P R VanOstenberg | PubMed Health

Yes! Practice guidelines are clearly connected to quality. To characterize that connection adequately, however, is a more formidable task and is the subject of this paper. This paper will capture, in a few words, the essence of my perspective and experience related to quality issues and then attempt to establish a connection between practice guidelines and quality from two perspectives: first, by suggesting a series of assumptions that would lead to a decision on what should be the focus of an appropriate guideline for an older adult, since there are many possibilities and agreeing on assumptions is a logical first step; and second, by suggesting a framework for the content of such guidelines.

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Characteristics of hospitals providing preventive services: does delivery system integration make a difference?

OBJECTIVE: As health care organizations consolidate into integrated delivery systems, increased delivery of preventive services is expected. The study objective was to evaluate the impact of hospitals' participation in multiorganizational arrangements and managed care on their delivery of preventive services. METHOD: The study is a secondary data analysis of data in the American Hospital Association 1993 Annual Survey of Hospitals Data Base. Two primary prevention variables (health promotion services to patients and to community members), and one secondary prevention variable (screening mammography) were included. Hospital characteristics included ownership, bed-size, and integration-participation in a multiorganizational arrangement and having managed care (HMO and PPO) contracts. RESULT: The 5,387 general medical and surgical hospitals responding to the 1993 survey were included in the analysis. Proportions of hospitals reporting delivery of health promotion services to patients, and to community members, and screening mammography services were respectively 90%, 83%, and 88%. Hospitals reporting participation in multiorganizational arrangements were more likely to report delivery of preventive services after adjusting for bed-size. The bed-adjusted odds ratios for providing health promotion services to inpatients, and to members of the community, and screening mammography services in hospitals with managed care contracts versus those without managed care contracts were respectively: 2.72 (95% CI: 1.65, 2.50), 2.03 (1.63, 2.53), and 1.51 (1.26, 1.81). CONCLUSION: Preliminary findings from this secondary data analysis support the expectation that current changes in the health care delivery system may expand the delivery of preventive services.

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