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Biomedical subjects

G S Lamb

Publications and source records attributed to G S Lamb.

17 recordsLinked to original sources
PubMed1997

Outcomes across the care continuum.

OBJECTIVES: This article focuses on issues facing scientists and clinicians in developing outcomes useful across the care continuum, particularly in examining the impact of care delivery systems. METHODS: Research and current corporate examples of the continuum of care delivery and relevant outcomes were reviewed. Questions addressed included the following: How do we know when networks or care systems are successful? What are the clinical and financial indicators of system success? What are the indicators of declining performance? RESULTS AND CONCLUSIONS: Approaches to describing program or system outcomes have included snapshots at single points in time, snapshots of system transitions, multiple snapshots (global indicators), and population-based outcomes. Crucial methodological issues include identification of severity and risk adjustment, access to usable data across settings, determination of the portion of an intervention to allocate to quality and cost outcomes, and integration of disease-specific, population-specific, and general outcome measures.

Continuity of Patient Care↗
PubMed1996

Impact of integrated community nursing services on hospital utilization and costs in a Medicare risk plan.

This study measures the impact of integrated community nursing services on hospital use and costs for elderly people in a health maintenance organization (HMO). We tracked 4,943 HMO patients over three consecutive five-month periods (one preintervention and two postintervention). We compared 326 patients who entered a program of integrated services during period 2 with 301 patients who entered during period 3 and 4,316 nonprogram patients in respect to their utilization and costs during periods 2 and 3. Regression results reveal that patients receiving integrated services had significantly higher utilization and costs during the period of enrollment and significantly lower utilization and costs during the period following enrollment, compared to nonprogram patients. These results were replicated when considering only patients with observed episodes of care in these periods, when controlling for hospital use and costs in the prior period, and when controlling for the risk of selection into the program. The findings suggest that integrating services at the community level may achieve substantial cost savings.

Aged↗
PubMed1995

Early lessons from a capitated community-based nursing model.

The community nursing organization (CNO) demonstration is a three-year Medicare program to develop, manage, and evaluate a new capitated, nurse-managed system of community and ambulatory care. Since February 1994, four national sites have started CNOs. The CNO at Carondelet Health Care in Tucson, Arizona, shares early experiences in designing and implementing an exciting new community practice model.

Capitation Fee↗
PubMed1995

Case management.

Explore the source record for details and available documents.

Case Management↗
PubMed1992

Conceptual and methodological issues in nurse case management research.

Conceptual and methodological issues facing researchers who are studying the process and outcomes of nurse case management are identified. The evolution of a research program designed to understand and evaluate one model of nurse case management is described as an example of responding to these issues. The development of a body of knowledge around nurse case management is essential to assure the expansion of this role and to justify reimbursement through current and evolving insurance mechanisms.

Humans↗
PubMed1991

Two explanations of nurse practitioner interactions and participatory decision making with physicians.

The purpose of this study was to test a theoretical model that integrated two explanations of nurse practitioner interaction and participatory decision making with physicians. The two explanations were derived from technology theory and social exchange theory. Nurse practitioners (N = 38) responded to a four-scale magnitude estimation instrument measuring each of four concepts in the model: complexity, expected benefit-cost ratio of interaction, interaction, and participatory decision making. Predictions derived from both theories were supported. Nurse practitioner decisions about interaction with physicians were influenced by the dynamics of social exchange with physicians, as well as the technological requirements of primary care. The findings offer nurse practitioners new strategies for managing professional exchanges on behalf of their patients.

Adult↗
PubMed1991

Nurse case management. The coming together of theory and practice.

Newman proves that theory can be a practical approach to nursing care delivery by applying a theory to the new nursing role of the case manager. The illustration applies Newman's theory of health and nursing and looks at its implications for various aspects of provider interface.

Continuity of Patient Care↗
PubMed1984

Physician-nurse practitioner interaction patterns in primary care practices.

A new method is presented which describes and measures the problem-solving and collaborative efforts between physicians and nurse practitioners on primary care teams. Application of the method would allow the relationship between team interaction and outcomes of health care to be studied. The method relates clinical problem-solving between team members to a measure of collaboration. Team interaction data were collected in a two-stage process for the purpose of tool development and refinement. Six nurse practitioner-physician teams practicing in three primary care settings participated. Audiotapes of team interactions were analyzed for initiation of interaction, character of the decision-making process that led to the interaction between providers, and characteristics of the exchange between physician and nurse practitioner. Inter-rater agreement was 0.80 for scoring of the rationale for interaction and 0.70 for collaborative scores. The findings suggest that this method is an uncomplicated clinically relevant means of allowing professionals in primary care practices to examine their own practice patterns. Trends in the data reveal little interaction between practitioners, and minimal physician initiation of exchange on the team.

Female↗
PubMed1982

The couvade syndrome: an epidemiologic study.

A tracer condition, to be used for clinical epidemiologic examination of psychosociogenic illness, must be common and clearly identifiable, distinguishable from concomitant physical problems, and found in general care. These criteria are met by couvade syndrome, the seeking of care for pregnancy-related symptoms by the mates of expectant women. Records of the mates of 267 postpartum women, representing a systemic sample of all births in a health maintenance organization of 36,000, were rated for the presence of nausea, vomiting, anorexia, abdominal pain, abdominal bloating, and other symptoms. Each patient was his own control. Sixty men (225 of 1000) sought care for couvade syndrome; they had a twofold increase in visits (p less than 0.001); had four times more symptoms than during control periods (p less than 0.001); and received twice as many prescriptions for medication as the men without this syndrome (p less than 0.05). The health care providers did not tend to recognize the "expectant" status of these patients or note the presence of the syndrome.

Adult↗
PubMedDate not supplied

Health-care seeking by men in their spouse's pregnancy.

This study compares the health-care seeking by 212 married male members of a health maintenance organization of 36,000 whose wives were pregnant, with a group of 212 " nonexpectant " married men matched for age, number of prior children, and HMO membership. Retrospective, blind chart review was used to examine the number and timing of medical visits and the types of symptoms, diagnoses, testing, and treatments recorded over the 21-month period surrounding and including each wife's pregnancy. Contrary to prior reports, the expectant fathers had a significantly lower group visit rate during the nine months of pregnancy when compared to their visit rates before conception and after delivery (p less than 0.01). The control group had a constant visit rate over the same time intervals. The types of symptoms and diagnoses recorded in the medical record over time were comparable in the two groups. The study suggests that expectant fatherhood, a clearly defined psychosocial event for a male, significantly influences health-care seeking but not the types of symptoms presented or diagnoses made.

Adaptation, Psychological↗