Missing links in the human services nonsystem.

Abstract:

:Four separate human services programs and their West Philadelphia service consumers were studied by the 1971 Health Network Project: a hospital receiving ward, a community mental health satellite center, a public assistance district office, and a public child welfare agency. The basic hypotheses were that 1) the four consumer groups present common health, economic, and social problems, and 2) each agency confines its services to its own specialized range of problems and provides minimal linkages to other service facilities, including those available within its own subdivisions. Data were obtained by interview and record review from over 600 patients and clients. Each agency was found to respond to presenting problems with specific interventions. However, failure to detect, treat, or refer concurrent problems was pronounced. Despite the great prevalence of physical and mental illness, compounded by economic marginality, each agency made minimal use of internal support services and external referrals. The human services nonsystem is discussed conceptually in light of specialization and fragmentation. Proposals for shifting the nonsystem toward a responsive service network include the introduction of comprehensive screening devices and of service generalists for case management.

journal_name

Med Care

journal_title

Medical care

authors

Leopold EA,Schein L

doi

10.1097/00005650-197507000-00007

keywords:

subject

Has Abstract

pub_date

1975-07-01 00:00:00

pages

595-606

issue

7

eissn

0025-7079

issn

1537-1948

journal_volume

13

pub_type

杂志文章
  • Statistical methods and strategies for working with large data bases.

    abstract::This article describes the statistical methods and strategies to be used in establishing the linkages between processes and structures of care with risk-adjusted outcomes in a large multicenter Veterans Affairs cooperative study in health services of patients undergoing cardiac surgery. The statistical analyses consis...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/00005650-199510001-00005

    authors: Marshall G,Henderson WG,Moritz TE,Shroyer AL,Grover FL,Hammermeister KE

    更新日期:1995-10-01 00:00:00

  • Access to care and utilization among children: estimating the effects of public and private coverage.

    abstract:OBJECTIVES:We examine the relationship between health insurance coverage and children's access to and utilization of medical care. Access measures we study are having a usual source of care (USC) and lacking a USC for financial or insurance reasons. We also examine indicators for ambulatory visits, well-child visits, d...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000208137.46917.3b

    authors: Selden TM,Hudson JL

    更新日期:2006-05-01 00:00:00

  • Insurance coverage and prenatal care among low-income pregnant women: an assessment of states' adoption of the "Unborn Child" option in Medicaid and CHIP.

    abstract:BACKGROUND:The "Unborn Child" (UC) option provides state Medicaid/Children's Health Insurance Program (CHIP) programs with a new strategy to extend prenatal coverage to low-income women who would otherwise have difficulty enrolling in or would be ineligible for Medicaid. OBJECTIVES:To examine the association of the UC...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000020

    authors: Jarlenski MP,Bennett WL,Barry CL,Bleich SN

    更新日期:2014-01-01 00:00:00

  • Physician response to patient insurance status in ambulatory care clinical decision-making. Implications for quality of care.

    abstract:OBJECTIVES:Individuals without health insurance in general receive fewer health services and are more likely than insured patients to experience poor outcomes. The main goal of this research was to study whether physicians' clinical recommendations vary for insured and uninsured patients, implying that physicians' choi...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00005650-199608000-00006

    authors: Mort EA,Edwards JN,Emmons DW,Convery K,Blumenthal D

    更新日期:1996-08-01 00:00:00

  • Hospice home care cost savings to third-party insurers.

    abstract::A population-based, retrospective analysis of Medicare Part A and Blue Cross hospital insurance claims data was used to determine whether hospice home care cost savings to third-party insurers are substantial and result from the substitution of less expensive home care visits for more costly hospital inpatient days. T...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198408000-00002

    authors: Brooks CH,Smyth-Staruch K

    更新日期:1984-08-01 00:00:00

  • Pediatric nurse practitioner functions in the outpatient clinics of a tertiary care center.

    abstract::Previous research has neglected to delineate pediatric nurse practitioner (PNP) roles in tertiary care settings (TCS). New PNP roles have developed as TCS seek cost-effective solutions to providing quality patient care and to meeting new demands for outpatient care. The authors evaluated the roles of 11 PNPs in eight ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198604000-00005

    authors: Cruikshank BM,Clow TJ,Seals B

    更新日期:1986-04-01 00:00:00

  • Reallocation of operating room capacity using the due-time model.

    abstract:BACKGROUND:Demand for surgical treatment is rising while operating room (OR) resources are limited. Requests for more resources therefore can only be partly met by repartitioning the existing sparse resources. OBJECTIVE:Our goal is to define a method to allocate OR block times among surgical disciplines in such a way ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3182549eb9

    authors: Vansteenkiste N,Lamote C,Vandersmissen J,Luysmans P,Monnens P,De Voldere G,Kips J,Rademakers FE

    更新日期:2012-09-01 00:00:00

  • Predictors of medication-refill adherence in an indigent rural population.

    abstract:OBJECTIVE:We evaluated the association of medication refill adherence with demographic and prescription characteristics to determine whether such factors could guide intervention strategies in an indigent rural population. METHODS:The study was conducted at a University-based internal medicine practice serving an indi...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200212000-00016

    authors: Schectman JM,Bovbjerg VE,Voss JD

    更新日期:2002-12-01 00:00:00

  • Facility and area variation affecting the use of physical restraints in nursing homes.

    abstract:OBJECTIVES:Various individual characteristics increase a nursing home resident's likelihood of being mechanically restrained. However, there is not good information on the role played by facility characteristics and geographic area in determining the likelihood of physical restraint use. This study investigates the imp...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199611000-00008

    authors: Phillips CD,Hawes C,Mor V,Fries BE,Morris JN,Nennstiel ME

    更新日期:1996-11-01 00:00:00

  • Changes in follow-up care for Medicare surgical patients under the prospective payment system.

    abstract::In this study, changes in the number, site, and source of follow-up visits and allowed charges were examined for follow-up visits provided to Medicare surgical patients between 1984 and 1986. Among the 21 surgical procedures studied, follow-up visits decreased by 5.2%, after adjusting for case mix. Despite the physici...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199303000-00005

    authors: Kominski GF,Biddle AK

    更新日期:1993-03-01 00:00:00

  • Beyond the uninsured: problems in access to care.

    abstract::This paper investigates the difficulties that people encounter in their attempt to obtain needed health services, other than their third-party coverage or lack of it. These problems can be temporal, geographic, attitudinal, or financial (even with insurance). A state-wide sample survey conducted in 1989 revealed that ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199405000-00001

    authors: Bashshur RL,Homan RK,Smith DG

    更新日期:1994-05-01 00:00:00

  • Can administrative data be used to compare postoperative complication rates across hospitals?

    abstract:BACKGROUND:Several quality assessment systems use administrative data to identify postoperative complications, with uncertain validity. OBJECTIVES:To determine how accurately postoperative complications are reported in administrative data, whether accuracy varies systematically across hospitals, and whether serious co...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200210000-00004

    authors: Romano PS,Chan BK,Schembri ME,Rainwater JA

    更新日期:2002-10-01 00:00:00

  • Short- and long-term residents of nursing homes.

    abstract::This article analyzes reported data on length of stay of discharged patients from the 1977 National Nursing Home Survey. Assuming that patients admitted to nursing homes are one of two types, short-stayers and long-stayers, the statistically best-fitting proportions and expected lengths of stay for the two types are d...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198103000-00011

    authors: Keeler EB,Kane RL,Solomon DH

    更新日期:1981-03-01 00:00:00

  • The impact of symptoms and impairments on overall health in US national health data.

    abstract:OBJECTIVE:To assess the effects on overall self-rated health of the broad range of symptoms and impairments that are routinely asked about in national surveys. DATA:We use data from adults in the nationally representative Medical Expenditure Panel Survey (MEPS) 2002 with validation in an independent sample from MEPS 2...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318179199f

    authors: Stewart ST,Woodward RM,Rosen AB,Cutler DM

    更新日期:2008-09-01 00:00:00

  • Validity of the AHRQ patient safety indicator for postoperative physiologic and metabolic derangement based on a national sample of medical records.

    abstract:OBJECTIVE:The Agency for Healthcare Research and Quality Patient Safety Indicator (PSI) 10, "Postoperative Physiologic and Metabolic Derangement" (PPMD), uses administrative data to detect postoperative acute kidney injury (AKI) requiring dialysis and diabetes-related complications. We sought to evaluate the indicator'...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e31829c8b91

    authors: Zrelak PA,Romano PS,Tancredi DJ,Geppert JJ,Utter GH

    更新日期:2013-09-01 00:00:00

  • Racial disparities in Medicaid enrollment and prenatal care initiation among pregnant teens in Florida: comparisons between 1995 and 2001.

    abstract:BACKGROUND:Teens and racial and ethnic minority women are less likely to initiate prenatal care (PNC) in the first trimester of pregnancy than their counterparts. OBJECTIVE:This study examines the impact of Medicaid program changes in the late 1990s on the timing of Medicaid enrollment and PNC initiation among pregnan...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318187d8f8

    authors: Kuo TM,Gavin NI,Adams EK,Ayadi MF

    更新日期:2008-10-01 00:00:00

  • Negligent care and malpractice claiming behavior in Utah and Colorado.

    abstract:BACKGROUND:Previous studies relating the incidence of negligent medical care to malpractice lawsuits in the United States may not be generalizable. These studies are based on data from 2 of the most populous states (California and New York), collected more than a decade ago, during volatile periods in the history of ma...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200003000-00002

    authors: Studdert DM,Thomas EJ,Burstin HR,Zbar BI,Orav EJ,Brennan TA

    更新日期:2000-03-01 00:00:00

  • When does an episode of care for cancer begin?

    abstract:BACKGROUND:Little is known about the medical care resources devoted to diagnosing and treating cancer-related symptoms before a definitive cancer diagnosis. Previous research using SEER-Medicare data to measure incremental costs and utilization associated with cancer started with the date of diagnosis. We hypothesized ...

    journal_title:Medical care

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/MLR.0b013e3182731277

    authors: Hornbrook MC,Fishman PA,Ritzwoller DP,Elston-Lafata J,O'Keeffe-Rosetti MC,Salloum RG

    更新日期:2013-04-01 00:00:00

  • Validation of a 10-item care-related regret intensity scale (RIS-10) for health care professionals.

    abstract:BACKGROUND:Regret after one of the many decisions and interventions that health care professionals make every day can have an impact on their own health and quality of life, and on their patient care practices. OBJECTIVES:To validate a new care-related regret intensity scale (RIS) for health care professionals. RESEA...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318280f02c

    authors: Courvoisier DS,Cullati S,Haller CS,Schmidt RE,Haller G,Agoritsas T,Perneger TV

    更新日期:2013-03-01 00:00:00

  • The effects of patient volume on the quality of diabetic care for Medicare beneficiaries.

    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

    authors: Holmboe ES,Wang Y,Tate JP,Meehan TP

    更新日期:2006-12-01 00:00:00

  • Disclosure of information to patients in medical care.

    abstract::It is generally agreed that patients have a right to be adequately informed. However, little is known about the extent to which doctors and patients agree about information that should be disclosed. We studied what patients want to know, as contrasted with what physicians report actually disclosing, in a population of...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198107000-00003

    authors: Faden RR,Becker C,Lewis C,Freeman J,Faden AI

    更新日期:1981-07-01 00:00:00

  • Family structure and children's use of ambulatory physician services.

    abstract::The purpose of this article is to examine children's use of ambulatory physician services in relation to three dimensions of family life: maternal employment, single-parent versus two-parent households, and the presence of a nuclear or extended family. Data from the National Medical Care Expenditure Survey show that m...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198504000-00007

    authors: Cafferata GL,Kasper JD

    更新日期:1985-04-01 00:00:00

  • Clinical Scenarios for Which Spinal Mobilization and Manipulation Are Considered by an Expert Panel to be Inappropriate (and Appropriate) for Patients With Chronic Low Back Pain.

    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

    authors: Herman PM,Hurwitz EL,Shekelle PG,Whitley MD,Coulter ID

    更新日期:2019-05-01 00:00:00

  • Designing and implementing research on a statewide quality improvement initiative: the DIAMOND study and initiative.

    abstract:OBJECTIVE:To demonstrate a rigorous methodology that optimally balanced internal validity with generalizability to evaluate a statewide collaborative that implemented an evidence-based, collaborative care model for depression management in primary care. STUDY DESIGN AND SETTING:Several operational features of the DIAM...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318249d8a4

    authors: Crain AL,Solberg LI,Unützer J,Ohnsorg KA,Maciosek MV,Whitebird RR,Beck A,Molitor BA

    更新日期:2013-09-01 00:00:00

  • Nursing Home Admissions Among Medicaid HCBS Enrollees: Evidence of Racial/Ethnic Disparities or Differences?

    abstract:OBJECTIVES:Rebalancing the long-term care system between institutional care and home-based and community-based services (HCBS) has become an important policy goal of most state Medicaid programs and several provisions of the Affordable Care Act. This study estimated nursing home admission patterns by race and ethnicity...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000379

    authors: Cai X,Temkin-Greener H

    更新日期:2015-07-01 00:00:00

  • Administrative hospitalization database validation of cardiac procedure codes.

    abstract:BACKGROUND:Although cardiac procedures are commonly used to treat cardiovascular disease, they are costly. Administrative data sources could be used to track cardiac procedures, but sources of such data have not been validated against clinical registries. OBJECTIVES:To examine accuracy of cardiac procedure coding in a...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3182329778

    authors: Lee DS,Stitt A,Wang X,Yu JS,Gurevich Y,Kingsbury KJ,Austin PC,Tu JV

    更新日期:2013-04-01 00:00:00

  • The Parent Report Form of the CHIP-Child Edition: reliability and validity.

    abstract:BACKGROUND:Valid, comprehensive instruments to describe, monitor, and evaluate health from childhood through adolescence are almost nonexistent, but are critical for health resource planning, evaluation of policy, preventive, and clinical interventions, and understanding trajectories of health during this important per...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000114909.33878.ca

    authors: Riley AW,Forrest CB,Starfield B,Rebok GW,Robertson JA,Green BF

    更新日期:2004-03-01 00:00:00

  • Are readmissions to the intensive care unit a useful measure of hospital performance?

    abstract:BACKGROUND:Although patients readmitted to intensive care units (ICUs) typically have poor outcomes, ICU readmission rates have not been studied as a measure of hospital performance. OBJECTIVES:To determine variation in ICU readmission rates across hospitals and associations of readmission rates with other ICU-based m...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199904000-00009

    authors: Cooper GS,Sirio CA,Rotondi AJ,Shepardson LB,Rosenthal GE

    更新日期:1999-04-01 00:00:00

  • Care of disabled children and women's time use.

    abstract::Previous research has estimated the effect of children's health care needs on women's market and nonmarket roles. This article reports the results of a study on the impact of health care for disabled children on women's nonmarket work. (Effects on women's market work are reported elsewhere.) Data from 369 families of ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198306000-00004

    authors: Breslau N

    更新日期:1983-06-01 00:00:00

  • Persistent medication affordability problems among disabled Medicare beneficiaries after Part D, 2006-2011.

    abstract:BACKGROUND:Disabled Americans who qualify for Medicare coverage typically have multiple chronic conditions, are highly dependent on effective drug therapy, and have limited financial resources, putting them at risk for cost-related medication nonadherence (CRN). Since 2006, the Part D benefit has helped Medicare benefi...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000205

    authors: Naci H,Soumerai SB,Ross-Degnan D,Zhang F,Briesacher BA,Gurwitz JH,Madden JM

    更新日期:2014-11-01 00:00:00