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Biomedical subjects

I Moscovice

Publications and source records attributed to I Moscovice.

51 records · Page 3Linked to original sources
PubMed1980

The influence of values and background on the location decision of nurse practitioners.

The purpose of this study is to examine the influence of the value systems of family nurse practitioners and the background characteristics of family nurse practitioners and their spouses on the decision about location of practice. Information collected from a questionnaire sent to the graduates of the first five classes of the Family Nurse Practitioner Program at the University of Washington revealed that value systems, as measured by the Rokeach Value Survey, did not significantly affect the location decision of the family nurse practitioners, whereas rural background of the family nurse practitioner and spouse did have a major effect. It is concluded that, if we want to encourage family nurse practitioner graduates to practice in rural areas, we need to reevaluate the admissions criteria and training experiences provided by family nurse practitioner programs.

Decision Making↗
PubMed1980

Regionalization in the Veterans Administration health care system: rhetoric and realities.

Criticisms of the Veterans Administration health care system have centered in part on the ability of the system to reallocate resources in response to the changing needs of veterans. VA hospitals use traditional budgeting and planning processes; new programs and projected increases in workload are added to the previous year's budget to yield the budget for the succeeding year. Since these activities occur on an individual institution bases, there is little effort to plan cooperatively between hospitals or to reassess the fundamental allocation of resources based on veteran needs. Over the past two years, the VA has devised a program of regionalized budgeting and planming. The publicity surrounding VA regionalization reflects the idealized potential of shared resources and joint planning within each of the newly created VA medical districts. The reality of the program, however, when examined on a national basis and illustrated by an in-depth study of five hospitals in one district, indicates that there has been little use of resource allocation methodology and that few planning resources have been allocated to this effort. As a result, the district program is a collation of individual hospital budgets, and plans to yield the district budget and plans. Regionalization is unlikely to succeed in any meaningful manner within the VA unless further changes occur in district resource allocation methods.

Age Factors↗
PubMed1980

The National Health Service Corps: rapid growth and uncertain future.

From inauspicious origins in laudable, but vague, legislation and diffident--even disorganized--implementation, the NHSC has evolved into a major federal program for delivering health care to underserved areas. Tying together the financing of medical education and the delivery of health services for the first time could enable responsiveness to both qualitative and quantitative changes in medical care. But competing demands, within the program and its administration, and in the communities to be served, have made evaluation of the NHSC effort and impact difficult, but all the more necessary for future planning.

Efficiency↗
PubMed1980

A comparison of hospital and state agency efficiency in processing medicaid claims in Washington state.

The performance of the Washington State Medicaid agency in processing Medicaid claims was compared with that of hospital providers for one year. We found that the in-hospital processing time was approximately twice that of the Medicaid processing agency. In-agency processing time was found to be significantly related to the size and disposition of a claim, while in-hospital processing time showed a significant relation to hospital dependence on Medicaid reimbursement, the amount of the claim not allowed reimbursement by the Medicaid agency, hospital expense per admission, and the question whether the claim was submitted by the university hospitals. We concluded that lengthy turnaround time for Medicaid reimbursement of hospitals in Washington State was primarily related to hospital speed in submitting claims.

Economics, Hospital↗
PubMed1979

Referral patterns of family physicians in an underserved rural area.

This paper examines the rates and patterns of referral of four family physicians in an underserved rural area of Washington State. The majority of referrals made by the family physicians were for management of a particular problem outside the scope of practice of the physician. The referral rates ranged from 1.8 to 3.2 percent of all patient visits and were comparable with those previously reported. A National Health Service Corps physician had the highest rate of referral and a foreign medical graduate had the lowest rate of referral. These results may be explained by practice building incentives as well as the ability to establish ties with the referral network.

Medically Underserved Area↗
PubMed1978

The influence of training level and practice setting on patterns of primary care provided by nursing personnel.

The influence that the level of training and practice setting have on the patterns of primary care provided by nurses at the Frontier Nursing Service (FNS) is assessed. The Frontier Nursing Service is the only available source the residents of Leslie County, Kentucky have for primary care; it utilizes nurses for the management of approximately 80% of its primary care patients. Patterns of care given by family nurse practitioners and registered nurses at FNS during 1974 were analyzed according to two tracer conditions, otitis media and urinary tract infection. Data were obtained from the encounter forms that are filled out for all primary care visits to FNS. Computerized routines were developed to group the relevant encounters into episodes of care for the two tracer conditions. Results indicate that the practice setting, rather than the level of training, has the strongest effect on the patterns of primary care rendered by nurses in a rural environment such as FNS.

Anti-Bacterial Agents↗
PubMed1977

A method for analyzing resource use in ambulatory care settings.

The major objective of this research is to develop a methodological framework to help analyze the use of resources in ambulatory care environments. Emphasis is placed on trying to understand reasons for variation in treatment patterns. Important methodological considerations include: 1) the selection of a set of medical problems appropriate for evaluating the interaction effects of the variables being considered; 2) the development of problem-specific computerized routines for defining episodes of care based on patient visit information; and 3) the selection of appropriate measures of utilization. The Frontier Nursing Service (FNS) was used as a study setting. FNS is a primary health care service and training center located in Leslie County in eastern Kentucky. an area that covers 1,000 square miles with a population of approximately 15,000. The analysis indicates that for common primary care problems, the level of provider training as well as accessibility of services significantly influence patterns of care.

Ambulatory Care↗
PubMedDate not supplied

Expanding rural managed care: enrollment patterns and prospects.

This paper synthesizes national data on rural HMO enrollment in commercial plans, Medicaid HMOs and prepaid plans, and Medicare risk-based plans. Although most rural counties now are included in the service area of at least one commercial HMO, rural HMO enrollment rates are still very low. The expansion of HMO capacity to serve rural enrollees, the continued implementation of Medicaid waivers, and the recent passage of the Balanced Budget Act of 1997 with substantial Medicare program revisions suggest increased rural managed care enrollment in the future.

Data Collection↗
PubMedDate not supplied

Rural health care: an American perspective.

Over the past five years, the authors have researched various aspects of health care in rural communities in the United States. Interviews were conducted with some 100 rural physicians and hospital administrators, 75 hospital governing board members, and other rural community leaders. The difficulties of maintaining reasonable access to health services in rural communities are discussed, as are the strategies for rural health care used by policy makers and hospital governing boards.

Community Health Services↗