care and 69 per cent of those needing unskilled care. The equations based on the logistic regressions could correctly classify 86 per cent of those needing skilled care and 63 per cent of those not needing such care. Further improvements in accuracy of prediction on one group came at the cost of less accurate identification of the other. In general, the simplest models proved the most useful.These techniques are recommended as useful for preliminary screening of nursing home patients for appropriate LOC but should not be used as a basis for final judgments. The advantages offered by this approach are the reduction of workload demands for skilled professional judgment and the availability of a very reliable preliminary screening judgment in a highly politicized atmosphere.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This study has attempted to determine the relationship between physician domain of practice and their quality of medical care. The study examined whether there was a quality difference in practice either 1) between general practitioners and specialists, or 2) between specialists practicing within and outside their specialty domains. The sample consisted of 454 physicians of Hawaii, involving 18 specialty categories: general practitioners (133) and specialists (321). The study finds that when the general practitioners in this study practiced without limitation, their quality of care was not as good as that of the specialists. The study also found that when the specialists practiced outside their specialty areas, the relative quality of their performance declined. The latter finding was sustained even when other important practice and background variables were held constant. The study also discusses its generalizability and policy implications.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This article documents the extent to which one type of quality assurance activity—the medical audit—includes evaluation of psychosocial aspects of health and disease. The criteria used for 448 medical audits completed in the Minneapolis–St. Paul area from 1975 to 1979 are examined in terms of three kinds of psychosocial criteria—those dealing with impact of illness, psychosocial consultation and psychosocial history, plus a fourth kind of criteria concerned with patient education. The majority of medical audits examined address no psychosocial or patient education criteria whatsoever (78 and 63 per cent, respectively). Audits of psychiatric diagnoses are more likely to include psychosocial criteria than those of surgical, pediatric, medical, or obstetricalgynecological diagnoses; on the other hand, pediatrics and psychiatry are most likely to include patient-education criteria. Furthermore, of the four kinds of criteria studied, those concerned with patient education are the most frequently found. It is recommended that methods to evaluate psychosocial health care be developed and implemented within the sphere of quality assurance activities, in order to more comprehensively define the quality of medical care.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This study examines the amount and sources of variation in dental practice profiles. Three years of insurance claims data on 227 general dental practices were used to generate practice-specific utilization rates for 16 treatment service categories. The results indicated considerable heterogeneity among and within practices in the distribution of service utilization rates such that most distributions could not be described by conventional parametric probability models. Basic standardization methods were used to examine sources of variation among practices. Of the patient and insurance characteristics investigated, only patient age had a major effect on utilization rates. However, there was considerable stability in utilization rates within practices over four consecutive six-month time intervals. The implications of these findings for profile-based utilization review and quality-assurance systems are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A national sample of both hospital administrators and hospital review chairpersons (the two adversarial providers in the hospital regulatory milieu) were surveyed and asked to estimate the degree and kind of unnecessary hospital utilization taking place both in the U.S. and at their own institution. Both groups indicated that inappropriate hospital use was considerable. Even more striking was the degree of concordant perceptions about the magnitude and type of unnecessary use at their own hospitals. The shared perceptions held by two conflicted parties in the regulatory process justifies continued scrutiny of hospital admissions, stays and ancillary services, forms a sound basis for policy intervention and illustrates how attitudinal research methods may be used in the making of health care policy.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This article examines the determinants of length of stay and ancillary service use for a single diagnostic category: normal delivery. Data for a systematic sample of 945 obstetrical admissions to 48 New England hospitals during 1969-70 are used to estimate a simultaneous equations model. The exogenous variables include socioeconomic and medical characteristics of the mother, medical condition of the newborn, type of labor and delivery, and hospital and physician characteristics.The important findings are threefold: First, evidence is found supportive of a simultaneous relationship between length of stay and ancillary services for normal deliveries. Second, the results show the importance of controlling for the performance of surgery, the presence of complications, the length of labor and the death of the baby in analyzing obstetrical utilization patterns. Third, holding maternal medical and socioeconomic factors constant, hospital size, teaching status, control and location, as well as physician mode of practice and relationship to the hospital, are important determinants of hospital use. It is concluded that the diagnostic-specific approach to utilization analysis is appropriate and useful. Only within such a narrowed focus can researchers disentangle the confounding effects of the attributes of the disease itself from the impact of hospital and physician characteristics on hospital use.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Renewed interest in less costly, less technologically oriented obstetrical care requires the accurate selection of women who may safely benefit from such alternatives. The distribution of complications of labor and delivery, among healthy women who had had uncomplicated pregnancies, was investigated by studying data from more than 240,000 birth certificates filed with the New York City Department of Health during the period 1972-1974. Complications of labor or delivery were reported for 21.0 per cent of births following apparently uncomplicated antepartum courses. Significantlyhigherrates of recorded complications were found for women who had initiated prenatal care earlier in pregnancy, for private patients as opposed to general service patients, for white patients compared with nonwhite patients, for married women than for unmarried women, and for better educated patients as opposed to those with less schooling. Labor and delivery complication rates were also noted to rise with maternal age. The positive association between earlier prenatal care and higher complication rates was found within all service, racial, marital, educational and age categories, and appeared to be independent of these variables. Factors which may contribute to these unexpected patterns, and further research to clarify them, are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Despite widespread support in the nursing literature for the adoption of primary nursing as the optimal method of organizing hospital nursing care, little empirical evidence exists as to its effects on patients or nursing staff. This study compares units that have employed primary nursing for at least five months (N = 31) with nonprimary units (N = 20) in two large university-affiliated hospitals. Comparisons are made with respect to structural attributes of nursing units, nurses' perceptions of their jobs and units, and three outcomes: nurses' job satisfaction, absenteeism rates and resignation rates for the units. No significant differences are found between primary and nonprimary nursing with respect to measures of job satisfaction. Primary units at one hospital exhibit lower resignation and absenteeism rates than do nonprimary units. The adoption of primary nursing is discussed in light of these findings.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Mailed questionnaires were analyzed for 100 physicians concerning their favorability toward allowing clinical pharmacists to perform role tasks which potentially encroach on the physician's role. A Guttman Scale of Task Favorability was computed and revealed that physicians were unfavorable to those pharmacy tasks that allow pharmacists to make independent technical-therapy decisions. Physicians were favorable toward clerical and patient-management tasks, but only as adjunct tasks to the physician's role. Generally, older physicians, those with a high risk of malpractice suit and those who write a large number of prescriptions, were least favorable to pharmacists expanding their roles. Younger physicians, those who spend a high proportion of their practice time in hospitals and those who have had previous experience with clinical pharmacists were most favorable. The analysis was framed in the theoretical context of professional power and professional role-boundary maintenance.

ISSN:0025-7079    

出版商:OVID    

年代:1981

数据来源: OVID