Evaluation & the health professions
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The General Accounting Office (GAO) is a legislative branch agency whose mission is to support the oversight role of Congress. Health policy issues have constituted a substantial part of GAO's recent workload. Whereas GAO's work on health has ranged broadly, it has often focused on fraud and abuse in federal programs, particularly Medicare and Medicaid; the lack of meaningful indicators and other information, particularly on outcomes in health programs; access to care, increasingly connected to managed care; quality of care; and issues related to cost control.
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State governments are experimenting with a variety of innovative approaches to the current tort system for medical malpractice liability. One such approach is to apply the concept of no-fault liability to medical practice. ⋯ The author concludes that the concept of no-fault compensation for medical malpractice is a promising remedy. However, it is a medicine that will require more testing before it can be pronounced a cure for the disease that plagues the current system.
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Comparative Study
A comparison of multiple indicators--observations, supervisor report, and self-report as measures of workers' hearing protection use.
The purpose of this study was to compare multiple indicators of behavior and identify the most viable measure of blue-collar workers' use of hearing protection. Three measures of use were employed: observations, supervisor report, and self-report. Supervisor report was highly discrepant from both self-report and observed use; self-report and observations were highly correlated, and discrepancies between the two were slight. These results suggest that, for this type of measurement, self-report is an appropriate measure and may be the best choice when time and monetary resources restrict measurement to one indicator.
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Review Comparative Study
Gender and hospital resource use. Unexpected differences.
Several recent studies have explored gender differences in medical care that are not attributable to clinical characteristics. At an 880-bed teaching hospital between July 1987 and June 1990, we studied the importance of gender on two measures of hospital care: length of stay and ancillary service use. The latter was measured on a relative value unit (RVU) scale, based on an estimation of direct cost dollars. ⋯ This RVU difference dissolved when intensive care unit (ICU) stays were eliminated; men were 1.13 times more likely (95% confidence interval 1.07 to 1.19) to be placed in the ICU. Being married shortened length of stay and women were less likely to be married (51% vs. 68%; p < 0.001), but even within marital status subgroups women remained in the hospital longer than men. Whether this longer length of stay and less technologically intensive care for women reflects a difference in illness severity or physician gender bias requires further study.
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This article describes a process to risk-adjust multiple outcomes of care and aggregate them into integrative measures of quality. A methodology is outlined for anesthesia services which is designed to use the new data base that is being constructed by the American Association for Nurse Anesthetists. Most of the methods should apply to other health professions as well, if outcomes of care and risk factors can be identified. The basic approach is to choose either exemplary or adverse outcomes of care which are under the control of the provider and to standardize these outcomes to take into consideration multiple risk factors.