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Natural history of residual air spaces after pulmonary resection.

It is emphasized that a decision for or against surgical intervention in the management of residual spaces, irrespective of cause, will not be required for several months after their occurrence in most cases. The stresses associated with the critical period of disability occasioned by a prolonged air leak, even if not voluminous, may preclude premature surgical intervention. The indications for initial surgical resection and the diseases for which it was required often are sufficiently debilitating to the patient to produce a protracted period of convalescence, necessitating prolonged observation before a decision for aggressive surgical therapy is mandated or indicated. In our experience, these pleural spaces are not a major threat to the health of the patient. In many cases, the concern over them and the fear that more egregious postoperative problems will ensue have resulted in premature and overzealous treatment that may lead to iatrogenic complications. If, instead, they are left alone and followed with judicious observation based on appropriate clinical, physiologic, and radiologic criteria, a more favorable outcome will result. Haste in arriving at a decision to intervene surgically therefore is not warranted. Many factors must be taken into account before surgical treatment is considered. The age of the patient, his or her ventilatory status, condition of the underlying lung, prospect for physical activity with gainful employment and accompanying quality of life, underlying disease (tuberculosis or cancer) for which even a curative resection may have been done, problems in maintaining drainage (including convenience or discomfort), or adverse metabolic effects of chronic infection are just a few considerations. More recently, economic factors attendant upon managed care programs mandate cost-effective therapies to reduce duration of hospital stay and to decrease resource utilization associated with repetitive surgical procedures and returns to the operating room, protracted use of expensive antimicrobial drugs, and increased outpatient visits and home services. Certainly, prevention of and avoidance of unwarranted interventions for intrathoracic spaces will assist in accomplishing these goals. Finally, it is apparent that patients can live in relatively good health for long periods of time with persisting vented or unvented spaces in association with air leak from alveolar seepage sources, and even with the presence of well-drained and controlled empyemas. The most important aspect of management is delineation of spaces that can be observed safely versus those that require surgical intervention. This discussion provides a basis for making that distinction. The algorithm illustrated in Figure 13 summarizes this management.

Humans↗

Application of a classical model of competitive business strategy to orthodontic practice.

This study explored how market forces might affect the business aspects of orthodontic practices; in particular, profitability. The forces identified were (1) intensity of rivalry, (2) threat of new entrants, and (3) bargaining power of buyers and suppliers. A mail survey instrument was used to collect the data. Results showed that more than half the surveyed practices show an increase in new case starts despite weak economic conditions. Although satellite offices and marketing increase the overhead, they do not add to net profit. New entrants are a threat to existing practices, as are the substitute discretionary spending by the consumer. Interestingly, while some orthodontic practices have joined the managed care programs, a majority of them realize neither increased patient load nor profit. Our data seem to indicate that orthodontic practices have not been successful in "cost containment" with their marketing, number of employees, computerization or inventory. Collectively, the results of this study suggest that success in an orthodontic office is primarily dependent on the practitioner's personality traits, rather than rigidly applied business principles.

Attitude of Health Personnel↗

Is your organization strategically prepared to be a Medicare PSO?

The new Medicare+Choice managed care program authorized by the Balanced Budget Act of 1997 affords hospitals and physicians an opportunity to contract directly with HCFA to provide services to Medicare beneficiaries through a provider-sponsored organization (PSO). Developing and operating a Medicare PSO is a complex process, however, and organizations that lack certain strategic and operational "readiness" characteristics may encounter significant barriers to success. To ascertain their readiness to form a Medicare PSO, providers should assess their capabilities in six key strategic areas: culture and governance, organizational and legal structure, market position and strategy, provider network, risk-contracting experience and supporting infrastructure, and capital resources and fiscal soundness.

Capitation Fee↗

The relationship between ethical ideology and ethical behavior intentions: an exploratory look at physicians' responses to managed care dilemmas.

Within the past few years, managed care health insurance programs have become commonplace. With managed care programs, however, physicians are facing increasing ethical pressures. This paper examines the relationship between physicians' behavior intentions with respect to four managed care ethical scenarios and their responses to Forsyth's (1980) Ethics Position Questionnaire (EPQ). This is one of the first papers to compare this scale to behavioral intentions in the workplace. We provide a literature review of the ethical dilemmas that doctors face under a managed care system and conduct a national random sample of general practitioners and surgeons regarding the four managed care ethical dilemmas. The results show that the doctors surveyed are significantly more idealistic than relativistic. In relating the EPQ to the ethical scenarios, however, there was no support for the proposition that ethical ideology was related to the ethical behavioral intentions. This suggests more research is needed to establish the links between ethical positions, attitudes, and behavioral intentions. Finally, there were little differences in EPQ scores by practice or demographic variables, the only significant result being that general surgeons are significantly more idealistic than family practitioners.

Confidentiality↗

Does distance between home and transplantation center adversely affect patient outcomes after heart transplantation?

BACKGROUND: The emergence of heart transplantation referral centers, in an era of cost-conscious managed care programs, frequently leads to long-distance patient consultation and care. The purpose of this project was to review one center's experience regarding the effect of long distances from home to transplantation hospital on outcomes. METHODS: Three hundred twelve adult, noninternational, transplant recipients surviving at least 3 months were assessed for 10 events: rejection episodes, number of endomyocardial biopsies, emergency department visits, hospital admissions, return to full-time work or school, infections, coronary allograft vasculopathy, malignancies, retransplantation, and death. Presence of a locally involved physician was also determined. Distance from the transplantation center was analyzed in three discrete groups: 0 to 150 miles (n = 207), 151 to 300 miles (n = 69), and >300 miles (n = 36). RESULTS: There were no differences among the groups in mean length of follow-up (40.6, 36.9, 39.0 months, p = 0.27) or number of biopsies (20.5 +/- 0.16, 18.3 +/- 1.1, 18.0 +/- 1.1, p = 0.07). As the distance increased from the transplantation center, there was no greater incidence of adverse outcomes. Cellular rejection was the same among the groups (45%, 45%, 36%, p = 0.58). Likewise, emergency department visits and hospital admissions also did not vary: (9.7%, 5.8%, 8.3%, p = 0.61) and (22.2%, 13.0%, 16.7%, p = 0.23, respectively). There were no differences in the incidence of coronary vasculopathy (9.2%, 11.6%, 13.9%, p = 0.63). More importantly, the three groups did not differ in death/retransplantation rates (3-year survival, 84.5, 94.0 and 86.9, p = 0.14). Patients cared for by a local physician in addition to their transplant cardiologist had better survival rates than patients without a local physician (3-year survival rate, 90.7 vs 72.6, p = 0.0008). CONCLUSIONS: Long-distance management of heart transplant recipients is successful and is not associated with an increase in adverse outcomes. By itself, distance should not represent a contraindication to transplantation. Patients should be encouraged to maintain contact with a local physician, in addition to the regularly scheduled visits at the transplantation center.

Adolescent↗

New users of antipsychotic medications among children enrolled in TennCare.

BACKGROUND: The use of antipsychotic medications in children and adolescents for indications other than psychosis or Tourette syndrome is controversial. Newer atypical antipsychotics with profiles of adverse effects that differ from those of traditional antipsychotics may lead providers to prescribe antipsychotics more frequently than in the past for behavioral indications not strongly supported by clinical study. OBJECTIVE: To identify population-based new use of antipsychotics among patients aged 2 to 18 years. DESIGN: Retrospective cohort study, January 1, 1996, through December 31, 2001. SETTING: Tennessee's managed care program for Medicaid enrollees and the uninsured (TennCare). MAIN OUTCOME MEASURES: New use of antipsychotic medications and indications for use by the child's diagnosis, adjusted for age, sex, race, county of residence, enrollment category, and income. RESULTS: The proportion of TennCare children who were new users of antipsychotics, adjusted for demographic characteristics, nearly doubled from 23/10 000 in 1996 to 45/10 000 in 2001 (adjusted incidence rate ratio, 1.98; 95% confidence interval, 1.82-2.16). In 1996, 6.8% of new users received an atypical antipsychotic; by 2001, this had increased to 95.9%. New use for attention-deficit/hyperactivity disorder and affective disorders increased 2.5-fold. New use of antipsychotics for schizophrenia, acute psychotic reaction, Tourette syndrome, and mental retardation or autism remained relatively constant. Secular trends of increasing use were most pronounced for those aged 6 to 12 years (93% increase) and 13 to 18 years (116% increase), although use among preschool children increased 61% during the study period. CONCLUSION: The proportion of TennCare children who became new users of antipsychotics nearly doubled from 1996 to 2001, with a substantial increase in use of antipsychotics for attention-deficit/hyperactivity disorder, conduct disorder, and affective disorders.

Adolescent↗

Chorioamnionitis and cerebral palsy in term and near-term infants.

CONTEXT: Half of all cases of cerebral palsy (CP) occur in term infants, for whom risk factors have not been clearly defined. Recent studies suggest a possible role of chorioamnionitis. OBJECTIVE: To determine whether clinical chorioamnionitis increases the risk of CP in term and near-term infants. DESIGN, SETTING, AND PATIENTS: Case-control study nested within a cohort of 231 582 singleton infants born at 36 or more weeks' gestation between January 1, 1991, and December 31, 1998, in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California. Case patients were identified from electronic records and confirmed by chart review by a child neurologist, and comprised all children with moderate to severe spastic or dyskinetic CP not due to postnatal brain injury or developmental abnormalities (n = 109). Controls (n = 218) were randomly selected from the study population. MAIN OUTCOME MEASURE: Association between clinical chorioamnionitis and increased risk of CP in term and near-term infants. RESULTS: Most CP cases had hemiparesis (40%) or quadriparesis (38%); 87% had been diagnosed by a neurologist and 83% had undergone neuroimaging. Chorioamnionitis, considered present if a treating physician made a diagnosis of chorioamnionitis or endometritis clinically, was noted in 14% of cases and 4% of controls (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.5-10.1; P =.001). Independent risk factors identified in multiple logistic regression included chorioamnionitis (OR, 4.1; 95% CI, 1.6-10.1), intrauterine growth restriction (OR, 4.0; 95% CI, 1.3-12.0), maternal black ethnicity (OR, 3.6; 95% CI, 1.4-9.3), maternal age older than 25 years (OR, 2.6; 95% CI, 1.3-5.2), and nulliparity (OR, 1.8; 95% CI, 1.0-3.0). The population-attributable fraction of chorioamnionitis for CP is 11%. CONCLUSION: Our data suggest that chorioamnionitis is an independent risk factor for CP among term and near-term infants.

Asphyxia Neonatorum↗

Maternal and infant characteristics associated with perinatal arterial stroke in the infant.

CONTEXT: Perinatal arterial ischemic stroke (PAS) is a common cause of hemiplegic cerebral palsy. Risk factors for this condition have not been clearly defined. OBJECTIVE: To determine maternal and infant characteristics associated with PAS. DESIGN, SETTING, AND PATIENTS: Case-control study nested within the cohort of all 199,176 infants born from 1997 through 2002 in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California. Case patients were confirmed by review of brain imaging and medical records (n = 40). Three controls per case were randomly selected from the study population. MAIN OUTCOME MEASURE: Association of maternal and infant complications with risk of PAS. RESULTS: The population prevalence of PAS was 20 per 100,000 live births. The majority (85%) of infants with PAS were delivered at term. The following prepartum and intrapartum factors were more common among case than control infants: primiparity (73% vs 44%, P = .002), fetal heart rate abnormality (46% vs 14%, P<.001), emergency cesarean delivery (35% vs 13%, P = .002), chorioamnionitis (27% vs 11%, P = .03), prolonged rupture of membranes (26% vs 7%, P = .002), prolonged second stage of labor (25% vs 4%, P<.001), vacuum extraction (24% vs 11%, P = .04), cord abnormality (22% vs 6%, P = .01), preeclampsia (19% vs 5%, P = .01), and oligohydramnios (14% vs 3%, P = .01). Risk factors independently associated with PAS on multivariate analysis were history of infertility (odds ratio [OR], 7.5; 95% confidence interval [CI], 1.3-45.0), preeclampsia (OR, 5.3; 95% CI, 1.3-22.0), prolonged rupture of membranes (OR, 3.8; 95% CI, 1.1-12.8), and chorioamnionitis (OR, 3.4; 95% CI, 1.1-10.5). The rate of PAS increased dramatically when multiple risk factors were present. CONCLUSIONS: Perinatal arterial ischemic stroke in infants is associated with several independent maternal risk factors. How these complications, along with their potential effects on the placenta and fetus, may play a role in causing perinatal stroke deserves further study.

Brain↗

Use of board certification and recertification of pediatricians in health plan credentialing policies.

CONTEXT: Health plans conduct credentialing processes to select and retain qualified physicians who will provide high-quality care to their subscribers. One of the tools available to health plans to help ensure physician competence is assessment of board certification status. OBJECTIVE: To determine the credentialing policies of health plans regarding the use of board certification and recertification for general pediatricians and pediatric subspecialists. DESIGN, SETTING, AND PARTICIPANTS: Telephone survey conducted February through July 2005 of credentialing personnel from a US national sample of 244 health plans stratified by enrollment size, Medicaid proportion, and for-profit or not-for-profit status. MAIN OUTCOME MEASURES: Proportion of health plans that require general or subspecialty board certification at initial contract or at any time during association with the plan and recertification to maintain credentialing or to bill as a specialist or subspecialist; percentage of physicians credentialed in each health plan and credentialing goals for each plan regarding the proportion of physicians to be board certified. RESULTS: Response rate was 193 of 244 (79%). Overall, 174 (90%) of the plans do not require general pediatricians to be board certified at the time of initial credentialing, and only 41% ever require a general pediatrician to become board certified. Similarly, only 80 (40%) ever require subspecialists to become board certified in their subspecialty. Although 80 of 192 (41%) report requiring recertification of general pediatricians, almost half do not have a time frame in which recertification must occur. Seventy-seven percent of plans allow physicians to bill as subspecialists with expired certificates. CONCLUSIONS: These findings, although specific to pediatrics, likely apply to other primary care disciplines and raise questions regarding the ability of plans to ensure initial or continued competence of their credentialed physicians. Growing public concern regarding patient safety, as well as demonstrated patient preferences for certified physicians, will likely result in greater emphasis on quality assessments in physician credentialing.

Certification↗

Economics of practice and inpatient care.

The nature and structure of inpatient psychiatric services are rapidly evolving. This article identifies and explores how these changes are being influenced by four interrelated areas: rapid growth in general and private hospital psychiatric practice; increased connections of public, private, and voluntary sectors of care; the emergence and quick acceptance of capitated and managed care programs; and dramatic change and growth in the insurance industry. These four interrelated areas further the development of a two-tier system in psychiatry: one for those with insurance, and one of the poor and the severely disabled. The changes in these four areas have also led to greater demand for increased economic competition among services, and new alliances and innovations in the delivery of treatment. This article discusses how the four areas have combined to support a two-tier system and how they are likely to affect the future evolution of general and private hospital inpatient psychiatric practice.

Cost Control↗

Geriatric versus non-geriatric approach of care to moderate Pra risk senior population.

A total of 432 members of Senior Dimensions, a second-generation social health maintenance organization, residing in northern Nevada were identified as moderate risk by P(ra) screening criteria for the time period of July 1, 2002, through June 30, 2003. Of these members, 166 were impaneled to a practice that only provides care for seniors (age 65 years or older), Geriatric Care of Nevada (GCN), and 266 members were impaneled to multiple primary care providers with standard community-based practices (non-GCN). An annualized cost comparison per unit of service provided as derived from the adjusted use data showed an average savings of $760.00 per member per year for the GCN over the non-GCN population. These savings have occurred apart from the provider fee reimbursement. This represents a potential savings of more than $760,000.00 per year per 1000 moderate P(ra) risk members within a Medicare managed care program.

Aged↗

Managed care and the US health care system a social exchange perspective.

Many countries are importing managed care and price competition from the US to improve the performance of their health care systems. However, relatively little is known about how power is organized and exercised in the US health care system to control costs, improve quality and achieve other objectives. To close this knowledge gap, we applied social exchange theory to examine the power relations between purchasers, managed care organizations, providers and patients in the US health care system at three interrelated levels: (1) exchanges between purchasers and managed care organizations (MCOs); (2) exchanges between MCOs and physicians; and (3) exchanges between physicians and patients. The theory and evidence indicated that imbalanced exchange, or dependence, at all levels prompts behavior to move the exchange toward power balance. Collective action is a common strategy at all levels for reducing dependence and therefore, increasing power in exchange relations. The theoretical and research implications of exchange theory for the comparative study of health care systems are discussed.

Delivery of Health Care↗

Validity of the Depression-Arkansas (D-ARK) Scale: a tool for measuring major depressive disorder.

The results of 2 validation studies for an assessment tool designed specifically for quality improvement and outcomes assessment efforts in mental healthcare are presented in this paper. The studies evaluated a new tool to assess the patient outcomes for major depressive disorder following treatment in routine clinical settings called the Depression-Arkansas Scale (D-ARK). Study 1 included 54 patients recruited from 3 hospital-based clinics (2 mental health clinics and 1 primary care clinic). Study 2 includes 827 patients from 5 clinical settings including a university based outpatient clinic, a VA based mental health clinic, and a managed-care program. These 2 very different studies provide preliminary evidence that the D-ARK may be a useful tool for quality improvement efforts in the mental healthcare setting. Specifically, they indicate that the D-ARK has strong validity when compared to 2 different research assessments, the Structured Clinical Interview for DSM-III-R, Patient Edition (SCID-P) and the Inventory to Diagnose Depression (IDD), and compared to clinical assessments using both the clinical diagnosis and a clinician checklist.

Adult↗

Is solo practice really dead?

For years, the demise of solo practice has been predicted as a consequence of the corporatization of health care, the rise of managed care programs, and the creation of preferred provider organizations (PPOs). The predictors of the demise are leaders in the health maintenance organization (HMO) and PPO movement and therefore have much to gain if solo practice dries up. A survey of a random sample of licensed psychologists in New Jersey was conducted to determine the current state of private practice. A 58% return of the anonymous questionnaire revealed that 87% were in solo practice; 90% were not members of any PPO; 92% received either no referrals or less than 5% from HMOs; and 92% indicated that their referral rates and practices have either stayed the same or increased in the past three years. Clearly the predictions as far as New Jersey goes are wrong! The findings are discussed in terms of economics, humanistic concerns, and political concerns.

Cost-Benefit Analysis↗

Factor VIII inhibitors. Immune tolerance induction: is it cost effective? We know too little.

The development of an inhibitor in a hemophiliac is a serious clinical problem. Many inhibitors have high titers, and thus one cannot guarantee hemostasis. The prevalence of this transfusion-transmitted disease reaches as high as 35%, even with newer products. The costs of product use for inhibitor patients are significantly higher than for those without an inhibitor. For more than 20 years, using the concept of antigen overload, several regimens have existed for the induction of immune tolerance to eradicate these inhibitors. Registries exist reviewing the results of these regimens in the United States and internationally. Although much has been garnered about predictors of outcomes, we have much to learn about who the ideal candidates are, what optimal regimens are, and when to stop, as well as how to maintain a success. The costs of managing an inhibitor patient with and without human immunodeficiency virus (HIV) have caused managed care programs to seriously challenge the use of these regimens. Data are needed to provide the cost benefit of immune tolerance.

Cost-Benefit Analysis↗

"Managing" the poor: neoliberalism, Medicaid HMOs and the triumph of consumerism among the poor.

In order to explore the contradictions of neoliberal health policy, this article examines Medicaid managed care in Philadelphia. At the federal and state levels, government is increasingly promoting private-sector market-based strategies over policies formerly associated with the welfare state, arguing that the former are the most effective means of achieving economic growth and guaranteeing social welfare. A prime example of this shift, Medicaid managed care is a policy by which states contract with private-sector health maintenance organizations to provide health coverage to the poor. Drawing on ethnographic and historical data, this paper shows how Pennsylvania's Medicaid managed care program has created access barriers for poor Philadelphians. It also illustrates how ideologies that justify this policy shift serve to mask its detrimental effects on the poor. By contrasting the state's consumerist model with one group's protest efforts, this article calls into question the neoliberal ideology that undergirds health and welfare "reform."

Community Participation↗