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Needs-based primary medical care capitation: Development and evaluation of alternative approaches

Health Care Management Science 2000年第2期3卷 89-99页

作者： Hutchison, Brian Hurley, Jeremiah Birch, Stephen Lomas, Jonathan Walter, Stephen D. Eyles, John Stratford-Devai, Fawne Department of Family Medicine Centre for Health Economics and Policy Analysis McMaster University Hamilton Ont. L3N 3Z5 1200 Main Street West Canada Centre for Health Economics and Policy Analysis Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton Ont. L3N 3Z5 Canada Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton Ont. L3N 3Z5 Canada Institute of Environment and Health McMaster University Hamilton Ont. L3N 3Z5 Canada

Objective. To develop and evaluate alternative methods of adjusting primary medical care capitation payments for variations in relative need for health care among enrolled practice populations. Methods. We developed alternative needs-based capitation formulae and applied them to a sample of capitation-funded primary care practices to assess each formula's performance against a reference standard of capitation payments based on age, sex and self-assessed health status of the enrolled populations. The alternative formulae were based on: (1) age and sex;(2) age, sex and individually-measured socioeconomic characteristics;(3) age, sex and socioeconomic characteristics imputed from census data for enrollees' neighbourhood of residence;(4) age, sex and standardized mortality ratio for enrollees' neighbourhood of residence. Results. Age/sex-adjusted capitation payments for the six practices studied ranged from 10% higher to 18% lower than the reference standard payments. Capitation formulae based on socioeconomic and mortality data did not perform consistently better than the current age/sex-based formula. Conclusions. Primary medical care capitation payments adjusted only for age and sex do not reflect the relative health care needs of enrolled practice populations. Our alternative formulae based on socioeconomic and mortality data also failed to reflect relative needs. Methods that use other approaches to adjusting for differences in relative need among enrolled populations should be investigated. © Baltzer Science Publishers BV.

关键词：年龄因素按人收费/组织和管理数据说明统计家庭医学/组织和管理健康状况管理医疗规划/组织和管理死亡率需求估价/组织和管理安大略/流行病学初级卫生保健/组织和管理规划制订/方法方案评价/方法可重复性结果性别因素社会经济因素青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Frequent emergency department use in Sweden: Implications fur emergency medicine in the United States

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 627-629页

作者： Williams, RM Department of Health Management and Policy University of Michigan School of Public Health Ann Arbor MI United States School of Public Health University of Michigan 1420 Washington Heights Ann Arbor MI 48109-2029 United States

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The need for the introduction of a course on drug management in pharmacy curriculum

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TROPICAL DOCTOR 2000年第1期30卷 54-55页

作者： Muko, KN Catholic Mission Gen Hosp Njinikom NW Province Cameroon

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Depression, service need, and use in vulnerable populations

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ARCHIVES OF PSYCHIATRIC NURSING 2000年第4期14卷 173-182页

作者： Badger, TA McNiece, C Gagan, MJ Univ Arizona Coll Nursing Tucson AZ 85721 USA

Health care reform has created opportunities for mental health nurses to develop innovative health care delivery models to provide integrated behavioral health and primary health care. A community health analysis is one method to ensure appropriate services are planned. This study examined the health care services most needed and those used by depressed and nondepressed participants (N = 231), and their satisfaction with these services. Individual and system characteristics were examined using a framework developed by Anderson and Aday. Significant differences were found between the 2 groups for predisposing characteristics, enabling characteristics, need for care, service use, and satisfaction with services. Copyright (C) 2000 by W.B. Saunders Company.

关键词：亚利桑那病例对照研究因果律抑郁/心理学卫生服务/利用卫生服务研究需求估价/组织和管理病人满意度贫困/心理学问卷调查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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Evaluation of case management needs of clients from non-English speaking backgrounds by key workers in a public agency.

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The Australian and New Zealand journal of mental health nursing 1999年第4期8卷 176-186页

作者： Shackleton, M.G. Julia Farr Services Adelaide Australia

Twenty key workers in a government agency evaluated the effectiveness of their interventions with culturally diverse clients. The sample comprised 73 clients, from 18 language groups. Forty per cent reported not having enough to do during the day and seventy-three per cent were visited regularly by their key workers. Ninety-two per cent were social security recipients. Though eighty-five per cent of key worker respondents perceived that the major needs of their clients were being met, twenty-one per cent felt they had insufficient contact with clients. The cultural appropriateness of interventions and client's accessibility to services were not confirmed in anecdotal comments.

关键词：医务工作者的态度病例管理/组织和管理信息交流障碍社区精神卫生服务/组织和管理文化多样性人种群/统计学和数值数据需求估价/组织和管理公共卫生工作问卷调查南澳大利亚青少年成年人老年人女(雌)性人类男(雄)性中年人

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Knowledge of human papillomavirus infection among young adult men and women: Implications for health education and research

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JOURNAL OF COMMUNITY HEALTH 2000年第1期25卷 67-78页

作者： Baer, H Allen, S Braun, L Brown Univ Dept Pathol & Lab Med Providence RI 02912 USA Brown Univ Dept Community Hlth Providence RI 02912 USA

Human papillomavirus (HPV) infection of the genital tract is one of the most common sexually transmitted diseases (STDs), and a subset of genital tract HPVs are etiologically associated with cervical cancer. The prevalence of HPV infection is highest among adolescents and young adults. This study was undertaken to explore first year college students' knowledge about HPVs and to determine whether there were gender differences in this knowledge. An anonymous survey was distributed to all fir st year students at a private university. The results were analyzed by gender. We found that 96.2% of males and 95.4% of females had heard of genital warts, although only 4.2% of males and 11.6% of females knew that HPV caused genital warts. Although there was a greater awareness of genital warts than HPV in this population, students were uncertain about modes of transmission of both genital warts and HPVs, and unclear about the importance of HPV infection relative to other STDs. For both men and women (87% and 87.4%, respectively), health education classes were the major source of information about STDs. We conclude that health education should be reconceptualized to incorporate a better understanding of STDs, including HPV infection, by engaging adolescents and young adults in exploring the biological and social context of STDs, their public health importance, strategies for prevention, and the uncertainty of our scientific knowledge.

关键词：教育考核健康教育/方法健康教育/标准健康知识态度实践男人/教育需求估价/组织和管理新英格兰患病率问卷调查研究/组织和管理危险因素学生美国/流行病学大学宫颈肿瘤/病毒学妇女/教育女(雌)性人类男(雄)性

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Proposed changes to designations of medically underserved populations and health professional shortage areas: Effects on rural areas

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JOURNAL OF RURAL HEALTH 1999年第1期15卷 44-54页

作者： Goldsmith, LJ Ricketts, TC Univ N Carolina Sheps Ctr Hlth Serv Res Chapel Hill NC 27599 USA

This paper reports an analysis of the proposed rule to combine medically underserved population (MUP) and health professional shortage area (HPSA) designations, as published by the Bureau of Primary Health Care (BPHC) in the Federal Register on Sept. 1, 1998 (Department of Health and Human Services, 1998). The effects of the proposed rule over all and on rural communities were examined, particularly with respect to current whole county HPSA designations and eligibility for federal assistance programs. National, county-level estimates of primary care provider counts and other measures included in the proposed rule were used. Different primary care provider sources were compared;results were highly dependent on the data source nod the inclusions of counts of nurse practitioners and physician assistants. The projections of losses from the proposed rule were higher than those of the BPHC, probably due to the use of different sources for provider counts. Overall, the authors projected that more than 50 percent of current whole-county HPSAs would lose designation using the proposed nib. The proportion of rural counties that lost designation was not significantly greater than the proportion Of urban counties, but because there are many more rural counties, more de-designations were projected to occur in rural areas. The researches also predicted that 58 percent of rural whole-county HPSAs with National Health Service Corps providers would lose their designation, but most rural whole-county HPSAs with Community and Migrant Health Centers or Rural Health Clinics retained their MUP designation using the proposed rule. The proposed rule likely has a larger effect on current designations than originally projected by the BPHC.

关键词：数据说明统计卫生人力/分类卫生服务研究健康状况指标缺医地区需求估价/组织和管理北卡罗来纳开业护士/供应和分配组织改革医师助理/供应和分配初级卫生保健/人力方案评价乡村卫生服务/人力人类

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STEP(ing)-UP to deliver clinical preventive services

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AMERICAN JOURNAL OF PREVENTIVE MEDICINE 2001年第1期21卷 68-69页

作者： Kottke, TE Solberg, LI Mayo Clin & Mayo Fdn Rochester MN 55905 USA HealthPartners Res Fdn Minneapolis MN USA

I n this issue of the American Journal of Preventive Medicine, Goodwin et al.1 report the success of their trial to help medical practices increase the delivery of the preventive services recommended by the U.S. Preventive Services Task Force. They randomized 77 community family practices in Northeast Ohio to receive a 1-day practice assessment and a series of meetings with a nurse facilitator for the purpose of choosing and implementing individualized approaches to increase the delivery of preventive services. The main outcome measure was a set of summary scores for health habit counseling, screening, and immunization services. Those researchers found a significant increase in global preventive service delivery rates at 1 year in the intervention group (31%–42%) compared with the control group. Two components of the summary score, rates for health habit counseling and screening services, were increased. The third component, immunization rates, was not changed.

关键词：卫生保健提供/组织和管理卫生服务研究/标准需求估价/组织和管理预防卫生服务/供应和分配预防卫生服务/利用研究设计/标准全面质量管理/组织和管理人类

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Public relations is a serious business.

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The British journal of theatre nursing : NATNews : the official journal of the National Association of Theatre Nurses 1999年第1期9卷 35-40页

作者： Radcliffe, P.

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Modelling of resource allocation to health care authorities in Stockholm County

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Health Care Management Science 2000年第2期3卷 141-149页

作者： Andersson, P.-Å. Varde, E. Diderichsen, F. Department of Public Health Sciences Karolinska Institute SE-171 76 Stockholm Sweden Department of Technology and Science University of Örebro Örebro Sweden

Since the Stockholm County Council introduced a system of purchasers and providers there has been a quest for population-based resource allocation models to allocate monies to purchasers of health care. In contrast to models used in Britain, Swedish models have been based on individual level data. This paper presents recent developments in the model used in Stockholm for all care except primary care, testing new statistical methods for compression and clustering of the matrices used and the effect of introducing diagnostic information in addition to the demographic and socio-economic information used before. We also show the effect of using more current data sources by replacing existing census variables with data from annually updated registers. Since the aim is to use the resource allocation models for prospective budgeting we test and evaluate the predictive power of the models one to two years ahead. Moreover, two calibration methods are compared: Cross-sectional modelling, based on data for one year only, versus prospective modelling, using population characteristics for one year and registered health-care costs for a following year. While models including diagnostic information are deemed valuable, the prospective models yield little improvement. Further, although it takes a combination of new variables to replace the census based model, the resulting model now implemented by Stockholm County Council has fewer estimated parameters. © Baltzer Science Publishers BV.

关键词：聚类分析社区卫生计划/组织和管理诊断相关患者组/经济学诊断相关患者组/发展趋势预测卫生保健公平提供/组织和管理医院费用/统计学和数值数据医院费用/发展趋势模型经济计量学国家卫生规划/组织和管理需求估价/组织和管理登记可重复性结果居住特征/统计学和数值数据社会经济因素瑞典青少年成年人老年人老年人 80以上儿童儿童学龄前人类婴儿中年人

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