摘要:

This study applies data from the Manitoba Longitudinal Study on Aging for two purposes. First examined were the hospital-utilization patterns of elderly nursing home admissions during the 2 years before and 2 years after entrance into a facility. In addition, use of the hospital by these new admissions and by long-term nursing home residents was compared with that of the use by the elderly living in the community. When age, sex, and mortality rate are taken into account, the results indicate that, although both new admissions and longterm nursing home residents are sicker than their community counterparts, they are significantly less frequently hospitalized.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A model is presented for classifying nursing home patients according to nursing resource use. The model is derived from a study of 558 Medicaid nursing home patients in 12 facilities in Virginia. Data were obtained from self-reports of nursing staff for care delivered over a 52-hour period. The measure of care time was validated through concurrent work sampling. Project staff also assessed the patients' health and functional status using a standardized instrument. Using AID analysis patients were classified into six groups that were homogeneous in their use of nursing resources. Patients were initially categorized by presence or absence of conditions requiring specialized care (e.g., nutritional intake problems, quadriplegia, wounds or lesions, coma, and physical rehabilitation potential). For the specialized care category, two groups were formed by presence or absence of a catheter/ostomy. In the nonspecialized care category, four groups were formed by ADL impairment score and assistance required in eating/feeding. Mean resource use for the highest group was nearly four times that of the lowest group. The model accounted for 53% of the variance in nursing resource use.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The quality of medical records data for patients who were hospitalized with community-acquired pneumonia was assessed by comparing medical records data with data obtained in a prospective study of pneumonia for the period April 1, 1984, to December 31, 1984. One hundred five patients fulfilled the case definition of pneumonia for entry into the prospective study. One hundred twenty-seven patients were identified by medical records data. Seventy-three of the patients appeared in both studies. The positive predictive accuracy of the medical records data was 57%. When the etiologic diagnoses for the 73 patients identified by both studies were compared, there was agreement only 52.6% of the time.Streptococcus pneumoniaewas overdiagnosed, and Mycoplasma, specific viral causes, andHaemophilus influenzaewere not recorded by the medical records data. The quality of medical records data regarding pneumonia can be improved by changing the current ICD-9-CM coding system for pneumonia and by providing instruction and an algorithm for abstractors to follow in assigning a diagnosis of pneumonia.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The cost-effectiveness of various end-stage renal disease (ESRD) treatments was compared using two different cost measures. The first measure, gross social costs, excluded output gains due to treatment, whereas the second measure, net social costs, included output gains from both market and nonmarket activities. The cost-effectiveness criterion was the cost-per-life year gained or the implicit value of a year of life. The lower the cost-per-life year gained, the more costeffective the treatment was. Four ERSD treatments were evaluated over 20 years. Home dialysis and transplantation were more cost-effective than in-center dialysis, regardless of whether gross or net social costs were used. However, lower values were obtained in the case of net social costs reflecting a provision for output gains due to treatment. The use of net social costs also resulted in greater variations in costs-per-life year gained by age. Changes in survival probabilities affected the results for transplant patients and dialysis patients differently.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Twenty months after the California State Department of Health Services turned its Medicaid program in Monterey County over to a local health care authority, the Monterey County Health Initiative (MCHI), the state terminated the pilot project in favor of a return to fee-for-service reimbursement. The MCHI, plagued from its inception with shaky provider support and a flawed program design, failed to demonstrate its anticipated cost savings. The key features of this failure were overly generous fees for primary case managers, inadequate utilization control measures, a general hesitancy to assume the necessary gatekeeper function, and a management information system that was not fully operational until well into the implementation of the program. Policy implications and recommendations for future state-sponsored Medicaid demonstration projects are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The case mix of publicly funded residents in 73 skilled nursing facilities (SNFs) in two Connecticut counties was examined. Data collected in 1980-1981 for utilization review by a professional standards review organization were used for the analysis. The findings indicate that considerable variation exists in case mix across the SNFs. Medicaid per diem rates, which are based on historic costs, have a low and negative correlation with case mix. Case mix indices are significantly higher for rural facilities, with a for-profit type of ownership, and with less than 75% of the bed days devoted to Medicaid residents.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

In 1979, MEDICAL CARE published a supplement1that summarized and evaluated existing research on changes in health care patterns associated with mental health, alcoholism, and drug abuse treatment. This paper, limited to alcoholism treatment, reviews research that has been completed since the 1979 supplement. Considerations of appropriate research methods are discussed, recent studies that have employed a variety of research approaches are reviewed and evaluated, overall findings are summarized, implications and conclusions that can be drawn about offset are discussed, and recommendations for future research are made. These studies have fewer methodologic limitations and utilize larger study groups and longer follow-up periods than did earlier studies. They confirm earlier findings that general health care utilization and costs drop after initiation of alcoholism treatment;

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Ambulatory medical clinics at academic centers are reputed to be expensive, inefficient, and poorly regarded by the medical residents who staff them. In an effort to address these problems, some centers have reorganized their traditional clinics into group practices. These group practices are thought to be more effective for teaching and providing services than are the traditional clinics. This is a report on the results of a study in which the authors reorganized two of four firm clinics into group practices in order to test the influence of the organizational changes on the various aspects of ambulatory care. During this controlled prospective trial of the group practice model, higher show rates were observed for patients in the group practices than in the traditional clinics (70% vs 65%,P< 0.0005). The possible reasons for the higher rates are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID