Health services research
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Health services research · Dec 2005
Randomized Controlled Trial Multicenter StudyPractice-level effects of interventions to improve asthma care in primary care settings: the Pediatric Asthma Care Patient Outcomes Research Team.
To assess the practice-level effects of (1) a physician peer leader intervention and (2) peer leaders in combination with the introduction of asthma education nurses to facilitate care improvement. And, to compare findings with previously reported patient-level outcomes of trial enrollees. ⋯ This analysis showed a slight increase in ambulatory asthma visits as a result of asthma care improvement interventions, using automated data. The absence of detectable impact on medication use at the practice level differs from the positive intervention effect observed in patient self-reported data from trial enrollees. Analysis of automated data on nonenrollees adds information about practice-level impact of care improvement strategies. Benefits of practice-level interventions may accrue disproportionately to the subgroup of trial enrollees. The effect of such interventions may be less apparent at the level of practices or health plans.
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Health services research · Mar 2000
Randomized Controlled Trial Comparative Study Clinical TrialAre nonspecific practice guidelines potentially harmful? A randomized comparison of the effect of nonspecific versus specific guidelines on physician decision making.
To test the ability of two different clinical practice guideline formats to influence physician ordering of electrodiagnostic tests in low back pain. ⋯ The clarity and clinical applicability of a guideline may be important attributes that contribute to the effects of practice guidelines.
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Health services research · Aug 1999
Randomized Controlled Trial Comparative Study Clinical TrialEffects of the Medicare Alzheimer's Disease Demonstration on caregiver burden and depression.
Does improved access to community-based care reduce perceived burden and reported levels of depression among primary caregivers of people with dementia? ⋯ Both the fact that these programmatic differences did not translate into substantial treatment group reductions in caregiver burden or depression, and the consistency of these findings with those of prior case management evaluations suggest the need to reformulate this programmatic intervention into areas not previously tested: 24-hour care, crisis intervention, coordination with primary care, or chronic disease management.
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Health services research · Oct 1991
Randomized Controlled Trial Comparative Study Clinical TrialCase management: a randomized controlled study comparing a neighborhood team and a centralized individual model.
This randomized controlled study compared two types of case management for skilled nursing level patients living at home: the centralized individual model and the neighborhood team model. The team model differed from the individual model in that team case managers performed client assessments, care planning, some direct services, and reassessments; they also had much smaller caseloads and were assigned a specific catchment area. While patients in both groups incurred very high estimated health services costs, the average annual cost during 1983-85 for team cases was 13.6 percent less than that of individual model cases. ⋯ Nursing home use was 48 percent higher for the team group than for the individual model group. Mortality was almost exactly the same for both groups during the first year (about 30 percent), but was lower for team patients during the second year (11 percent as compared to 16 percent). Probable mechanisms for the observed results are discussed.