Abstract:
BACKGROUND:With the goal of improving clinical efficiency and effectiveness, programs to enhance care coordination are a major focus of health care reform. OBJECTIVE:To examine whether "care density"--a claims-based measure of patient sharing by office-based physicians--is associated with measures of quality. Care density is a proxy measure that may reflect how frequently a patient's doctors collaborate. RESEARCH DESIGN:Cohort study using administrative databases from 3 large commercial insurance plans. SUBJECTS:A total of 1.7 million adult patients; 31,675 with congestive heart failure, 78,530 with chronic obstructive pulmonary disease, and 240,378 with diabetes. MEASURES:Care density was assessed in 2008. Prevention Quality Indicators (PQIs), 30-day readmissions, and Healthcare Effectiveness Data and Information Set quality indicators were measured in the following year. RESULTS:Among all patients, we found that patients with the highest care density density--indicating high levels of patient sharing among their office-based physicians--had significantly lower rates of adverse events measured as PQIs compared with patients with low-care density (odds ratio=0.88; 95% confidence interval, 0.85-0.92). A significant association between care density and PQIs was also observed for patients with diabetes mellitus but not congestive heart failure or chronic obstructive pulmonary disease. Diabetic patients with higher care density scores had significantly lower odds of 30-day readmissions (odds ratio=0.68, 95% confidence interval, 0.48-0.97). Significant associations were observed between care density and Healthcare Effectiveness Data and Information Set measures although not always in the expected direction. CONCLUSION:In some settings, patients whose doctors share more patients had lower odds of adverse events and 30-day readmissions.
journal_name
Med Carejournal_title
Medical careauthors
Pollack CE,Lemke KW,Roberts E,Weiner JPdoi
10.1097/MLR.0000000000000319subject
Has Abstractpub_date
2015-04-01 00:00:00pages
317-23issue
4eissn
0025-7079issn
1537-1948journal_volume
53pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract::Cost-benefit (CBA) and cost-effectiveness analyses (CEA) are methods that enumerate the costs and consequences associated with health-related technologies, services, and programs. This article examines the trends in published CBA and CEA of personal health services from 1979 through 1990. It is based on a bibliography...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199307001-00001
更新日期:1993-07-01 00:00:00
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
更新日期:1983-06-01 00:00:00
abstract:BACKGROUND:Clinical practice guidelines quickly become outdated. One reason they might not be updated as often as needed is the expense of collecting expert judgment regarding the evidence. The RAND-UCLA Appropriateness Method is one commonly used method for collecting expert opinion. We tested whether a less expensive...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000100583.76137.3E
更新日期:2003-12-01 00:00:00
abstract:OBJECTIVES:To study the reported medical practice of euthanasia in Belgium since implementation of the euthanasia law. RESEARCH DESIGN:Analysis of the anonymous database of all euthanasia cases reported to the Federal Control and Evaluation Committee Euthanasia. SUBJECTS:All euthanasia cases reported by physicians fo...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181bd4dde
更新日期:2010-02-01 00:00:00
abstract::Broken appointments have been a major problem at the Anthony L. Jordan Health Center since it opened in 1968. In an earlier 6-month study of broken appointments at the center the authors found 48% of pediatric appointments and 43% of medicine appointments to be broken. Daily broken appointment rates were correlated be...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198409000-00005
更新日期:1984-09-01 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:A prerequisite for using administrative data to study the care of critically ill patients in intensive care units (ICUs) is that it accurately identifies such care. Only limited data exist on this subject. OBJECTIVE:To assess the accuracy of administrative data in the Canadian province of Manitoba for ident...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318245a754
更新日期:2012-03-01 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:BACKGROUND:Performance measurement at the provider group level is increasingly advocated, but different methods for selecting patients when calculating provider group performance have received little evaluation. OBJECTIVE:We compared 2 currently used methods according to characteristics of the patients selected and im...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31821b3604
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVES:Family members and other "carepartners" often play an important role in the care and support of patients during and after hospitalization, yet little is known about how they assess their hospital experience or the factors that may influence their perceptions. METHODS:A nationwide telephone survey of 1,800 r...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199901000-00006
更新日期:1999-01-01 00:00:00
abstract::Past research in continuity of medical care has generally examined its determinants or its consequences. A model is proposed which combines these lines of research and incorporates a continuity measure as a process and specifying variable. The validity of this model is tested with a set of data consisting of 1,410 per...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197910000-00004
更新日期:1979-10-01 00:00:00
abstract::Even with the passage of state safety belt laws, primary care physicians can contribute to their patients' safety by brief interventions. The present study explores the prevalence of such action with adult patients and tests the power of constructs taken from social learning theory to explain physicians' behavior. The...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198804000-00006
更新日期:1988-04-01 00:00:00
abstract::This paper describes a comparative analysis of questionnaire-based measures of functional status and clinical ratings of disability made by general practitioners and health visitors. Both approaches to functional assessment were used in rating 92 elderly primary care patients in terms of their performance of 13 mobili...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197908000-00003
更新日期:1979-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the psychometric assumptions underlying the construction and scoring of SF-36 scales and summary measures among clinical trial participants with arthritis. METHODS:Cross-sectional SF-36 data from the baseline assessment of adult patients (n = 1,016) participating in four placebo-controlled clinic...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199905001-00002
更新日期:1999-05-01 00:00:00
abstract::A valid and reliable vignette-based measure of DSM-III psychiatric diagnostic knowledge was administered to practicing primary care physicians (PCPs; generally, internal and family practice medicine) and mental health professionals (MHPs, in psychiatry and psychology). Recognition, diagnosis, and treatment recommendat...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198909000-00003
更新日期:1989-09-01 00:00:00
abstract::To test the hypothesis that the ability of physicians to speak the same language as asthmatic patients promotes patient compliance and the use of scheduled office appointments in preference to emergency services, the charts of 96 Spanish-speaking patients with asthma were reviewed. Of these patients, 65 were cared for...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198812000-00003
更新日期:1988-12-01 00:00:00
abstract::This paper examines relationships between true and treated prevalence of mental illness in a community by examining the use of mental health and other professional services for emotional problems and the relationship of this use to the individual's diagnostic status. The results are based upon a third round of 515 int...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198001000-00009
更新日期:1980-01-01 00:00:00
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
更新日期:2000-03-01 00:00:00
abstract:BACKGROUND:Several organizations are advocating for patients' preferences to be considered in clinical practice guideline development and implementation. However, lack of agreement on the goal and meaning of this policy curtails evaluation and development of patient involvement programs. GOAL:To describe guideline dev...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181a81158
更新日期:2009-08-01 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: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::To compare the utilization of an imaging technology in the United States and Canada and its effect on clinical outcomes, trends in the utilization of mammography among women aged 50 to 75 years from 1984 through 1988 in Washington State and British Columbia were examined. Also compared were trends in the stage at time...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199204000-00003
更新日期:1992-04-01 00:00:00
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
更新日期:2006-05-01 00:00:00
abstract::This article reports the results of an analysis to determine the relationships between the quality of restorative dental care for 1,466 patients and 9 categories of dentist characteristics for 102 volunteer Washington practitioners. In this study, patients were recalled and restorations were examined clinically. Quest...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198004000-00005
更新日期:1980-04-01 00:00:00
abstract:BACKGROUND:As Medicaid clients have come to be enrolled in managed care, concerns have arisen about the ability of private sector systems to meet the needs of enrollees with substance abuse problems. OBJECTIVES:This project describes treatment initiation and duration for Medicaid and commercial substance abuse treatme...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000215814.01127.ce
更新日期:2006-06-01 00:00:00
abstract::This paper describes an instrument design effort aimed at measuring patient-satisfaction among older (65 years and over) subscribers of HMOs. The study was conducted in a multi-satellite prepaid group practice in Buffalo, New York. In order to be able to construct a satisfaction measure that would reflect the interest...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198908000-00004
更新日期:1989-08-01 00:00:00
abstract:BACKGROUND:The Veterans Choice Program (VCP) was launched in 2014 to address the growing concerns about the timeliness and quality of Veterans Health Administration (VHA) care. Given that many sex-specific health services, such as mammography and maternity care, are not routinely provided in all VHA facilities, women V...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000933
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Chinese Americans are one of the fastest growing ethnic groups in the United States; however, language and cultural obstacles have challenged health workers and policy makers seeking to understand the health status and needs of this population. OBJECTIVES:This study is the first to use a large-scale probabi...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200005000-00010
更新日期:2000-05-01 00:00:00
abstract::Patients often receive medical care from many different providers. Consequently, the various episodes of care may not be integrated into a meaningful whole, and the quality of care may suffer. Before this possibility can be evaluated, it is necessary to develop a measure of the integrating process. The authors studied...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198405000-00004
更新日期:1984-05-01 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