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Biomedical subjects

R Penchansky

Publications and source records attributed to R Penchansky.

17 recordsLinked to original sources
PubMed1998

Disaggregating the effects of race on breast cancer survival.

BACKGROUND AND OBJECTIVES: This study examines differences in breast cancer survival between African-American and white women to determine whether there is a racial difference in survival after accounting for established influences on outcome, such as stage of cancer, health status, health behavior, utilization patterns, access to care, quality of care, and the doctor-patient relationship. METHODS: This study is a retrospective review of clinical records. The sample consists of 246 patients of three staff model HMOs who had mastectomies at stage II or above. Data on patient demographics, stage of cancer, health status, and health behavior and utilization, including preventive care, were extracted from patient records. Multivariate logistic regression was used to predict the determinants of advanced stage of cancer. Cox survival analysis was used to predict the determinants of survival. RESULTS: Missed appointments and stage of cancer were the key determinants of survival. The effect of race on survival was marginal after adjusting for these factors. Race, patients who missed appointments, and patients who delayed in reporting breast cancer symptoms were determinants of advanced stage. African-Americans were overrepresented among patients who missed appointments. CONCLUSIONS: Missed appointments was a determinant of both advanced stage and shorter survival. This measure is an important component of how race affects survival. Compliance with appointment keeping and alleviating reasons for noncompliance must be considered as factors in breast cancer survival.

Adult↗
PubMed1995

Vision testing and the elderly driver: is there a problem meriting policy change?

BACKGROUND: The number of elderly drivers is increasing. The primary purpose of public policy requiring vision screening for driver's license renewal is to identify, and, when necessary, restrict drivers with functional vision impairments. Because of age-related ocular conditions, elderly drivers, as a group, have a higher incidence and prevalence of functionally impaired vision. To date, there is no empirical evidence of a significant predictive relationship between changes in vision function and automobile crashes. METHODS: Most states require vision screening for driver's license renewal, whereas some do not. Among those states requiring vision screening, there is considerable variation in the frequency and level of testing. Efforts to determine the role of vision in driving, while suggestive, have not been useful in identifying at-risk older drivers. RESULTS: Researchers have observed that older drivers are often aware of their decreased functional capacity and voluntarily adjust their driving patterns by driving less frequently, for shorter distances, during daylight hours, more slowly, and during non-rush hours. However, although not statistically significant, the decline in the mean annual traffic fatality rates with increased state vision screening requirements suggests a possible beneficial effect of vision screening. CONCLUSIONS: Because older drivers are at risk for sight-threatening conditions, they are most affected by vision screening requirements for driver's license renewal. Since a loss of driving privileges represents a major loss of mobility and independence, there is a pressing need to better understand the relationship between age-related vision changes and the frequency and severity of traffic crashes.

Accidents, Traffic↗
PubMed1994

Initiation of medical malpractice suits: a conceptualization and test.

Despite the concern with medical malpractice suits and research about them, little is known about why some perceived injuries lead to claims of malpractice while other similar injuries do not. This paper presents a conceptualization and hypotheses regarding the determinants of an injury or perceived injury leading to suit. The conceptualization and hypotheses are tested using information collected from 113 medical malpractice plaintiffs' attorneys in three states. A series of proposed concepts prove useful in explaining patient willingness to pursue a suit as well as the plaintiff's success and award size. These are concepts of anger, reluctance to sue, patient and provider worthiness, affinity, economic burden and potential for compensation. Specific attributes of the injury, the patient, the provider, and the doctor-patient relationship relate to these concepts. Injury and doctor-patient relationship attributes prove more important than patient or provider attributes. However, the reported impact of the attributes of the patient and physician on plaintiff success and award is high and suggests that the impact of "non-relevant" variables in the medical malpractice process. Doctor-patient relationship variables hypothesized to reflect affinity are reported to be important in reducing patient willingness to pursue a case; and, certain populations, such as minorities, elderly, foreign-born, are perceived to have a reluctance to sue. The effect of specific characteristics of the patient, the doctor, the injury and the patient-doctor relationship on patient reaction and on disposition is reported, as well as evidence that relates to the validity of the overall conceptualization.

Adult↗
PubMed1994

Targeting ambulatory care cases for risk management and quality management.

Means are needed to identify "highly productive" areas for quality review and risk management in ambulatory care; untargeted medical record reviews have too low a yield and too high a cost to be useful. Highly productive areas are those with important medical and economic consequences, large numbers of cases, and a reasonable potential that problems exist. This paper describes untoward event screens to identify highly productive areas for review based on hospital discharge diagnosis, procedure codes, and parameters such as length of stay and cancer staging. The approach proposed has been evaluated in six ambulatory care organizations and appears effective and efficient.

Ambulatory Care↗
PubMed1993

Ensuring excellence: reconceptualizing quality assurance, risk management, and utilization review.

A new conceptualization of the related activities QA, RM, and UR may allow an organization to ensure appropriate, proficient, and satisfactory care and to ameliorate the consequences of bad outcomes. Three processes incorporated into the conceptualization are essential to ensuring excellence, as are specific attributes of the care process. The difference in initiation of activities (reactive versus proactive) is part of the model; relationships among the essential activities and processes and between reactive and proactive activities are suggested; and viewing data sources or collection as separate from the processes and activities is suggested. Areas for development and research within the conceptualization that are inadequately understood include data sources and analysis methods useful for the processes needed, evaluation of the consequences of different reactive activities, and the usefulness of TQI activities for setting goals or standards and for changing behavior. Implementing such an approach to ensuring excellence would be a challenge. It is hoped that this formulation will assist in communication among those working to ensure excellence; promote analysis of whether current organizational structures for ensuring excellence and for cost containment are creating redundance, competition, or gaps in needed activities; broaden the perception of the possible and/or appropriate scope of some activities, such as the inclusion of proactive preventive care and the provision of special high-risk programs; and assist in the identification of areas of needed research and development.

Health Services Research↗
PubMed1984

Estimating the number of residents needed in community teaching hospitals.

Hospitals are concerned with the performance of their graduate medical education programs because of increasing costs and reduced reimbursements, residency review committees' decisions about the number and size of programs, and pressures that derive from the increasing supply of physicians. In any effort by hospitals to evaluate the need for residency programs and the costs and benefits of having them, it is essential to forecast accurately the number of residents needed for specific activities. Refined methods to do this have not been developed. In this article, the author reports on an evaluation of a methodology developed by Chan and Bernstein to estimate the number of residents required and presents (a) the changes in the methodology that were necessary to estimate needs for both service care and assisting attending physicians with their private cases; (b) the data collection process; (c) some representative findings; (d) an evaluation of the method that employs as criteria the cost, the ease of use, understandability, communicability, and validity; and (e) the limitations found.

Hospitals, Community↗
PubMed1984

Relating satisfaction with access to utilization of services.

Underlying the continuing emphasis on access by health services researchers and policymakers is the assumption that patients having poorer access will receive less than appropriate health care, other things being equal. However, recent research results typically have not supported this assumption, and the nature and importance of relationships between access and use still remain unclear. Most published studies have sought to define general relationships that are descriptive of the behavior of all patients in a population facing access problems. The authors use interview data to show that significant relationships between satisfaction with access and use of services can be found if segments of the population, homogeneous in terms of age, sex, or other characteristics, are considered separately. This approach is based on the assumption that dissatisfaction with a particular dimension of access may be salient for some groups of patients but not others, and it is consistent with the view that patients' beliefs and perceptions are important determinants of health behavior.

Adult↗
PubMed1981

The concept of access: definition and relationship to consumer satisfaction.

Access is an important concept in health policy and health services research, yet it is one which has not been defined or employed precisely. To some authors "access" refers to entry into or use of the health care system, while to others it characterizes factors influencing entry or use. The purpose of this article is to propose a taxonomic definition of "access." Access is presented here as a general concept that summarizes a set of more specific dimensions describing the fit between the patient and the health care system. The specific dimensions are availability, accessibility, accommodation, affordability and acceptability. Using interview data on patient satisfaction, the discriminant validity of these dimensions is investigated. Results provide strong support for the view that differentiation does exist among the five areas and that the measures do relate to the phenomena with which they are identified.

Adolescent↗
PubMed1978

Expectations and experience of HMO enrollees after one year: an analysis of satisfaction, utilization, and costs.

The impact of HMO enrollment on utilization and satisfaction in a sample of industrial employees was investigated using a panel study design. Preenrollment and postenrollment ambulatory utilization rates, out-of-pocket costs, and measures of satisfaction are presented for enrollees in two closed- and one open-panel HMO-type plans. Their health care experiences are compared to those of reenrollees remaining in the HMOs during both surveys, as well as to those retaining their Blue Cross-Blue Shield membership. Lack of access to and dissatisfaction with previous sources of care distinguished the preenrollment experience of those who selected the closed-panel plans; their postenrollment experience produced increasing satisfaction reflecting that their expectations in these areas were met. Continuing enrollees in closed-panel plans were somewhat less satisfied after a year of experience than they were earlier. Those who joined the open-panel plan did so because of the expanded benefits and financial advantages which, their postenrollment experience showed, were accurately perceived. Utilization patterns also changed: continuing enrollees in both types of plans made fewer illness but more preventive visits; new enrollees used greater numbers of both types of services after enrolling than before.

Ambulatory Care↗
PubMed1978

Enrollment choices in different types of HMOs: a multivariate analysis.

Enrollment decisions of a sample of an employed population choosing among open-panel and closed-panel HMOs and Blue Cross/Blue Shield are analyzed. This report, unlike previous ones, overcomes some of the difficulties of bivariate analysis by the use of the multivariate logistic probability model, logit. The results show that there are four consistent predictors of enrollment choice: previous source of care as the measure of access; family life stage and chronic conditions per family member as indicators of health risk; per capita income as the measure of economic vulnerability; and health concern. Having a private physician as the source of care is the best single predictor, its absence predicting a higher probability of enrollment in the closed, and its presence in the open-panel HMO. Higher risk life stage families, younger and with more children, are more likely to join the open-panel plan than the closed or retain BC/BS; higher incomes and larger numbers of chronic conditions appear to have the same effects. Higher levels of health concern, on the other hand, predict a greater probability of choosing the closed-panel plan. The probability of enrollment in any HMO is predicted with more than 50 per cent accuracy for 60 per cent of the sample. Choice between open and closed-panel plans is predicted with an accuracy in excess of 50 per cent for 80 per cent, and with an accuracy greater than 90 per cent for over 10 per cent of potential enrollees. The applicability of this approach to HMO feasibility analysis and planning is clearly indicated.

Analysis of Variance↗
PubMed1977

Enrollment choice in a mutli-HMO setting:the roles of health risk, financial vulnerability, and access to care.

Results of an analysis of enrollment decisions in HMO-type plans are reported. Previous studies concern dual-choice situations; this paper deals with a quadruple-choice situation involving one open- and two closed-panel HMO-type plans as well as Blue Cross/Blue Shield (BC/BS). The risk-vulnerability hypothesis is disaggregated into its components and the results show that there is no adverse health risk self-selection in an employed population. The hypothesis of economic vulnerability is maintained when tested in terms of per capita income rather than the previously used measure of family income. It is shown that those who enroll in any HMO-type plan are younger and have younger and larger families and lower per capita income than those who do not. No meaningful differences in terms of health status, health concerns, or prior utilization are found. Of the few differences found between those who enroll in closed- and open-panel HMO-type plans, having a private physician as the usual source of care is the most significant: those with an established physician relationship who join any HMO-type plan tend to follow their physician into the open-panel plan. The results should not be generalized to situations involving premium differences since the premium cost to subscribers in any of the plans considered here was fully paid by the employer. The validity of the results in terms of nonfinancial factors, on the other hand, is enhanced by the removal of cost considerations.

Adolescent↗