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PubMed1997

Medicare revenue in large medical groups.

The aged are the heaviest users of physician services. A ageing population and escalation in medical costs have pressured Medicare budgets, which have increased fastest in Part B physician reimbursement. Policy responses include adoption of the Resource Based Relative Value Scale (RBRVS) for physician payment. This paper considers receipt of Medicare revenues by large medical groups and expectations of how groups will fare under RBRVS. In a 73-percent sample of U.S. large group practices, Medicare coverage accounted for one-fourth of clients, Medicare-related revenues for slightly more than one-fourth of revenues, suggesting a slightly higher revenue intensity for Medicare clients, but showing no evidence of truly disproportionate revenues from Medicare users. Medicare shares of revenues are explained by factors related to Medicare clientele and geriatric service provision. Overly-strict Medicare assignment policy may control costs by limiting access to needed care, rather than by limiting overpayments to physicians. Expectations as to how groups will fare under RBRVS are not found to be related to reliance on Medicare, rather to group auspices and ability to contain costs under Medicare payment. The findings are important not only to physician payment under RBRVS but also under health care reform.

Aged↗
PubMed2005

Quality, value, accountability and information as transforming strategies for patient-centred care: a commentary from an international perspective.

The reviewed paper describes how one of the largest integrated healthcare systems in the US has successfully transformed itself to provide 21st-century healthcare. Even though there are other examples of successful transformation of public health services, it is difficult for large, bureaucratic systems to change, and a substantial number of ministries of health or social security health systems in the developing world are run under the assumption that change is very difficult if not impossible to achieve. The VA has significant differences and more financial resources compared to most of the developing world public health institutions; but still, change is often not only about money, but also about strategic direction, commitment and leadership. On the basis of the main strategies used by the VA in its transformation process, the author makes some comments and suggestions for improving developing world healthcare organizations through lessons learned from the VA management strategies. Demand-driven or patient-centred systems are key for success and for the buy-in and involvement of the population and users of healthcare services, but this is easier said than done, especially in developing healthcare systems with immature information systems, access mechanisms and knowledge management. There is a belief in general that large bureaucratic organizations have a hard time adapting and transforming in response to the rapid change of society, technology and most importantly the needs and expectations of their users. The article describes how the largest integrated healthcare organization in the United States, the Veterans Health Administration, has undertaken changes that have turned it into a modern, well-managed organization that outperforms its competitors and has significantly increased its efficiency and users' satisfaction.

Delivery of Health Care, Integrated↗
PubMed1984

Health beliefs and physician identified "worried well".

Health belief variables of the frequent and inappropriate user of medical services, or "worried well," were examined in two studies. Study 1 showed the physician identified "worried well" to be concerned about both general and mental health issues and to perceive typically minor symptoms as more serious than other frequent appropriate users, infrequent users, and mental health comparison groups. Study 2, a prospective study, measured beliefs and subsequent use for one year. Ratings of inappropriateness of use and psychosomatic involvement made by medical providers were predicted by high degrees of self reported somatic symptomatology, mental health concern, belief in self responsibility for health care, belief that one should handle one's own problems, and a limited belief in the responsibility of powerful others for health care.

Adolescent↗
PubMed1981

[Methodological focus of research applied to the health services].

The article enumerates the areas in which health service research is feasible. A model of evaluation research is described which the author regards as best suited to the current needs of the countries. The model would include three kinds of analyses: a description, an explantation, and an evaluation. The components or objects of a comprehensive evaluative study of health services are as follows: the demand for and supply of health activities, the process by which they are carried on, their results, and their impacts or effect on the given population. The author makes the point that the research teams, users of the services, and decision makers in the fields of health and education must participate actively in this research if it is to be successful, and that national and international groups must also collaborate.

Colombia↗
PubMed2002

Perceived quality of care of primary health care services in Burkina Faso.

INTRODUCTION: Patients' views are being given more and more importance in policy-making. Understanding populations' perceptions of quality of care is critical to developing measures to increase the utilization of primary health care services. OBJECTIVE: Documentation of user's opinion on the quality of care of primary health care services. METHODS: A 20-item scale, including four sub-scales related to health personnel practices and conduct, adequacy of resources and services, health care delivery, and financial and physical accessibility, was administered to 1081 users of 11 health care centres in the health district of Nouna, in rural Burkina Faso. RESULTS: The respondents were relatively positive on items related to health personnel practices and conduct and to health care delivery, but less so on items related to adequacy of resources and services and to financial and physical accessibility. In particular, the availability of drugs for all diseases on the spot, the adequacy of rooms and equipment in the facilities, the costs of care and the access to credit were valued poorly. Overall, the urban hospital was rated poorer than the average rural health care centre. Analysis of variance showed that, overall, health system characteristics explain 29% of all variation of the responses. CONCLUSION: Improving drug availability and financial accessibility to health services have been identified as the two main priorities for health policy action. Policy-makers should respect these patient preferences to deliver effective improvement of the quality of care as a potential means to increase utilization of health care.

Burkina Faso↗
PubMed2002

A nationwide survey of hepatitis C services provided by drug treatment programs.

Drug treatment programs are a site of opportunity for the delivery of primary and secondary hepatitis C (HCV) prevention services to drug users, a population at great risk for contracting and transmitting the virus. Using data collected from a random nationwide sample (N = 439) of drug treatment programs in the United States, this study examines the extent to which various types of HCV services are provided to their patients. Findings indicate that the majority of drug treatment programs educate at least some of their patients about HCV, and provide some type of support for patients who are infected with the virus. Only 29 of the programs in the sample test all of their patients for HCV, however, and 99 programs test none of them. For the most part, residential treatment programs offer more HCV related services than outpatient drug-free programs.

Ambulatory Care↗
PubMed2001

Medical care use among women before and after sexual assault: a population study.

We set out to compare medical care utilisation patterns between women who were sexually assaulted and women who were not sexually assaulted in the year before and the year after the assault. Cases studied were 690 females aged 15 and over who had undergone a forensic evidence examination for sexual assault between April 1996 and March 1997 and the same number of female age-matched controls. This was a population-based, matched case-control study using administrative databases of medical encounters (only physician services). Outcomes included physician visits by physician specialty; clinic and hospital diagnoses and hospital discharges. Of the cases, 38.4% were aged 1519; 21.4% aged 2024; and 40.2% aged 25 or older. Before and after the sexual assault, cases were more frequent users of medical services than controls. Cases were seen more often, received more medical services and were more likely to be hospitalised than controls in both time periods. Cases were also more likely to be diagnosed with a vast range of physical and psychological problems during the period of study. The persistence of mental and physical health problems before and after a forensic examination for sexual assault presents a challenge. Of paramount concern are issues concerning informed consent to undergo the examination. Collection and documentation of evidence may be important for victims with severe mental illness who may have more difficulty testifying in court. Our study suggests the need for future research examining the reasons why women do not undergo the examination both in terms of whether it is offered and declined or not offered to them.

Journal Article↗
PubMed1998

Community-based outreach HIV intervention for street-recruited drug users in Madras, India.

OBJECTIVE: Community-based outreach to drug injectors is an important component of human immunodeficiency virus (HIV) prevention strategy. The purpose of this chapter is to evaluate the effectiveness of community-based outreach HIV intervention that has been implemented in two locations in the city of Madras, India, to reduce risk behaviors for HIV transmission. METHODS: Baseline data were collected for street-recruited injecting drug users (IDUs) at two outreach locations in Madras, India (n = 250), and follow-up data are available at 18 months (n = 61). Baseline (n = 150) and follow-up data (n = 87) were obtained from control group of IDUs recruited from locations at which outreach services were not utilized. RESULTS: Significant decline in injecting risk behavior was noted at 18-month follow-up from baseline for the IDUs recruited from outreach locations. CONCLUSION: Results indicate that outreach service for drug users produce significant changes in injecting risk behavior but that sexual risk behavior is difficult to change. There are problems in implementing and evaluating the interventions, and the research findings are limited because HIV serodata were not studied for all participants.

Adolescent↗
PubMed2003

The role of Medicaid HMO enrollment in the longitudinal utilization of medical care services in a cohort of injecting drug users in Baltimore, Maryland.

Although injecting drug users (IDUs) are highly dependent on Medicaid, the literature has not explored the effect of Medicaid HMO enrollment on medical care utilization. This longitudinal analysis compares 6-month utilization levels of IDUs in Medicaid HMOs with those of other Medicaid-enrolled IDUs and IDUs in other insurance arrangements. The analysis includes 1064 participants from the AIDS Link to Intravenous Experience (ALIVE) study, a natural history study of HIV infection in a community-based sample of IDUs in Baltimore, Maryland. A generalized linear modeling approach was used to examine self-reported inpatient admissions, ER visits, and ambulatory care visits from January 1995 through June 1997. Non-HMO Medicaid beneficiaries had more inpatient admissions and ambulatory care visits than Medicaid HMO enrollees. These findings suggest that HMO enrollment has been effective in lowering utilization among IDUs in Medicaid, but it is unclear whether utilization differences are the result of inappropriate utilization or access issues.

Adult↗
PubMed2000

How are policy makers using evidence? Models of research utilisation and local NHS policy making.

STUDY OBJECTIVE: This paper is based on a qualitative study that aimed to identify factors that facilitate or impede evidence-based policy making at a local level in the UK National Health Service (NHS). It considers how models of research utilisation drawn from the social sciences map onto empirical evidence from this study. DESIGN: A literature review and case studies of social research projects that were initiated by NHS health authority managers or GP fundholders in one region of the NHS. In depth interviews and document analysis were used. SETTING: One NHS region in England. PARTICIPANTS: Policy makers, GPs and researchers working on each of the social research projects selected as case studies. MAIN RESULTS: The direct influence of research evidence on decision making was tempered by factors such as financial constraints, shifting timescales and decision makers' own experiential knowledge. Research was more likely to impact on policy in indirect ways, including shaping policy debate and mediating dialogue between service providers and users. CONCLUSIONS: The study highlights the role of sustained dialogue between researchers and the users of research in improving the utilisation of research-based evidence in the policy process.

England↗
PubMed2001

Physician satisfaction and emergency department laboratory test turnaround time.

OBJECTIVES: To determine the length of time for the components of the emergency department (ED) turnaround time (TAT) study in 1998 and to ascertain physician satisfaction concerning laboratory services to the ED. METHODS: Using forms supplied by the College of American Pathologists Q-Probes program, participants conducted a self-directed study of ED TAT over a 4-week period. Data requested included various times of day associated with the ordering, specimen collection, laboratory receipt, and result-reporting stages of stat ED TATs for potassium and hemoglobin. Additionally, practice-related questions associated with the laboratory were asked. Participating laboratories also provided a physician satisfaction survey for up to 4 physicians who were users of ED services. Results of both the TAT study and the physician satisfaction survey were returned by mail. Participants were drawn from the 952 hospital laboratories enrolled in the 1998 College of American Pathologists Q-Probes study on ED TAT. The main outcome measures included the components of the ED TAT process, factors associated with decreases in ED TAT, and the results of the physician satisfaction survey. RESULTS: Six hundred ninety hospital laboratories (72.4% response rate) returned data on up to 18 230 hemoglobin and 18 259 potassium specimens. Half of these laboratories responded that 90% of potassium tests were ordered and reported in 69 minutes or less, whereas the TAT for 90% of hemoglobin results was 55 minutes or less. Comparison of the components of TAT for both potassium and hemoglobin with similar studies done in 1990 and 1993 showed no change. Factors found to statistically contribute to faster TATs for both tests were laboratory control of specimen handling and rapid transport time. When whole blood specimens were used for potassium determination, TAT improved. Emergency department physicians chose the study-defined lower satisfaction categories of Often, Sometimes, Rarely, and Never for the questions concerning the laboratory being sensitive to stat testing needs (39.1%) and meeting physician needs (47.6%). Many of the physicians surveyed believed that laboratory TAT caused delayed ED treatment more than 50% of the time (42.9%) and increased ED length of stay more than 50% of the time (61.4%) when compared with other specialty users of the ED. CONCLUSIONS: Laboratory ED TATs have remained unchanged for almost a decade. Emergency department physicians are not satisfied with laboratory services. Although it appears that one issue may relate to the other, the interaction between the laboratory and the ED is quite complex and has been evolving for at least 30 years. Improvement in interoperability between the departments is essential for operational efficiency and patient care. Effective communication channels need to be established to achieve these goals.

Attitude of Health Personnel↗
PubMed1998

Videotelephony-based services--the proven improvement of quality of life.

As described above, the research activities showed very promising and fascinating results. It could be observed that the presumed acceptance problems of elderly technology users are not larger than in other groups. What is more: the elderly user of videotelephony-based services is a very pragmatic user. He or she accepts the new service offer as long as he or she sees the benefits. Decision makers in the social field should not be afraid of this client group! All of the users were willing to pay for the service--up to three times their current communication costs. It seems that there is a market for both the network providers and the telecommunication manufacturers. Private social service provider organisations were the first to realise the potential of the videotelephony-based social support and care services. Some of them are already developing service design schemes and are eagerly awaiting affordable technology. To ensure equal accessibility to these kind of services financial support is necessary to address the needs of socially disadvantaged user groups. Moreover, policy makers should concentrate on the definition of quality requirements for different issues. At the same time, neutral control institutions have to be set up to overcome prejudices and prevent misuse. All in all the authors still believe that picture-based social support and care services are one solution for the increasing problems resulting from demographical and social changes in many industrial societies. The technical evolution and the rapidly decreasing costs will lead to the implementation of picture-based social support and care services within a very short time. Some large application projects are currently underway throughout Europe. What is more: in Frankfurt/Germany, for instance, the first commercially available picture-based service will be introduced to the public in the spring of 1997.

Aged↗
PubMedDate not supplied

Honeylands' role in the pre-school years: II. Patterns of use; and III. Factors inhibiting use.

This is the second paper arising from an independent evaluation of Honeylands' role in the pre-school years. The study was based on interviews with parents of young handicapped children in the Exeter area, both 'users' and 'non-users' of Honeylands' services. In the first section of the paper we examine the ways in which parents made use of Honeylands' facilities. Residential care, both regular and 'on demand' is considered in particular detail. We then go on to examine the reasons for non-use and the factors inhibiting the use made by 'user' families. After considering some objective factors which may effect take-up, we discuss more generally the dilemma of accepting help.

Child↗
PubMed2005

The National Cancer Institute's cancer information service: a new generation of service and research to the nation.

The National Cancer Institute (NCI), the nation's leading agency for cancer information and research, mandated by the U.S. Congress to provide accurate, up-to-date information about cancer to all segments of the U.S. population, established the Cancer Information Service (CIS) on July 1, 1975. Using a two-pronged approach, the telephone information service and education programs for the public and health professionals, the CIS was designed to maximize its reach. In 1982, the CIS implemented three tools: the Call Record Form to record data about each call to the service, a national user survey, and a system of national test calls. These resulted in a rich data source and an infrastructure that allowed collaborative health communications research with the CIS to emerge later in the decade. As the CIS embarks on a new generation of service to the nation, it is now characterized by three vital components that advance the NCI's overall mission of cancer prevention and control: a Partnership Program, Multichannel Contact Centers, and a Health Communications Research Program.

Communication↗
PubMed2003

Construction and characteristics of the RxRisk-V: a VA-adapted pharmacy-based case-mix instrument.

BACKGROUND: Assessment of disease burden is the key to many aspects of health care management. Patient diagnoses are commonly used for case-mix assessment. However, issues pertaining to diagnostic data availability and reliability make pharmacy-based strategies attractive. Our goal was to provide a reliable and valid pharmacy-based case-mix classification system for chronic diseases found in the Veterans Health Administration (VHA) population. OBJECTIVE: To detail the development and category definitions of a VA-adapted version of the RxRisk (formerly the Chronic Disease Score); to describe category prevalence and reliability; to check category criterion validity against ICD-9 diagnoses; and to assess category-specific regression coefficients in concurrent and prospective cost models. RESEARCH DESIGN: Clinical and pharmacological review followed by cohort analysis of diagnostic, pharmacy, and utilization databases. SUBJECTS: 126,075 veteran users of VHA services in Washington, Oregon, Idaho, and Alaska. METHODS: We used Kappa statistics to evaluate RxRisk category reliability and criterion validity, and multivariate regression to estimate concurrent and prospective cost models. RESULTS: The RxRisk-V classified 70.5% of the VHA Northwest Network 1998 users into an average of 2.61 categories. Of the 45 classes, 33 classes had good-excellent 1-year reliability and 25 classes had good-excellent criterion validity against ICD-9 diagnoses. The RxRisk-V accounts for a distinct proportion of the variance in concurrent (R2 = 0.18) and prospective cost (R2 = 0.10) models. CONCLUSIONS: The RxRisk-V provides a reliable and valid method for administrators to describe and understand better chronic disease burden of their treated populations. Tailoring to the VHA permits assessment of disease burden specific to this population.

Adolescent↗