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Biomedical subjects

I Moscovice

Publications and source records attributed to I Moscovice.

14 recordsLinked to original sources
PubMed1992

Accuracy of diagnoses of schizophrenia in Medicaid claims.

Medical insurance claims are increasingly important as a source of data in monitoring health care utilization and patient outcomes and in identifying patient cohorts for research. In a study that attempted to verify that those with Medicaid claims for treatment of schizophrenia did indeed have the disorder, two psychiatrists evaluated clinical information obtained from primary mental health care providers in relation to DSM-III-R criteria. The psychiatrists classified 86.8 percent of 319 patients with claims for treatment of schizophrenia and 27.5 percent of 156 patients with claims for treatment of other psychiatric diagnoses as definitely or probably having schizophrenia. The authors conclude that most diagnoses of schizophrenia listed on Medicaid claims are accurate, but that a substantial number of individuals with schizophrenia may not be identified by claims data.

Algorithms↗
PubMed1989

Mainstreaming the mentally ill in HMOs.

Administratively complex and politically sensitive issues can arise when mentally ill persons who are public program beneficiaries are enrolled in existing HMOs. The experiences of a demonstration program undertaken in Minnesota illustrate these issues.

Contract Services↗
PubMed1989

Health insurance and welfare reentry.

This study presents a theoretical model of welfare reentry that examines the importance of private health insurance in determining whether working recipients terminated from Aid to Families with Dependent Children (AFDC) as a result of the Omnibus Budget Reconciliation Act returned to welfare over a two-year period. Our empirical results suggest that the lack of private health insurance is a statistically significant and quantitatively important determinant of welfare reentry. Since the vast majority of the terminated families remained off welfare, however, these results suggest the difficulty of meeting the health needs of the employed uninsured.

Adolescent↗
PubMed1989

Allocative efficiency of case managers for the elderly.

This study presents an analysis of the allocative efficiency of case managers for the community-based elderly in an environment in which case management and a range of home and community-based services were available and directly linked to a mandatory preadmission screening program for nursing home applicants. We collected data for a one-year follow-up period on client placement, health and functional status, informal support, and use of health and social services for clients in two urban and two rural counties that participated in the Minnesota Pre-Admission Screening/Alternative Care Grants Program (PAS/ACG). We found that among those receiving ACG-supported services, the relationship between variation in the level of support for home and community-based services and the length of time elderly clients remained in the community suggested that case managers were allocating home and community-based services in a reasonably efficient manner. This finding offers support for using case managers to target services to the elderly.

Activities of Daily Living↗
PubMed1988

Substitution of formal and informal care for the community-based elderly.

The Minnesota Pre-Admission Screening/Alternative Care Grants Program screens those at risk of nursing home placement and funds services that will allow the elderly to be cared for at home. Information was collected for a 1-year period on client placement, health and functional status, informal support, use of health and formal services, and care-giver characteristics for 214 clients screened during the last quarter of 1984. A two-equation model was hypothesized to examine the formal service decisions of case managers and the amount of informal care provided for elderly clients at risk of institutionalization. A system of two simultaneous equations was estimated using a two-stage least-squares approach. The findings suggest that case managers allocate formal services based primarily on client need. The amount of informal care provided to clients did not affect significantly the decisions of case managers and is not determined significantly by the amount of formal services received by the elderly in the community. The lack of substitution between formal services and informal care reinforces the findings of previous research.

Aged↗
PubMed1987

Health care and insurance loss of working AFDC recipients.

The federal Omnibus Budget Reconciliation Act of 1981 (OBRA) produced substantial changes in the Aid to Families With Dependent Children (AFDC) program. The main effect of the changes has been the denial of assistance and hence Medicaid coverage to many AFDC recipients with jobs. Our analysis of the health care and insurance loss of working AFDC recipients in Hennepin County, Minnesota, found that the vast majority (87%) of families that were terminated from AFDC due to OBRA were able to remain off welfare and the majority (70% adults, 60% children) had private health insurance coverage 2 years later. These results highlight the dilemma facing state policymakers who want to develop successful programs to meet the health needs of the working poor, yet at the same time must cope with tight, short-term fiscal constraints.

Adolescent↗
PubMed1979

Referral patterns of family physicians in an underserved rural area.

This paper examines the rates and patterns of referral of four family physicians in an underserved rural area of Washington State. The majority of referrals made by the family physicians were for management of a particular problem outside the scope of practice of the physician. The referral rates ranged from 1.8 to 3.2 percent of all patient visits and were comparable with those previously reported. A National Health Service Corps physician had the highest rate of referral and a foreign medical graduate had the lowest rate of referral. These results may be explained by practice building incentives as well as the ability to establish ties with the referral network.

Medically Underserved Area↗
PubMed1978

The influence of training level and practice setting on patterns of primary care provided by nursing personnel.

The influence that the level of training and practice setting have on the patterns of primary care provided by nurses at the Frontier Nursing Service (FNS) is assessed. The Frontier Nursing Service is the only available source the residents of Leslie County, Kentucky have for primary care; it utilizes nurses for the management of approximately 80% of its primary care patients. Patterns of care given by family nurse practitioners and registered nurses at FNS during 1974 were analyzed according to two tracer conditions, otitis media and urinary tract infection. Data were obtained from the encounter forms that are filled out for all primary care visits to FNS. Computerized routines were developed to group the relevant encounters into episodes of care for the two tracer conditions. Results indicate that the practice setting, rather than the level of training, has the strongest effect on the patterns of primary care rendered by nurses in a rural environment such as FNS.

Anti-Bacterial Agents↗
PubMed1977

A method for analyzing resource use in ambulatory care settings.

The major objective of this research is to develop a methodological framework to help analyze the use of resources in ambulatory care environments. Emphasis is placed on trying to understand reasons for variation in treatment patterns. Important methodological considerations include: 1) the selection of a set of medical problems appropriate for evaluating the interaction effects of the variables being considered; 2) the development of problem-specific computerized routines for defining episodes of care based on patient visit information; and 3) the selection of appropriate measures of utilization. The Frontier Nursing Service (FNS) was used as a study setting. FNS is a primary health care service and training center located in Leslie County in eastern Kentucky. an area that covers 1,000 square miles with a population of approximately 15,000. The analysis indicates that for common primary care problems, the level of provider training as well as accessibility of services significantly influence patterns of care.

Ambulatory Care↗