ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This study evaluates a mandatory second-opinion consultation program administered on behalf of a large Taft-Hartley welfare fund providing medical care coverage for 120,000 beneficiaries and covered dependents. During a two-year intake period (1977-1978), 2,284 individuals received second-opinion consultations for an elective surgical procedure recommended by a first-contact physician or surgeon. Of this group, 366 received a nonconfirmation of their need for surgery. Medical claims data were available for 342 individuals in this group, and they constitute the base for the current analysis. A comparable number of individuals who received a positive confirmation were randomly selected and served as a control for estimating program savings. Both groups were followed for a one-year period from the date of their consultations. Total program savings were estimated at $534,791. Of this amount, medical care utilization savings were $361,756 and productivity savings were $173,035. The cost of the program was $203,300, yielding a benefit—cost ratio of 2.63. These findings indicate that mandatory second-opinion consultation programs, which are consumer oriented and intervene before care is rendered, are clearly cost-effective.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The effect of the Massachusetts second-opinion program on the volume of elective surgery in the Medicaid population was assessed using two approaches: a study of the program experience and surgery decisions of 2,501 program referrals, and an analysis of Medicaid surgery rates before and after program implementation. Nonconfirmation rates, which averaged 14.5 per cent, varied by procedure from 4 per cent for cholecystectomy to 26 per cent for disc surgery. The patient's surgery decision was related to the outcome of the second-opinion consultation: 85.5 per cent of the confirmed patients had the originally proposed operation, as compared with 31 per cent of the nonconfirmed patients. In the year after program implementation, the program was associated with a 20 per cent reduction in the volume of those procedures covered by the program. The greatest percentage declines were for hysterectomies, meniscectomies, hemorrhoidectomies and tonsillectomies/ adenoidectomies. The decline in surgery rates was attributed both to a direct effect on patients referred to the program and to a sentinel effect whereby fewer operations were proposed. We conclude that the mandatory second-opinion program in Massachusetts saved Medicaid $3 to $4 for every dollar spent.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This study, conducted in four general hospitals, evaluates the effectiveness of feedback from utilization review coordinators in reducing the number of inappropriate hospital days. Experimental control was exerted over the type of feedback provided in the utilization review process to produce four treatment groups (including a control group) that vary according to 1) the channel used to inform an attending physician of a probable inappropriately located patient and 2) the amount of discretion permitted the nurse coordinator in deciding whether, when and to whom this information is provided. The results of the study indicate that physician and hospital performance in utilization review, measured both by inappropriate patient days and length of stay, are affected by the feedback strategy employed. For patients inappropriately located for a portion of their hospital stay, provision of concurrent feedback resulted in reduction of approximately two thirds of an inappropriate day and two and one half total days, compared with patients for whom no feedback was provided or for whom physician advisor involvement was required. In addition, the effect of reasons causing patients to be inappropriately located (barriers) was assessed. Barriers outside the realm of influence of the hospital or the physician were found to impede the effectiveness of the utilization review systems.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This study describes the influence of a computerized medical record summary system in three disease areas (hypertension, obesity and renal disease) observed in the course of a controlled, randomized and prospective study of 479 Northwestern University Clinic patients. Experimental patients, who had available automated record summaries, and control patients, who had available only the manual record, were compared on several medical tests and procedures whose yearly occurrence was considered good medical practice for this patient population, and were compared as well on several measures of outcome of medical care. Evidence suggesting better care and outcome of care among patients with computerized record summaries available is presented.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Nine Professional Standards Review Organizations jointly conducted an areawide medical care evaluation study of Cesarean births. Of 5,002 Cesarean births studied in 158 hospitals, only 1.1 per cent were judged to be unjustified procedures by local physician peer review. Although there was substantial geographic variation in rates of Cesarean birth (11.0%-18.3 per cent), no statistically significant pattern of variation was identified. Maternal outcomes and infant outcomes were generally good. This study demonstrates the potential for use of PSRO data in studying major issues in health care, as well as the practical constraints of such studies.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Periodic Medical Review (PMR) of all Medicaid beneficiaries in skilled nursing facilities (SNFs) in Pennsylvania was implemented in fiscal year 1973-74. In this study, the authors explored the impact of PMR through its first four annual review periods. Because over two thirds of all SNF patients who were determined (over the four-year period) to require lower levels of care were identified during the first year of the program, the study was focused on the impact of first-year reviews on patient placements and nursing home industry characteristics in the subsequent years. Although the results did not strongly show that PMR had significant long-term effects, the general conclusions reached were that: 1) first year PMR decisions altered (in the intended direction) SNF patient placements and structural characteristics of the nursing home industry in Pennsylvania; 2) the initial impact of PMR was still apparent by the fourth year, but much weaker; and 3) the PMR review team may have been more lenient in their decisions concerning appropriate levels of care for reviewed SNF patients after the first year.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The issue of whether outpatient treatment of alcoholism is cost-advantageous, in the long run, for health maintenance organizations (HMOs) depends in part on whether alcoholics represent a relatively heavy burden on the health care delivery system. To clarify this issue, the paper asks whether alcoholics utilize HMO services at higher rates and in different ways than do other HMO members, and whether alcoholics experience more illnesses and injuries associated with their service utilization. The study subjects were alcoholics, identified during one year as new clients of an HMO's counseling department, which houses an alcoholism treatment component. Study subjects were matched with controls on the basis of sex, age, date of HMO enrollment, type of membership and family size. HMO medical records provided data on service utilization and associated morbidities during the three-year study period. Alcoholics were found to have utilized about 50 per cent more of all HMO services studied than did their matched controls. Alcoholics were especially high utilizers of more expensive, inpatient services. Psychosocial problems and problems classified as accidents, poisonings and violence were much more likely to underlie alcoholics' hospitalizations, and, to a lesser extent, their outpatient noncounseling utilization, than was the case for controls. Some tendency was noted for more chronic illnesses to be associated with alcoholics' service utilization, and more acute illnesses with controls' utilization.

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1982

数据来源: OVID