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 distribution report (CDR). Health benefit categories were based on those of health care insurers. Cost reapportionment was based on CDR data and reviews of source accounting and payroll documents. RESULTS:Actual expenditures for many benefits can be accurately identified and reapportioned using CDR data, but other expenditures were not identifiable in the CDR and required inspection of source documents. Inpatient expenditures amounting to $75,110,094 US dollars and outpatient expenditures amounting to $73,594,284 US dollars were reapportioned into other benefit categories, primarily professional fees. Expenditures for some VA benefits could not be identified because of differences in accounting and clinical practice between the VA and the community. DISCUSSION:Revisions to bring the CDR more in line with private sector payment categories would improve effectiveness for internal VA analyses and external expenditure comparisons. CDR revisions would require changes in recording some clinical workload (eg, rehabilitation and extended care) and classifying residential and domiciliary programs separate from inpatient care. Benefits that were not assigned expenditures for comparison with payments represent a potential liability if the VA were to purchase health care services in the marketplace. Variation among hospitals on expenditures not clearly identified in the CDR was significant and raises questions about the effectiveness of capitated budget methodologies using either the CDR or the decision support system.
journal_name
Med Carejournal_title
Medical careauthors
Nugent G,Grippen G,Parris YC,Mitchell Mdoi
10.1097/01.MLR.0000068422.03255.6Bkeywords:
subject
Has Abstractpub_date
2003-06-01 00:00:00pages
II80-90issue
6 Suppleissn
0025-7079issn
1537-1948journal_volume
41pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract::Physician integration strategies are attempts to bring physicians into hospital administration by giving them a role on the hospital board, employing them in administrative or clinical capacities, or expanding the administration issues dealt with by medical staff committees. This study used a production function model...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199007000-00005
更新日期:1990-07-01 00:00:00
abstract:OBJECTIVE:Most Veterans Affairs (VA) Health Care System enrollees age 65+ also have the option of obtaining care through Medicare. Reliance upon VA varies widely and there is a need to optimize its prediction in an era of expanding choice for veterans to obtain care within or outside of VA. We examined whether survey-b...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001155
更新日期:2019-08-01 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:BACKGROUND:A requirement of the Arkansas Medicaid Section 1115 demonstration waiver was to evaluate the level of care received for Medicaid expansion eligible beneficiaries enrolled in commercial Qualified Health Plans (QHPs) in the Health Care Independence "Private Option" Program. This allowed for a direct comparison...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001248
更新日期:2020-02-01 00:00:00
abstract::This study analyzes the relationship between medical student participation in rural training programs, including preceptorships, and the decision to locate medical practice in rural areas. Data consist primarily of responses to questionnaires mailed in 1972 to all graduates of United States medical schools in 1965. St...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197503000-00004
更新日期:1975-03-01 00:00:00
abstract::Queues arise in medical care and serve as allocators in the absence of an effective market and when resources become perceptibly constrained. This is essentially the case in all countries where money is not the means for gaining access to medical services. A study estimated that the total wait in England was 96 days f...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198702000-00006
更新日期:1987-02-01 00:00:00
abstract:BACKGROUND:Engaging patients as partners in their care is clinically appealing, yet challenging to implement, and we lack a measurement framework that is applicable to vulnerable populations. To address this gap, we conducted a qualitative study to refine a conceptual framework that reflects an individual's propensity ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001240
更新日期:2020-02-01 00:00:00
abstract::There has been controversy about whether confounding by indication for treatment--that is, owing to physicians' conscious efforts to base treatment decisions on patients' pretreatment prognoses--makes nonrandomized, observational comparisons of treatments invalid. Some now believe evidence from studies of practice var...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:1995-04-01 00:00:00
abstract:OBJECTIVES:The present study evaluated alternative patient classification systems for skilled nursing facility and rehabilitation facility patients. METHODS:Medicare patients were selected from a random sample of 27 rehabilitation facilities and 65 skilled nursing facilities participating in a national longitudinal st...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199805000-00009
更新日期:1998-05-01 00:00:00
abstract:OBJECTIVES:The relative performance of three widely used generic health status measures (EQ-5D, a modified HUI3 [mHUI3], and SF-12) was compared within a general population sample. MATERIALS AND METHODS:Data were taken from a cohort of persons identified from the patient list of a large general practice in York, UK. T...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000044901.57067.19
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVE:We sought to evaluate the extent of changes in usual source of care and associations with perceived health care access, quality, and use. RESEARCH DESIGN:We collected cross-sectional data on adults from the 1998 to 1999 Community Tracking Household Survey (n = 48,720). Linear and logistic regressions account...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200410000-00006
更新日期:2004-10-01 00:00:00
abstract:BACKGROUND:Hospital discharge planning has been hampered by the lack of predictive models. OBJECTIVE:To develop predictive models for nonelective rehospitalization and postdischarge mortality suitable for use in commercially available electronic medical records (EMRs). DESIGN:Retrospective cohort study using split va...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000435
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND:Access to health care is a critical concept in the design, delivery, and evaluation of high quality care. Meaningful evaluation of access requires research evidence and the integration of perspectives of patients, providers, and administrators. OBJECTIVE:Because of high-profile access challenges, the Depart...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001177
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Previous research has indicated that the needs of persons infected with human immunodeficiency virus (HIV) for supportive services often go unmet. Although case management has been advocated as a method of decreasing unmet needs for supportive services, its effectiveness is poorly understood. OBJECTIVES:To ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200001000-00007
更新日期:2000-01-01 00:00:00
abstract::The effectiveness of sharing medical records in improving physician-older patient communication was evaluated in 203 ambulatory chronically ill older patients (mean age, 70.1 years) by a randomized controlled trial. Ninety-five experimental group patients received copies of their physicians' progress notes 1 week afte...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-198604000-00004
更新日期:1986-04-01 00:00:00
abstract:BACKGROUND:Conceptual equivalence of measures is essential in research that compares health across diverse racial/ethnic groups. Cognitive interviews are pretest methods to explore the conceptual equivalence of survey items. Systematic approaches for using these methods are emerging. OBJECTIVE:We describe an interacti...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000245425.65905.1d
更新日期:2006-11-01 00:00:00
abstract::The total utilization rate of ambulatory illness-related physician services in Finland is higher in big urban health center areas than in rural areas. When only the health center physician utilization rates were studied the finding was opposite. A notable finding related to the impact of the national health planning w...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198208000-00004
更新日期:1982-08-01 00:00:00
abstract:OBJECTIVE:We sought to quantify Veterans Health Administration (VA) patients' utilization of coronary revascularization in the private sector and to assess the potential impact of directing this care to high-performance hospitals. METHODS:Using VA and New York State administrative and clinical databases, we conducted ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000215888.20004.5e
更新日期:2006-06-01 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: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
更新日期:2004-03-01 00:00:00
abstract:BACKGROUND:Functional limitations of persons living with HIV affect their care needs and ability to perform social roles such as employment. Earlier estimates are outdated, and nationally representative estimates of prevalence and distribution of these limitations have not previously been available. OBJECTIVES:The obj...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200012000-00008
更新日期:2000-12-01 00:00:00
abstract:BACKGROUND:Increasing recognition of the failure to translate research findings into practice has led to greater awareness of the importance of using active dissemination and implementation strategies. Although there is a growing body of research evidence about the effectiveness of different strategies, this is not eas...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:2001-08-01 00:00:00
abstract:BACKGROUND:The 2016 President's Cancer Panel Connected Health report calls for thoroughly characterizing the team structures and processes involved in coordinating care for people with chronic conditions. We developed a multilevel care coordination framework by integrating existing frameworks from the teams and care co...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/MLR.0000000000000874
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:High opioid dosage has been associated with overdose, and clinical guidelines have cautioned against escalating dosages above 100 morphine-equivalent mg (MEM) based on the potential harm and the absence of evidence of benefit from high dosages. However, this 100 MEM threshold was chosen somewhat arbitrarily....
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000505
更新日期:2016-05-01 00:00:00
abstract:BACKGROUND:Monitoring mental health treatment outcomes for populations requires an understanding as to which patient information is needed in electronic format and is feasible to obtain in routine care. OBJECTIVE:To examine whether bipolar disorder outcomes can be accurately predicted and how much clinical detail is n...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182422aec
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVES:The authors developed an "off-the-shelf" source of health-related quality of life (HRQL) scores for cost-effectiveness analysts unable to collect primary data. METHODS:The authors derived and conducted preliminary validation on a set of health-related quality of life scores for chronic conditions using nati...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199806000-00002
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVE:This paper describes the history of the Department of Veterans Affairs (VA) Community-Based Outpatient Clinics (CBOCs), CBOC Performance Evaluation Project, and characteristics of CBOCs within the VA, and summarizes the findings and implications of the CBOC Performance Evaluation Project. SUBJECTS:There were...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200207000-00001
更新日期:2002-07-01 00:00:00
abstract:OBJECTIVE:Understanding provider perceptions of and experiences with order entry and order checks (drug alerts) in an electronic prescribing system may help improve medication safety technology. DESIGN:Cross-sectional, national survey of Veterans Administration physicians practicing in various specialties. MEASUREMEN...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318222a6f5
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Numerous studies have examined the impacts of pay-for-performance programs, yet little is known about their long-term effects on health care expenses. OBJECTIVES:This study aimed to examine the long-term effects of a pay-for-performance program for diabetes care on health care utilization and expenses. MET...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31822d5d36
更新日期:2012-02-01 00:00:00
abstract:BACKGROUND:Teamwork in health care settings is widely recognized as an important factor in providing high-quality patient care. However, the behaviors that comprise effective teamwork, the organizational factors that support teamwork, and the relationship between teamwork and patient outcomes remain empirical questions...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/MLR.0b013e31827feef6
更新日期:2015-04-01 00:00:00