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Biomedical subjects

C Sennett

Publications and source records attributed to C Sennett.

At least 19 recordsLinked to original sources
PubMed2001

Mammography utilization among california women age 40-49 in a managed care environment.

OBJECTIVE: To examine the utilization of screening mammography and the relationship between risk factors and mammography use in women age 40-49 in a managed care environment. DESIGN: Retrospective observational study based on a mailed survey. SETTING: A large HMO in California. PATIENTS/PARTICIPANTS: The study population included respondents age 40-49 who completed a breast health assessment questionnaire mailed to all women age 34-49 and enrolled in a California HMO in early 1997. MAIN RESULTS: About 67.6% of the 20,391 women age 40-49 had at least one mammogram during 1995 and 1996. Logistic regression revealed that women age 40-44 were less likely (odds ratio: 0.83-0.90) than women age 45-49 to obtain mammography. Family history of breast cancer (odds ratio: 1.12-1.16), breast biopsy (odds ratio: 1.14-1.18), and a mammogram in the previous three years (odds ratio: 1.15-1.18) were associated with an increased likelihood of taking a mammogram. However, monthly breast self-exams (odds ratio: 0.996-1.04), having a child at or after age 30 (odds ratio: 0.97-1.02), and having menarche at age 12 or younger (odds ratio: 0.96-1.01) had no significant effect on the screening mammography rates. CONCLUSION: A relatively higher percentage of younger HMO members receive screening mammography than that of general population. However, some higher-risk groups, especially women whose first pregnancies were late in life, do not show a higher rate of using mammography.

Adult↗
PubMed2001

Improving the quality of care of patients with asthma: the example of patients with severely symptomatic disease.

The increasing economic burden of asthma care is incurred partly by patients with more severe symptoms. However, little is known about the characteristics of these severe asthma patients. This study examined sociodemographic, disease-specific characteristics and health care utilization that are related to asthma disease severity, for the purpose of identifying areas for treatment improvement. A total of 2927 asthma patients (12 years or older), who were continuously enrolled in one of three participating health plans for a 6-month study period and who responded to an asthma survey, were included in the study. Univariate and multivariate analyses were performed to examine the sociodemographic, disease-specific characteristics and health care utilization by asthma severity. About 25% of the patients reported experiencing severe asthma symptoms. They were more likely to be African-Americans, Hispanics, women, patients with less than a college education, residents in the south-west, current smokers, and those receiving care from non-specialists. Severe asthmatics reported having less of an understanding of the clinical manifestation of asthma and the means to manage asthma exacerbation. Outpatient contacts did not differ significantly between severe and other patients, although their utilization of emergency room and inpatient care was significantly greater. This study suggests that a significant proportion of asthma patients is experiencing severe symptoms and barriers other than access to care prevent appropriate control of asthma. Poor control appears to be related to smoking, deficits in knowledge about self-care, not receiving medical care from a specialist, and inadequate use of medications.

Adolescent↗
PubMed2001

Ambulatory care in the new millennium: the role of consumer information.

The past decade has been marked by extensive change in the organization of health care delivery systems (the "supply side" of health care). There has been relatively less change in the nature of the health care consumer (the "demand side" of health care). The emergence of the Internet as a consumer health care technology, however, should significantly affect the nature of demand. The Internet will prepare health care consumers to better express and evaluate care against their preferences. This will create additional pressure on--but significant positive opportunity for--ambulatory care and ambulatory care providers.

Ambulatory Care↗
PubMed2001

Comparison of prevalence, cost, and outcomes of a combination of salmeterol and fluticasone therapy to common asthma treatments.

OBJECTIVES: To compare a combination of salmeterol and fluticasone with common asthma pharmacologic regimens used in real-world clinical practice, and to evaluate the associated costs and outcomes of care. STUDY DESIGN: Cross-sectional examination of medical and pharmacy claims. METHODS: The study population included 33,939 adult asthmatics (at least 12 years of age) continuously enrolled in 1 of 4 participating health plans for the 6-month study period. Every subject was in 1 of 10 different pharmacotherapy treatment groups. Univariate and multivariate analyses were used to compare the rates and costs of pharmaceutical prescriptions and medical care services between patients on salmeterol plus fluticasone and patients with other pharmacologic therapies. RESULTS: About 60.4% of the patients were on single controllers; the balance was on short-acting beta 2-agonists alone (23%) or double controllers (16.8%). The average overall cost of asthma care was approximately $228 per patient over the 6 months of the study. Pharmaceutical cost was the major cost driver, which was significantly lower for single-controller (mean = $134) than for double-controller therapies (mean = $325). However, total costs were $50-$200 lower (P < .029) for patients on salmeterol plus fluticasone and inhaled steroids plus mast cell stabilizing agents than for those on other double controllers. CONCLUSIONS: Single-controller regimens and short-acting beta-agonists were less costly than double-controller regimens. Within the double-controller groups, salmeterol plus fluticasone appeared to be less costly than other double controllers, except inhaled steroids plus mast cell stabilizing agents.

Adult↗
PubMed2000

Clinical goals and performance measures for cholesterol management in secondary prevention of coronary heart disease.

Guidelines from the National Cholesterol Education Program (NCEP) recommend reduction of low-density lipoprotein cholesterol (LDL-C) to 100 mg/dL (2.59 mmol/L) or less in patients with established coronary heart disease (CHD). However, the National Committee for Quality Assurance (NCQA) is implementing a new performance measure as part of the Health Plan Employer and Data Information Set (HEDIS) that appears to endorse a different target. The new HEDIS measure will require managed care organizations seeking NCQA accreditation to measure and report the percentage of patients who have had major CHD events who achieve LDL-C levels less than 130 mg/dL (3.36 mmol/L) between 60 and 365 days after discharge. These different LDL-C thresholds emphasize the difference between a clinical goal for the management of individual patients (< or =100 mg/dL) and a performance measure used to evaluate the care of a population of patients (<130 mg/dL). This article discusses the rationale for each threshold and explains the use of 2 different thresholds for these 2 purposes. Both the NCQA and NCEP expect that the new HEDIS measure will encourage managed care organizations to develop systems that improve secondary prevention of CHD.

Adult↗
PubMed2000

Impact of sociodemographic case mix on the HEDIS measures of health plan quality.

BACKGROUND: The widely used Health Plan Employer Data and Information Set (HEDIS) measures may be affected by differences among plans in sociodemographic characteristics of members. OBJECTIVE: The objective of this study was to estimate effects of geographically linked patient sociodemographic characteristics on differential performance within and among plans on HEDIS measures. RESEARCH DESIGN: Using logistic regression, we modeled associations between age, sex, and residential area characteristics of health plan members and results on HEDIS measures. We then calculated the impact of adjusting for these associations on plan-level measures. SUBJECTS: This study included 92,232 commercially insured members with individual-level HEDIS data and an additional 20,615 members whose geographic distribution was provided. MEASURES: This study used 7 measures of screening and preventive services. RESULTS: Performance was negatively associated with percent receiving public assistance in the local area (6 of 7 measures), percent black (5 measures), and percent Hispanic (2 measures) and positively associated with percent college educated (6 measures), percent urban (2 measures), and percent Asian (1 measure) after controlling for plan and product type. These effects were generally consistent across plans. When measures were adjusted for these characteristics, rates for most plans changed by less than 5 percentage points. The largest change in the difference between plans ranged from 1.5% for retinal exams for people with diabetes to 20.2% for immunization of adolescents. CONCLUSIONS: Performance on quality indicators for individual members is associated with sociodemographic context. Adjustment has little impact on the measured performance of most plans but a substantial impact on a few. Further study with more plans is required to determine the appropriateness and feasibility of adjustment.

Adolescent↗
PubMed2000

Ambulatory care in the new millennium: the role of consumer information.

The past decade has been marked by extensive change in the organization of health care delivery systems (the "supply side" of health care). There has been relatively less change in the nature of the health care consumer (the "demand side" of health care). The emergence of the Internet as a consumer health care technology, however, should significantly affect the nature of demand. The Internet will prepare health care consumers to better express and evaluate care against their preferences. This will create additional pressure on--but significant positive opportunity for--ambulatory care and ambulatory care providers.

Ambulatory Care↗
PubMed2000

Implementing the new HEDIS hypertension performance measure.

There is a problem with blood pressure control in the United States--a problem with significant implications for the health and welfare of the populace. This problem is bigger than managed care, but managed care organizations have both unique opportunities and unique obligations to address it. NCQA has responded to this problem, and to the opportunity for better care implicit in it, by introducing into HEDIS a measure that focuses on hypertension control. This measure will add pressure to health plans to address the problem of hypertension control, but it also will create the opportunity for positive recognition for those plans that succeed. The HEDIS hypertension measure is well grounded in both the science of medicine and the science of measurement. But HEDIS measurement alone will not create change. To effect change will require analysis of the problems that limit the delivery of effective care to patients with hypertension. It will require measurement of the success of the key processes of care upon which effective care depends. And it will require response--rational, focused, and operationally effective. These, in turn, will challenge key managers in health plans. Medical directors will have to influence provider behavior. Pharmacy directors will have to leverage pharmacy resources to support efforts to change provider and enrollee behaviors. And QA directors will have to manage a challenging set of measurement activities, from which plans' efforts to improve will be launched. The next few years will not be easy--demands for improvement increase annually, and resources are every year more scarce. Yet the goal is worth the struggle--to transform an industry that the public perceives to be interested in limiting care into one that the public turns to for assurance that care represents high value. Responding effectively to the HEDIS hypertension measure creates a unique opportunity for managed care--to demonstrate to the public that managed care is leading national efforts to improve quality for 50 million Americans needlessly at risk for heart disease and stroke, and in doing so, to demonstrate its commitment to health maintenance--the very foundation of managed care.

Adolescent↗
PubMed1998

An introduction to the National Committee for Quality Assurance.

The corporations that purchase private health benefits and the public payers, Medicare and Medicaid, are insisting increasingly that managed care plans be publicly accountable for the quality of care and service delivered. NCQA has responded to that demand with programs that assess both the organization and operation of the plan and the results that the plan actually achieves. Although our capacity to evaluate managed care is still incomplete, an increasingly complete picture of quality in managed care is emerging. We see evidence already that the capacity is driving improvement, and we hope that our work will mean that practicing physicians will find themselves better able to deliver the highest quality care possible to children in America.

Child↗
PubMed1998

Measuring health plans' performance in chronic care.

To accurately assess a health plan's ability to care for its chronically ill patients, accreditors must look not only at disease-specific criteria but at the organization's ability to provide and manage care for its entire population, according to Cary Sennett of the National Committee for Quality Assurance.

Chronic Disease↗
PubMed1993

Performance-based hospital contracting for quality improvement.

A carefully negotiated process that ties improvements in performance to additional compensation can align incentives and support efforts to improve care. Such a process needs to be objective, data-driven, and focused on issues that are important both to the purchaser and to the provider.

Consumer Behavior↗
PubMed1991

Utilization management as a cost-containment strategy.

Utilization management (UM) is now an integral part of most public and private health plans. Hospital review, until recently the primary focus of UM, is associated with a reduction in bed days and rate of hospital cost increases. These reductions appear to have had limited impact on aggregate health care costs because of increases in unmanaged services. In the future, with electronic connectivity between payers and providers and the use of clinical guidelines and computer-based decision-support systems, the need for prospective case-level reviews will be reduced. With these changes, UM programs are likely to become more acceptable to providers and patients.

Cost Control↗