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Biomedical subjects

C M Clancy

Publications and source records attributed to C M Clancy.

At least 55 records · Page 3Linked to original sources
PubMed1993

Health insurance and subjective health status: data from the 1987 National Medical Expenditure survey.

OBJECTIVES: The relationship between health insurance and subjective health status was investigated. It was hypothesized that persons without health insurance would have lower levels of subjective health status than those with health insurance and that this relationship would hold for both poor and nonpoor persons. METHODS: Data from the 1987 National Medical Expenditure Survey were analyzed to examine the relationship between health insurance and self-reported health status. The analysis controlled for sociodemographic and attitudinal variables and medical conditions. RESULTS: Persons without health insurance had significantly lower levels of subjective health status than did persons with insurance. This adverse effect persisted after adjustments were made for the effects of age, sex, race, income, attitude toward the value of medical care and health insurance, and medical conditions. The detrimental effect of lacking health insurance on subjective health status was present for persons at all income levels and was greater than the effect on subjective health status found for 2 of the 11 reported medical conditions. CONCLUSIONS: Lacking health insurance is associated with clinically significant lower levels of subjective health status in both poor and non-poor persons.

Adult↗
PubMed1993

Questions and answers about managed competition.

The Managed Competition strategy for health care financing reform would push most people into cut-rate versions of health maintenance organizations chosen for them by their employer and owned by an insurance company. Many of those who currently enjoy good coverage would be forced into bare bones plans, and would forfeit the right to choose their health care provider. There is little evidence that the rigidly multi-tiered system created by Managed Competition would be more efficient or less expensive than the current U.S. system, and administrative costs would likely rise. Promises to expand coverage for the uninsured are likely to fall by the wayside if cost containment fails, and no current Managed Competition proposals address long-term care. In rural areas including at least 30 percent of the U.S. population, price competition central to the Managed Competition strategy is untenable since a long hospital or other provider cannot compete with itself. Managed Competition would empower vertically integrated corporate health care insurer/providers and disempower patients and the clinical work force.

Competitive Medical Plans↗
PubMed1989

Physicians as gatekeepers. The impact of financial incentives.

Incentives encouraging physicians to reduce their use of diagnostic tests are controversial. We studied physicians enrolled in an independent practitioner association who see both fee-for-service and prepaid (health maintenance organization [HMO]) patients concurrently. We asked the following questions: (1) Do physicians order fewer tests for their patients enrolled in an HMO relative to their patients seen on a fee-for-service basis? (2) Are any reductions in testing selective or indiscriminate? We reviewed the charts of 273 new patients, 167 enrolled in a fee-for-service system and 106 enrolled in an HMO, who were seen by 17 physicians "for a check-up," and graded test use as "indicated" or "discretionary." We used multiple logistic regression to control for the effects of patient age and sex. Patients in the HMO underwent fewer tests than did patients in the fee-for-service system, as well as fewer discretionary tests, but received the same proportion of preventive services. We conclude that physicians ordered fewer tests for patients in the HMO, apparently because of selective omission of discretionary tests. Physicians also did not reduce preventive services for patients in the HMO relative to all other physicians.

Adult↗
PubMed1989

More for less.

Explore the source record for details and available documents.

Canada↗
PubMed1988

Guiding individual decisions: a randomized, controlled trial of decision analysis.

In early 1983, all 1,280 faculty and resident physicians at one hospital who were eligible to be vaccinated against hepatitis B were divided randomly into three groups: Group 1 physicians received general information about the risks and benefits of alternative vaccine decisions; Group 2 physicians were additionally invited to provide personal information for an individualized decision analysis (12.6 percent responded); and Group 3 physicians, who served as controls, were not contacted. In one year's follow-up, 20 percent of physicians were screened for hepatitis B antibody or vaccinated. More Group 2 physicians whose decision analyses recommended screening or vaccination took these actions (39 percent) than any other group. Group assignment remained significantly associated with vaccine decisions after analyzing results by the "intention to treat" principle, and after adjusting for training status, exposure to blood and blood products, and pre-study intentions about the vaccine. Despite the low overall vaccine acceptance rate, it is concluded that individualized decision analysis can influence the clinical decisions taken by knowledgeable and interested patients.

Clinical Trials as Topic↗
PubMedDate not supplied

Rational decision making based on history: adult sore throats.

Primary care physicians are often required to make preliminary evaluations based only on the patient's history, especially during telephone encounters about sore throats. The authors studied adults with sore throats to determine whether patients can be stratified into higher and lower risks of strep throat by history alone. They first obtained data from 517 patients seen in an emergency room. Providers graded symptoms on a four-point scale (absent, mild, moderate, or severe). Initial analyses showed that prediction based on history should include three variables: fever, difficulty in swallowing, and cough. For ease of computation, these were consolidated into one score, "history" (= fever history + difficulty in swallowing - cough). This score was used to develop a model that predicts the probability of infection with group A beta-hemolytic streptococcus, and the model's performance was tested in two additional patient groups. The predictive accuracy of the "history" score was confirmed in all patient groups, despite differences in providers and disease prevalences. Primary care physicians may use this model to help them make decisions in situations such as telephone encounters without using additional data.

Adult↗
PubMedDate not supplied

A strategy to improve the utilization of pneumococcal vaccine.

OBJECTIVE: To evaluate the effectiveness of a computerized reminder for pneumococcal vaccination at hospital discharge and to determine patient and physician characteristics associated with increased use of the vaccine. DESIGN: Pre- and postintervention study. SETTING: All medical services in a university teaching hospital. PARTICIPANTS: All patients with at least one indication for pneumococcal vaccination discharged from the hospital during one of two three-month time periods; resident and faculty physicians caring for the same patients. INTERVENTIONS: Incorporation of a predischarge reminder for pneumococcal vaccination in the hospital information system. MEASUREMENTS AND MAIN RESULTS: Of 539 eligible patients discharged during the three months after the intervention, 244 (45%) received the vaccine compared with 16 of 474 (3.4%) before the intervention (p less than 0.0001). Following the intervention, patients discharged with a diagnosis of alcoholism were more likely to receive the vaccine than were those without that diagnosis (58.1% vs. 42.7%, p less than 0.05), while patients with a diagnosis of cancer were less likely to get the vaccine (42 of 130, or 32.3%) than were those without cancer (202 of 409, 49.3%) (p less than 0.01). Patients whose attending physicians specialized in hematology-oncology or cardiology were also less likely to receive the vaccine than were all other patients. With the intervention in place, physicians were more likely to vaccinate patients with more than one indication for pneumococcal vaccine. CONCLUSIONS: 1) A predischarge reminder is an inexpensive, effective method to improve physicians' utilization of pneumococcal vaccine in high-risk patients; 2) additional improvements in pneumococcal vaccine utilization will require selective components directed toward specific diagnoses or attending physician subspecialities.

Aged↗
PubMedDate not supplied

Ensuring health care quality: an AHCPR perspective. Agency for Health Care Policy and Research.

This paper discusses the role of the Agency for Health Care Policy and Research (AHCPR) in identifying and solving problems within the health care industry. It reviews current AHCPR activities and details the results of the Consumer Assessment of Health Plans Survey, the recent poll of how people in the United States make choices about health care. A discussion of present quality measurement tools, such as CONQUEST, a database of existing performance measures, includes an outline of plans for developing new measures of quality and outcomes. Also explored are ideas for improving quality measurements, potential problems and risks, and the public role in health services research.

Government↗
PubMedDate not supplied

Quality and outcomes of care for older women with chronic disease.

This is the fourth in a series of six papers that will be published from the 1999 lecture series on "Quality Assessment in Women's Health Care" held at the University of Michigan School of Public Health. The lectures are presented by leaders in women's health research, and they explore key issues in the definition, measurement, and improvement of quality in women's health services. The series is supported by an unrestricted educational grant from Pfizer Inc. and is presented by the Interdepartmental Concentration in Reproductive and Women's Health at the University of Michigan School of Public Health; the University of Michigan National Center of Excellence in Women's Health; and the Michigan Initiative for Women's Health. The series coordinator is Carol S. Weisman, PhD, and Catherine L. Maroney prepared the summary of the discussants' comments.

Aged↗
PubMedDate not supplied

Gender and patient satisfaction in managed care plans: analysis of the 1999 HEDIS/CAHPS 2.0H Adult Survey.

This paper investigates gender differences in satisfaction, and in the variables associated with satisfaction, using the Consumer Assessment of Health Plans Study (CAHPS) adult questionnaire administered by the National Committee for Quality Assurance (NCQA) as part of HEDIS 1999. Data represent 97,873 men and women enrolled in 206 commercial managed care plans nationwide. Mean plan-level gender differences in satisfaction measures are small, with no consistent pattern of one gender being more satisfied than the other. Controlling for health plan, member, utilization, and selected HEDIS performance indicators, health plan characteristics account for the largest proportion of variance explained in satisfaction. Not-for-profit status and lower turnover of primary care providers are stronger determinants of women's than men's satisfaction. We conclude that it can be useful to analyze CAHPS scores by gender to identify areas for quality improvement in women's health care.

Adolescent↗