Abstract:
BACKGROUND:The number of older patients enrolling in health maintenance organizations (HMOs) is increasing. Concerns have been raised that older patients may be targeted by HMOs for more stringent cost-containment mechanisms, including reduced access to expensive specialty care. OBJECTIVES:We investigated the relationship between membership in an HMO and the decision to consult with a neurologist or admit to a neurology ward for patients hospitalized with acute stroke. We then compared 1-year mortality of patients who received neurology care to the 1-year mortality of those who did not receive neurology care. DESIGN:Retrospective medical record review. SUBJECTS:A sample of hospitalized acute stroke patients (age range, 30-79 years) who were discharged from Minneapolis-St. Paul metropolitan hospitals with a diagnosis code of acute cerebrovascular disease from 1991 to 1993. MEASURES:Trained nurses abstracted the medical records. Stroke events (n = 2,320) were validated using clinical criteria and neuroimaging reports. Mortality data were obtained from the Minnesota Death Index. RESULTS:Among patients enrolled in HMOs, 30% of validated stroke patients did not receive neurology care in comparison with 19% of patients not enrolled in HMOs. After adjusting for patient mix and hospital characteristics, the odds of receiving neurology care were half as great for patients enrolled in HMOs as compared with patients not enrolled in HMOs (odds ratio [OR] = 0.52, 95% confidence interval [CI] 0.36-0.74). The association of membership in HMOs with lower use of neurology care was concentrated in older patients. Within each age group, the odds ratios and 95% CI of receiving neurology care for patients enrolled in HMOs versus patients not enrolled in HMOs were: < 55 years (1.06, 0.42-2.67), 55 to 64 years (0.54, 0.34-0.87), 65 to 74 years (0.51, 0.36-0.71), and >75 years (0.40, 0.24-0.68). Using Cox regression, 30-day mortality did not differ between patients who received neurology care and those who did not. Among 30-day survivors, the mortality hazards ratio (HR) during the next 11 months for patients who received neurology care was 71% of the hazard for patients who did not receive neurology care (HR = 0.71, 95% CI = 0.55-0.91). CONCLUSIONS:These data suggest that membership in an HMO was associated with reduced access to neurology care for older patients with acute stroke and that patients who received neurology care had a lower risk of death during the year after their stroke. It remains to be determined if these differences in outcome are caused by true differences in stroke management or by unmeasured characteristics.
journal_name
Med Carejournal_title
Medical careauthors
Smith MA,Shahar E,McGovern PG,Kane RL,Doliszny KM,Arnett DK,Luepker RVdoi
10.1097/00005650-199912000-00002keywords:
subject
Has Abstractpub_date
1999-12-01 00:00:00pages
1186-98issue
12eissn
0025-7079issn
1537-1948journal_volume
37pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract::The association of underutilization of drugs prescribed for the treatment of hypertension and acute-care hospital readmissions was evaluated. The data base consisted of computerized hospitalization records and computerized out-patient pharmacy records, checked by chart audit for validity. The number of days' supply of...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198912000-00007
更新日期:1989-12-01 00:00:00
abstract:BACKGROUND:Researchers need valid methods to assess whether patients are taking their antidepressant medications. Two important sources of data on drug exposure are patients' self-reports and pharmacy claims. OBJECTIVE:To compare self-report and claims data for antidepressant exposure. RESEARCH DESIGN:Cross-sectional...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000053019.79054.B6
更新日期:2003-03-01 00:00:00
abstract:BACKGROUND:Applying disease-specific guidelines to people with multimorbidity may result in complex regimens that impose treatment burden. OBJECTIVES:To describe and validate a measure of healthcare task difficulty (HCTD) in a sample of older adults with multimorbidity. RESEARCH DESIGN:Cross-sectional and longitudina...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182a977da
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVES:To estimate cost and outcomes of the Arthritis Foundation aquatic exercise classes from the societal perspective. DESIGN:Randomized trial of 20-week aquatic classes. Cost per quality-adjusted life year (QALY) gained was estimated using trial data. Sample size was based on 80% power to reject the null hypoth...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-200105000-00002
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:The decision to perform orthopedic surgery requires substantial discretion and judgment. Similar conditions have been associated with health care disparities in other fields, but the extent of racial and ethnic disparities in orthopedics is unknown. OBJECTIVE:To evaluate the quality of extant orthopedic lit...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/MLR.0000000000000177
更新日期:2014-09-01 00:00:00
abstract::The application of analytical and interactive decision models to decisions, in EMS councils, with various levels of uncertainty is described. Uncertainty is defined as having temporal, procedural, quantifiability, and environmental attributes. Highly uncertain decisions are unique, with unknown decision procedures. De...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197902000-00005
更新日期:1979-02-01 00:00:00
abstract:OBJECTIVES:To reapportion Veterans Health Administration (VA) annual expenditures into benefit categories for comparison with estimated payments by private sector providers. METHODS:Total expenditures for six VA medical centers for federal fiscal year 1999 were reapportioned by benefit category using the cost distribu...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000068422.03255.6B
更新日期:2003-06-01 00:00:00
abstract::In a large randomized trial involving over 2,000 women with abnormal cervical cytology (pap smear), three clinic-based interventions were tested as strategies to increase return rates for screening follow-up: 1) a personalized follow-up letter and pamphlet; 2) a slide-tape program on pap smears; and 3) transportation ...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-199203000-00004
更新日期:1992-03-01 00:00:00
abstract:BACKGROUND:Spinal mobilization and manipulation are 2 therapies found to be generally safe and effective for chronic low back pain (CLBP). However, the question remains whether they are appropriate for all CLBP patients. RESEARCH DESIGN:An expert panel used a well-validated approach, including an evidence synthesis an...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001108
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Performance measures often fail to account for legitimate reasons why patients do not achieve recommended treatment targets. METHODS:We tested a novel performance measurement system for blood pressure (BP) control that was designed to mimic clinical reasoning. This clinically guided approach focuses on (1) ...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e318245a147
更新日期:2012-05-01 00:00:00
abstract:AIMS:There are situations in which patient self-reported health-related quality of life must be substituted by proxy assessments. Pickard and Knight recently delineated 2 proxy perspectives that may influence the nature of proxy measurements: the "proxy-patient" (the proxy's assessment from the patient's perspective) a...
journal_title:Medical care
pub_type: 杂志文章,随机对照试验
doi:10.1097/MLR.0b013e318158af13
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:Federal regulation requires hospitals to present patients with a Notice of Privacy Practices (NPP) that contains all stipulated content items, is readable by patients, and posted on institutional web sites. OBJECTIVE:The objective of this study was to determine whether the NPP texts contain the required con...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000163646.90393.e4
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:Prescribing of exogenous testosterone is increasing. Because of the risks associated with testosterone, it is important to follow evidence-based procedures when initiating therapy. OBJECTIVE:We evaluated whether dispensing of testosterone was preceded by appropriate ascertainment of androgen deficiency, and...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000398
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Prescription of new drugs contributes to substantial increases in annual drug expenditures. A small proportion of physicians appear to be early users of new prescription drugs and little is known about their characteristics. OBJECTIVE:To estimate the initial utilization rate of new prescription drugs among ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200308000-00004
更新日期:2003-08-01 00:00:00
abstract:BACKGROUND:Information is limited regarding the effects of processes of care on cardiac surgical outcomes. Correspondingly, many recommended cardiac surgical processes of care are derived from animal experiments or clinical judgment. This report from the VA Cooperative Study in Health Services, "Processes, Structures, ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000102295.08379.57
更新日期:2004-01-01 00:00:00
abstract::The authors tested the "uncertainty hypothesis," which holds that variations in rates of hospitalization or surgeries across small geographic areas reflect differences in physicians' decision making when confronting uncertainty. A small-areas variation analysis of suspected acute cardiac ischemia (ACI) admissions in n...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199411000-00002
更新日期:1994-11-01 00:00:00
abstract::In-hospital cardiopulmonary resuscitation (CPR) is associated with substantial costs beyond those of the resuscitation itself. These costs are important to understand because health care resources are limited. To that end, a model of CPR is proposed, including an examination of the effect of several variables on the c...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199406000-00008
更新日期:1994-06-01 00:00:00
abstract:BACKGROUND:The transition from Medicaid-only to dual Medicare/Medicaid coverage has the potential to reduce financial barriers to health care for patients with serious mental illness through increased coverage or expanded access to clinicians as their reimbursement increases. AIMS:To estimate the effect of dual covera...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000572
更新日期:2016-09-01 00:00:00
abstract::We evaluated the quality of care of physician's extenders (PEs: 23 physician's assistants, 7 primary care nurse practitioners) in Air Force primary medicine clinics, as part of an evaluation of PEs' assuming a considerable portion of the care, formerly provided by physicians in the military medical system. Physician's...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198109000-00007
更新日期:1981-09-01 00:00:00
abstract:BACKGROUND:Adherence is a factor in the outcome of medical treatment, but the strength and moderators of the adherence-outcome association have not been systematically assessed. OBJECTIVES:A quantitative review using meta-analysis of three decades of empirical research correlating adherence with objective measures of ...
journal_title:Medical care
pub_type: 杂志文章,meta分析
doi:10.1097/00005650-200209000-00009
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:Patients with depression use more health services than patients without depression. However, when depression symptoms respond to treatment, use of health services declines. Most depression quality improvement studies increase total cost in the short run, which if unevenly distributed across stakeholders, cou...
journal_title:Medical care
pub_type: 杂志文章,随机对照试验
doi:10.1097/MLR.0b013e31821d2b35
更新日期:2011-09-01 00:00:00
abstract::Data from the 1980 to 1981 National Health Interview Survey on morbidity, principally bed-disability days, was age standardized and indexed by region of the United States and metropolitan and nonmetropolitan residence within region. There were substantial differences in both age-specific and age-adjusted morbidity by ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198704000-00007
更新日期:1987-04-01 00:00:00
abstract:BACKGROUND:The need for evidence about the effectiveness of therapeutics and other medical practices has triggered new interest in methods for comparative effectiveness research. OBJECTIVE:Describe an approach to comparative effectiveness research involving cluster randomized trials in networks of hospitals, health pl...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e3181dbebcf
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:Few studies examine the link between measured process of care and outcome. OBJECTIVE:To evaluate the relationship of claims-based assessment of process of care to subsequent function and survival. RESEARCH DESIGN:Retrospective cohort study using claims from 1999 to assess performance on 41 quality indicato...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31820e5aab
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:Patient experience data can be collected by sampling patients periodically (eg, patients with any visits over a 1-year period) or sampling visits continuously (eg, sampling any visit in a monthly interval). Continuous sampling likely yields a sample with more frequent and more recent visits, possibly affecti...
journal_title:Medical care
pub_type: 社论
doi:10.1097/MLR.0000000000001134
更新日期:2019-12-01 00:00:00
abstract::To enhance the efficient utilization of health providers, medical care researchers are increasingly concerned with the measurement of task performance. One job analysis methodology that is widely used is the task inventory technique, characterized by retrospective self-reporting. The purpose of this study was to valid...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197502000-00002
更新日期:1975-02-01 00:00:00
abstract::This report describes efforts to develop and test scales for measuring attitudes toward the medical care of chronically and terminally ill patients and their families. The following satisfaction scales were developed: General Satisfaction, Availability of Care, Continuity of Care, Physician Availability, Physician Com...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198405000-00011
更新日期:1984-05-01 00:00:00
abstract:BACKGROUND:Acute health shocks can reduce the ability to work and earn among working-age survivors. The full economic impact includes labor market effects on spouses/partners, but there is a knowledge gap in this area. OBJECTIVES:The objective of this study was to assess how 3 common health shocks, acute myocardial in...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001249
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Approximately 2.5 million Americans are admitted to the hospital after traumatic physical injury each year. Few investigations have elicited patients' perspectives regarding posttraumatic outcomes. OBJECTIVE:To identify and categorize physically injured trauma survivors' posttraumatic concerns. RESEARCH DE...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200104000-00004
更新日期:2001-04-01 00:00:00
abstract::Federal interest in prepaid group practices as a means to control rising health care costs in reviving. This article is an empirical study of price and membership at a prepaid group practice among employees of Yale University. This article is the first to estimate the effect of price on the decision for membership in ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198102000-00005
更新日期:1981-02-01 00:00:00