Biomedical subjects

M E Michnich

Publications and source records attributed to M E Michnich.

6 recordsLinked to original sources

PubMed1993

Managed care and cardiac pacing and electrophysiology.

Managed care is having an increasing impact on the administrative and clinical practices of cardiovascular specialists including physicians providing cardiac pacing and electrophysiology services. This article provides an overview of the five key areas where managed care is affecting cardiovascular practices including the following: (1) administrative burdens; (2) competitive/economic pressures; (3) cost/efficiency requirements; (4) interference in the physician-patient relationship; and (5) disruption in physician-physician relationships. The issues associated with each of these areas of concern are discussed in detail with specific examples that are relevant to cardiac pacing and electrophysiology.

Cardiac Pacing, Artificial↗

PubMed1988

Effectiveness of smoking cessation interventions integrated into primary care practice.

Using a complete factorial design, we tested three interventions for smoking cessation in routine primary care practice. The interventions tested were 1) physician counseling, 2) mailed letters and educational materials designed by the National Cancer Institute (NCI), and 3) referral to smoking cessation classes. Thirty-seven family practice physicians at three of Group Health's outpatient facilities participated. Patient participation rates were 95%, and follow-up was complete for 92% of those participating. None of the interventions had any effect on point prevalence of quitting as determined 8-9 months later by self-report. However, the combination of physician counseling and NCI materials doubled the odds of occurrence of significant antismoking behavior (quit, quit and relapse, or cut down) during the ensuing 8-9 months in those individuals receiving that combination. Referral to smoking cessation classes was strikingly ineffective in this setting. Of 369 individuals designated by study design for referral, only 14% even investigated the classes. This compares with a 10% self-referral rate for those persons not designated for referral by our study design. Our results and other recent work suggest that more intensive interventions on multiple occasions based on relapse prevention strategies hold promise for future success in smoking cessation efforts in primary care.

Counseling↗

PubMed1986

Maximizing compliance with hemoccult screening for colon cancer in clinical practice.

A factorial design randomized controlled trial to test several clinically feasible strategies primary-care practitioners may use in routine practice to increase patient participation in occult blood testing for colorectal cancer is reported. Three compliance-enhancing intervention strategies (physician/nurse talk, and/or reminder postcard, and/or reminder phone call) were introduced. Patient health beliefs were examined as compliance predictors. High compliance levels were seen in all intervention groups, with a mean of 89% compared with 68% in controls. An interactive talk by the physician or nurse increased compliance by 12-13%. The reminder postcard was the most effective single intervention. It increased compliance by 24-25%, achieving 92.7% overall compliance, and appeared to be cost-effective. Patient health beliefs were of minimal value in predicting compliance in this study.

Adult↗

PubMed1981

Program evaluation: resource for decision making.

Formal program evaluation is an important resource for health care decision making. It is necessary in situations where traditional organizational evaluative capabilities an no longer meet the requirements of the job at hand.

Decision Making↗

PubMed1978

A new planning methodology to assess the impact of the health care system on health status.

This article summarizes a new methodology recently developed by the Rand Corporation which permits health planners to assess the impact of the local health care system on the health status of the population. The methodology, in algorithm form, should assist health planners in developing objectives and actions related to the occurrence of selected health status indicators and should be amenable to health care interventions. Emphasis has been placed on developing a simplified, approximate analysis that health planners will find both feasible and effective. No detailed mathematic analyses are called for. The data required are, in most instances, readily obtainable. The algorithm is a methodology by which HSAs can investigate determinants of health status, identify breakdowns in the health care system, and specify needed improvements in the system. The goal of these algorithms is to assist HSAs to obtain valid and sufficiently detailed data that will provide a basis for monitoring breakdowns in the health care system and to improve planning decisions aimed at preventing such breakdowns. This should, in turn, affect population health status in the planning area.

Breast Neoplasms↗

PubMedDate not supplied

Changes in Medicare reimbursement for echocardiographic procedures.

Medicare reimbursement for echocardiographic procedures is clouded by the fact that Medicare defines ultrasound services to be "radiologic." As such, a 40% limitation has been imposed in some states. In addition, as a result of the Omnibus Budget Reconciliation Act of 1987, a new radiology fee structure was negotiated with Medicare, without the input of internists and cardiologists, that may significantly affect reimbursement patterns for echocardiographic services. Those who perform and interpret cardiac ultrasound studies are again urged to use the medicine codes (90,000 series) rather than radiology codes (70,000 series).

Abstracting and Indexing↗