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Biomedical subjects

J R Lave

Publications and source records attributed to J R Lave.

85 records · Page 5Linked to original sources
PubMed1976

An evaluation of a hospital stay regulatory mechanism.

The results of an evaluation of a predischarge utilization review program [PDUR] for Medicaid Patients are presented. A group of hospitals in Allegheny County, Pennsylvania, participated in this program on a voluntary basis prior to the program's being mandated statewide. All other hospitals in the county experienced retrospective review of Medicaid cases. Our analysis incorporates both types of hospitals in a quasi-experimental design. We found that during the period studied the length of stay of Medicaid patients fell proportionately more than that of the Blue Cross patients in both groups of hospitals; the relative decrease in the length of stay began to occur prior to the introduction of the PDUR program, but no differential effect of the PDUR review process could be demonstrated. The decline in the length of stay was, however, more continuous and smooth in those hospitals participating in the program.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

The 'usual care' of major depression in primary care practice.

OBJECTIVE: To determine how primary care physicians treat patients with major depression in the course of routine practice and the degree to which such practice produces outcomes anticipated with interventions recommended by the Agency for Health Care Policy and Research Depression Guideline Panel. DESIGNS: Prospective cohort study. SETTINGS: Academically affiliated ambulatory family practice centers and internal medicine clinics in urban neighborhoods of Pittsburgh, Pa. PATIENTS: Ninety-two patients who were seen in primary care practices and who met criteria for a current major depression as determined by the Diagnostic Interview Schedule and a psychiatrist's assessment. INTERVENTION: Physicians were informed of the patient's psychiatric diagnosis, and were urged to treat it in whatever manner and for whatever duration they deemed appropriate (ie, with "usual care"). MAIN OUTCOME MEASURES: The treatments that were provided, the patients' clinical course, and the relationship between the type of treatment and clinical course. RESULTS: Health center records indicated that 67 patients (73%) received a depression-specific treatment in the 8 months following study entry. A majority of the total cohort were prescribed an antidepressant drug. Of the 92 patients, 18 (20%) were asymptomatic at 8 months (Hamilton Rating Scale for Depression score, < or = 7). The treatment pattern was not clearly related to the clinical course. CONCLUSIONS: The recovery rates for the patients with major depression who were treated with usual care in routine primary care practices were lower than those anticipated from treatments consistent with the Agency for Health Care Policy and Research guidelines. Further studies of the caregiving elements that influence the effectiveness of depression-specific treatments of patients in primary care settings are needed.

Adult↗
PubMedDate not supplied

Participation in health promotion programs by the rural elderly.

The Health Care Financing Administration (HCFA) funded a series of demonstration programs to learn about the implications of extending coverage for disease prevention/health promotion services to Medicare beneficiaries. This article examines the use of such services by a rural population under this demonstration program. Individuals enrolled in the demonstration were eligible for specific risk reduction interventions. They were enrolled in one of two groups: (1) a hospital-based group in which hospitals were paid a capitated fee for providing all services and (2) a physician-based group in which physicians were paid fee-for-service for providing each service. Chi-square tests of association as well as logistic regression models were used to assess whether eligibility for services, and use of services by those eligible, varied by group and by sociodemographic characteristics. Forty-one percent were eligible for a nutrition program, 11% for smoking cessation, 2% for alcohol counseling, and 7% for dementia/depression evaluations. Participation in the programs varied across the programs and within programs by gender, education, and group assignment. Older rural Americans will use some disease prevention/health promotion services if they are covered by Medicare. Use will be higher among those with more education. Rural beneficiaries are more likely to use preventive services if encouraged to do so by their doctors rather than by hospital-based programs.

Aged↗
PubMedDate not supplied

Mammography and pap smear use by older rural women.

OBJECTIVE: To compare the characteristics of older women who did and did not have screening mammograms and Pap smears during the first two years both services were a Medicare Part B benefit. METHODS: A prospective study was conducted in five rural Pennsylvania counties of 2205 female community-dwelling Medicare Part B beneficiaries who volunteered to participate in a Medicare prevention demonstration project. The baseline health risk appraisal included information on demographics, insurance status, disease history, symptomatology, and functional and cognitive status. These variables were tested for their association with the use of mammography and Pap smear using Medicare utilization claims data from 1991 to 1992. RESULTS: Of 2175 women still alive after three years, 44.6% had had a mammogram and 14.6% had had a Pap smear in either 1991 or 1992. Multivariate logistic regression revealed that women were more likely to have a mammogram if they were younger, were more educated, had supplemental insurance, did not need assistance with activities of daily living, and did not have diabetes or arthritis. Younger, college educated, and non-widowed women were more likely to have Pap smears than women in other categories. CONCLUSIONS: With cost less of a barrier, more aggressive efforts to persuade older women to have mammograms and Pap smears must be developed.

Age Factors↗