Abstract:
:Managed care has entered the lexicon of healthcare reform, but confusion and ignorance surround its meaning and purpose. It seeks to cut the costs of health care while maintaining its quality, but the evidence that it is able to achieve these aims is mixed. As well as raising awareness and understanding of the issues surrounding managed care, this series considers whether managed care is desirable for the NHS. Developed in the United States as a response to spiralling healthcare costs and dysfunctional fragmented services, managed care is not a discrete activity but a spectrum of activities carried out in a range of organisational settings. Due to its constantly changing nature, managed care is a slippery concept--but all its permutations have in common an attempt to influence and modify the behaviour and practice of doctors and other health professionals towards cost effective care. Whatever potential managed care may hold in this regard, careful appraisal of its implications is essential.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Fairfield G,Hunter DJ,Mechanic D,Rosleff Fdoi
10.1136/bmj.314.7097.1823subject
Has Abstractpub_date
1997-06-21 00:00:00pages
1823-6issue
7097eissn
0959-8138issn
1756-1833journal_volume
314pub_type
杂志文章,评审abstract:OBJECTIVES:To assess the experiences of obstetricians in England and Wales of serum screening for Down's syndrome. DESIGN:Postal questionnaire survey. SUBJECTS:Questionnaires were sent to all practising obstetricians in England and Wales with nonacademic appointments who had not participated in an earlier (randomly s...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.309.6957.769
更新日期:1994-09-24 00:00:00
abstract:OBJECTIVE:To evaluate the effect on general practitioners' prescribing of feedback on their levels of prescribing. DESIGN:Randomised controlled trial. SETTING:General practice in rural Australia. PARTICIPANTS:2440 full time recognised general practitioners practising in non-urban areas. INTERVENTION:Two sets of gra...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.318.7182.507
更新日期:1999-02-20 00:00:00
abstract:OBJECTIVES:To estimate survival after a diagnosis of dementia in primary care, compared with people without dementia, and to determine incidence of dementia. DESIGN:Cohort study using data from The Health Improvement Network (THIN), a primary care database. SETTING:353 general practices in the United Kingdom providin...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.c3584
更新日期:2010-08-05 00:00:00
abstract:OBJECTIVE:To investigate the association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. DESIGN:Systematic review. ELIGIBILITY CRITERIA:Studies that compared the association between conflicts of interest and favour...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m4234
更新日期:2020-12-09 00:00:00
abstract:OBJECTIVES:To compile a register of diabetic patients within the catchment area of a district general hospital and evaluate the characteristics of the population using aggregated data from a general practice audit. DESIGN:Cross sectional study. Practices identified all known diabetics and completed a questionnaire fro...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6911.1046
更新日期:1993-10-23 00:00:00
abstract:OBJECTIVES:To identify and calculate the prevalence of spin in studies of spin. DESIGN:Meta-research analysis (research on research). SETTING:35 studies of spin in the scientific literature. MAIN OUTCOME MEASURES:Spin, categorised as: reporting practices that distort the presentation and interpretation of results, c...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.l6202
更新日期:2019-12-18 00:00:00
abstract::The results of the work of the Edinburgh Rehabilitation Medicine Service in one year were evaluated. Over 1400 new patients were seen, of whom 525 were in hospital at the time. Patients most often referred were those who had had cardiovascular accidents, back pain, lower limb amputations, and head injuries and those c...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6648.601
更新日期:1988-09-03 00:00:00
abstract::Medical audit has its critics, who point to the large sums of NHS cash that seem to be disappearing down a medical plughole. These criticisms are recognised by medical audit advisory groups but there are many reasons why the work of these groups has not yet resulted in many publications in journals or bumped up health...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.309.6947.98
更新日期:1994-07-09 00:00:00
abstract:OBJECTIVE:To investigate whether work related stress, measured and defined as job strain, is associated with the overall risk of cancer and the risk of colorectal, lung, breast, or prostate cancers. DESIGN:Meta-analysis of pooled prospective individual participant data from 12 European cohort studies including 116,056...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.f165
更新日期:2013-02-07 00:00:00
abstract:OBJECTIVES:To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweete...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.h3576
更新日期:2015-07-21 00:00:00
abstract:OBJECTIVES:To estimate life expectancy for people with HIV undergoing treatment compared with life expectancy in the general population and to assess the impact on life expectancy of late treatment, defined as CD4 count <200 cells/mm(3) at start of antiretroviral therapy. DESIGN:Cohort study. SETTING:Outpatient HIV c...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.d6016
更新日期:2011-10-11 00:00:00
abstract:OBJECTIVE:To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in med...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.d199
更新日期:2011-02-03 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of dietary antioxidants in the primary prevention of age related macular degeneration (AMD). DESIGN:Systematic review and meta-analysis. DATA SOURCES:Search of seven databases without limits on year or language of publication, and retrieval of references in pertinent reviews an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.39350.500428.47
更新日期:2007-10-13 00:00:00
abstract::All developmental screening in Somerset is performed by general practitioners and health visitors. A retrospective review of a cohort of 1504 7 year old children living in semirural Somerset found that the development assessment by a health visitor at age 3 1/2 years had a sensitivity of 45% for identifying the 103 ch...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6733.1177
更新日期:1990-05-05 00:00:00
abstract:OBJECTIVE:To determine the implications of variation in mortality associated with use of weapons in different contexts. DESIGN:Literature review. SETTINGS:Armed conflicts and civilian mass shootings, 1929-96. MAIN OUTCOME MEASURE:Mortality from wounds. RESULTS:During the fighting of war the number of people wounded...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.319.7207.407
更新日期:1999-08-14 00:00:00
abstract:OBJECTIVE:To study the dynamic function of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome. DESIGN:Prospective comparison of patients with postviral fatigue syndrome with two control groups. SETTING:Department of neurology, University of Glasgow, Southern General Hospital; depar...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6833.1010
更新日期:1992-04-18 00:00:00
abstract:OBJECTIVES:To assess whether supplementation with antioxidants, folinic acid, or both improves the psychomotor and language development of children with Down's syndrome. DESIGN:Randomised controlled trial with two by two factorial design. SETTING:Children living in the Midlands, Greater London, and the south west of ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.39465.544028.AE
更新日期:2008-03-15 00:00:00
abstract:OBJECTIVE:To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources. DESIGN:Cluster randomised controlled trial. SETTING:Five healthcare organisations in the United States and 60 affiliated practices. PATIENTS:405 patients, aged ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38219.481250.55
更新日期:2004-09-11 00:00:00
abstract:OBJECTIVES:To investigate potential determinants of severe hypoglycaemia, including baseline characteristics, in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the association of severe hypoglycaemia with levels of glycated haemoglobin (haemoglobin A(1C)) achieved during therapy. DESIGN:Post ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.b5444
更新日期:2010-01-08 00:00:00
abstract::A study was conducted (a) to assess the number of patients registered with a south London general practice who over 11 weeks referred themselves to an accident and emergency department, (b) to identify the characteristics of those patients, and (c) to determine their perceptions of the services and resources available...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6657.1179
更新日期:1988-11-05 00:00:00
abstract:OBJECTIVE: To identify and characterise non-specific immunological effects after routine childhood vaccines against BCG, measles, diphtheria, pertussis, and tetanus. DESIGN: Systematic review of randomised controlled trials, cohort studies, and case-control studies. DATA SOURCES: Embase, PubMed, Cochrane library, and...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.i5225
更新日期:2016-10-13 00:00:00
abstract::Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st birth weight standard.Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestatio...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j3677
更新日期:2017-08-17 00:00:00
abstract:OBJECTIVE:To compare characteristics of patients and outcomes after elective surgery in independent sector treatment centres (ISTCs) and NHS providers. DESIGN:Follow-up study with outcomes reported by patients three to six months after surgery. SETTING:25 ISTCs and 72 NHS providers in England. Population Consecutive ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.d6404
更新日期:2011-10-19 00:00:00
abstract:OBJECTIVE:To describe the mechanism established by Richmond, Twickenham, and Roehampton Health Authority to manage extracontractual referral requests made on behalf of its resident population and to examine its working in the first three months of the new arrangements. DESIGN:Description of the procedures for managing...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6801.499
更新日期:1991-08-31 00:00:00
abstract:OBJECTIVE:To compare the risk profile of women receiving public and private obstetric care and to compare the rates of obstetric intervention among women at low risk in these groups. DESIGN:Population based descriptive study. SETTING:New South Wales, Australia. SUBJECTS:All 171,157 women having a live baby during 19...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.321.7254.137
更新日期:2000-07-15 00:00:00
abstract:OBJECTIVE:To assess the impact of teaching general practitioners to carry out structured assessments of their long term mentally ill patients. DESIGN:Randomised controlled trial. SETTING:Sixteen group general practices in South Thames (west) region. SUBJECTS:440 adults disabled by long term mental illness. INTERVEN...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.311.6997.93
更新日期:1995-07-08 00:00:00
abstract:OBJECTIVE:To investigate the impact of patients' preferences for the treatment of atrial fibrillation, by using individualised decision analysis combining probability and utility assessments into a decision tree. DESIGN:Observational study based on interviews with patients. SETTING:Eight general practices in Avon. P...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.320.7246.1380
更新日期:2000-05-20 00:00:00
abstract:OBJECTIVE:To do an indirect comparison analysis of apixaban against dabigatran etexilate (2 doses) and rivaroxaban (1 dose), as well as of rivaroxaban against dabigatranetexilate (2 doses), for their relative efficacy and safety against each other, with particular focus on the secondary prevention population for stroke...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e7097
更新日期:2012-11-05 00:00:00
abstract:OBJECTIVE:To assess the potential effects of primary prevention with anticoagulants or aspirin in atrial fibrillation on Swedish population. DESIGN:Analysis of cost effectiveness based on the following assumptions: about 83,000 people have atrial fibrillation in Sweden, of whom 22,000 would be potential candidates for...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6867.1457
更新日期:1992-12-12 00:00:00
abstract::National allocation of resources to regional health authorities and by them to districts is now determined by a weighted capitation formula. The national formula was derived from regression analysis, with hospital utilisation as an index of need for health care--a method which has fundamental limitations. This paper a...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6881.835
更新日期:1993-03-27 00:00:00