摘要:

This study has two objectives: (1) to examine the relationship between the involvement of community health centers (CHCs) in managed care and various center characteristics, including patient, provider, services, and financial characteristics, that are critically linked with the fulfillment of their mission and (2) to identify factors significantly associated with CHCs' involvement in managed care. Regarding the first objective, the study indicates that CHCs involved in managed care have more diversified sources of revenue and depend less on grant funding than other CHCs, and they serve a significantly smaller proportion of uninsured and homeless patients. Involvement in managed care is also associated with greater financial vulnerability, reflected in higher costs and net revenue deficits. Regarding the second objective, the study finds that CHCs have become involved in managed care largely in response to external market pressures, such as the prospect of reduced federal grant funding. Other significant factors include center size, location, and the percentage of users who are Medicaid patients.

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Under managed care, community health center (CHC) care patterns will be increasingly subject to outside scrutiny. This article discusses results of medical records reviews assessing quality of care at CHCs for acute otitis media, diabetes, asthma, and hypertension. As a group, these safety net providers meet or exceed prevailing practice across other health care settings; however, there is substantial variation among sites. Regression analyses indicate that the individual CHC used by a patient is the most consistent determinant of whether a patient receives recommended care. Drawing on these results, the article explores approaches for improving care and discusses the implications for performance measurement among CHCs and other safety net providers.

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The rate at which primary physicians refer patients to consultants varies considerably, not only within different regions, but also among practices within defined areas. Differences also have been identified between doctors within the same practice. This variation in referral rates is a source of concern because of the costs generated and implications for quality and quantity of care. Many studies that tried to identify the sources for this variation explained only part of it; however, these studies were based on small numbers.

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

In a large multi-specialty group practice treating approximately equal numbers of health maintenance organization (HMO) and fee-for-service (FFS) patients, we analyzed a natural experiment by the administration to introduce a dual incentive system for physicians. We examine the impact on care when they announced that each physician would be remunerated for HMO care based on a per capita budget, but for FFS care based on billable services. Data were 86,230 episodes for treating patients under age 65 with seven common illnesses. There was no evidence that the intended impact (reducing HMO care) occurred; instead, there were undesired and unintended effects (reduced care for FFS and upset physicians and threats to their corporate culture).

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

This article presents baseline work sampling data from an outpatient oncology clinic prior to an electronic medical record implementation. The physicians and medical office assistants spent 29% and 39% of their time, respectively, entering and retrieving information from medical records. The physicians and medical office assistants spent 43% and 17% of their time, respectively, on direct patient contact. Using scheduled outpatient counts to measure the productivity of the physicians and medical office assistants failed to capture 19% and 29% of their workload.

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID