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The use of administrative data to assess quality of care for bipolar disorder in a large staff model HMO

GENERAL HOSPITAL PSYCHIATRY 2000年第1期22卷 1-10页

作者： Unützer, J Simon, G Pabiniak, C Bond, K Katon, W Univ Calif Los Angeles Inst Neuropsychiat Ctr Hlth Serv Res Los Angeles CA 90024 USA Grp Hlth Cooperat Puget Sound Ctr Hlth Studies Seattle WA 98121 USA Univ Washington Dept Psychiat & Behav Sci Seattle WA 98195 USA

We examined patterns of care for 1246 adults treated for bipolar disorder in a large health maintenance organization. Computerized pharmacy and visit data were used to identify patients treated for bipolar disorder. Automated medical records for the following year were used to assess continuity and nosing of treatment with mood stabilizers, laboratory monitoring for adverse effects and therapeutic serum levels, and frequency of follow-up visits. Of our 1246 subjects 83% filled a mood stabilizer prescription during the 1-year study period, and doses were within recommended ranges 80% of the rime. Over 75% of the patients on mood stabilizers had at least one apparent interruption in medication use. Approximately half of the long-term users of mood stabilizers had at least one 7-month period without a recorded blood level and approximately half had a similar period without monitoring for adverse medication effects. Of the 116 subjects discharged from a psychiatric hospitalization 58% had a visit with a psychiatrist or a psychiatric nurse practitioner within 30 days. Of those discontinuing mood stabilizer treatment 68% made a mental health visit within 90 days. Our findings demonstrate the feasibility of using administrative data systems for population-based qualify of care assessment and suggest opportunities for improving the care of bipolar patients. (C) 2000 Elsevier Science Inc.

关键词：抗躁狂药/副作用抗躁狂药/药代动力学抗躁狂药/治疗应用双相情感障碍/血液双相情感障碍/药物疗法数据收集/统计学和数值数据药物监测/统计学和数值数据可行性研究健康维护组织/组织和管理病案系统计算机化/统计学和数值数据病人医疗小组/统计学和数值数据质量保证卫生保健/统计学和数值数据华盛顿青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Optimizing treatment of dyslipidemia in patients with coronary artery disease in the managed-care environment (The Rocky Mountain Kaiser Permanente experience)

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第3A期85卷 36A-42A页

作者： Merenich, JA Lousberg, TR Brennan, SH Calonge, NB Rocky Mt Kaiser Permanente Dept Endocrinol Denver CO USA Rocky Mt Kaiser Permanente Dept Cardiol Denver CO USA Rocky Mt Kaiser Permanente Dept Pharm Denver CO USA Rocky Mt Kaiser Permanente Dept Prevent Med Denver CO USA

Rocky Mountain Kaiser Permanente has taken aggressive steps to ensure optimal treatment of all modifiable cardiac risk factors, especially low-density lipoprotein (LDL) cholesterol, in patients with coronary artery disease. In this article, we are presenting (1) the basic rationale for our approach, (2) the critical steps translating philosophy into practice, and (3) justification for all health plans to pursue a similar course. The continuum of physician-directed disease management systems that have evolved in our region-one administered by cardiology nurses in the perihospitalization period and the other by pharmacists in the long-term, outpatient setting-is then detailed. Although the relatively short duration that our comprehensive systems have been in place precludes any assessment of their impact on cardiac death, coronary artery disease events, or coronary artery disease procedure rates, the improvements in intermediate surrogate outcomes are promising. Virtually all surveyed patients participating in our manage-ment systems have been "very" or "extremely" satisfied with their experience. The LDL-cholesterol screening rate in the approximately 2,500 participants in the programs to date has reached 97%. Of these patients, 84% have LDL cholesterol <130 mg/dL and 48% <100 mg/dL, and only 15% of those few with LDL cholesterol >130 mg/dL (2.5% overall) are currently not receiving lipid-lowering therapy. The proportions of patients on aspirin/antiplatelet and beta-blocker therapy after myocardial infarction are 97% and 92%, respectively. The lipid-screening and treatment rates, especially, represent significant improvement from our own baseline, and compare favorably with outcomes from other practice settings. In conclusion, health maintenance organizations have tremendous incentive and the unique opportunity and ability to develop systems to better manage large numbers of individuals with coronary artery disease. (C) 2000 by Excerpta Medica, Inc.

关键词：降血脂药/治疗应用胆固醇 LDL/血液科罗拉多冠心病/血液冠心病/并发症冠心病/治疗健康维护组织/组织和管理高脂血症/血液高脂血症/并发症高脂血症/药物疗法管理医疗规划/组织和管理病人满意度人类

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EVALUATING PERIODIC MULTIPHASIC HEALTH CHECKUPS - CONTROLLED TRIAL

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JOURNAL OF CHRONIC DISEASES 1979年第5期32卷 385-404页

作者： DALES, LG FRIEDMAN, GD COLLEN, MF KAISER FDN RES INST DEPT MED METHODS RES 3700 BROADWAY OAKLAND CA 94611 USA KAISER PERMANENTE MED CTR OAKLAND CA 94611 USA

In 1964 a controlled trial was initiated to evaluate the effectiveness of a program of urging subjects to take periodic multiphasic health checkups (MHC) in preventing or postponing morbidity, disability and mortality. Over 5000 Kaiser Foundation Health Plan members aged 35-54 yr at entry to the study was urged to take MHC annually. Along with a comparable group of members not so urged, these subjects were followed for 11 yr. Use of outpatient clinic services, other than those services forming part of the MHC was similar in the urged (study) group and in non-urged (control) group. Hospital use was also similar in the 2 groups. There was no difference between the overall groups in self-reported disability. Self-reported disability was significantly less common in the older study group men (aged 45-54 at entry), largely due to less disability from hypertension complications, ischemic heart disease and back conditions. This provides a hypothesis as to a beneficial effect in a specific age-sex group that should be tested further. Mortality from a set of conditions hypothesized in advance to be most postponable or preventable through periodic MHC was significantly lower in the study group as a whole, primarily due to fewer deaths from hypertension complications and colorectal cancer. Suicides and lymphohematopoietic cancer deaths were significantly more common in the study group, although reanalysis of the data revealed little relationship between these latter death rates and actual MHC exposure. Total mortality, from all causes combined, was slightly lower in the study group, but this difference was not statistically significant. Though the prevalence of a number of disability and mortality risk factors was somewhat higher in the control group at entry, adjustment for these differences did not eliminate the statistically significant control group excesses in disability (older men only) and potentially postponable cause mortality. With regard to processes by which increa

关键词：加利福尼亚结肠肿瘤/流行病学费用效益分析评价研究(主题) 健康维护组织/组织和管理住院蒙特卡罗法年患病率死亡率多相筛查/经济学直肠肿瘤/流行病学成年人女(雌)性人类男(雄)性中年人

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HMOs and Managed Care: Implications for Rural Physician Manpower Planning

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The Journal of Rural Health 1991年第4期7卷 373-387页

作者： Weiner, Jonathan P. SchoolofHygieneandPublicHealth JohnsHopkinsUniversityBaltimoreMD21205.

American health care is changing dramatically. Health maintenance organizations (HMOs) and other managed care plans are central to this change. Today, the majority of Americans living in metropolitan areas receive their care from these types of plans. The goal of this article is two‐fold. First, it will discuss the potential implications of HMOs and managed care for physician needs and supply in rural regions. Second, it will derive insight into alternative approaches for meeting rural health manpower needs by analyzing HMO staffing patterns. As HMOs and other managed care plans expand, rural physicians, their practices, and their patients will almost certainly be affected. As described in this paper, most of these effects are likely to be positive. The staffing patterns used by HMOs provide an interesting point of comparison for those responsible for rural health manpower planning and resource development. HMOs appear to meet the needs of their enrollees with significantly fewer providers than are available nationally or suggested by the federal standards. Moreover, HMOs make greater use of nonphysician providers such as nurse practitioners and physician assistants. Copyright © 1991, Wiley Blackwell. All rights reserved

关键词：数据收集评价研究预测健康维护组织/人力健康维护组织/组织和管理卫生人力/发展趋势管理医疗规划/发展趋势医师/统计学和数值数据医师/供应和分配专业场所/发展趋势农村卫生/发展趋势美国

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MEDICAL-EDUCATION IN PREPAID SETTINGS - SYNTHESIS OF THE LITERATURE USING THE CASE SURVEY METHOD

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EVALUATION & THE HEALTH PROFESSIONS 1989年第3期12卷 300-317页

作者： BARZANSKY, B PERLOFF, J SUNY ALBANY ALBANYNY 12222

Reports in the literature that describe the use of prepaid settings for medical education are typically anecdotal. Synthesis of this information was accomplished using the case survey method, an approach that uses a common conceptual framework to combine case studies. A total of 18 references published between 1973 and 1986, describing the educational activities in 12 HMOs, were identified. Each reference was analyzed using a checklist composed of forced-choice items grouped into five categories: classification of HMO, type and extent of teaching program, organizational relationship between HMO and medical school, "scholarly" focus of HMO, and involvement of trainees in monitoring resource utilization. Many gaps were identified in the literature, especially those related to the mechanisms of financing the educational program and the types of organizational linkages between the medical school and the HMO. These gaps indicate the need for more systematic research to aid planners of future educational programs.

关键词：临床实习/组织和管理教育医学/组织和管理教育医学本科/组织和管理健康维护组织/组织和管理机构间关系方案评价研究设计学生医科教学美国

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Psychometric properties of a decision-support tool for the era of managed care

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JOURNAL OF MENTAL HEALTH ADMINISTRATION 1996年第2期23卷 226-233页

作者： Glazer, WM Gray, GV PSYCHRESOURCES GRP INC N HAVENCT

This article reports psychometric properties of a decision-support scale designed to quantify the decision-making process for allocating psychiatric care. The authors developed a scale to evaluate the level of care needed for patients requiring psychiatric treatment in a health maintenance organization (HMO) setting. This study examines the reliability and validity of that scale by measuring interrater agreement among utilization reviewers from the HMO and between those reviewers and the clinicians who evaluated the patients directly Agreement (kappa) among the five clinical raters acting in a utilization review capacity on dimensions of the scale ranged from .71 to .98. Kappas for agreement between the treatment intensity proposed by the reviewer/rater and used by the treating clinician were .41, .38, .40, .35, .36, and .39, respectively. The scale is reliable in the hands of trained personnel. Although there were important differences between clinicians' ratings and those of utilization review raters, these differences do not suggest that use of the scale would limit patient access to care.

关键词：康涅狄格决策支持系统管理卫生保健公平提供健康维护组织/组织和管理卫生政策精神卫生服务/利用心理测定学

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Assessing the feasibility of risk contracted hmos for the elderly: Applying the marketing concept

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Health Marketing Quarterly 1993年第3-4期10卷 195-210页

作者： Bingham, Frank G. Quigley, Charles J. Checko, Mary Beth Bryant College United States Health Care Administration program Salve Regina University United States

No abstract available for this article.

关键词：按人收费用户满意/统计学和数值数据合同业务/标准费用控制/方法评价研究集中研讨小组健康维护组织/经济学健康维护组织/组织和管理老年人保健服务/经济学卫生服务使用研究/统计学和数值数据 Medicare/组织和管理模型经济计量学问卷调查危险美国老年人人类

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Physicians’ perspectives of HMOs and marketing: Implications and recommendations

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Health Marketing Quarterly 1994年第1期12卷 113-128页

作者： Ellis, Brien Ellis, George H. Corle, Gary College of Business and Economic University of Kentucky Lexington KY 40506-0034 United States Rankin Family Medical Clinic Pearl MS 39208 3560 Highway 80 East United States University of Kentucky Lexington KY 40506-0034 United States

The authors compare physicians in HMOs and those not in HMOs in order to determine how HMOs have affected their practices. Physicians in HMOs see more patients per day, but recieve less income per patient than physicians not in HMOs;however, both groups of physicians agree that HMOs have not changed marketing practices. In fact, both groups report uncertainty as to the best way to market their practice, and in their understanding of marketing. The physicians do agree that patient referrals are the most important means of patient acquisition;however, both groups report a surprisngly low use of patient questionnaires. Implications and recommendations for HMOs, physicians, and health care marketing researchers are discussed. © 1994 Taylor & Francis Group, LLC.

关键词：医务工作者的态度数据收集教育医学继续健康维护组织/组织和管理肯塔基卫生服务使用研究/统计学和数值数据卫生服务使用研究/利用医师/心理学医师/统计学和数值数据规划技术转诊和会诊人类

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How does an open house benefit your organization?

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Journal of Hospital Marketing 1989年第2期3卷 69-79页

作者： McBride, Jim San Diego University United States

Major corporations are emphasizing the importance of evaluating marketing and public relations functions more and more these days. However, while companies do report using various evaluation tools, they do not report the findings of their evaluation studies quite so often. Furthermore, evaluations of special events like open houses are all too often limited to the subjective assessments of a few key senior *** article reports on an evaluation of an open house using research methods, which produce a more objective and therefore more accurate measure of the special event. Since the article is intended to be a model for others to follow, the methods used to conduct the evaluation are *** article describes (1) how many and who attended the open house at Kaiser Permanente’s Park Sierra Medical Offices in Riverside, California (employees, current Health Plan members and prospective enrollees);(2) what the attendees’ perceptions were of the event and the company organizing it;(3) whether or not they learned anything at the open house;and more. © 1989, Taylor & Francis Group, LLC.

关键词：周年纪念日和特殊事件加利福尼亚评价研究健康维护组织/组织和管理卫生服务使用研究/方法模型理论公共关系问卷调查

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The status of marketing in the health care industry

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Journal of Hospital Marketing 1987年第3-4期1卷 25-44页

作者： Zukos, Helen M. Barry, Thomas E. PARTNERS National Health Plans United States Edwin L. Cox School of Business Southern Methodist University Dallas TX 75275 United States

No abstract available for this article.

关键词：健康维护组织/组织和管理家庭医疗保健服务/组织和管理医院管理卫生服务使用研究/组织和管理美国

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