When do anesthesiologists delegate?

Abstract:

:Nurse anesthetists (CRNAs) are a lower cost substitute for anesthesiologists in the delivery of anesthesia services. This article addresses the question of when anesthesiologists delegate in a team approach as opposed to using a solo arrangement. Logistic regression analysis was done using data from the 1986 Anesthesia Practice Survey and revealed that the team approach is more likely in areas with a relatively large supply of CRNAs; in hospitals with large surgical volumes, teaching facilities, and public hospitals; during emergency procedures, more lengthy procedures, and less complex surgeries; and among patients with poorer preoperative physical status. However, as the supply of anesthesiologists increases, the probability of CRNA use declines and in areas outside New England the "solo anesthesiologist" arrangement is significantly more common. Medicare and other third-party payers should eliminate regional variations in provider mix that are due to locational preferences and provider attitudes. Delegation to CRNAs can be encouraged by reducing what anesthesiologists are paid for practicing alone.

journal_name

Med Care

journal_title

Medical care

authors

Rosenbach ML,Cromwell J

doi

10.1097/00005650-198905000-00002

subject

Has Abstract

pub_date

1989-05-01 00:00:00

pages

453-65

issue

5

eissn

0025-7079

issn

1537-1948

journal_volume

27

pub_type

杂志文章
  • Collaboration in Health Care and Social Service Networks for Older Adults: Association With Health Care Utilization Measures.

    abstract:BACKGROUND:Services targeting social determinants of health-such as income support, housing, and nutrition-have been shown to improve health outcomes and reduce health care costs for older adults. Nevertheless, evidence on the properties of effective collaborative networks across health care and social services sectors...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001097

    authors: Brewster AL,Yuan CT,Tan AX,Tangoren CG,Curry LA

    更新日期:2019-05-01 00:00:00

  • Self-reported racial discrimination in health care and diabetes outcomes.

    abstract:BACKGROUND:Self-reported racial discrimination in healthcare has been associated with negative health outcomes, but little is known about its association with diabetes outcomes. METHODS:We used data from the Behavioral Risk Factor Surveillance System to investigate associations between self-reported healthcare discrim...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318215d925

    authors: Peek ME,Wagner J,Tang H,Baker DC,Chin MH

    更新日期:2011-07-01 00:00:00

  • Construct validity and factor structure of survey-based assessment of cost-related medication burden.

    abstract:BACKGROUND:Millions of Americans are burdened by out-of-pocket prescription costs. Although many survey measures have been developed to assess this burden, the construct validity and the factor structure of these instruments have not been rigorously assessed. OBJECTIVES:To characterize the factor structure and the con...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000286

    authors: Burcu M,Alexander GC,Ng X,Harrington D

    更新日期:2015-02-01 00:00:00

  • An examination of the Resource-Based Relative Value Scale cross-specialty linkage method.

    abstract::The Resource-Based Relative Value Scale (RBRVS) was developed by surveying panels of physicians from single specialties, then merging the specialty-specific results into a common work scale. The merging process involved two steps: 1) specification of links or equivalent services across specialties: and 2) use of links...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199401000-00003

    authors: Morton SC,Kominski GF,Kahan JP

    更新日期:1994-01-01 00:00:00

  • An index of insurance adequacy for fertility-related health care.

    abstract::Health insurance plans are evaluated here in terms of ability to guarantee financial access to a set of basic fertility-related health services. Extent of coverage is determined by whether a service is a contract benefit, its market cost, and how often it is used in a given population in one year. Comprehensive covera...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197501000-00003

    authors: Muller C,Krasner M,Jaffe FS

    更新日期:1975-01-01 00:00:00

  • Longitudinal Patterns of Spending Enhance the Ability to Predict Costly Patients: A Novel Approach to Identify Patients for Cost Containment.

    abstract:BACKGROUND:With rising health spending, predicting costs is essential to identify patients for interventions. Many of the existing approaches have moderate predictive ability, which may result, in part, from not considering potentially meaningful changes in spending over time. Group-based trajectory modeling could be u...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000623

    authors: Lauffenburger JC,Franklin JM,Krumme AA,Shrank WH,Brennan TA,Matlin OS,Spettell CM,Brill G,Choudhry NK

    更新日期:2017-01-01 00:00:00

  • Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic-based trial of three intervention strategies.

    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

    authors: Marcus AC,Crane LA,Kaplan CP,Reading AE,Savage E,Gunning J,Bernstein G,Berek JS

    更新日期:1992-03-01 00:00:00

  • Self-care and the doctor-patient relationship.

    abstract:OBJECTIVES:An important factor contributing to the steep rise in health care costs in the late 1960s was a reversal from the predominance of acute illness to that of chronic disease. Beginning with the philosophy of Illich and Levin, and the practical instruments of Fries, Sehnert, Vickery, and Ferguson, a new movement...

    journal_title:Medical care

    pub_type: 历史文章,杂志文章,评审

    doi:10.1097/00005650-200204001-00007

    authors: Shoor S,Lorig KR

    更新日期:2002-04-01 00:00:00

  • Psychosocial factors affecting adherence to medical regiments in a group of hemodialysis patients.

    abstract::The present research was designed to identify psychosocial correlates of adherence among patients receiving hemodialysis at two outpatient clinics. The 116 participants were interviewed concerning their knowledge of treatment, health beliefs, treatment history, social support, personal characteristics, and adherence t...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198206000-00003

    authors: Cummings KM,Becker MH,Kirscht JP,Levin NW

    更新日期:1982-06-01 00:00:00

  • Changes in thiazolidinedione use and outcomes following removal of a prior-authorization policy: controlled time-series analysis.

    abstract:OBJECTIVE:The aim of this study was to assess the impact of removing prior-authorization restrictions on the use of thiazolidinediones (TZDs) and outcomes. METHODS:In a controlled interrupted time-series analysis, whereby new users of antidiabetic agents over 65 years of age in adjacent Canadian provinces with differe...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000006

    authors: Gamble JM,Majumdar SR,Johnson JA,McAlister FA,Simpson SH,Eurich DT

    更新日期:2014-01-01 00:00:00

  • A comparative study of seven measures of patient satisfaction.

    abstract::The acceptability of satisfaction as a quality indicator is qualified by several well known measurement problems. This study examines the variability in satisfaction evaluations related to different measurement methods and the effect of response biases on reported satisfaction. Satisfaction evaluations using seven dif...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199504000-00006

    authors: Ross CK,Steward CA,Sinacore JM

    更新日期:1995-04-01 00:00:00

  • Physician attitudes and experience regarding the care of patients with acquired immunodeficiency syndrome (AIDS) and related disorders (ARC).

    abstract::The number of patients with acquired immunodeficiency syndrome (AIDS) continues to increase. These patients require medical care from physicians who are well trained and who are willing to provide that care. In 1985, we undertook a survey of 314 heterosexual and homosexual physicians in Los Angeles County to determine...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198708000-00001

    authors: Richardson JL,Lochner T,McGuigan K,Levine AM

    更新日期:1987-08-01 00:00:00

  • Complete Versus Staged Repair for Neonates With Tetralogy of Fallot: Establishment and Validation of a Cohort of 2235 Patients Using Detailed Surgery Sequence Review of Health Care Administrative Data.

    abstract:BACKGROUND:The surgical strategy for neonates with tetralogy of Fallot (TOF) consists of complete or staged repair. Assessing the comparative effectiveness of these approaches is facilitated by a large multicenter cohort. We propose a novel process for cohort assembly using the Pediatric Health Information System (PHIS...

    journal_title:Medical care

    pub_type: 杂志文章,多中心研究

    doi:10.1097/MLR.0000000000000846

    authors: Savla JJ,Fisher BT,Faerber JA,Huang YV,Mercer-Rosa L

    更新日期:2018-11-01 00:00:00

  • Development and validation of a model for predicting inpatient hospitalization.

    abstract:BACKGROUND:Hospitalizations are costly for health insurers and society. OBJECTIVES:To develop and validate a predictive model for acute care hospitalization from administrative claims for a population including all age groups. RESEARCH DESIGN:We constructed a retrospective cohort study using a US health plan claims d...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3182353ceb

    authors: Lemke KW,Weiner JP,Clark JM

    更新日期:2012-02-01 00:00:00

  • Is there an association between quality of in-hospital cardiac care and proportion of low-income patients?

    abstract:BACKGROUND:Process measures have been developed and implemented to evaluate the quality of care patients receive in the hospital. This study examines whether there is an association between the quality of in-hospital cardiac care and a hospital's proportion of low-income patients. METHODS AND RESULTS:A retrospective a...

    journal_title:Medical care

    pub_type: 杂志文章,多中心研究

    doi:10.1097/MLR.0b013e3181c161ba

    authors: Culler SD,Schieb L,Casper M,Nwaise I,Yoon PW

    更新日期:2010-03-01 00:00:00

  • Application of functional independence measure-function related groups and resource utilization groups-version III systems across post acute settings.

    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

    authors: Eilertsen TB,Kramer AM,Schlenker RE,Hrincevich CA

    更新日期:1998-05-01 00:00:00

  • Effect of standardized, patient-centered label instructions to improve comprehension of prescription drug use.

    abstract:OBJECTIVE:To evaluate the effectiveness of standardized, patient-centered label (PCL) instructions to improve comprehension of prescription drug use compared with typical instructions. METHODS:A total of 500 adult patients recruited from 2 academic and 2 community primary care clinics in Chicago, IL and Shreveport, LA...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181f38174

    authors: Wolf MS,Davis TC,Curtis LM,Webb JA,Bailey SC,Shrank WH,Lindquist L,Ruo B,Bocchini MV,Parker RM,Wood AJ

    更新日期:2011-01-01 00:00:00

  • Quality-of-life weights for the US population: self-reported health status and priority health conditions, by demographic characteristics.

    abstract:BACKGROUND:Many of the large ongoing national surveys of the US population contain a question that asks for the respondent's self-reported health status: "excellent," "very good," "good," "fair," or "poor." These surveys could be used to conduct cost-utility analyses of health care policies, treatments or other interve...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e31803dce05

    authors: Nyman JA,Barleen NA,Dowd BE,Russell DW,Coons SJ,Sullivan PW

    更新日期:2007-07-01 00:00:00

  • The use of attitudinal data for public policy: the case of unnecessary hospital use.

    abstract::A national sample of both hospital administrators and hospital review chair-persons (the two adversarial providers in the hospital regulatory milieu) were surveyed and asked to estimate the degree and kind of unnecessary hospital utilization taking place both in the U.S. and at their own institution. Both groups indic...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198101000-00006

    authors: Rothberg DL,Gertman PM

    更新日期:1981-01-01 00:00:00

  • Evaluation of centers of excellence program for knee and hip replacement.

    abstract:BACKGROUND:Medicare and private plans are encouraging individuals to seek care at hospitals that are designated as centers of excellence. Few evaluations of such programs have been conducted. This study examines a large national initiative that designated hospitals as centers of excellence for knee and hip replacement....

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3182699407

    authors: Mehrotra A,Sloss EM,Hussey PS,Adams JL,Lovejoy S,Soohoo NF

    更新日期:2013-01-01 00:00:00

  • Assessing the performance of utility techniques in the absence of a gold standard.

    abstract:BACKGROUND:Utility techniques are the most commonly used means to assess patient preferences for health outcomes. However, whether utility techniques produce valid measures of preference has been difficult to determine in the absence of a gold standard. OBJECTIVE:To introduce and demonstrate two methods that can be us...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199906000-00007

    authors: Giesler RB,Ashton CM,Brody B,Byrne MM,Cook K,Geraci JM,Hanita M,Souchek J,Wray NP

    更新日期:1999-06-01 00:00:00

  • Health Care Experiences of Latino Children in Emerging and Traditional Destinations.

    abstract:BACKGROUND:Latino populations have disproportionately moved to areas in the Southeast and Midwest (emerging destinations), outside traditional Latino enclaves, in recent years. OBJECTIVE:To examine whether health care experiences differ between traditional and emerging destinations for Latino children. RESEARCH DESIG...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000504

    authors: Saloner B,Gresenz CR

    更新日期:2016-05-01 00:00:00

  • Regression analysis in health services research: the use of dummy variables.

    abstract::Dummy variables frequently are used in regression analysis but often in an incorrect fashion. A brief review of examples in the medical care literature showed that the interpretation of dummy variable regression coefficients and their significance was often incorrect or unclear. This article shows how dummy variables ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198209000-00008

    authors: Polissar L,Diehr P

    更新日期:1982-09-01 00:00:00

  • Rural-Urban Differences in Medicare Quality Outcomes and the Impact of Risk Adjustment.

    abstract:BACKGROUND:There has been considerable debate in recent years about whether, and how, to risk-adjust quality measures for sociodemographic characteristics. However, geographic location, especially rurality, has been largely absent from the discussion. OBJECTIVE:To examine differences by rurality in quality outcomes, a...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000761

    authors: Henning-Smith C,Kozhimannil K,Casey M,Prasad S,Moscovice I

    更新日期:2017-09-01 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

  • Lifetime earnings for physicians across specialties.

    abstract:BACKGROUND:Earlier studies estimated annual income differences across specialties, but lifetime income may be more relevant given physicians' long-term commitments to specialties. METHODS:Annual income and work hours data were collected from 6381 physicians in the nationally representative 2004-2005 Community Tracking...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318268ac0c

    authors: Leigh JP,Tancredi D,Jerant A,Romano PS,Kravitz RL

    更新日期:2012-12-01 00:00:00

  • Changes in usual source of care and perceptions of health care access, quality, and use.

    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

    authors: Smith MA,Bartell JM

    更新日期:2004-10-01 00:00:00

  • Out-of-plan use and disenrollment: outgrowths of dissatisfaction with a prepaid group plan.

    abstract::Two opposing theories have been suggested to describe the relationships among member dissatisfaction with a prepaid group practice (PGP), the choice to go outside for care normally covered by the plan, and disenrollment from the PGP: 1) out-of-plan use--a consequence of dissatisfaction, precedes disenrollment and 2) d...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198303000-00007

    authors: Hennelly VD,Boxerman SB

    更新日期:1983-03-01 00:00:00

  • Opportunity or Burden? A Behavioral Framework for Patient Engagement.

    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

    authors: Kimerling R,Lewis ET,Javier SJ,Zulman DM

    更新日期:2020-02-01 00:00:00

  • Differential item functioning (DIF) and the Mini-Mental State Examination (MMSE). Overview, sample, and issues of translation.

    abstract:BACKGROUND:Various forms of differential item functioning (DIF) in the Mini-Mental State Examination (MMSE) have been identified. Items have been found to perform differently for individuals of different educational levels, racial/ethnic groups, and/or of groups whose first language is not English. The articles in this...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.mlr.0000245181.96133.db

    authors: Ramirez M,Teresi JA,Holmes D,Gurland B,Lantigua R

    更新日期:2006-11-01 00:00:00