Managed care: why is it "better".
Of the health care "solutions" available today, only managed care is capable of earning health care a competitive role in the nation's consumer-driven marketplace.
Consumer Advocacy↗
Biomedical subjects
W A Schaffer
Publications and source records attributed to W A Schaffer.
Design of legal audits for utilization management.
Liability for managed care risks, the enactment of detailed state regulation of utilization management and the process requirements of accreditation agencies and managed care customers all create the need for new approaches to legal auditing. Concepts from industrial quality management theory can be used to define process elements that serve the legal adequacy of the utilization management process. The information systems that record information gathered and judgments made by reviewers and generate basic notices of certification can be designed so as to produce data relevant to compliance and liability management. These key process elements then can be analyzed statistically to develop plans for preventive counseling.
Contract Services↗
Consumer awareness of hospital mortality data.
Of 386 consumers surveyed nearly two years after the federal government's initial release of hospital mortality ratings, a majority were unaware of the data. Once made aware of their availability, however, the majority indicated they would use those data with other traditional indicators of quality to influence their choice of hospital.
Awareness↗
Falsification of clinical credentials by physicians applying for ambulatory-staff privileges.
As part of a quality-assurance program, we reviewed the clinical credentials listed on applications from 773 physicians applying for clinical positions in the Humana MedFirst national ambulatory care program between March 1 and December 31, 1986. In 39 applications (5.0 percent), physicians presented false clinical credentials: 27 physicians (3.5 percent) gave false information about their residency, 10 (1.3 percent) falsely reported board certification, and 2 (0.3 percent) provided false information about both residency and board certification. There was no significant difference between the falsification rates among graduates of U.S. medical schools and those among graduates of foreign medical schools, or among those in the various medical specialties. Falsification was more common among physicians recruited locally than among those recruited nationally, and was significantly more common among applicants who graduated before 1970. Because of this sample included only applicants for ambulatory privileges within a single organization, the findings may be of uncertain generalizability to groups of physicians applying for other classes of privileges in other institutions. We conclude that in applying for some clinical privileges, physicians present inaccurate clinical credentials more frequently than might be expected.
Certification↗
Consultation and referral between physicians in new medical practice environments.
The traditional exchange of medical expertise between physicians for patient benefit has been accomplished by referral. Physicians have traditionally decided when and to whom to refer patients. Health care "systems" now dominate medical practice, and their formats can alter spontaneous collegial interaction in referral. Institutional programs now pursue patient referrals as part of a marketing strategy to attract new patients who then become attached to the institution, rather than to a physician. Referral behavior can affect a physician's personal income in prepaid insurance programs where referrals are discouraged. The referring physician may bear legal liability for actions of the consultant. New practice arrangements and affiliations may place physicians in financial conflict-of-interest situations, challenge ethical commitments, and add new moral responsibility.
Advertising↗
Recurrent ventricular fibrillation and modes of death in survivors of out-of-hospital ventricular fibrillation.
We examined the causes of death in patients previously resuscitated from out-of-hospital ventricular fibrillation. In 51 months, 234 patients were sucessfully resuscitated, hospitalized and discharged home. During follow-up observation, 89 episodes of recurrent ventricular fibrillation or death (or both) occurred, 64 of which (72 per cent) were unexpected, out-of-hospital circulatory arrests. Ventricular fibrillation occurred in 77 per cent of the 44 episodes in which the electrocardiogram was observed. Ten patients survived one or more episodes of recurrent ventricular fibrillation. Median time to recurrent ciruclatory arrest was 20 weeks after the preceding episode. Prodromal symptoms were infrequent, and activity levels were generally low at the time of cardiac arrest. Recurrent ventricular fibrillation of sudden death (or both) occurred predominantly when the initial episode was not associated with acute myocardial infarction. Patients resuscitated from ventricular fibrillation are susceptible to early recurrence, probably reflecting continuing myocardial electrical instability.
Adult↗
Resuscitation from out-of-hospital ventricular fibrillation: 4 years follow-up.
In 51 months, 234 patients with out-of-hospital ventricular fibrillation (VF) were successfully resuscitated, hospitalized, and discharged home. Patients surviving an episode of primary ventricular fibrillation, that is, VF not associated with acute myocardial infarction, showed a 2-year mortality rate greater than three times that of survivors from VF associated with acute transmural infarction. Recurrent out-of-hospital VF was common, and a pattern of early recurrence was noted, with a median interval of 17 weeks in 34 documented cases. Ten patients were counted as long-term survivors from second episodes of out-of-hospital VF, one of whom survived a third episode. Coronary anatomy and ventricular function were studied in 29 survivors of primary VF. Of the 29 patients, 23 had coronary disease, considered "operable" in 17. Exercise testing and left ventricular function studies were normal or minimally abnormal in approximately half of these patients. There is an obvious need to develop effective measures to prevent primary VF, which commonly presents almost instantaneously, without prodromal symptoms.
Acute Disease↗
Consumer perceptions: quality becoming a basis for optimal choice of hospitals.
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Community Participation↗