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Biomedical subjects

A F Nelson

Publications and source records attributed to A F Nelson.

6 recordsLinked to original sources
PubMed1998

IMPROVE: bridge over troubled waters.

BACKGROUND: The original collaborative project was described in a 1995 Journal article titled "Competing HMOs Collaborate to Improve Preventive Services." IMPROVE (IMproving PRevention through Organization, Vision, and Empowerment) was a large randomized controlled trial using continuous quality improvement to implement clinical systems to improve the delivery of adult preventive services in primary care settings. The project was funded by the Agency for Health Care Policy and Research and initiated as a collaboration between two health maintenance organizations (HMOs) in the Twin Cities: Health Partners and Blue Plus. METHODOLOGY: Forty-four clinics were recruited for the study. Initially the 22 intervention clinics received the multifaceted intervention of leadership support, training on CQI and prevention systems, and consultation and networking opportunities. Next, the comparison clinics received similar assistance, and other clinics were invited into the collaboration. Ultimately, 57 clinics were involved in the project. Multiple collaborations--among clinics, leaders, and HMOs--developed during the project. STATUS: Despite turmoil in the environment during the project, many benefits have been described, including enhanced leadership, growth of systems thinking, better change management skills, and collaboration of competing organizations. SUMMARY: The IMPROVE collaboration survived and flourished in a very competitive market. It was viewed positively by clinicians, medical clinics, and HMOs, and its benefits have extended into the community.

Adult↗
PubMed1996

Alcohol and other drugs of abuse in pregnancy.

This paper presents an overview of the Mother-Baby Chemical Health Program (MBCHP), which was designed to decrease preterm births among pregnant women who use and abuse drugs. Three hundred and fifty-two patients enrolled in the program between January 1990 and December 1992 were followed. More than 90% of the women involved in the MBCHP did not use substances during their pregnancies. Approximately 93% of the participants delivered at 37 or more weeks gestation, and over 91% of the infants weighed 2500 grams or more.

Adolescent↗
PubMedDate not supplied

Physician staffing ratios in staff-model HMOs: a cautionary tale.

Predictions of imminent large physician surpluses stem from two observations: rapid increases in the proportion of Americans in managed care plans, and the relatively lean physician staffing ratios reported for health maintenance organizations (HMOs). We use internal data from two large, mature staff-model HMOs to determine precise specialty-specific physician staffing ratios, to see whether these HMOs use fewer physicians than the fee-for-service sector uses. The two HMOs provided the equivalent of 180 physicians per 100,000 enrollees, which is near the national average and far above figures that typically are reported in the literature. Thus, caution regarding current workforce predictions is warranted.

Fee-for-Service Plans↗
PubMedDate not supplied

The state of research within managed care plans: 1997 survey.

The growing need for information about managed care and for the use of managed care organization (MCO) members in clinical and health services research requires research capability within MCOs. To learn the extent to which such capability exists, we conducted a survey of readily identifiable MCO research programs. Responses were obtained from twenty of twenty-three eligible organizations. Although there is great variability in size, these organizations have a collective budget of $93 million, more than 158 career researchers, and extensive research infrastructure and applied research activities.

Data Collection↗
PubMedDate not supplied

Failure of a continuous quality improvement intervention to increase the delivery of preventive services. A randomized trial.

CONTEXT: Although there has been enormous interest in continuous quality improvement (CQI) as a measure to improve health care, this enthusiasm is based largely on its apparent success in business rather than formal evaluations in health care. OBJECTIVE: To determine whether a managed care organization can increase delivery of eight clinical preventive services by using CQI. DESIGN: Primary care clinics were randomly assigned to improve delivery of preventive services with CQI (intervention group) or to provide usual care (control group). INTERVENTION: Through leadership support, training, consulting, and networking, each intervention clinic was assisted to use CQI multidisciplinary teams to develop and implement systems for delivery of preventive services. SETTING: 44 primary care clinics in greater Minneapolis-St. Paul. PATIENTS: Patients 19 years of age and older completed surveys at baseline (n = 6830) and at follow-up (n = 6431). Medical chart audits were completed on 4777 patients at baseline and 4546 patients at follow-up. MAIN OUTCOME MEASURES: The proportion of patients who were up-to-date (according to chart audit) and the proportion of patients who were offered a service if not up-to-date (according to patient report) for 8 preventive services. RESULTS: Compared with the control group, based on the proportion of patients who were up-to-date, use of only one preventive service--pneumococcal vaccine--increased significantly in the intervention group (17.2% absolute increase from baseline to follow-up compared with a 0.3% absolute increase in the control group, P = 0.003). Similarly, based on patient report of being offered a service if not up-to-date, delivery of only one preventive service--cholesterol testing--significantly increased in the intervention group compared with the control group (4.6% increase vs. 0.4% absolute decrease in the control group; P = 0.006). CONCLUSION: In this trial, CQI methods did not result in clinically important increases in preventive service delivery rates.

Adult↗