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Biomedical subjects

S M Wolfe

Publications and source records attributed to S M Wolfe.

At least 19 recordsLinked to original sources
PubMed1999

Quality of care in investor-owned vs not-for-profit HMOs.

CONTEXT: The proportion of health maintenance organization (HMO) members enrolled in investor-owned plans has increased sharply, yet little is known about the quality of these plans compared with not-for-profit HMOs. OBJECTIVE: To compare quality-of-care measures for investor-owned and not-for-profit HMOs. DESIGN, SETTING, AND PARTICIPANTS: Analysis of the Health Plan Employer Data and Information Set (HEDIS) Version 3.0 from the National Committee for Quality Assurance's Quality Compass 1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned and 81 not-for-profit), representing 56% of the total HMO enrollment in the United States. MAIN OUTCOME MEASURES: Rates for 14 HEDIS quality-of-care indicators. RESULTS: Compared with not-for-profit HMOs, investor-owned plans had lower rates for all 14 quality-of-care indicators. Among patients discharged from the hospital after myocardial infarction, 59.2% of members in investor-owned HMOs vs 70.6% in not-for-profit plans received a beta-blocker (P<.001); 35.1% of patients with diabetes mellitus in investor-owned plans vs 47.9% in not-for-profit plans had annual eye examinations (P<.001). Investor-owned plans had lower rates than not-for-profit plans of immunization (63.9% vs 72.3%; P<.001), mammography (69.4% vs 75.1%; P<.001), Papanicolaou tests (69.2% vs 77.1%; P<.001), and psychiatric hospitalization (70.5% vs 77.1%; P<.001). Quality scores were highest for staff- and group-model HMOs. In multivariate analyses, investor ownership was consistently associated with lower quality after controlling for model type, geographic region, and the method each HMO used to collect data. CONCLUSIONS: Investor-owned HMOs deliver lower quality of care than not-for-profit plans.

Health Facilities, Proprietary↗
PubMed1998

Physicians disciplined for sex-related offenses.

CONTEXT: Physicians who abuse their patients sexually cause immense harm, and, therefore, the discipline of physicians who commit any sex-related offenses is an important public health issue that should be examined. OBJECTIVES: To determine the frequency and severity of discipline against physicians who commit sex-related offenses and to describe the characteristics of these physicians. DESIGN AND SETTING: Analysis of sex-related orders from a national database of disciplinary orders taken by state medical boards and federal agencies. SUBJECTS: A total of 761 physicians disciplined for sex-related offenses from 1981 through 1996. MAIN OUTCOME MEASURES: Rate and severity of discipline over time for sex-related offenses and specialty, age, and board certification status of disciplined physicians. RESULTS: The number of physicians disciplined per year for sex-related offenses increased from 42 in 1989 to 147 in 1996, and the proportion of all disciplinary orders that were sex related increased from 2.1% in 1989 to 4.4% in 1996 (P<.001 for trend). Discipline for sex-related offenses was significantly more severe (P<.001) than for non-sex-related offenses, with 71.9% of sex-related orders involving revocation, surrender, or suspension of medical license. Of 761 physicians disciplined, the offenses committed by 567 (75%) involved patients, including sexual intercourse, rape, sexual molestation, and sexual favors for drugs. As of March 1997, 216 physicians (39.9%) disciplined for sex-related offenses between 1981 and 1994 were licensed to practice. Compared with all physicians, physicians disciplined for sex-related offenses were more likely to practice in the specialties of psychiatry, child psychiatry, obstetrics and gynecology, and family and general practice (all P<.001) than in other specialties and were older than the national physician population, but were no different in terms of board certification status. CONCLUSIONS: Discipline against physicians for sex-related offenses is increasing over time and is relatively severe, although few physicians are disciplined for sexual offenses each year. In addition, a substantial proportion of physicians disciplined for these offenses are allowed to either continue to practice or return to practice.

Criminal Law↗
PubMed1998

Homeless and matched housed adolescents: a comparative study of psychopathology.

Compared a probability sample of 118 homeless adolescents (ages 12-17) from 6 shelters from throughout the 7-county Detroit metropolitan area to a matched sample of 118 housed adolescents using the Diagnostic Interview Schedule for Children (DISC), which yields diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R; American Psychiatric Association, 1987) criteria, and the Brief Symptom Inventory (BSI). Adolescents in the housed comparison group were matched on age, sex, race, and neighborhood characteristics. Analyses, including ones controlling for a set of 10 risk and resilience factors, indicated that the homeless showed more disruptive behavior disorders and alcohol abuse or dependence on the DISC and greater levels of symptomatology on the BSI. There were no significant group differences on drug abuse or affective disorders, and psychotic disorders were rare in both groups. This pattern of findings is not entirely consistent with popular stereotypes about homeless youth nor with many existing studies (which have often failed to include an appropriate comparison group).

Adolescent↗
PubMed1998

Requesting organ donation: an interview study of donor and nondonor families.

BACKGROUND: Approximately half of the families asked to consider donation of a relative's organs decline to give consent. Understanding the difference between stated public support of organ donation and actual behavior is key to decreasing the shortage of donor organs. OBJECTIVES: To gain insight into the experiences of potential donor families and to define features of the donation-request process and other factors that are associated with consent for organ donation. METHODS: A structured telephone interview was conducted with the immediate next of kin of 164 medically suitable potential organ donors. Interviews 30 to 60 minutes long were held with members of both donor and nondonor families 4 to 6 months after the death of the study participant's relative. RESULTS: Several factors were associated with consent for organ donation: characteristics of the patient and the patient's family, beliefs and attitudes about organ donation and transplantation, whether the family knew the deceased's wishes about donation, the family's satisfaction with the hospital care that their relative received, specific aspects of the donation-request process, and the family's understanding of brain death. CONCLUSIONS: Organ donation rates could be increased by enhancing the quality of hospital care and ensuring that the request for donation is handled in a way that meets the families' informational and emotional needs.

Adolescent↗