abstract：:This is a report on the extension of the concept of the appropriateness of a procedure to the necessity, or crucial importance, of that procedure. To state that a procedure is crucial means that withholding the procedure would be deleterious to the patient's health. Appropriateness and necessity ratings for six proced...

journal_title：Medical care

authors： Kahan JP,Bernstein SJ,Leape LL,Hilborne LH,Park RE,Parker L,Kamberg CJ,Brook RH

更新日期：1994-04-01 00:00:00

abstract：:Current health care system reform proposals center on reducing the number of uninsured by extending private health insurance coverage. Discussion has also included enrolling Medicaid recipients in private programs. Much of the deliberation concerning extending coverage has centered on cost, but largely has not address...

journal_title：Medical care

authors： Hahn B

更新日期：1994-03-01 00:00:00

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

authors： Morton SC,Kominski GF,Kahan JP

更新日期：1994-01-01 00:00:00

abstract：:This study uses Medicare physician-claims data to examine patient and physician contributions to variations in cataract surgery rates across U.S. metropolitan areas. Utilization is modelled as having two phases: the decision to seek an ophthalmologist's care, which is made by patients, and the decision to perform surg...

journal_title：Medical care

authors： Escarce JJ

更新日期：1993-12-01 00:00:00

abstract：:Studies evaluating relationships between physician background characteristics (e.g. years of practice and medical training) and quality of care have found few consistent associations. Site of practice variables have been better predictors of quality than have characteristics of individual physicians. This study explor...

journal_title：Medical care

authors： Salem-Schatz SR,Avorn J,Soumerai SB

更新日期：1993-10-01 00:00:00

abstract：:With no additional effort to revise adult day health care (ADHC) services or the types of patients who receive them, it would appear that adding an ADHC program to a VA Medical Center would not achieve the desired objectives. The authors discuss here the advantages, disadvantages, and feasibility of 2 options for prog...

journal_title：Medical care

authors： Hedrick SC,Chapko M,Ehreth J,Rothman ML,Kelly JR,Inui TS

更新日期：1993-09-01 00:00:00

abstract：:The second phase of the ADHC Evaluation Study was designed to assess ADHC provided under contract by community ADHC programs. Outcomes for the 163 patients enrolled in this prospective cohort evaluation were compared with those of patients assigned to ADHC provided directly by VA (VA-ADHC) and customary care in the ra...

journal_title：Medical care

authors： Rothman ML,Diehr P,Hedrick SC,Erdly WW,Nickinovich DG

更新日期：1993-09-01 00:00:00

abstract：:There are various reasons why physicians order laboratory tests. Earlier studies have shown that in many cases test-ordering behavior lacks efficiency, resulting in excessive laboratory utilization. Throughout the years various attempts have been made to improve this situation. This review, based on the literature of ...

journal_title：Medical care

authors： Axt-Adam P,van der Wouden JC,van der Does E

更新日期：1993-09-01 00:00:00

abstract：:Lack of consensus about the treatment of low back pain is reflected by wide regional variations in lumbar spine surgery rates. Neck pain may be as common as low back pain, but there has been no similar evaluation of regional variation for the surgical treatment of neck pain. This report examines the geographic variati...

journal_title：Medical care

authors： Einstadter D,Kent DL,Fihn SD,Deyo RA

更新日期：1993-08-01 00:00:00

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

authors： Elixhauser A,Luce BR,Taylor WR,Reblando J

更新日期：1993-07-01 00:00:00

abstract：:In this article, we compared hospital efficiency using a multiple input-output approach in two ways: one way used a straightforward count of inpatient days and outpatient services as outputs; and the second used a case mix-adjusted count of inpatient services and outpatient care as outputs. Our results show that there...

journal_title：Medical care

authors： Grosskopf S,Valdmanis V

更新日期：1993-06-01 00:00:00

abstract：:When studying variation in medicine, traditional hypothesis-testing procedures are too limited to obtain useful inferences except in special situations. More generally, full probability modelling is necessary. Even a relatively simple example can illustrate this point rather dramatically. The development and applicati...

journal_title：Medical care

authors： Rubin DB

更新日期：1993-05-01 00:00:00

abstract：:An expository account of multiple time series analysis is presented. Modeling several related time series together makes it possible to ascertain dynamic leading, lagging, and feedback relationships among the series; to produce more efficient forecasts and, in some situations; to develop control schemes. Procedures fo...

journal_title：Medical care

authors： Tiao GC

更新日期：1993-05-01 00:00:00

abstract：:Breast cancer is the most common neoplasm in North American women. The psychosocial impact of breast cancer has been extensively studied, and a number of investigators have attempted to characterize women who are at high risk for increased psychosocial morbidity. Although a detailed interview performed by a profession...

journal_title：Medical care

authors： Ganz PA,Hirji K,Sim MS,Schag CA,Fred C,Polinsky ML

更新日期：1993-05-01 00:00:00

abstract：:In this study, trends in hospital use were identified in Japanese cities. Data for all inpatient care in May 1985 (9,555 patients) and in May 1988 (11,205 patients) paid for by National Health Insurance in 12 cities in Osaka Prefecture were analyzed. The main factor affecting differences in inpatient days per insured ...

journal_title：Medical care

authors： Tatara K,Shinsho F,Nishigaki C,Takatorige T,Okamoto E,Kuroda K

更新日期：1993-04-01 00:00:00

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

authors： Kominski GF,Biddle AK

更新日期：1993-03-01 00:00:00

abstract：:The differences between female and male general practitioners (GPs) were studied regarding three different factors: 1) Do female GPs see more female patients than their male colleagues in the same practice?; 2) Are female GPs confronted with different types of health problems from their male colleagues?; and 3) Do fem...

journal_title：Medical care

authors： Bensing JM,van den Brink-Muinen A,de Bakker DH

更新日期：1993-03-01 00:00:00

abstract：:There have been recent increases in asthma prevalence, morbidity, and mortality in the United States. There is substantial evidence that problems in health care delivery may be contributing to these recent trends. Because of these recent changes, a reduction in asthma-related morbidity has been identified as a new nat...

journal_title：Medical care

authors： Weiss KB,Budetti P

更新日期：1993-03-01 00:00:00

abstract：:This study examines evidence of market segmentation on the basis of patients' insurance status, demographic characteristics, and medical condition in selected local markets in California in the years 1983 and 1989. Substantial differences exist in the probability patients may be admitted to particular hospitals based ...

journal_title：Medical care

authors： Dranove D,White WD,Wu L

更新日期：1993-01-01 00:00:00

abstract：:Every year since 1984, Congress has expanded Medicaid to cover an increasing proportion of low-income children. In this study, a multivariate analysis of data from the 1987 National Medical Expenditure Survey was used to determine whether expanded Medicaid eligibility is likely to be effective in encouraging recommend...

journal_title：Medical care

authors： Short PF,Lefkowitz DC

更新日期：1992-09-01 00:00:00

abstract：:Data from the Longitudinal Survey of Income and Program Participation were used to examine the dynamics of health insurance among persons 55 to 64 years of age. Persons in this age range are especially vulnerable to incurring high health care costs. Between the summer of 1983 and early 1986, 21% of persons 55 to 64 ye...

journal_title：Medical care

authors： Jensen GA

更新日期：1992-07-01 00:00:00

abstract：:This research explored whether differentiating patients whose severity of illness worsened, improved, or remained the same over the hospital stay is a good screen for quality of care. The hypothesis was that substandard care is more likely to occur among patients who have worsened. Severity was measured using the Comp...

journal_title：Medical care

authors： Iezzoni LI,Restuccia JD,Shwartz M,Schaumburg D,Coffman GA,Kreger BE,Butterly JR,Selker HP

更新日期：1992-05-01 00:00:00

abstract：:The goals of this study were to determine 1) the prevalence of exposure to intrafamilial violence among children attending a pediatric primary care clinic; 2) the prevalence of psychosocial distress among mothers bringing their children to the clinic; 3) the extent to which pediatricians are aware of family violence a...

journal_title：Medical care

authors： Wissow LS,Wilson ME,Roter D,Larson S,Berman HI

更新日期：1992-05-01 00:00:00

abstract：:In the past decade physicians have identified the need to expand patient assessment to include global function and quality of life. During the same period, the busy clinic has evolved into the location where this assessment seems most appropriate. Integrating functional health assessment into a busy clinical practice ...

journal_title：Medical care

authors： Wasson J,Keller A,Rubenstein L,Hays R,Nelson E,Johnson D

更新日期：1992-05-01 00:00:00

abstract：:In recent years, employers, insurers, and government purchasers have paid increased attention to the measurement of patient outcomes and health status. Such interest is stimulated less by policy or quality concerns than by the need to reduce health care expenditures. Any expected benefits which might accrue from healt...

journal_title：Medical care

authors： Lansky D,Butler JB,Waller FT

更新日期：1992-05-01 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

authors： Katz SJ,Larson EB,LoGerfo JP

更新日期：1992-04-01 00:00:00

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

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

abstract：:Informal caregiving by women, and to a lesser extent by men, is a major source of assistance for the chronically disabled and most dependent older persons living in the community. However, because women's commitment to career employment may diminish, this source of help at the time when (according to demographic trend...

journal_title：Medical care

authors： Boaz RF,Muller CF

更新日期：1992-02-01 00:00:00

abstract：:To explore the reliability of Medicare Part A claims data for clinical and health services research related to the care of patients with cancer, the authors compared estimates of the incidence of and resection rates for cancer of the breast, colon, and lung derived from analysis of Medicare Part A data versus data fro...

journal_title：Medical care

authors： Whittle J,Steinberg EP,Anderson GF,Herbert R

更新日期：1991-12-01 00:00:00

abstract：:This study uses a new database containing clinical risk factors for cardiac surgery to investigate the relationship between surgical volume (hospital and surgeon) and inhospital mortality rate for all patients receiving coronary artery bypass surgery in New York State in 1989. Also, hospitals with significantly higher...

journal_title：Medical care

authors： Hannan EL,Kilburn H Jr,Bernard H,O'Donnell JF,Lukacik G,Shields EP

更新日期：1991-11-01 00:00:00

abstract：:The effect of large numbers of patients with a history of substance abuse upon a health care system is rarely considered, nor is the health care system's response to such a clientele ever assessed. In this preliminary study, the collective effect of large numbers of substance abuse patients upon a clinic serving the u...

journal_title：Medical care

authors： Cahill DF,Hodgkins BJ

更新日期：1991-10-01 00:00:00

abstract：:This study examines practice mobility among young physicians, based on a large nationwide 1987 survey of physicians under age 40 years and in their second through fifth years of practice. Averaged across all physicians, there is a 10% to 12% chance of changing practices for each of the first 3 years, and about one in ...

journal_title：Medical care

authors： Willke RJ

更新日期：1991-10-01 00:00:00

abstract：:While Preferred Provider Organizations (PPOs) are designed to contain the costs of health care, they may not be able to do so if sicker individuals opt not to use PPO providers. This study examined how level of mental health status and prior use of mental health services affected the decision to use or not use PPO pro...

journal_title：Medical care

authors： Wells KB,Marquis MS,Hosek SD

更新日期：1991-09-01 00:00:00

abstract：:Because of the rapid changes that have occurred in the dental profession, the Dentist Satisfaction Survey (DSS) was developed to assess both facet and overall job satisfaction among dentists. The DSS was administered to a sample of 558 California general dentists. The results suggest that the DSS is a practical, relia...

journal_title：Medical care

authors： Shugars DA,Hays RD,DiMatteo MR,Cretin S

更新日期：1991-08-01 00:00:00

abstract：:Data from the Cancer Control Supplement of the 1987 Health Interview Survey (NHIS), a nationally representative sample of the United States population, was used to examine rates of six screening tests for cancer. The rates of screening were compared for people who receive their usual source of medical care in an HMO o...

journal_title：Medical care

authors： Bernstein AB,Thompson GB,Harlan LC

更新日期：1991-03-01 00:00:00

abstract：:The human immunodeficiency virus (HIV) epidemic and the prevalence of HIV-positive persons in the population has provoked marked anxiety among hospital staffs of acquiring nosocomially transmitted HIV infections. A national telephone survey of key staff in a sample of 561 acute-care hospitals was undertaken to describ...

journal_title：Medical care

authors： Freeman HE

更新日期：1991-02-01 00:00:00

abstract：:This article examines the quality of acute episodic care for five diagnostic categories amenable to one-visit diagnosis and treatment at the nation's largest chain of investor-owned ambulatory care centers. A total of 803 medical records were audited for five common conditions and measured against specific protocols. ...

journal_title：Medical care

authors： Parks CL,Cashman S,Winickoff RN,Bicknell WJ

更新日期：1991-01-01 00:00:00

abstract：:Our purpose was to identify factors predictive of reported dental care use by elders (65+) over a ten-year period in Massachusetts. The Massachusetts Health Care Panel Study began in 1974-75 (wave 1) as a statewide survey of 1625 noninstitutionalized elders. Wave 2 occurred in 1976, wave 3 in 1980, and wave 4 in 1985....

journal_title：Medical care

authors： Gilbert GH,Branch LG,Orav EJ

更新日期：1990-12-01 00:00:00

abstract：:Medical record review is increasing in importance as the need to identify and monitor utilization and quality of care problems grow. To conserve resources, reviews are usually performed on a subset of cases. If judgment is used to identify subgroups for review, this raises the following questions: How should subgroups...

journal_title：Medical care

authors： Ash A,Schwartz M,Payne SM,Restuccia JD

更新日期：1990-11-01 00:00:00

abstract：:Physicians who participate in preferred provider organizations (PPOs) usually agree to various types of utilization review and sometimes discount their charges or agree to accept lower fees. This study was performed to determine whether they provided more or fewer services to their PPO patients than to their indemnity...

journal_title：Medical care

authors： Garnick DW,Luft HS,Gardner LB,Morrison EM,Barrett M,O'Neil A,Harvey B

更新日期：1990-10-01 00:00:00