摘要:

Urban safety net providers are under pressure to improve primary care productivity. In a survey of ambulatory care facilities in New York City, productivity (measured as the number of primary care visits per provider hour) increases with exam rooms per physician but has no association with computerized information systems or tightly controlled reimbursement. Also, sample facilities rely heavily on residents, which makes these facilities sensitive to medical education policies and raises questions about quality of care for the poor. We conclude that urban safety net providers will have difficulty making the productivity improvements demanded by a more competitive health system.

ISSN:0148-9917    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Cooperative disease management programs sponsored by pharmaceutical companies and managed care organizations or health care providers can offer significant benefits to patients. They can be structured so as to comply with applicable OIG, FDA, and IRS regulations. Such programs must be structured for the benefit of patients, and not to require the use of or otherwise directly promote the selection of the sponsoring pharmaceutical company's products.

ISSN:0148-9917    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

In randomized clinical trials, children and adolescents improved their self care and reduced their emergency clinical utilization after playing health education and disease management video games. A diabetes game reduced diabetes-related urgent and emergency visits by 77 percent after diabetic youngsters had the game at home for six months, compared to no reduction in clinical utilization in a control group of diabetic youngsters who took home an entertainment video game that had no health content. Positive impacts were also found in clinical trials of games for asthma self-management and smoking prevention.

ISSN:0148-9917    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Diabetes mellitus (DM) is a common chronic health condition among the adult population in the United States. DM is more prevalent and complications higher in Latinos, possibly due to inadequate medical and self-care as well as inaccurate culture-bound beliefs. Project Dulce is a nurse-managed DM educational and treatment program designed to measure the effect on clinical outcomes, adherence to American Diabetes Association and American Heart Association standards of care, and cultural beliefs in 210 high risk (HbA1c > 9.5%) and 346 lower risk (HbA1c < 9.5%) indigent Latinos with DM.Methods:All patients were given a 12-week culturally sensitive educational program. Nurse manager/certified diabetes educators working together with primary care providers treated high-risk patients using protocols from Staged Diabetes Management®. Physical exam and biochemical markers of DM were followed. Pre- and post-program questionnaires measured changes in diabetes knowledge, cultural beliefs practices, treatment satisfaction, and health locus of control. Chart reviews of Latinos with diabetes (n = 311) not enrolled in Project Dulce provided the case controls.Results:After 1 year, the high-risk group showed significant improvements in HbA1c (11.5% to 8.3%, p < 0.0001), total cholesterol (219 to 181 mg/dL, p < 0.00001), SBP (129 to 122 mmHg, p < 0.03), and DBP (79 to 75 mmHg, p < 0.006). Pre- and post-test evaluations showed improved diabetes knowledge (p = .024), treatment satisfaction (p = .001) and internal locus of control (p = 0.04), and fewer inaccurate culture-bound beliefs (p = 0.001). Compliance was 100% in the high-risk group in obtaining HbAlc, lipids, urine microalbumin, and foot exams and 47% in obtaining eye exams, while the case controls had 28%, 46%, 31%, 14%, and 6% respectively. Mean TC and LDL values improved in Project Dulce patients compared to case controls (181 vs 221 lmg/dL, p < 0.0001 and 99 vs 1241 mg/dL, p < 0.0004).Conclusion:Patients enrolled in Project Dulce had significantly improved clinical outcomes, adherence to standards of care, and culture bound beliefs. Nurse managed diabetes managemnent programs that are culturally sensitive may decrease the incidence of complications of diabetes and improve health outcomes.

ISSN:0148-9917    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

This study describes the development of a patient satisfaction assessment instrument used at the Medical University of South Carolina Outpatient Services clinics. Three years of responses were analyzed and a logistic regression model is presented to identify components of care that predict patient intent to return for additional care. Waiting time and understanding doctor's explanation were the only items that were significant predictors of intent to return. Additionally, the calculated probability of a return visit was used to calculate the potential impact of changes in mean satisfaction scores on the number of patient visits to the hospital ambulatory clinics.

ISSN:0148-9917    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

This article examined the impact of managed care involvement on vulnerable populations served by community health centers (CHCs), while controlling for center rural-urban location and size, and found that centers involved in managed care have served a significantly smaller proportion of uninsured patients but a higher proportion of Medicaid users than those not involved in managed care. The results suggest that the increase in Medicaid managed care patients may lead to a reduced capacity to care for the uninsured, thus hampering CHCs from expanding access to health care for the medically indigent.

ISSN:0148-9917    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

CHW is a large and diverse hospital system that developed a systematic planning process to define, prioritize, and assess the current status of those functionalities needed by caregivers to assist them in providing optimal care. In order to develop a durable consensus, a bottom-up approach was used. The details of the process including the structure of the meetings and many of the methodologies employed are presented.

ISSN:0148-9917    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

This article looks at the nation's community and migrant health centers, where substantial numbers of female physicians are medical directors, the second highest executive position, in search of insights for managed care organizations for recruiting and retaining women medical directors. This paper provides the first comparative national profile of women and men community and migrant health center (C/MHC) medical directors in terms of their personal and work characteristics, as well as job satisfaction. The study findings indicate that, for the most part, female medical directors do not differ much from their male colleagues in issues of work characteristics or job satisfaction.

ISSN:0148-9917    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2001

数据来源: OVID