Biomedical subjects

D S Main

Publications and source records attributed to D S Main.

26 records · Page 2Linked to original sources

PubMedDate not supplied

Comparing medical costs by analyzing high-cost cases.

Most of the medical care expenses paid by an entire company are generated by a small percentage of employees. The most expensive employee may have costs 100 to 500 times as much as the typical employee. Instead of comparing average costs, it makes sense to investigate whether employees with unhealthy behaviors are more prone to extreme costs. This article describes methods of comparing the costs of health risk groups by examining the proportion of high-cost employees in each group. The article illustrates the methods using a health claims dataset that compares male smokers, ex-smokers, and nonsmokers.

Adolescent↗

PubMedDate not supplied

Practice style differences between family physicians and internists.

BACKGROUND: Because an estimated 70 percent of all medical care expenditures are generated by physicians, evaluation of specialty practice styles is essential to learn what changes in policies governing physician training, service delivery, and patterns of medical practice would promote cost containment. METHODS: We examined the 1981 and 1985 National Ambulatory Medical Care Survey for seven primary care diagnoses to compare practice style differences between family physicians and internists and to look for changes in family physicians' practice styles between 1981 and 1985. RESULTS: Family physicians referred fewer patients in 1985 and spent 3 to 10.5 minutes less per patient encounter than internists. Clinical laboratory testing, electrocardiogram (ECG) ordering, and radiographic examinations differed significantly between the two groups in 1981 and 1985 for some diagnoses. In 1981, family physicians did Papanicolaou smears 2.2 times more often than internists during general medical examinations; however, in 1985, there was no difference. Between 1981 and 1985, family physicians ordered significantly more laboratory tests and ECGs for some diagnoses but had no change in the number of radiographs ordered or referrals. For six diagnoses, they spent more time with a patient encounter in 1985 than in 1981. CONCLUSIONS: Family physicians and internists appear to be more alike in practice style, but significant differences remain. These differences, as well as changing practice styles of family physicians, have implications for training and health care resource distribution.

Clinical Laboratory Techniques↗

PubMedDate not supplied

Measuring health: guidelines for reliability assessment.

In the area of health measurement, few guidelines exist for the health professional interested in understanding the concept of reliability. Yet, often there is a need to construct, modify, or select a reliable instrument that will satisfy a particular research or clinical need. This article reviews the concept of reliability and presents a few of the more common techniques used to calculate the reliability of health assessment instruments. Practical guidelines for questionnaire construction and administration are also discussed.

Data Collection↗

PubMedDate not supplied

The contraceptive implant and the injectable: a comparison of costs.

A comparison of the relative costs of the injectable contraceptive (depot medroxyprogesterone acetate) and the hormonal implant (Norplant) indicates that the implant is a less costly contraceptive option when it is used for its full five-year lifespan. Over a five-year period, the implant costs $107 annually, compared with $140 per year for the injectable. However, if a woman discontinues the implant before she has used it for at least four years, the injectable becomes the less costly option. Relatively high continuation rates--around 95% annually--are necessary to make the implant the more cost-effective contraceptive method.

Cost-Benefit Analysis↗

PubMedDate not supplied

Measuring physician readiness to change cancer screening: preliminary results.

Our objective was to describe the development and validation of an instrument for measuring physician readiness to change cancer screening and counseling. We designed a cross-sectional survey of primary care physicians. Participants were 745 enrollees in the Copic Insurance Company, a physician liability insurer of more than 80% of Colorado's physicians. A large percentage of physicians do not perceive a need to change their screening patterns for eligible patients in both mammography and Pap tests. Approximately one third of the physicians are contemplating screening more of their patients within the next six months for sigmoidoscopy, clinical skin, and oral cavity exams and counseling more of their patients on skin protection and dietary fat. Few physicians are planning significant changes in cancer screening and counseling within the next month. Scales of readiness to change screening and counseling, as well as an overall readiness-to-change scale, had high internal consistency: .81, .65, .84, for screening, counseling, and overall, respectively. We conclude that readiness to change may be a useful construct for determining if and when physicians may be willing to make behavior changes. Moreover, the assessment of physician readiness to change may facilitate the tailoring of interventions designed to foster physician behavior change and improve patient care.

Attitude of Health Personnel↗

PubMedDate not supplied

Comparison of HIV-risk behaviors and demographics of adolescents tested or not tested for HIV infection.

In a survey of 2,548 adolescents, 11.5 percent reported ever having had the human immunodeficiency virus (HIV) antibody test. Those who had been tested were significantly more likely to be male, black, and to reside in metropolitan areas than those who had not been tested. Tested adolescents were more than three times as likely to report having injected drugs and were more than twice as likely to have had sexual intercourse, had sexual intercourse at earlier ages, and with multiple partners. More than half of adolescents who had been HIV-tested had no reported risks for HIV infection. More than one-quarter of adolescents not tested reported at least one HIV risk factor. These data suggest the importance of discussing the HIV testing and counseling process within any HIV education program directed to adolescents.

Adolescent↗

PubMedDate not supplied

Appropriateness of hospital use by family physicians.

BACKGROUND: Reducing inappropriate hospital admissions could lead to lower total health care costs without compromising the quality of care. Research suggests that a sizeable portion of hospital admissions are inappropriate. Other studies indicate that family physicians use health care resources, including hospitalizations, less often than other primary care physicians. To gain additional insight into family physicians' decisions to admit patients, we performed an exploratory study using the Appropriateness Evaluation Protocol, a validated, clinically based utilization review instrument. METHODS: We assessed admissions by community-based and residency-based family physicians to a single university-affiliated hospital during calendar year 1988. A total of 905 patients were admitted to the hospital by family physicians during the study period. Of these, 889 records had complete data. Each was reviewed for appropriateness of admission. We calculated percentages of inappropriate admissions and used logistic regression to ascertain variables that were significant predictors of inappropriateness. RESULTS: Overall, 5.4 percent of admissions were categorized as inappropriate. Omitting obstetric cases, the rate was 10.5 percent. Inappropriate admissions did not cluster around a small number of diagnoses or diagnosis-related groups. Using logistic regression, we found that urgency of admission, patient insurance status, and residency-based physician admission versus community-based physician admission were significant predictors of inappropriate hospital use. Of the inappropriate admissions, 70 percent were so rated because diagnostic procedures or treatments could have been performed on an outpatient basis. CONCLUSIONS: In contrast with other studies for which physician specialty was not controlled, family physicians less frequently admitted patients inappropriately. Predictors of inappropriateness differed from those found in other studies. Changes in hospital systems, in addition to educational efforts directed toward individual physicians, hold promise as a strategy for reducing inappropriate hospital use.

Adult↗

PubMedDate not supplied

Continuation rates among injectable contraceptive users.

Few published data exist on the ongoing use of depot medroxyprogesterone acetate, the injectable contraceptive. Women who obtained the injectable from Planned Parenthood of the Rocky Mountains between January 1993 and March 1995 were followed to ascertain continuation rates for the method. Of the 5,178 women who received an initial injection, only 57% returned for a second administration; 63% of those who returned for their second injection went on to receive a third. The overall one-year continuation rate was 23%. No significant differences in continuation rates were found based on age, race or payment type.

Adolescent↗