Turning the tables--an interview with Nicholas Wade. Interview by Jane Gitschier.
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Consumer evaluations of the quality of hospital services have become increasingly important as the patient and the patient's family have become more involved in hospital selection. The authors investigate the appropriateness of the search, experience, and credence typology of economics of information theory as a framework for analyzing how consumers judge the quality of specific hospital services. Advertising strategies are recommended for each category for hospitals seeking to create images of quality and excellence.
The U.S. health care industry is in crisis--a crisis of accountability. Many believe that improved information, especially outcomes information, is at least part of the solution. If this assessment is accurate, outcomes measurement could offer a powerful opportunity to help mold our dysfunctional health care machinery into an effective infrastructure. This article explores whether implementing an outcomes measurement system in a hospital compels this kind of change. It examines the experiences of 31 hospitals that implemented a market-leading outcomes measurement system. Despite its potential, MedisGroups did not compel important improvements in hospitals' quality of care or their internal practices. Hospitals found it particularly difficult to maintain momentum throughout implementation and to structure the system as a supporting tool, rather than a driving influence, in their pursuit of operating improvements.
Case management for high-cost patients is offered by virtually all private insurers and many health management firms. Despite the proliferation of the service, little is known about the process of case management, how it varies among vendors, what its impact is on short- and long-run patient costs, and what its effects are on quality. In this article, the authors present the results of a survey of insurance-based programs that reveal some process variations that could lead to differences in program effectiveness and cost.
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The aim of this study was to assess the use and adequacy of informed consent in research involving the elderly in Brazil. Using a reading index, we observed that in 83% of informed consent forms, the text was considered difficult, and demanded a higher schooling level than that presented by the subjects. Whereas 100% of the investigators considered the text in informed consent forms accessible, 75% of the subjects considered it hard to understand. This difference was statistically significant. 94% percent of the elderly participating in research protocols made the decision to participate in the study before reading the term of consent. More attention should be given both to the writing of informed consent forms and to the entire informed consent process, which in gerontology research, should be reviewed at each encounter with study participants.
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We have recently reported that a monoclonal antibody-based enzyme immunoassay for detection of filarial antigen in human serum is sensitive and specific for active infection with Wuchereria bancrofti. The present studies were undertaken to assess the feasibility of testing whole blood collected by finger prick in this assay. A preliminary study was performed to compare antigen test results obtained with whole blood, blood dried on filter paper, and serum. Results obtained with anticoagulated whole blood specimens agrees with serum results in 94 of 97 cases. All whole blood and serum specimens from 28 people with positive microfilaria smears were positive in the test. Filter paper blood specimens were less satisfactory because of decreased sensitivity and specificity. A population-based survey of 1009 persons was conducted in a village near Calicut, India, to evaluate the use of finger prick blood specimens for filarial antigen detection in field studies. Thirty-eight of 39 microfilaria carriers had positive antigen tests. In addition, 10.7% of amicrofilaremic endemic controls had positive tests. Additional studies are needed to test the hypothesis that filarial antigenemia in endemic controls indicates the presence of subclinical infection.
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