Abstract:
BACKGROUND:With the growth of managed care, there are increasing concerns but inconclusive evidence regarding deterioration in the quality of medical care. OBJECTIVES:To assess physicians' perceptions of their ability to provide high-quality care and explore what factors, including managed care, affect these perceptions. RESEARCH DESIGN:Bivariate and multivariate analyses of the Community Tracking Study Physician Survey, a cross-sectional, nationally representative telephone survey of 12,385 patient-care physicians conducted in 1996/1997. The response rate was 65%. PARTICIPANTS:Physicians who provide direct patient care for > or =20 h/wk, excluding federal employees and those in selected specialties. MEASURES:Level of agreement with 4 statements: 1 regarding overall ability to provide high-quality care and 3 regarding aspects of care delivery associated with quality. RESULTS:Between 21% and 31% of physicians disagreed with the quality statements. Specialists were generally 50% more likely than primary care physicians to express concerns about their ability to provide quality care. Generally, the number of managed care contracts, but not the percent of practice revenue from managed care, was negatively associated with perceived quality. Market-level managed care penetration independently affected physicians' perceptions. Practice setting affected perceptions of quality, with physicians in group settings less likely to express concerns than physicians in solo and 2-physician practices. Specific financial incentives and care management tools had limited positive or negative associations with perceived quality. CONCLUSIONS:Managed care involvement is only modestly associated with reduced perceptions of quality among physicians, with some specific tools enhancing perceived quality. Physicians may be able to moderate some negative effects of managed care by altering their practice arrangements.
journal_name
Med Carejournal_title
Medical careauthors
Reschovsky J,Reed M,Blumenthal D,Landon Bdoi
10.1097/00005650-200103000-00006keywords:
subject
Has Abstractpub_date
2001-03-01 00:00:00pages
254-69issue
3eissn
0025-7079issn
1537-1948journal_volume
39pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract:BACKGROUND AND OBJECTIVES:Having health insurance is usually associated with better access to care and better health outcomes. For patients receiving care at Federally Qualified Health Centers (FQHCs), where care is provided regardless of insurance status, the role health insurance status plays in affecting receipt of ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/mlr.0b013e318190ccac
更新日期:2009-04-01 00:00:00
abstract::Between 1989 and 1992, the Agency for Health Care Policy and Research (AHCPR) awarded funding to 14 special projects known as Patient Outcomes Research Teams (PORTs). These large, complex projects form the centerpiece of the first generation of research under the Medical Treatment Effectiveness Program. In carrying ou...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:1994-07-01 00:00:00
abstract:OBJECTIVE:To examine the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemic stroke, controlling for patient demographic, clinical, facility-level variables, as well as select in-hospital treatments and procedures. METHODS:A longitudinal observational populat...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000366
更新日期:2015-06-01 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:The Veterans Health Administration does not routinely collect and document sexual orientation and gender identity (SOGI) data, despite existing health disparities among sexual and gender minority Veterans. Because of the legacy of previous Department of Defense (DoD) policies that prohibited disclosure of se...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000744
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:The quality of care for Medicare beneficiaries with diabetes remains suboptimal. The contributing factors at the physician level are not well characterized, especially the relationship of patient volume and physician performance. OBJECTIVE:We sought to determine associations between the number of Medicare d...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000233685.22497.cf
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:Reference drug pricing (RP) is a cost-sharing strategy commonly used to control drug expenditures. Under RP, a benefit plan fully reimburses medications that are equally or less expensive than the reference price, and requires patients to pay the extra cost of therapeutically equivalent but higher priced dru...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000129497.10930.a2
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:To identify consistent provision of clinical preventive services, we sought to benchmark all acute care Veterans Affairs Medical Centers (VAMCs) against each other nationally on the basis of multiple evidence-based, performance measures to identify facilities performing consistently higher and lower than expe...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200206000-00011
更新日期:2002-06-01 00:00:00
abstract:CONTEXT:Small studies suggest that the quality of healthcare provided to older patients needs improvement. However, measuring the quality of care for larger groups of older adults is difficult. OBJECTIVE:To measure the quality of care in a community-dwelling vulnerable geriatric population using administrative data to...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318127143e
更新日期:2007-10-01 00:00:00
abstract:BACKGROUND:Evidence that medical error is a systemic problem requiring systemic solutions continues to expand. Developing a "safety culture" is one potential strategy toward improving patient safety. A reliable and valid self-report measure of safety culture is needed that is both grounded in concrete behaviors and is ...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/01.mlr.0000244635.61178.7a
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Despite clinical guidelines, many patients with hypercholesterolemia do not achieve treatment goals in clinical practice. OBJECTIVES:This study examined physician attitudes and beliefs about hyperlipidemia and whether they are associated with lipid treatment decisions. METHODS:This was a cross-sectional st...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000208017.18278.1a
更新日期:2006-05-01 00:00:00
abstract::The accurate measurement of physician job satisfaction in organized practice settings is important for both policy and administrative purposes. Previous efforts to measure physician job satisfaction have been unsatisfactory because of either conceptual or methodologic weaknesses. New measures of physician job satisfac...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198401000-00005
更新日期:1984-01-01 00:00:00
abstract:BACKGROUND:Safety-net and teaching hospitals are somewhat more likely to be penalized for excess readmissions, but the association of other hospital characteristics with readmission rates is uncertain and may have relevance for hospital-centered interventions. OBJECTIVE:To examine the independent association of 8 hosp...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000713
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Research on frequent emergency department (ED) use shows that a subgroup of patients visits multiple EDs. This study characterizes these individuals. OBJECTIVE:The objective of this study was to determine how many frequent ED users seek care at multiple EDs and to identify sociodemographic, clinical, and co...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001228
更新日期:2020-02-01 00:00:00
abstract::The authors of this study examine temporal patterns of medical expenditures by Medicare beneficiaries. A random sample of 204,917 individuals who were alive and in the program from 1974 to 1977 was investigated. Individuals hospitalized in 1974 were found to have twice the rate of hospitalization in 1975, 1976, or 197...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198402000-00005
更新日期:1984-02-01 00:00:00
abstract:BACKGROUND:Versus whites, blacks with diabetes have poorer control of hemoglobin A1c (HbA1c), higher systolic blood pressure (SBP), and higher low-density lipoprotein (LDL) cholesterol as well as higher rates of morbidity and microvascular complications. OBJECTIVE:To examine whether several mutable risk factors were m...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/mlr.0b013e318192609d
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:In 1999, the US Congress mandated the Agency for Healthcare Research and Quality (AHRQ), Department of Health and Human Services (DHHS), to report annually to the nation about healthcare quality. One chapter in the National Healthcare Quality Report (NHQR) is focused on patient safety. OBJECTIVES:The object...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/00005650-200503001-00007
更新日期:2005-03-01 00:00:00
abstract::Seven general surgeons in a prepaid group practice previously shown to have a mean operative work load of 9.2 hernia equivalents (HE) per week were found to have a standardized mean daytime working week of 56.2 hours, exclusive of evening activities of which 50.7 hours were devoted to professional activities. The surg...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197610000-00003
更新日期:1976-10-01 00:00:00
abstract::To explore the reliability of Medicare Part A claims data for clinical and health services research related to the care of patients with cancer, the authors compared estimates of the incidence of and resection rates for cancer of the breast, colon, and lung derived from analysis of Medicare Part A data versus data fro...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199112000-00005
更新日期:1991-12-01 00:00:00
abstract:BACKGROUND:Population-based cancer registries represent a potentially valuable tool to evaluate treatment; however, information on the completeness of registry treatment data is sparse. OBJECTIVE:To evaluate the completeness of registry treatment data for patients with colorectal cancer and to identify predictors of c...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000083740.12949.88
更新日期:2003-09-01 00:00:00
abstract:BACKGROUND:Methods to select physicians most likely to benefit from educational interventions to improve the outcome of depression have not been adequately developed. OBJECTIVE:The purpose of this study was to identify a combination of primary care provider (PCP) self-report questions to improve the precision of PCP e...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200007000-00009
更新日期:2000-07-01 00:00:00
abstract::Acceptance by target populations of new programs funded by government is a phenomenon which one should be able to explain with existing innovation theory. In a study of a newly formed group health practice, funded in part by OEO, it is found that a commonly used set of predictors has little utility in explaining indi...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197904000-00008
更新日期:1979-04-01 00:00:00
abstract:OBJECTIVES:The author highlights changes in hospital utilization that have occurred in association with restructuring of Ontario hospitals. The basic features of the epidemiology of hospital utilization described link the analysis of the organizational and structural components of hospitals with a more comprehensive ev...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199710001-00012
更新日期:1997-10-01 00:00:00
abstract::This article assesses the extent to which formally provided comprehensive community care tends to substitute for informal care provided by family and friends to impaired elderly persons living in the community. Using simultaneous equations causal modeling techniques to control for selective targeting and other interve...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198306000-00003
更新日期:1983-06-01 00:00:00
abstract:BACKGROUND:The variability in preferences used in quality-adjusted life-years estimation jeopardizes the comparability of cost-effectiveness analyses and has led the Panel on Cost-Effectiveness in Health and Medicine (the PCEHM) to call for a catalog of "off-the-shelf" preference weights associated with conditions that...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000172050.67085.4f
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVE:To examine the association of drug users' outpatient patterns of care with subsequent intensity of antiretroviral therapy (ART). MATERIALS AND METHODS:Annual types of ART in 8897 New York State Medicaid drug users who were prescribed ART for > or =6 months in 1996 or 1997 were determined. From pharmacy claim...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200210000-00014
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVE:In the United States, data on transplanted and waitlisted patients collected by the Organ Procurement and Transplantation Network (OPTN) have been widely used in transplantation research. Administrative claims data, collected by health plans for reimbursement purposes, are also commonly used in health-service...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3180326121
更新日期:2007-06-01 00:00:00
abstract:OBJECTIVES:Many patients have limited English proficiency and require an interpreter. The authors evaluated the effect of current interpreting practices on Spanish-speaking patients' satisfaction with the patient-provider relationship. METHODS:A cross-sectional survey was conducted of 457 patients seen in a public hos...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199810000-00004
更新日期:1998-10-01 00:00:00
abstract:OBJECTIVES:Administrative data from Manitoba, Canada document variation in procedure utilization rates over a period of 15 years. With coronary angiography and cardiovascular surgery centralized in the capital, Winnipeg, previous analyses from 1977 to 1983 found angiography and coronary artery bypass surgery (CABS) rat...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199807000-00009
更新日期:1998-07-01 00:00:00
abstract:BACKGROUND:It is unclear if volume-outcome relationships exist in inpatient rehabilitation. OBJECTIVES:Assess associations between facility volumes and 2 patient-centered outcomes in the 3 most common diagnostic groups in inpatient rehabilitation. RESEARCH DESIGN:We used hierarchical linear and generalized linear mod...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e318286e3c8
更新日期:2013-05-01 00:00:00