Inquiry J Health Car
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Inquiry J Health Car · Jan 1991
Trends in length of stay and rates of readmission in Massachusetts: implications for monitoring quality of care.
In this study, we examined lengths of stay and readmission rates for all Medicare patients discharged from Massachusetts acute care hospitals from October 1982 through September 1986. Using multivariate time series models, we controlled for case mix and assessed trends over time and the impact of prospective payment on lengths of stay and rates of readmission within 7, 14, and 30 days of discharge. We examined patterns for patients overall and for those admitted initially with one of several specific medical conditions or for a surgical procedure. ⋯ Overall readmission rates within 7 and 14 days increased by approximately 10% (p less than .05), although the increase was not statistically associated with prospective payment. Readmission rates for individual medical and surgical conditions were not significantly changed. Further study should assess whether the change in overall rates reflects lower quality care.
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Inquiry J Health Car · Jan 1990
Medicare surgical global fees: the relationship between included services and payment.
This paper documents how extensively the component services Medicare carriers include in their global fees vary for four common operations. Although payment for each of the operations also varies substantially among Medicare carrier areas, differences in the extent of services included in the surgical global fee do not contribute to explaining the variations in payment. The recently enacted Medicare fee schedule based on resources can rationalize the current pattern of payments, but only if a uniform global service policy is implemented.
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Inquiry J Health Car · Jan 1990
The effect of office visit copayments on preventive care services in an HMO.
We examined the impact of a $5 office visit copayment on use of preventive care services by Washington State enrollees in a health maintenance organization. Utilization data were compared for 30,415 State enrollees and 21,633 enrollees without copayments who were enrolled 12 months before and after the start of copayments. Copayments resulted in a 14% decrease in physical examinations but did not significantly affect immunization rates for young children, cancer screening tests received by women, or medication use by persons with cardiovascular disease. For employed populations small copayments appear to have little impact on the most valuable types of preventive care services.
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Larger, more complex medical care organizations have the inherent capability to improve the quality of the care they deliver because of the improved competency that follows higher volumes of service, the interdependence of staff, and the emergence of responsible leadership in large organizations. The potential for slackened physician-patient relationships, however, could jeopardize that quality. We suggest that professional associations can counterbalance the negative influences of large organizations. We envision that the changing political and economic environment of medical practice, along with the greater professional and public scrutiny of care in highly visible large organizations, will act together to exert pressure on organized practices to examine and demonstrate quality clinical practice.
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Working with the ethical principles of beneficence and autonomy, I address three questions: How can communication between physicians and their patients be improved? How does the public availability of practice guidelines and other alternative sources of health information influence the interactions between physicians and patients? How can a partnership in health care in which the patient and the physician share responsibility be achieved? Educating patients for a partnership in health care will offer a further incentive for physicians to enter and sustain such a partnership.