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Biomedical subjects

L C Baker

Publications and source records attributed to L C Baker.

35 records · Page 2Linked to original sources
PubMed1994

Excess cost of emergency department visits for nonurgent care.

After examining data for patients with selected conditions and statistically adjusting for patient, diagnosis, and treatment characteristics, this Data Watch finds that charges for emergency department visits were two to three times more than charges for visits in other settings. Large differences persist when conditions are examined individually and when total episode charges are examined. Based on our findings, a rough estimate of nationwide excess charges is $5-$7 billion for 1993.

Emergency Service, Hospital↗
PubMed1994

What makes young HMO physicians satisfied?

While much attention has been paid to the effect of managed care on patient outcomes and health care costs, little attention has been focused on the ways in which managed care affects the satisfaction of physicians. Examination of the practice and career satisfaction of 189 young physicians practicing in group and staff model HMOs finds high levels of satisfaction. More than 82% are satisfied with their current practice. The most important factor influencing physician satisfaction appears to be the extent of perceived autonomy. Neither the number of hours worked per week nor yearly income were strongly associated with decreases in satisfaction. The fact that minority and female physicians report less satisfaction with some dimensions of practice raises important issues for HMO physicians and managers.

Adult↗
PubMed1993

Preparedness for practice. Young physicians' views of their professional education.

OBJECTIVE: To describe the views of young physicians (younger than age 45 years) regarding the appropriateness of specific aspects of medical training that have often been criticized as inadequate. DESIGN: Proportional analysis of survey data, stratified by medical school type and graduate medical education specialty and adjusted for demographics. SETTING: National sample of 4756 allopathic and osteopathic physicians trained in allopathic residencies representing a variety of practice settings. DEPENDENT VARIABLES: Overall satisfaction with medical training, including medical school through residency and fellowship; satisfaction with preparedness for five aspects of practice and six types of patients; and satisfaction with the amount of time spent in each of six training settings. RESULTS: Eighty percent of young physicians reported that their formal medical training did an excellent or good job of preparing them for medical practice. Much smaller proportions (21% to 78%) reported excellent or good preparation to treat specific conditions or types of patients, and few (3%) reported being well prepared to manage business aspects of practice. Large proportions (35% to 63%) would prefer to have received more training in settings outside of hospitals, including managed care settings (67%). Significant differences in preparedness were observed by type of training; those trained in general and family practice reported better preparedness along many dimensions than did those trained in general internal medicine. CONCLUSIONS: Young physicians generally confirm critiques of medical training noted by scholars and commissions. Health care reform is likely to increase the urgency for remedial action.

Adult↗
PubMed1993

Physician satisfaction under managed care.

Data from a survey of young physicians have been analyzed to study the relationship between practicing medicine under managed care and the levels of perceived professional autonomy, practice satisfaction, and career satisfaction. Although practicing under managed care is associated with lower levels of perceived autonomy in patient selection and time allocation, it is associated with higher levels of perceived autonomy in use of hospital care, tests, and procedures. Specialists associated with managed care perceive more autonomy than generalists. Analyses of physicians' satisfaction with their practices and careers show that practicing under managed care is not uniformly associated with lower levels of satisfaction. Overall, managed care does not seem to have had the deleterious impact on medical practice that was forecast for it.

Attitude of Health Personnel↗
PubMed1993

Twenty-four-hour coverage and workers' compensation insurance.

Workers' compensation insurance provides cash benefits and health care for workers who are injured on the job. This DataWatch considers the costs and benefits of combining the health insurance component of workers' compensation with universal health insurance, creating a twenty-four-hour coverage plan. The paper documents a large potential savings from twenty-four-hour coverage: Workers' compensation medical charges are about twice as high as those for comparable off-work injuries. This disparity seems to result from price discrimination and lack of cost controls in workers' compensation. Twenty-four-hour coverage, however, may be difficult to implement.

Humans↗
PubMed1991

The effects of family functioning on infant birthweight.

A prospective cohort study was undertaken to evaluate the relationship of family functioning to infant birthweight adjusted for length of gestation. The mother's perception of family functioning was assessed at the initial prenatal visit using the Family Adaptability and Cohesion Evaluation Scales (FACES II). All obstetric patients at four family medicine clinics from April 1984 through April 1987 whose initial prenatal visits occurred by the 28th week of gestation were invited to participate; 95% chose to do so. Information was obtained on 833 mother-infant pairs. Listwise deletion on any one variable reduced the sample to 772 with no apparent bias in the dependent or predetermined variables. Twelve percent of the families were considered to be dysfunctional by scoring on the extremes of both the cohesion and adaptability continua of the self-report FACES II questionnaire. Infant birthweight was regressed on length of gestation and other known biomedical, anthropometric, risk-behavior, and sociodemographic determinants, as well as family functioning. Women who perceived their families as dysfunctional were delivered of infants who weighed on the average 126.4 g (95% CI 37.4, 215.4) less than infants born to women from functional families (P = .0055), after adjusting for other known determinants. Family functioning also was found to modify the effects of prepregnancy weight and infant sex on infant birthweight.

Birth Weight↗
PubMed1991

The effects of maternal smoking on infant birth weight.

A prospective cohort study was designed to examine the independent effects of maternal smoking on infant birth weight adjusted for length of gestation. Obstetrical patients were enrolled from four university based family practice clinics; 772 mother-infant pairs were included in the final analyses. A multiple regression analysis found 53% of the variance in infant birth weight to be explained by length of gestation, race, pre-pregnancy weight, weight gain, gender of the infant, highest systolic blood pressure, and smoking. After adjusting for the effects of other independent variables, women who were self-reported smokers delivered infants who weighed 141.8 g less, on the average, than infants of nonsmoking mothers. Women who smoked fewer than 10, 10-19, or 20+ cigarettes per day delivered infants weighing 96 g, 183 g, and 200 g less, respectively, than infants born to nonsmokers, a clear dose-response effect among relatively low-risk obstetrical patients in a primary care setting. Multiple regression analysis within each smoking group found the effect of length of gestation upon infant birth weight to be markedly reduced among the heavy smokers; this indicates a strong association between heavy (one pack a day) smoking and infant birth weight adjusted for length of gestation.

Birth Weight↗
PubMed1986

The relationship between family functioning, life events, family structure, and the outcome of pregnancy.

A prospective study was undertaken to evaluate the relationship of family functioning, family structure, and life events with pregnancy outcome. Family functioning was assessed utilizing the Family Adaptability and Cohesion Evaluation Scales (FACES) and the Family APGAR. One hundred twenty-five infants were delivered with a mean birth weight of 3,283 g and a mean gestational age of 281.2 days. Listwise deletion of missing data reduced the study sample to 102 mother-infant pairs with no bias in the dependent or predetermined variables in the subsample. Birth weight was regressed on medical, anthropometric, risk-behavior, sociodemographic, and life-events variables, which together explained 42 percent of the variance. Family functioning was found to contribute an additional 7 percent of the variance (adjusted R2 = 0.49). Family structure accounted for 4.5 percent of the variance in birth weight, and life events added 5 percent. As a complementary analysis, infant birth weight was regressed on the medical, anthropometric, sociodemographic, risk-behavior, and life-events variables, and the residuals from this equation were then regressed on the measures of family functioning. Again, abnormal family functioning proved to be a powerful and significant contributor to the explained variance.

Adult↗
PubMedDate not supplied

Managed care and technology diffusion: the case of MRI.

A growing body of evidence suggests that managed care can reduce overall health care costs but provides little insight into how this could happen. One possibility is that managed care influences the adoption of new medical technologies. In examining the relationship between health maintenance organization (HMO) activity and market-level availability and use of magnetic resonance imaging (MRI), we find that high HMO market share is associated with low levels of MRI availability and use. This suggests that managed care may be able to reduce health care costs by influencing the adoption and use of new medical equipment and technologies.

Diffusion of Innovation↗
PubMedDate not supplied

Physicians' perceptions of autonomy and satisfaction in California.

This study compares levels of satisfaction and autonomy among California physicians using data from a 1991 survey of physicians and a 1996 survey of California physicians. The surveys measured physicians' perceived freedom to undertake eight common activities that may be threatened by marketplace changes, satisfaction with current practice, and inclination to attend medical school again. Young physicians in 1996 were significantly less likely to report that they were able to spend enough time on the eight identified patient-care activities. They also were significantly less satisfied with their current practice and less likely to say that they would go to medical school again. Satisfaction also declined for older physicians between 1991 and 1996.

Adult↗
PubMedDate not supplied

HMO market penetration and costs of employer-sponsored health plans.

Using two employer surveys, we evaluate the role of increased health maintenance organization (HMO) market share in containing costs of employer-sponsored coverage. Total costs for employer health plans are about 10 percent lower in markets in which HMOs' market share is above 45 percent than they are in markets with HMO enrollments of below 25 percent. This is the result of lower premiums for HMOs than for non-HMO plans, as well as the competitive effect of HMOs that leads to lower non-HMO premiums for employers that continue to offer these benefits. Slower growth in premiums in areas with high HMO enrollments suggests that expanded HMO market share may also lower the long-run growth in costs.

Economic Competition↗