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Impact of the '2 week wait' directive for suspected cancer on service provision in a symptomatic breast clinic

BRITISH JOURNAL OF SURGERY 2000年第8期87卷 1082-1086页

作者： Cant, PJ Yu, DSL Rotherham Gen Hosp Trust Combined Breast Clin Rotherham S60 2UD S Yorkshire England

Background: The '2 week wait' directive (Health Service Circular (HSC 1998/242) guaranteeing that 'everyone with suspected breast cancer will be able to see a specialist within two weeks of their general practitioner (GP) deciding they need to be seen urgently' is a unique audited approach to access for the British National Health Service, the effects of which have been assessed in a non-academic symptomatic breast clinic. Methods: New GP referrals (n = 607) were reviewed prospectively in two comparable 3-month intervals, beginning 1 April 1998 and 1 April 1999, to determine the probability of a breast cancer diagnosis from the referral letter and the effects of the directive on waiting times for appointments and utilization of clinics. Results: The urgency of referral was not specified in 53 per cent of GP referrals. For the 'urgent' cases (25 per cent of all new referrals) the probability of a final diagnosis of breast cancer was 0.19. The breast specialists prospectively achieved a rate of 0.26 from 99 per cent of the same referral letters. 'Urgent' referrals did not wait significantly longer in 1999 (median 9 versus 10 days) but waiting times for new appointments overall increased (13 versus 16 days;P < 0.01), and this was greatest for 'routine' referrals (14 versus 21 days;P < 0.001). These changes were caused by an increase in the number of clinic appointments, due to significant increases in median number of visits to diagnosis or discharge and clinic non-attendance in 1999, resulting in overbooking. Telephonic communications were associated with faster median access times (fax 8 days;telephone 2 days), relative to mailed referrals (19 days) (P < 0.01). Conclusion: Breast specialists were better overall at assessing the probability of a breast cancer diagnosis. The waiting time for 'urgent' appointments was unchanged following HSC 1998/242, but there was an increased wait for other patients, especially those assessed as having a lower probability of cancer.

关键词：乳腺肿瘤/诊断大不列颠卫生服务易得程度/组织和管理卫生服务易得程度/标准前瞻性研究卫生保健质量转诊和会诊/标准公费医疗时间因素预约名单女(雌)性人类

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Health promotion information: Sources and significance for those with serious and persistent mental illness

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ARCHIVES OF PSYCHIATRIC NURSING 2002年第6期16卷 263-274页

作者： MacHaffie, S Univ Washington Seattle WA 98195 USA

For 19 sources of health promotion information 41 adult outpatients with severe and persistent mental illness (SPMI) indicated by questionnaire how much information they received from each source and their opinion of its reliability. Nonpsychiatrist physicians, psychiatrists, nurses and pharmacists provided the most health promotion information and were regarded as the most reliable sources. Nurses and pharmacist were seen as providing more, and media and print sources as providing less, information than in similar studies of nonmentally ill samples. Nonpsychiatrist physicians, psychiatrists, nurses and pharmacists are significant sources of health promotion information for persons with SPMI - perhaps even more so than for those with no mental illness. Copyright 2002, Elsevier Science (USA). All rights reserved.

关键词：健康态度慢性病健康促进/方法健康促进/标准卫生服务易得程度/标准精神障碍/心理学精神病护理学/标准精神病学/标准问卷调查疾病严重程度指数华盛顿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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Diabetes educators' perspectives on barriers for patients and educators in diabetes education

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DIABETES EDUCATOR 1999年第6期25卷 907-916页

作者： Sprague, MA Shultz, JA Branen, LJ Lambeth, S Hillers, VN Washington State Univ Dept Food Sci & Nutr Pullman WA 99164 USA

PURPOSE This study assessed diabetes educators' perspectives on barriers that potentially affect patient access to and utilization of diabetes education. METHODS A 40-item questionnaire was developed to collect needs assessment data on diabetes education programs. The questionnaire was mailed to a Washington State professional practice group in diabetes education (N=143), RESULTS Most respondents were registered nurses (61%) or registered dietitians (27%);74% were certified diabetes educators, The educators' perceptions of the difficulty that type 1 versus type 2 patients experience in different areas of self-management after diabetes education underscored the importance of learning effective long-term skills for self-care. Some of the reasons given for type 2 patients dropping out of diabetes education programs were also cited as barriers to conducting follow-up, such as education being a low priority for the patient and the patient not being able to afford diabetes care services, CONCLUSIONS Educators appeared to relate many patient barriers to a lack of patient understanding of the evolving nature of diabetes and the subsequent need for educational support. The role of continuing education for all patients needs to be emphasized to the patient during the initial education, as well as to the healthcare community and the patient's support network.

关键词：医务工作者的态度健康态度证明糖尿病/心理学糖尿病/治疗卫生服务易得程度/标准结果与过程评价(卫生保健) 病人教育(主题)/标准方案评价华盛顿女(雌)性人类男(雄)性

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Automated external defibrillation/public access defibrillation

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ANNALS OF EMERGENCY MEDICINE 2001年第4期37卷 S60-S67页

作者： Atkins, DL Bossaert, LL Hazinski, MF Kerber, RE Mancini, MB Ornato, JP Peberdy, MA Quan, L Tang, WC Timerman, S Weisfeldt, ML White, RD Mayo Clin Dept Anesthesiol Rochester MN 55905 USA Univ Iowa Iowa City IA USA Univ Antwerp B-2020 Antwerp Belgium Vanderbilt Univ Nashville TN USA Parkland Hlth & Hosp Syst Dallas TX USA Med Coll Virginia Richmond VA USA Childrens Reg Med Ctr Seattle WA USA Inst Crit Care Med Palm Springs CA USA Natl Comm Resuscitat Sao Paulo Brazil Columbia Univ New York NY USA

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THE RELATIONAL STRUCTURE OF HUMAN-SERVICES PLANNING - AN INPUT-OUTPUT-ANALYSIS

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SOCIO-ECONOMIC PLANNING SCIENCES 1992年第1期26卷 15-26页

作者： AKKERMAN, A UNIV SASKATCHEWAN DEPT GEOGSASKATOON S7N 0W0SASKATCHEWANCANADA

The relationship between human needs and human services can be quantified in terms of service standards and service units. A service standard is defined as the adopted norm for the minimum number of service units per person. The relationship between need, service (or care) and service standard is similar to the relationship between demand, supply and price in economics. Of particular interest in planning is the case where service units are given in terms of service providers per person. In a population where each person is considered to be a receiver of n categories of service and a provider of one category of service, the relationship between needs and services can further be presented in a service standard matrix. Examination of such a matrix shows that it fulfills a function analogous to the input-output matrix in economics. The principal eigenvector of the service standard matrix expresses ratios of activity levels for a human service system in an equilibrium. Another, related equilibrium is identified for a human service system in which there are providers as well as nonproviders. Application of the two equilibria identifies optimum planning conditions for the provision of human services when service standards and population are known.

关键词：艾伯塔数据收集人口统计学评价研究卫生人力/标准卫生人力/统计学和数值数据卫生服务/标准卫生服务/供应和分配卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据卫生服务需求/标准卫生服务需求/统计学和数值数据模型统计学规划技术地区卫生计划/标准

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Quality-of-care challenges for rural health

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JOURNAL OF RURAL HEALTH 2000年第2期16卷 168-176页

作者： Moscovice, I Rosenblatt, R Univ Minnesota Div Hlth Serv Res & Policy Minneapolis MN 55455 USA Univ Washington Dept Family Med Seattle WA 98195 USA

The purpose of this article is to examine the issue of quality of care in rural America and to help others examine this issue in a way that is consistent with the very real challenges faced by rural communities in ensuring the availability of adequate health services. Rural citizens have a right to expect that their local health care meets certain basic standards. Rural rural providers can document that the quality of local health care meets objective external standards third-party payers might refuse to contract with rural providers, and increasingly sophisticated consumers might leave their communities for basic medical care services. To improve measurement of health care quality in a rural setting, a number of issues specific to the rural environment must be addressed, including small sample sizes (volume and outcome issues), limited data availability, the ability to define rural health service areas, rural population preferences and the lower priority of formal quality-of-cure assessment in shortage areas. Several current health policy initiatives have substantial implications for monitoring and measuring the quality of rural health services health services. For example, to receive community acceptance and fiscal stability, critical access hospitals (CAHs) must be able to document that the care they provide is at least comparable to that of their predecessor institutions. The expectations for quality assurance activities in CAHs should consider their limited institutional resources and community preferences. As managed care extends from urban areas, there will be an inevitable collision between the ability to provide care and the ability to measure quality. As desirable as it might be to have a national standard for health care quality, this is not ail attainable goal. The spectrum and content of rural health care are different from the spectrum and content of care provided in large cities. Accrediting agencies, third-party carriers and health insurance purchase

关键词：卫生服务易得程度/标准医院乡村/标准卫生保健组织鉴定联合委员会缺医地区 MedicareC部病人满意度质量保证卫生保健/标准卫生保健质量/标准乡村卫生服务/标准样本大小美国人类

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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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Rural Emergency Medical Services: Patients, Destinations, Times, and Services

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The Journal of Rural Health 1995年第4期11卷 286-294页

作者： Morrisey, Michael A. Johnson, Victoria Treat, Richard Lister Hill Center for Health Policy University of Alabama at Birmingham Birmingham Alabama 35294‐2010 1825 University Blvd. United States

Abstract: This study sought to describe the volume of use, mix of patients, origin and destination of runs, times and distances to care, and the volume of clinical services provided in a rural emergency medical services region. This study summarizes all 6,080 rural emergency ambulance trip reports filed from April through September 1991 from the 12 rural counties surrounding Augusta, GA. Rural ambulances are regularly used and are used extensively by elderly populations. The pattern of services provided suggests that while advanced care may or may not have been indicated, it was rarely provided and that rural emergency medical service programs should consider a greater reliance on basic life support teams. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：救护车/统计学和数值数据卫生服务范围地理学佐治亚卫生服务易得程度/组织和管理卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据病人/分类病人/统计学和数值数据乡村卫生服务/组织和管理乡村卫生服务/标准乡村卫生服务/统计学和数值数据乡村卫生服务/利用时间因素病人转送/统计学和数值数据青少年成年人老年人儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Age Differences in the Breast Cancer Management of Rural Women

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Journal of Aging and Health 1993年第3期5卷 402-416页

作者： Howe, Holly L. Lehnherr, Melinda Keller, Jane Katterhagen, J. Gale Fountain, Marsha Illinois Department of Health United States St. Joseph Medical Center Burbank California United States Harris Methodist Fort Worth Hospital United States

This article describes the effect of age on the pattern of access to breast cancer care among rural women diagnosed in 1986-1989. Cases were identified by the Illinois State Cancer Registry and information on breast cancer management was obtained through review of hospital records and physician survey. Case follow-back was more than 99% complete. State-of-the-art breast cancer management was defined by the Physician Data Query (PDQ) and included diagnostic evaluation, prognostic evaluation, and stage-specific definitive treatment. The data did not indicate age differences in bilateral diagnostic mammography, performance of hormone receptor assays, radiation therapy, and stage-appropriate treatment. Tumor staging and axillary node dissection did differ by age with significant negative trends in the multivariate model. Also, women younger than 55 years were the most likely to receive separate diagnostic biopsy, limited surgery, and chemotherapy, whereas women 55 to 74 years were most likely to receive hormone therapy. Although rural populations may experience barriers to some aspects of state-of-the-art breast cancer management, age does not always exacerbate them. © 1993, Sage Publications. All rights reserved.

关键词：年龄因素乳腺肿瘤/流行病学乳腺肿瘤/治疗数据收集卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据医院乡村/标准医院乡村/统计学和数值数据伊利诺伊/流行病学 Logistic模型多元分析比值比肿瘤科医院/标准肿瘤科医院/统计学和数值数据老年人女(雌)性人类中年人

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EQUITY IN THE DELIVERY OF HEALTH-CARE - SOME INTERNATIONAL COMPARISONS

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JOURNAL OF HEALTH ECONOMICS 1992年第4期11卷 389-411页

作者： VANDOORSLAER, E WAGSTAFF, A UNIV SUSSEX SCH SOCIAL SCIARTS BLDGBRIGHTON BN1 9QNENGLAND ERASMUS UNIV 3000 DR ROTTERDAMNETHERLANDS

This paper presents the results of an eight-country comparative study of equity in the delivery of health care. Equity is taken to mean that persons in equal need of health care should be treated the same, irrespective of their income. Two methods are used to investigate inequity: an index of inequity based on standardized expenditure shares, and a regression-based test. The results suggest that inequity exists in most of the eight countries, but that there is no simple one-to-one correspondence between a country's delivery system and the degree to which persons in equal need are treated the same.

关键词：文化交叉比较卫生保健提供/经济学卫生保健提供/标准卫生保健提供/统计学和数值数据欧洲卫生经费支出/统计学和数值数据卫生服务易得程度/经济学卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据卫生服务研究收入/分类保险健康/经济学保险健康/标准保险健康/统计学和数值数据国际性模型经济计量学国家卫生规划/经济学国家卫生规划/标准国家卫生规划/统计学和数值数据回归分析社会正义/经济学社会经济因素公费医疗/经济学公费医疗/标准公费医疗/统计学和数值数据美国

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