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Biomedical subjects

T T Wan

Publications and source records attributed to T T Wan.

At least 37 records · Page 2Linked to original sources
PubMed1992

Longitudinal analysis of patient satisfaction among Medicare beneficiaries in different models of health maintenance organizations and fee-for-service care.

Based on a randomly selected nationwide sample of Medicare beneficiaries, this study analyzes changes in patient satisfaction over a one year period for beneficiaries receiving care in a variety of delivery settings: fee for service, group model HMO, staff model HMO, and Independent Practice Association model HMO. The findings reveal the patient satisfaction changes significantly over a one year period, from lower levels of satisfaction to higher levels of satisfaction. The primary explanation for this change in satisfaction is a decline in health status over the same one year period. Additional differences in satisfaction with care were observed for Medicare beneficiaries served by different types of delivery settings with varying degrees of utilization controls.

Aged↗
PubMed1991

Determinants of psychiatric rehospitalization: a social area analysis.

The purpose of this paper is to develop an analytic framework and methodology for estimating the demand for psychiatric hospitalization in state facilities, either new admissions or readmissions of clients from the Community Services Boards (CSBs) of Virginia. The combination of community and organizational factors with inpatient characteristics for the CSBs can help identify pertinent predictors of psychiatric hospitalization. Review of the literature on psychiatric epidemiology shows that the predictors of psychiatric hospitalization can be classified into four major dimensions including community resources, socio-demographic factors, CSB client characteristics, and CSB organizational factors. It is postulated that the rates of first admissions and readmissions to state facilities are influenced by four dimensions. Furthermore, the variation in readmissions rates is contingent upon previous first admission rates and the average length of stays in state institutions while other conditions-such as community resources and demographics, CSB client mix, and CSB organizational factors-are simultaneously considered. The data were compiled from multiple sources. A path analytic model, using a linear structural relations program (LISREL VI), was validated. After the model was carefully fitted, the estimation equations for the rates of first admissions and readmissions were finalized. The estimates for psychiatric hospitalization, both first- and re-admissions, were made for each of the study CSBs.

Health Services Accessibility↗
PubMed1991

Assessing the impacts of community-based health care policies and programs for older adults.

This article presents a framework for evaluating long-term care policies and programs to determine how well community-based programs benefit the older adult population. Equity, accessibility, quality, and efficiency are identified as core criteria for implementing and evaluating long-term care policy. Special problems with conducting process and/or outcome evaluation of community-based programs are noted, and findings of evaluation research on community-based health care programs are reviewed. Most previous research indicates that community-based health programs for older adults are not a substitute for institutional care and do not reduce either informal caregiving or ambulatory medical services. The article concludes with policy implications.

Aged↗
PubMed1991

Modeling organizational determinants of hospital mortality.

This study examines hospital characteristics that affect the differential in hospital mortality. Death rates for 1984 Medicare inpatients in acute care hospitals, released by the Health Care Financing Administration in 1986, were analyzed. A confirmatory statistical approach to organizational determinants of hospital mortality was formulated and validated through an empirical examination of 239 hospitals. The findings suggest that the effect of hospital size and specialization on mortality was a spurious one when the effects of other variables were simultaneously controlled. A positive association existed between service intensity and hospital mortality: the more hospital services consumed, the higher the mortality rate. Community attributes accounted for more variance in hospital mortality rates than did organizational attributes. The organizational and community factors studied explained 27 percent of the total variance in hospital mortality.

Catchment Area, Health↗
PubMed1989

Patient satisfaction among elderly enrollees and disenrollees in Medicare health maintenance organizations. Results from the National Medicare Competition Evaluation.

More than 1 million Medicare beneficiaries have enrolled in health maintenance organizations (HMOs) and competitive medical plans under a new program in which beneficiaries can freely enroll in a risk-based HMO in their area or remain in the fee-for-service sector under Medicare. Based on a randomly selected nationwide sample of beneficiaries, we analyzed differences in patient satisfaction between 2091 beneficiaries who were continuously enrolled in an HMO plan for 1 year and 1000 beneficiaries in the fee-for-service sector. We also studied the reasons for disenrollment. No significant difference in overall satisfaction was found between HMO enrollees and fee-for-service beneficiaries. However, HMO enrollees expressed less satisfaction compared with fee-for-service beneficiaries regarding the professional competence of their health care providers and the willingness of the HMO staff to discuss problems. On the other hand, HMO enrollees were more satisfied than fee-for-service beneficiaries with waiting times and claims processing. Approximately half of the disenrollment from an HMO within 1 year was attributed to misunderstanding the terms of enrollment.

Consumer Behavior↗
PubMed1989

The effect of managed care on health services use by dually eligible elders.

This study examined the effect of a managed-care demonstration program on use of health services by a dually eligible elderly population. Our analysis of utilization data generated from a survey of Medicaid-Medicare beneficiaries in two California counties revealed that utilization behavior of the two study groups did not differ significantly, with two exceptions. The beneficiaries in the demonstration group made more frequent visits to community health clinics and had longer stays in hospitals for medical procedures than did those in the comparison group. In modeling the determinants of health services use, we found that the relationship between ambulatory physician visits and hospitalization of the elderly was complementary rather than substitutive.

Aged↗
PubMed1989

Ambulatory care use among the noninstitutionalized elderly. A causal model.

While it is recognized that need for care is the dominant factor influencing utilization of health services, little is known regarding the determinants of ambulatory care use by the noninstitutionalized elderly. It is important to examine the relationships among need factors and how physical and mental dysfunctions influence use of services. This study uses a LISREL model to identify the extent to which ambulatory care use was affected by physical or mental functioning and whether strong linkages would be exhibited by both factors.

Aged↗
PubMed1986

Socio-medical determinants of hospital utilization in Quebec, Canada, 1970-1975.

The relationship between ambulatory physician use and hospitalization was studied using aggregate data in the Province of Quebec, Canada. The analysis showed that the introduction of health insurance covering physician services had a negligible influence on hospitalization. The average length of short-term hospital stays was determined by the proportion of aged population, the proportion of English speaking persons, and the prior level of hospitalization in the medical market areas. Overall, hospital discharge rates remained very constant during the period of six years (1970-1975). There were, however, reductions in hospitalization for infectious diseases, diseases of the blood and blood-forming organs, respiratory diseases, and diseases of the skin and subcutaneous tissue, and increases in the hospitalization rates for neoplasms, circulatory system disorders, musculoskeletal conditions, congenital anomalies, and perinatal morbidity and mortality.

Adult↗
PubMed1983

Indicators for planning of health services: assessing impacts of social and health care factors on population health.

Community health planning requires identification of the level of access to care and factors which affect the differentials in use of health services. In formulating strategies or alternatives for planning, some assessment of the current level or patterns of health services must be made. It is this element of the planning process that is addressed in this paper. In this study sixty-five specifically designated areas (medical market areas) in the Province of Quebec, Canada were selected. The analysis was performed using data obtained from a large scale study of physicians' responses to the introduction of universal medical care insurance in Quebec. Our analysis offered an opportunity to observe the impact of Medicare on access to care for those thought to be underserved.

Catchment Area, Health↗
PubMed1983

The accuracy of prognostic judgments of elderly long-term care patients.

Health care professionals' ability to make accurate prognostic judgments for long-term care patients was tested in a study employing quarterly assessments and prognoses for more than 700 patients. Prognoses were made for patients to 'improve', 'decline', or 'remain the same', in physical functioning ability for the next 90 days, after which reassessments took place. Despite substantial information on their patients, these teams of physicians, nurses, physical therapists, and social workers were not very accurate in making prognoses. They were right only about half the time. In general, they tended to be too optimistic. The study has profound implications for policy makers considering reimbursement on the basis of performance related to patient outcome goals. The goals are not likely to have much validity. Health care professionals may also be disturbed by the poor rate of correct guesses about patients' future courses of recovery.

Aged↗
PubMed1983

Care for the chronically ill: nursing home incentive payment experience.

Nursing home reimbursement systems which do not adjust payment levels to patient care needs lead to access problems for heavy-care patients. Unnecessarily long and costly hospital stays may result. A patient-based nursing home incentive reimbursement system has been designed and is being evaluated in a controlled field experiment in 36 California skilled nursing facilities. Incentives are paid for admitting heavy-care patients, meeting outcome goals on some patients, and discharging and maintaining some patients in the community. This article describes a nursing home reimbursement system which is intended to simultaneously mitigate problems of restricted access, inefficient use of beds, and nonoptimal care. It also discusses the approach to evaluating this broad social intervention by application of a controlled experimental design.

California↗
PubMed1982

Use of health services by the elderly in low-income communities.

Although it is generally assumed that there has been a narrowing of the gap in health care between poor and nonpoor families, the relative contributions of improved fiscal and geographic access are not well documented. Almost 2,000 elderly poor persons were studied to examine factors affecting their use of health services. A number of personal and structural problems are identified when cultural and ethnic backgrounds are considered.

Black or African American↗