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PubMed1980

Evaluating a voluntary second surgical opinion program.

Numerous problem areas were encountered in the evaluation of a voluntary second surgical opinion program. Some problems could be handled only on a conceptual level, while others require for their solution the integration of existing with new data sets. (1) Reliance on program participants to provide medical data was sensitivity tested and found to have minimal impact. (2) Program impact on hospital bed reduction was considered in the context of the total market and political environment in the region, and the anticipated duration of the program. A reasonable judgment was that almost the entire fixed component in the per diem cost of anticipated patient days foregone could be written off as part of the cost savings of the program. (3) As hospital reporting systems identify only average per diem costs, a methodology was developed to separate surgical from nonsurgical case costs. (4) Quality of care evaluation will incorporate a substratum of cases for which there exists a control group within the program user population. Outcome measures obtainable through survey interviews were identified.

Evaluation Studies as Topic↗
PubMed1990

The Pediatric Cardiac Care Consortium: a physician-managed clinical review program.

A voluntary physician-initiated and physician-managed clinical review program for pediatric cardiology uses clinical practice data and expected outcome to influence physicians to change their clinical behavior. The program offers a model for clinical review in situations where disease incidence is relatively low and physician performance is difficult to assess and evaluate. The program's major accomplishment is a collective pooling of data across cardiac centers that allows for statistical analysis and comparison not routinely possible at a single center because of sample size; a forum for comparison of different practice styles; and feedback to participants of actual, in contrast to anecdotal, results. The principles, structure, and format of the program can be applied to other specialty areas.

Cardiac Care Facilities↗
PubMed1986

In California, voluntary mass prenatal screening.

A statewide program in California to detect neural tube and other birth defects may revive enthusiasm for mass prenatal screening. Participation in the program is voluntary, but all expectant mothers are asked to sign a statement of "informed consent/refusal." So far California's program seems to be working well, but questions for the future include the level of participation, the possibility that normal fetuses will be aborted, the kinds of information given to women, and the elusive nature of free choice.

California↗
PubMed2000

Effect of different types of Medicaid managed care on childhood immunization rates.

Medicaid managed care can improve access to prevention services, such as immunization, for low-income children. The authors studied immunization rates for 7,356 children on Medicaid in three managed care programs: primary care case management (PCCM; n = 4,605), a voluntary HMO program (n = 851), and a mandatory HMO program (n = 1,900). Immunization rates (3:3:1 series) in PCCM (78%) exceeded rates in the voluntary HMO program (71%), which in turn exceeded those in the mandatory HMO program (67%). Adjusting for race, urban residence, and gender, compared to children in PCCM, children in the voluntary HMO program were less likely to complete the 3:3:1 series (OR = 0.75, CI = 0.63, 0.90), and children in the mandatory HMO program were even less likely to complete the series (OR = 0.59, CI = 0.51, 0.68). Results differed by individual HMOs. Monitoring of outcomes for all types of managed care by Medicaid agencies is imperative to assure better disease prevention for low-income children.

Child, Preschool↗
PubMed2003

A framework and case study for exposure assessment in the Voluntary Children's Chemical Evaluation Program.

A conceptual framework is presented for conducting exposure assessments under the U.S. EPA's Voluntary Children's Chemical Evaluation Program (VCCEP). The VCCEP is a voluntary program whereby companies that manufacture chemicals of potential concern are asked to conduct hazard, exposure, and risk assessments for the chemicals. The VCCEP is unique in its risk-based, tiered approach, and because it focuses on children and requires a comprehensive consideration of all reasonably foreseeable exposure pathways for a particular chemical. The consideration of all potential exposure pathways for some commonly used chemicals presents a daunting challenge for the exposure assessor. This article presents a framework for managing this complicated process, and illustrates the application of the framework with a hypothetical case study. The framework provides guidance for interpreting multiple sources of exposure information and developing a plausible list of exposure pathways for a chemical. Furthermore, the framework provides a means to process all the available information to eliminate pathways of negligible concern from consideration. Finally, the framework provides guidance for utilizing the tiered approach of VCCEP to efficiently conduct an assessment by first using simple, screening-level approaches and then, if necessary, using more complex, refined exposure assessment methods. The case study provides an illustration of the major concepts.

Adolescent↗
PubMed1998

The demand for health insurance by employees in a voluntary small group insurance program.

OBJECTIVES: This study examined the decisions of small group employees to enroll in prepaid plans offered through Healthcare Group of Arizona (HCGA), a state-sponsored and state-administered voluntary insurance program. METHODS: The study population included 653 potential employee enrollees who were offered the option of two health plans between January 1993 and June 1993, with 447 enrolling in one of the two plans. Data sources included two telephone surveys, HCGA administrative files, and enrollment application forms. RESULTS: The estimates of adjusted price elasticity were in the range of -0.12 to -0.24 for employees with prior insurance and were in the range of -0.42 to -0.51 for employees without prior insurance. The likelihood of enrolling in HCGA increased with log(income) and decreased with log(income) squared. The average income elasticity across income groups was 0.12. CONCLUSIONS: The results indicate that small group employees without prior insurance were more sensitive to the price of health insurance than those with prior insurance. Healthcare Group of Arizona health plans may have been viewed as inferior goods by high income employees possible because of their association with the Medicaid program.

Adult↗
PubMed1997

The early experience of a voluntary small group insurance program utilizing managed care plans.

HealthCare Group of Arizona (HCGA), a state-sponsored, voluntary health insurance purchasing program offering prepaid health plans to small businesses, became operational in 1988. This article summarizes the results from a wide-ranging evaluation of that program and discusses their implications. In general, enrollees were satisfied with their experience in their plans. HCGA did not appear to attract an adverse mix of health risks, and service utilization rates were consistent with HMO industry averages. However, these findings varied across health plans and the marketing approaches they adopted. Enrollment growth in HCGA has been steady, but premium subsidies may be necessary if HCGA is to substantially increase its enrollment of low-wage, uninsured workers.

Adolescent↗
PubMed2003

Voluntary changes in surgery career paths: a survey of the program directors in surgery.

BACKGROUND: This article attempts to quantify the current scope of attrition, identify the reasons why categorical residents are leaving general surgery residency programs voluntarily, and correlate the program directors' and residents' perspectives. STUDY DESIGN: A questionnaire asked the Program Directors of general surgery residency programs how many categorical residents left voluntarily in the 2000-2001 academic year, their postgraduate (PGY) levels, why they left, and where they went. Another questionnaire asked the residents why they entered surgery and why they left. The surveys' responses were compared. RESULTS: A total of 206 programs (81%) responded. One hundred ten programs (53%) reported voluntarily attrition of 167 categorical residents (mean: 0.8 residents per program for all responders and 1.5 residents per program for programs that reported attrition). Seventy-three programs (66%) lost one resident; 23 programs (21%), 2 residents; 9 programs (8%), 3 residents; 4 programs (4%), 4 residents; and 1 program (<1%), 5 residents. Eighty-five PGY-1 residents (51%), 42 PGY-2 residents (25%), 27 PGY-3 residents (16%), and 13 PGY-4 residents (8%) left. The most common reasons for attrition cited by the program directors were personal and work hours/lifestyle in 40% and 35%, respectively. One hundred five residents (63%) entered other fields of medicine; 40 residents transferred to other general surgery programs. Net voluntary attrition, defined as the number of residents who left general surgery voluntarily (127) divided by the resident population at risk, was 3%, indicating that 97% of the residents at risk in the responding programs remained in general surgery. CONCLUSIONS: Most surgery programs that responded were affected by attrition in 2000-2001, with approximately one-third losing more than one resident. Attrition tends to occur early in training. Most residents enter other specialties, primarily for quality-of-life reasons. But many stay in general surgery.

Career Choice↗
PubMed2004

Reduction of acute respiratory illness (ARI) due to a voluntary workplace influenza vaccination program: who are more likely to get the benefit?

The study investigated the overall effectiveness and its determinants of an influenza vaccination in the reduction of acute respiratory illness (ARI) clinic visits and sickness absence for a working population. We collected and compared the data of clinic visits and hours of sick leave among vaccinated and non-vaccinated workers during January and April in 1998 and 1999. A multiple regression analysis was conducted to explore possible determinants. The incidence rate of ARI clinic visits dropped 37.9% in 1999, with 57.3% reduction in vaccinated and 14.1% in un-vaccinated workers. Multiple regression analysis showed that the reduction was significantly associated with vaccination status, a history of diabetes, and occurrence of ARI clinic visits in 1998. Influenza vaccination is effective in reducing ARI clinic visits and sickness absence. Workers with a previous history of ARI, diabetes, and possibly young workers living with children were more likely to get the benefit. The identification of potential susceptible subpopulations can also minimize confusion on company policy for isolation during an epidemic of new infectious disease with flu-like symptoms.

Acute Disease↗