Biomedical subjects

J Zapka

Publications and source records attributed to J Zapka.

23 records · Page 2Linked to original sources

PubMed1979

Self care for colds: a cost-effective alternative to upper respiratory infection management.

A Cold Self-Care (CSC) Center was established in a prepaid ambulatory care setting serving 21,500 subscribers and their dependents. After CSC establishment, a decrease in visits to practitioners for common colds was demonstrated. The operating cost ratio of an outpatient visit as compared to a CSC visit was 14.7/1. Savings over a two-year period are estimated at over $46,000, representing an average estimated ratio of $.09 cost per dollar saved per member per year.

Activities of Daily Living↗

PubMed1976

Medical self-care programs.

Self-care has its roots outside of the traditional or formal medical delivery system. However, as potential advantages of such efforts are considered, self-care projects are increasingly being integrated within the delivery system. The authors comment on the rationale behind the self-care movement, report examples of successful models and discuss planning, organization and implementation issues pertinent to the development of a cost-effective, targeted program.

Activities of Daily Living↗

PubMedDate not supplied

Using patient reports to measure health care system performance.

We developed a self-administered patient questionnaire that asks for data concerning the time to receive services (access to care), communication between providers (coordination of care), and follow up after tests and treatment (continuity of care). From these data, we construct rates of performance about the clinical management systems that support provision of these services. Rates of system performance are calculated for indicators using patients' responses to survey questions. These indicators add the number of patients reporting a problem of those patients who have encountered a particular clinical management system. Information derived from 3000 patient questionnaires is matched with data abstracted from health care medical records. The sensitivity and specificity of patient reports are being evaluated for all indicators classified as gold standards for medical records. Indicators considered gold standard items for patient reports are matched for agreement with any information contained in the medical record. Also, patient characteristics associated with accurate reporting is to be assessed using multivariate logistic regression models.

Algorithms↗

PubMedDate not supplied

Colorectal cancer screening in Massachusetts: measuring compliance with current guidelines.

CONTEXT: Professional organizations have published guidelines for colorectal cancer screening. Defining which patients are currently, or should be, screened is an important clinical and public health issue. OBJECTIVE: To document the prevalence of colorectal cancer screening and profile the tests patients have had. DESIGN/POPULATION: A random-digit telephone survey of Massachusetts adults, 50 years of age and older. OUTCOME MEASURES: Percentage of persons ever and currently tested by fecal occult blood tests, flexible sigmoidoscopy, barium enema, colonoscopy, or some combination of these tests. RESULTS: Sixty-five percent of those contacted agreed to the telephone interview. Approximately 29% of the 1119 respondents had never had any currently accepted test, including 10% who reported having only a fecal occult blood test done in a provider's office and 19% who reported having no tests. At least 51% were currently tested by one or more tests for screening, diagnosis, or both. Another 10% were possibly current by colonoscopy or barium enema, both of which can be ordered for screening but are more commonly used to evaluate a problem, such as rectal bleeding, or for surveillance after identification of a polyp or other abnormality. An additional 11% had been tested at some point but were not current according to guidelines. CONCLUSIONS: Accurate assessment of rates of colorectal cancer screening is complex because of the multiple acceptable screening methods, the fact that patients may be tested for screening or diagnostic purposes, and the lack of adequate systems for tracking such testing. For accurate measurement, all methods must be assessed regardless of whether tests were ordered for screening, diagnosis, or surveillance.

Barium Sulfate↗

PubMedDate not supplied

The effect of Medicare reimbursement for screening mammography on utilization and payment. National Cancer Institute Breast Cancer Screening Consortium.

OBJECTIVE: In January 1991, Medicare extended its mammography benefit to reimburse for breast cancer screening mammograms. In 1991 and again in 1993, the National Cancer Institute Breast Cancer Screening Consortium (BCSC) conducted a survey to test the hypothesis that this benefit would increase mammography use among women over the age of 65. METHODS: The authors analyzed data on non-Hispanic white women ages 65 to 74 living in 11 geographic areas targeted by the BCSC for an earlier study--six that had received cancer screening educational interventions and five control subsites--to measure the impact of the newly adopted Medicare benefit on the use of mammography and use of Medicare to reimburse mammography costs. RESULTS: The data show little overall increase between 1991 and 1993 in reported mammography use among respondents to the survey. However, in six intervention and five control subsites there was an increase in the percentage of women who reported using public payment sources to at least partially reimburse the cost of mammograms. In three intervention subsites, the increase from 1991 to 1993 in the percentage of women using public sources of payment was greater than in the corresponding control subsites. CONCLUSIONS: These findings suggest that public health interventions are more likely to succeed when educational promotion accompanies a financial benefit.

Aged↗