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Private health cave in Nigeria: walking the tightrope

HEALTH POLICY AND PLANNING 1999年第2期14卷 174-181页

作者： Ogunbekun, I Ogunbekun, A Orobaton, N Mediplan Ltd Lagos Nigeria Gen Hosp Dent Ctr Lagos Nigeria Minist Hlth Basics Project Asmara Eritrea

The persistently low quality and inadequacy of health services provided in public facilities has made the private sector an unavoidable choice for consumers of health care in Nigeria. Ineffective state regulation, however, has meant little control over the clinical activities of private sector providers while the price of medical services has, in recent years, grown faster than the average rate of inflation. Reforms that are targeted at reorganizing the private sector, with a view to enhancing efficiency in the supply of services, are urgently required if costs are to be contained and consumers assured of good value for money.

关键词：发展中国家效率组织坚持准则卫生保健公平提供卫生保健改革卫生保健部门/组织和管理卫生经费支出/发展趋势卫生政策尼日利亚私营部门/经济学私营部门/组织和管理卫生保健质量/标准

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Quality of care for patients hospitalized with heart failure at academic medical centers

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AMERICAN HEART JOURNAL 1999年第6期137卷 1028-1034页

作者： Nohria, A Chen, YT Morton, DJ Walsh, R Vlasses, PH Krumholz, HM Yale Univ Sch Med Yale New Haven Hosp Ctr Outcomes Res & EvaluatSect Cardiovasc Med New Haven CT USA Yale Univ Sch Med Yale New Haven Hosp Ctr Outcomes Res & EvaluatDept Med New Haven CT USA Qualidigm Middletown CT USA Univ Healthsyst Chicago IL USA

Background The purpose of this study was to determine the standard of care provided by academic medical centers For the management of congestive heart failure (CHF). Methods and Results The standard of care was estimated by assessing adherence to the treatment guidelines published by the US Agency for Health Care Policy and Research among 522 patients hospitalized at 7 university hospitals with a diagnosis of CHF. Data were abstracted by retrospective chart review. Of the 522 patients analyzed, 435 (83%) had a left ventricular ejection fraction (LVEF) measured or documented. Among these patients, 192 were considered "ideal" candidates for angiotensin-converting enzyme (ACE) inhibitor therapy tie, with systolic dysfunction [LVEF <40%] and no contraindications to ACE inhibitors). In this cohort of "ideal" candidates, 138 (72%) were receiving ACE inhibitors at hospital discharge, including 60 (44%) who were prescribed doses recommended in large clinical trials. Compliance with patient education guidelines was assessed in all 487 patients who were alive at the time of discharge. Of these patients, 365 (75%) received dietary counseling, 404 (83%) were educated about exercise, 54 (11%) were instructed to follow daily weights, and 468 (96%) were counseled regarding medication compliance. Among the 87 smokers who were alive at time of discharge, 8 (9%) had documented advice to quit smoking. Conclusions This study indicates that academic medical centers performed fairly well on the assessment of LVEF, the prescription of ACE inhibitors at discharge, and on education regarding diet, exercise, and compliance with medications. However, the results suggest opportunities for improvement in ACE inhibitor dosing and patient education regarding the importance of monitoring daily weights and smoking cessation.

关键词：医学科学研究中心/标准医学科学研究中心/统计学和数值数据血管紧张素转换酶抑制药/治疗应用心脏病学科医院/标准心脏病学科医院/统计学和数值数据数据收集/方法住院/统计学和数值数据 Logistic模型质量指标卫生保健卫生保健质量/标准卫生保健质量/统计学和数值数据美国老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Benefits of an "angina clinic" for patients with coronary artery disease: A demonstration of health status measures as markers of health care quality

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AMERICAN HEART JOURNAL 2002年第1期143卷 145-150页

作者： Spertus, JA Dewhurst, TA Dougherty, CM Nichol, P McDonell, M Bliven, B Fihn, SD Univ Missouri Mid Amer Heart Inst Dept Med Cardiol Sect Kansas City MO 64111 USA Seattle Vet Affairs Med Ctr Hlth Serv Res & Dev Ctr Excellence Seattle WA USA Seattle Vet Affairs Med Ctr Gen Internal Med Sect Seattle WA USA Polyclin Seattle WA USA

Objective Our purpose was to determine the efficacy of health status measurement in quantifying improvements in quality of care provided by an "angina clinic." Study Design In a pretest-posttest, nonequivalent control group design in the outpatient clinics of a Veterans Affairs Medical Center, 535 patients with coronary disease were followed up, without intervention, for 3 months and were defined as the "usual-care" group. Concurrently, a clinical trial that optimized the antianginal medications of 100 patients with chronic, stable coronary disease was conducted and defined as the "angina clinic" group. The 3-month change in scores for the Seattle Angina Questionnaire, a valid, reliable, and responsive disease-specific health status measure for patients with coronary disease, was used as the main outcome measure. Results After baseline differences between groups were controlled, the "angina clinic" conferred substantial improvement on patient symptom control (3-month benefit in angina frequency +9.4, P < .001;in angina stability +14.7, P < .001), treatment satisfaction (+8.6, P < .001), quality of life (+6.8, P < .001), and physical limitations resulting from coronary disease (+3.6, P = .047). Only the changes in physical limitation were not clinically significant. Conclusion Disease-specific health status measures can provide valuable insights into the quality of care associated with innovations in health care delivery. These results suggest that patients in a clinical trial optimizing antianginal medications had greater improvements in symptom control, treatment satisfaction, and quality of life compared with similar patients receiving "usual care" in a general medicine clinic.

关键词：病例对照研究健康状况指标门诊部医院以病人为中心医护试点项目卫生保健质量/标准问卷调查可重复性结果老年人女(雌)性人类男(雄)性

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Academic internal medicine: Challenges and opportunities - Part II

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AMERICAN JOURNAL OF MEDICINE 2000年第7期108卷 601-608页

作者： Ibrahim, T

Over the past decade, the US health-care system has fallen into crisis. The nation□s health expenditures have increased 57.5%, from $699.4 billion in 1990 to an estimated $1.2 trillion in 1999 (1). Despite these increases, a growing number of Americans lack health insurance. In 1999, nearly 46 million US citizens (about 20% of the population) were uninsured (2). Because the health-care system has four distinct financers of care—employers, government, individuals, and providers—few, if any, Americans benefit from a coordinated continuum of care.

关键词：基因疗法政府医院教学/组织和管理医院教学/发展趋势内科学/经济学内科学/教育内科学/人力内科学/发展趋势医师/统计学和数值数据卫生保健质量/标准院校医学/组织和管理院校医学/发展趋势美国人类

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Assessing the Influence of Adult Day Care on Client Satisfaction

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Journal of Aging and Health 1992年第2期4卷 303-321页

作者： Buelow, Janet R. Conrad, Kendon J. The Brookdale Center on Aging United States Northwestern University and Department of Veterans Affairs Hospital (151 H) United States

Using data collected from 74 adult day care centers, this study measured various program characteristics from four different categories of respondents - clients, care-givers, staff members, and administrators. The perceptions of these respondents were examined for their associations with each other and with client satisfaction. Three program characteristics, -as perceived by clients, were significantly associated with client satisfaction (staff caring, general morale, and interior environment). The caregivers', staff members and administrators perceptions were not significantly associated with client satisfaction. In addition, most of these program component ratings were not significantly associated among clients, caregivers, staff members, and administrators. © 1992, Sage Publications. All rights reserved.

关键词：卫生设施环境士气病人满意度/统计学和数值数据职业病人关系卫生保健质量/标准卫生保健质量/统计学和数值数据问卷调查回归分析社会经济因素美国女(雌)性人类男(雄)性

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Best medical practice is important‐whatever it is

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The International Journal of Health Planning and Management 1989年第3期4卷 247-252页

作者： Mooney, Gavin Loft, Anne Guest Editors

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Satisfaction with Medical Care among Elderly People in Fee-for-Service Care and an HMO

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Journal of Aging and Health 1992年第2期4卷 282-302页

作者： Kasper, Judith D. Riley, Gerald Johns Hopkins School of Hygiene and Public Health United States Health Care Financing Administration United States

This study investigates satisfaction with care among elderly Medicare beneficiaries enrolled in a health maintenance organization (HMO) and beneficiaries in fee-for-service (FFS) care in the same geographic area. Satisfaction with two dimensions of care, access/quality and costs, are examined, to investigate differences in enrollee/FFS evaluation of these dimensions of care as well as predictors of satisfaction with care. In addition, satisfaction among healthy and chronically ill elderly people in these two care settings is explored. Results indicate higher satisfaction with access/quality of care among those in FFS and higher satisfaction with costs among HMO enrollees. These relationships hold controlling for other variables and among the chronically ill elderly. Sources of variation in satisfaction are somewhat different among the HMO and FFS elderly. Satisfaction with paperwork and ease of getting to care, however, influences satisfaction with other aspects of care in both populations. © 1992, Sage Publications. All rights reserved.

关键词：数据收集评价研究费用医疗/标准健康维护组织/经济学健康维护组织/标准健康维护组织/利用卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据马萨诸塞 MedicareB部/组织和管理病人满意度/经济学病人满意度/统计学和数值数据试点项目卫生保健质量/标准卫生保健质量/统计学和数值数据回归分析社会经济因素美国老年人女(雌)性人类

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Trying to judge what is best medical practice

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The International Journal of Health Planning and Management 1989年第3期4卷 159-166页

作者： Loft, Anne Mooney, Gavin Department of Obstetrics and Gynaecology Gentofte County Hospital Hellerup 2900 Niels Andersens Vej Denmark Institute for Social Medicine University of Copenhagen Panum Institute Copenhagen 2200 Blegdamsvej 3 Denmark

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Is quality of health care a meaningful guide?

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Journal of Ambulatory Care Marketing 1990年第2期3卷 19-37页

作者： Scammon, Debra L. Fuller, Dan A. University of Utah United States Weber State College United States

Health care consumers are beginning to learn that what you dont know can hurt you. Though consumers consistently rank quality of care as an important attribute, quality of care does not appear to be particularly useful in decision making. The quality of health care is difficult to measure, communicate, and interpret. Yet if consumers are to make efficient choices including both value and cost in their decisions, quality information must be available to them. This paper outlines a scheme to conceptualize quality of care and suggests some ways to operationalize measures of quality that could provide empirically based indices of quality of care to facilitate health care consumer decision-making. © 1990 by The Haworth Press, Inc. All rights reserved.

关键词：用户满意结果与过程评价(卫生保健)/方法病人接受卫生保健的程度卫生保健质量/标准美国

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What happens when capitated behavioral health comes to town? The transition from the Fort Bragg demonstration to a capitated managed behavioral health contract

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 2000年第4期27卷 390-405页

作者： Heflinger, CA Northrup, DA Vanderbilt Ctr Mental Hlth Policy Nashville TN USA

Capitated managed care contracts for behavioral health services are becoming more prevalent across the country in both public and private sectors. This study followed the transition from a demonstration project for child mental health services to a capitated managed behavioral health care contract with a for-profit managed care company. The focus of the study was on the impact-at both the service system and the individual consumer level-pertaining to the start-up and maintenance of a capitated managed behavioral health program. A case study using multiple methods and multiple sources of information incorporated a program fidelity framework that examined micro to macro levels of program implementation. The findings of this study include the following: access to services decreased, the lengths of stay and average daily census in the more intensive levels of treatment declined, difficult-to-treat children were shifted to the public sector and ratings of service system performance and coordination fell.

关键词：青少年保健服务/统计学和数值数据按人收费费用分配/统计学和数值数据保健福利计划雇员卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据管理医疗规划/经济学管理医疗规划/组织和管理管理医疗规划/标准管理医疗规划/统计学和数值数据精神卫生服务/经济学精神卫生服务/组织和管理精神卫生服务/标准精神卫生服务/统计学和数值数据北卡罗来纳卫生保健质量/标准卫生保健质量/统计学和数值数据回顾性研究利用情况审核/标准利用情况审核/统计学和数值数据青少年儿童人类

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