摘要:

This study explores the effects of capitation payment on the structural elements used by medical group practices to control physician-directed use of resources and the quality of patient care. Forty-five medical groups located in the highly competitive Minneapolis/St. Paul metropolitan area were studied. The range of capitation payment in these medical group practices is from 2% to 87%. Although the practices vary considerably in the extent to which they have developed these control mechanisms, it does not appear that capitation payment is a major factor influencing that pattern. It appears that many of these medical group practices either use less formal mechanisms than those included in this study to control resource use and the quality of care or use none at all. In either event, the data suggest that the effects of capitation payment on the structure of medical practices may be overestimated.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In an effort to develop a patient questionnaire with sufficient validity and reliability to be used to measure patient perceptions of quality, over 30,000 patients from 178 solo and group practices completed the Physician Office Quality of Care Monitor (QCM). The study found strong evidence of construct validity, predictive validity, and internal consistency for the questionnaire. Physician interactions were the most important aspect of office care while coordination of care over time was found to be the best issue to differentiate patients likely to recommend a practice from those less likely to recommend. An inverse relationship was found between practice size and patient satisfaction. Health maintenance organization (HMO) patients reported lower satisfaction, as did younger patients.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Pneumocystis pneumonia (PCP) is the most common pneumonia in persons with acquired immunodeficiency syndrome (AIDS) and a frequent cause of hospitalization. The incidence of PCP in patients with AIDS can be substantially reduced when patients comply with standard prophylaxis protocols. However, achieving acceptable prophylaxis compliance in any patient population is difficult, particularly with intravenous drug users (IVDU), homeless, or medically disenfranchised patients. This study defines the rates and locations of treatment of PCP in a prepaid managed care program for a Medicaid-covered population with AIDS, with comparisons to PCP incidence rates in the same population receiving care in the fee-for-service system.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A research demonstration pilot project for hospitalized adult and pediatric long-term ventilator-dependent patients was conducted by Kaiser Permanente Southern California Region from 1985 until 1992. The purpose of the pilot project was to investigate if home care was a realistic alternative to continued hospital care. Many aspects of home care as compared to hospital care were studied. The results of the quality of life and quality of care study in addition to cost data are presented in this paper. Standardized questionnaire tools were used to obtain patient data from the perspective of the patient, as well as others providing direct patient care. Respondents were asked to measure perceptions of quality of life and quality of care at home versus at the hospital in regard to health status, life satisfaction, emotional well-being, caregiver ability, and professional care and services. Quality of care was found to be similar to hospital care. Quality of life was judged to be better at home.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Growing emphasis on managed care has led to increased Interest in physician practice profiling. Standardized techniques for conducting profiling are not yet well established. One particularly challenging methodologic issue, case mix adjustment, Is explored here using actual cost profiles derived from primary care physicians at two independent practice association (IPA)-model health maintenance organizations (HMOs). Specifically, this article examines how the ambulatory care group case mix methodology can be applied to profiling and illustrates that it provides more depth of information with which to assess performance than does standard demographic adjustment alone. This analysis suggests both the potential and methodologic limitations of profiling at the individual physician level.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Physician profilers encompass an array of technological products that purport to evaluate individual clinician performance on utilization and other measures. Prior to installation, an organization should be familiar with a number of major concepts that encompass understanding of clinical practice processes, claims data limitations and idiosyncrasies, ethical issues, and mathematical principles. Twelve specific elements are described to assure that these concepts are addressed.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A variety of profiling models and tools is utilized by payers, providers, and regulators to evaluate physician work, performance, and resource utilization. In physician profiling, the provider's pattern of practice is expressed as a rate of service or outcome. The article by Tucker, Weiner, Honigfeld, and Parton (this issue) compares the practice-based norms of primary care physicians by adjusting for case mix using ambulatory care groups (ACGs), a population-based classification method. Once the case mix is adjusted, the actual use of resources, as measured by overall charges, is compared with the expected value of resource use. In the Center for Research in Ambulatory Health Care Administration (CRAHCA) Physician Profiling Project, funded by The Robert Wood Johnson Foundation, physicians learn which services other physicians in their specialties perform. Physicians are able to compare their profiles with state and national level medians. The profiling project is one of the first demonstration projects In the field to profile ambulatory care practice patterns and collect patient demographics. An aspect of the project is to test the ACG classification system to data selected from 130 nonacademic practices representing over 5,000 physicians.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Increasing demands for provider profiling have led to the growth of health information services units within payers and health plans. An important decision faced by these groups is whether to buy or build the information infrastructure necessary to support the activities of the department. The article offers an overview of a system that was collaboratively designed and built by Blue Cross and Blue Shield of Iowa and the Dartmouth Medical School. A case study illustrating the flexibility of the information system in adapting ambulatory care groups to the fee-for-service payer industry is reviewed.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The Iowa Community Health Management Information System (CHMIS) is a legislatively authorized system that is designed to meet Iowa's shared information needs and reduce administrative costs. A public/private partnership has been planning this system for over three years, implementation is scheduled to begin in July 1996. At that time, certified transaction networks will route claims data between providers and payors, a subset of that data will be stored by a centralized data repository. As the system evolves, provider access will be expanded and additional data elements will be captured.

ISSN:0148-9917    

出版商:OVID    

年代:1996

数据来源: OVID