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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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At least 883 records · Page 49Linked to original sources
PubMed2005

Quality as a passion.

CIGNA Senior Vice President and Chief Clinical Officer W. Allen Schaffer, M.D., describes how a national health plan combines IT and human resources, and embraces national evidence-based standards, to influence the individual health status of millions of members.

Delivery of Health Care, Integrated↗
PubMed1992

Government, private health insurance, and the goal of universal health care coverage.

The Health Insurance Association of America advocates joint efforts by federal and state governments and the private sector to achieve the goal of universal access to health care. It recommends several changes in the small employer market to provide greater predictability and protection to those insured, including establishment of private, not-for-profit reinsurance organizations authorized by the states. State risk pools for uninsurable individuals who are not part of an employer group are also proposed. The federal government role would include expanding Medicaid eligibility and exempting all insured plans from state mandated benefits. HIAA's proposal also stresses the continued growth and use of managed care programs.

Cost Control↗
PubMed2005

A health plan intervention to improve pneumococcal vaccination in the elderly.

In 1998, the Hawaii Medical Service Association, headquartered in Honolulu, partnered with a pharmaceutical manufacturer to promote pneumococcal immunization of its 33,017 Medicare cost-contract members. They disseminated newsletter articles, magazine advertisements, letters, posters, and broadcast announcements; held injection clinics; and provided physicians reminder postcards with patient labels. Medicare claims indicated that immunization rose by 13.3% in 1997, 20.7% in 1998, and 42.3% in 2000, exceeding rates in a fee-for-service control group. Moreover, the rate of hospitalization for pneumococcal pneumonia dropped after 1998. The data suggest that multimodal promotion of pneumococcal vaccine will result in more extensive immunization and less frequent hospitalization.

Aged↗
PubMed2005

Dental visits among dentate adults with diabetes--United States, 1999 and 2004.

One of the major complications of diabetes is periodontal disease, a chronic infection of tissues supporting the teeth and a major cause of tooth loss. Adults with diabetes have both a higher prevalence of periodontal disease and more severe forms of the disease, contributing to impaired quality of life and substantial oral functional disability. In addition, periodontal disease has been associated with development of glucose intolerance and poor glycemic control among adults with diabetes. Regular dental visits provide opportunities for prevention, early detection, and treatment of periodontal disease among dentate adults (i.e., those having one or more teeth); moreover, regular dental cleaning improves glycemic control in patients with poorly controlled diabetic conditions. One of the national health objectives for 2010 is to increase the proportion of persons with diabetes who have an annual dental examination to 71% (revised objective 5-15). To estimate the percentage of dentate U.S. adults aged > or =18 years with diabetes who visited a dentist within the preceding 12 months, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys for 1999 and 2004. This report describes the results of that analysis, which indicated that, in 2004, age-adjusted estimates in only seven states exceeded 71% and estimated percentages for four states and District of Columbia (DC) increased significantly from their levels in 1999. The findings underscore the need to increase awareness and support for oral health care among adults with diabetes, including support for national and state diabetes care management programs.

Adult↗
PubMed2006

Effective diabetes care by a registered nurse following treatment algorithms in a minority population.

OBJECTIVE: To compare usual care with nurse-directed care for patients with diabetes. STUDY DESIGN: Randomized before-after trial. METHODS: Diabetic patients were randomly selected for a diabetes managed care program (DMCP), in which a specially trained registered nurse, supervised by an endocrinologist, followed detailed treatment algorithms. Process and outcome measures during the year before DMCP entry were compared with those during the first year of DMCP enrollment. RESULTS: A total of 367 patients completed a full year in the DMCP. Data from the prior year were available for 331 patients. Among a subset of Latino patients, 95% earned less than 25,000 US dollars and 73% had an education of 6th grade or less. Process measures recommended by the American Diabetes Association (ADA) were met 98% of the time during the DMCP year compared with 54% of the time during the prior year (P <.001). Mean glycosylated hemoglobin (A1C) levels fell from 9.3% to 8.7% in the year before entry into the DMCP and to 7.0% by the end of the first DMCP year (P < .001). At DMCP entry, 28% met the ADA A1C goal of <7%; 60% did so at the end of the year. Fifty-one percent met the ADA low-density lipoprotein cholesterol goal at entry into the DMCP compared with 82% at the end of the year. CONCLUSION: A nurse making clinical decisions based on detailed treatment algorithms did a better job of achieving ADA-recommended process and outcome measures than physicians providing usual care.

Adult↗
PubMed2006

The semblance of autonomy: treatment of persons with disabilities under the Uniform Health-Care Decisions Act.

This Article illuminates the dangers of the Uniform Health-Care Decisions Act, which provides a set of model rules designed to clarify and expedite end-of-life health-care decisionmaking for incapacitated patients. The uniform commissioners and many scholars who have commented on the Act have touted the legislation as a model for defending patient autonomy. As this Article will reveal, the impression of autonomy is an illusion. In fact, the Act privileges the perspectives of the able-bodied over those of persons with disabilities, endangers the autonomy of incapacitated patients, and empowers proxy decisionmakers who have incentives to terminate treatment. These risks have become all the more significant with the rise of managed-care programs that create pressures to minimize care. After highlighting the serious risks to vulnerable patients under the Uniform Health-Care Decisions Act, the Article offers alternative rules and stronger safeguards to better protect patient autonomy and defend against wrongful health-care decisions. This Article urges states seeking improved end-of-life health-care procedures to codify these or similar protections in order to avoid the lethal shortcomings of the Uniform Health-Care Decisions Act.

Decision Making↗
PubMed2006

State Medicaid coverage for tobacco-dependence treatments--United States, 2005.

In 2005, approximately 41 million persons in the United States had health insurance coverage through Medicaid, a federally and state-funded health-care program, managed at the state level, for persons with limited incomes. An estimated 29% of adult Medicaid recipients were current smokers in 2004. The 2000 Public Health Service (PHS) clinical practice guideline recommends that insurance coverage be provided for tobacco-dependence treatments, including both medication (i.e., bupropion hydrochloride or nicotine patch, gum, inhaler, or nasal spray) and counseling (i.e., individual, group, or telephone). A national health objective for 2010 is to increase insurance coverage of evidence-based treatments for tobacco dependence among all 51 Medicaid programs (objective 27-8). The type of coverage for tobacco-dependence treatments offered by Medicaid has been reported since 1998, and most recently for 2003, from state surveys conducted by the Center for Health and Public Policy Studies at the University of California, Berkeley. All states and the District of Columbia (collectively referred to as states in this report) were resurveyed in 2005 regarding types of coverage and limitations in coverage since 1994. This report summarizes the results of that survey, which indicated that as of December 31, 2005, 1) 38 state Medicaid programs covered some tobacco-dependence treatment (i.e., counseling or medication) for all Medicaid recipients; 2) four states offered coverage only for pregnant women; 3) one state (Oregon) offered coverage for all medication and counseling treatments recommended by the 2000 PHS guideline; and 4) seven states (including Oregon) covered all recommended medications and at least one form of counseling. If the 2010 national health objective is to be achieved, states should offer or increase Medicaid coverage for treatment of tobacco dependence.

Counseling↗
PubMed1991

Intensity of in-hospital care for persons with AIDS.

We evaluated the intensity of medical care for 30 consecutive AIDS patients at one hospital, using methodology based on the Delay Tool of Selker et al. Of 25 AIDS patients who survived hospitalization, 15 had at least one delay day in the hospital. Major factors associated with care that could have been provided at an alternative site included difficulty with skilled nursing facility placement in 20% of the patients, difficulty coordinating out-of-hospital care in 28%, and scheduling of outpatient surgical procedures in 12%. For the 15 patients who could have received some of their care at a lower intensity setting, a median of 7 hospital days could have been potentially saved with better coordination of outpatient care and increased availability of skilled nursing facilities. The five patients who died in hospital also used large amounts of resources and had long lengths of stay. Prior studies of non-AIDS patients revealed similar results, suggesting that, for reasons of quality of care, quality of life, and economics, policy-makers must develop managed care programs, skilled nursing facilities that accept AIDS patients, inpatient psychiatry facilities, and increased hospice availability.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Development of clinical and economic prognoses from Medicare claims data.

Using a 5% nationally random sample of Medicare beneficiaries, we calculated the probability of dying, the probability of being readmitted, and the mean level of inpatient hospital expenditures within various time periods following discharge for those beneficiaries who were discharged alive from an acute-care hospital during 1983. We then examined the 674 most common principal discharge diagnoses and found significant variations by diagnosis code for all three outcomes. We believe that analyses of claims data by diagnosis code can provide useful information to clinicians and their patients regarding the clinical and economic prognosis of specific diseases, help managed-care programs identify patients likely to incur substantial costs over a several-year period, and inform insurers regarding the expected level of resources that will be used following discharge for patients with specific diseases.

Health Expenditures↗
PubMed1995

Multispecialty medical groups: adapting to capitation.

Capitation payments are becoming a significant source of revenue for many multispecialty medical groups. These medical groups are discovering that financial success under capitation requires proper prospective evaluation and planning, diligent monitoring, and a sound understanding of insurance and risk concepts. The most successful groups will be those that can deliver quality medical care in the most cost-efficient manner.

Capitation Fee↗
PubMed1994

The role of community hospitals in the performance of local economies.

Many hospital administrators recognize an increasing need to educate the public on the important role their institutions play in the economic viability of the local community. Reasons include negative coverage by the press of increasing hospital costs, eroding philanthropy, managed care programs mandating out-of-area preferred providers, and declining city revenues, which have caused some municipalities to attempt to place not-for-profit health care facilities on the tax roles. This article reviews a technique that can be used by hospitals to build community support by demonstrating the favorable economic impact hospitals have on the communities they serve.

Commerce↗