摘要:

To determine temporal changes in the outpatient use of diagnostic tests, the authors studied ambulatory testing for 208 patients diagnosed with uncomplicated hypertension, cared for by 15 private office internists in 1971 through 1980. Patients diagnosed and treated earlier in the decade tended to have significantly higher blood pressure. After adjustment for blood pressure, use of diagnostic tests in terms of total charges for testing per patient per year peaked between 1973-74 and thereafter remained fairly stable at a level slightly lower than that in 1973-74. Considering the decade as a whole, use of tests was generally greater for patients with higher blood pressure readings (P<0.05). These findings suggest that use of tests for hypertensive patients in outpatient settings is related to severity of disease. Although treatment of new patient groups may be one factor increasing medical costs, the use of tests per se may have stabilized for diseases in which the diagnostic technologies have remained stable

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This study compares the extent to which need, predisposing, and enabling factors affect the use of mental health services in the specialty and general medical health sectors during a 6-month period. Data are drawn from the first wave of interviews of the Epidemiological Catchment Area (ECA) project at the Yale University site. The results indicate that 1) in the general population, factors affecting use of the two sectors differ; 2) among those using any mental health services, factors affecting use of the two sectors differ; 3) indicators of need have the strongest relationships with utilization; and 4) the effects of predisposing and enabling factors are contingent upon the presence of need.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Dental records and client survey reports were compared as sources of data for dental research. Further, two forms of the client survey were completed, a mail survey and telephone interview. A random sample of 271 clients of a dental group practice based within a university health service was selected. The Kappa values indicated a reasonable level of agreement of client survey and dental record with regard to the types of services received but not with regard to actual number of visits.Responses to the mail and the telephone versions of the client survey were compared for service satisfaction, hygiene behavior, and attitude and belief variables. Two potential sources of bias: nonrespondent/respondent bias and other response biases, such as acquiescent responses, were detected. The study illustrates the importance of weighing which source of response bias is more crucial to the general validity of a study based on the research questions to be addressed.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This paper presents two complementary measures of geographic access to medical care in rural regions that necessitate only modest information inputs on the location of services and client populations. An application for the Abitibi- Temiscamingue region in the Province of Quebec, Canada, is used to illustrate the types of product yielded by the measures. These include mapped patterns of potential accessibility by rural community and a graphic display of the delivery system's potential effectiveness in 'reaching' distant consumers. The relevance of the measures to the planning of medical care provision in rural areas is discussed, as is their extension through disaggregation and improvement of data inputs.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This paper analyzes the length of enrollment in Health Maintenance Organizations (HMOs) by performing secondary data analysis. It estimates a Weibull survival function using only simple regression. For middle-class enrollees in one HMO, the hazard rate (the disenrollment rate for the remaining members of a cohort) falls sharply with the length of enrollment. For Medicaid beneficiaries allowed to remain in the fee-for-service sector, the hazard rate in another HMO is much greater but falls less sharply. Limiting the choice of Medicaid beneficiaries to HMOs would increase their length of enrollment, lowering a major barrier to HMOs' participation in Medicaid.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The authors were interested in exploring the extent to which differences in the complexity of patients could be determined by modifications in combinations of the ICD-9-CM codes used to define DRGs. The 150 most common medical and surgical DRGs in one teaching hospital were studied. With clinical experts they identified 41 DRGs that were believed to have subgroups reflecting quite different types of patients, one group sicker and costlier than the other. Using a national data set, the authors then showed that 24 of these DRGs showed significant differences in standardized charges. In 11 of these 24 DRGs the higher cost subgroups were seen proportionately more often in major teaching hospitals compared with other types of hospitals. Results suggest that clinical modifications of a few DRGs would lead to clinically more meaningful case-mix groupings. These same results can also serve as the basis for a discussion on the implication of DRG payments for those DRGs with distributional differences among the higher-cost subgroups.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Using a complete factorial design, we tested three interventions for smoking cessation in routine primary care practice. The interventions tested were 1) physician counseling, 2) mailed letters and educational materials designed by the National Cancer Institute (NCI), and 3) referral to smoking cessation classes. Thirty-seven family practice physicians at three of Group Health's outpatient facilities participated. Patient participation rates were 95%, and follow- up was complete for 92% of those participating. None of the interventions had any effect on point prevalence of quitting as determined 8-9 months later by self-report. However, the combination of physician counseling and NCI materials doubled the odds of occurrence of significant antismoking behavior (quit, quit and relapse, or cut down) during the ensuing 8-9 months in those individuals receiving that combination. Referral to smoking cessation classes was strikingly ineffective in this setting. Of 369 individuals designated by study design for referral, only 14% even investigated the classes. This compares with a 10% self-referral rate for those persons not designated for referral by our study design. Our results and other recent work suggest that more intensive interventions on multiple occasions based on relapse prevention strategies hold promise for future success in smoking cessation efforts in primary care.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID