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At least 343 records · Page 19Linked to original sources
PubMed1993

Predictors of psychologic distress one year after spinal cord injury.

This study investigated predictors of psychologic distress at 1 year after injury. The brief symptom inventory, a symptom checklist that provides an overall index of distress, was administered to 119 spinal cord-injured patients. All patients had diagnoses of recent, traumatic SCI and had been admitted for initial inpatient rehabilitation between 1985 and 1990. Results showed levels of psychologic distress to be significantly higher 1 year after injury when compared with results obtained on admission and at discharge from the inpatient rehabilitation program. The prevalence rate for elevated distress after injury was 28%. Significant predictors of psychologic distress 1 year after injury included level of distress at admission, neurologic completeness of SCI, type of rehabilitation insurance payor (catastrophic v noncatastrophic), occupational status before SCI and participation status in an inpatient independent living program. A multiple regression model with nine independent variables was specified that explained 63% of the variance in psychologic distress measured after injury.

Adaptation, Psychological↗
PubMed1976

The role of new health practitioners in a prepaid group practice: changes in the distribution of ambulatory care between physician and nonphysician providers of care.

Changes in the distribution of ambulatory care between physicians and new health practitioners (NHP) are examined in the pediatric and adult medicine departments of a prepaid group practice program. The study covers a three-year period during which NHP were extensively introduced to provide a broad range of ambulatory care. The source of data is a routine data information system that utilizes an encounter form to capture a minimal data set on every patient visit, including the provider's statement of diagnosis. Based on these data, changes in staffing are related to changes in workload and content of practice of both physicians and NHP.

Adolescent↗
PubMed2002

Personal choices of health plans by managed care experts.

BACKGROUND: Expert opinion has not been used as a basis for comparing different forms of health insurance, in part because this perspective may not be appropriately sensitive to aspects of care that consumers value. RESEARCH DESIGN: Using a case-control design, managed care experts were surveyed at 17 academic institutions in the United States to determine the type of health plan they chose (fee-for-service, HMO, POS, PPO, or catastrophic). Controls consisted of academicians from other disciplines at these institutions who ostensibly faced the same insurance options. We then compared the choices of physician experts, nonphysician experts and controls using a multinomial logit model that was sensitive to the choice set available at each institution. We also examined the choice behavior of respondents within moderate (< $150,000) and high (> or =$150,000) income levels. RESULTS: Four hundred thirty-seven experts and 465 controls were surveyed and responses were received from 73.7% and 52.7%, respectively. Physician experts were approximately half as likely (14.9%) as controls (26.6%) or nonphysician experts (27.6%) to enroll in HMO plans. In moderate-income households, both physicians (Relative Risk [RR] = 0.42; P <0.01) and nonphysician experts (RR = 0.71; P <0.1) were less likely than controls to opt for an HMO. Experts' propensity to choose HMO coverage varied little with income, whereas controls' propensity changed dramatically between moderate (39.1% in HMOs) and high (14.0% in HMOs) income categories. CONCLUSIONS: The aversion of physician experts, and nonphysician experts with moderate income, to HMO plans may be caused by their stronger distaste for the constraints on choice and access that typically accompany HMO coverage. Alternatively, it may be explained by their superior ability to absorb, understand, and use information about available insurance options. Insights into quality in managed care may also play a role.

Adult↗
PubMed1997

Impact of the Medicare Catastrophic Coverage Act on nursing homes.

The Medicare Catastrophic Coverage Act (MCCA) of 1988 altered eligibility and coverage for skilled nursing facility (SNF) care and changed Medicaid eligibility rules for nursing-home residents. Detailed data on the residents of a for-profit nursing-home chain and Medicare claims for a 1 percent sample of beneficiaries were used to examine the impact of the MCCA on nursing homes. The case mix of nursing-home admissions was scrutinized, specifically for length of stay, discharge disposition, rate of hospitalization, and changes in payer source. Findings revealed that, although the proportion of Medicare-financed nursing-home care increased, as did the case-mix severity of residents during the MCCA period, there was no corollary reduction in hospital use by nursing-home residents.

Diagnosis-Related Groups↗
PubMed1997

Implications of managed care for health systems, clinicians, and patients.

The rhetoric and realities of managed care are easily confused. The rapid growth of managed care in the United States has had many implications for patients, doctors, employers, state and federal programmes, the health insurance industry, major medical institutions, medical research, and vulnerable patient populations. It has restricted patients' choice of doctors and limited access to specialists, reduced the professional autonomy and earnings of doctors, shifted power from the non-profit to the for-profit sectors and from hospitals and doctors to private corporations. It has also raised issues about the future structuring and financing of medical education and research and about practice ethics. However, managed care has also accorded greater prominence to the assessment of patient satisfaction, profiling and monitoring of doctors' work, the use of clinical guidelines and quality assurance procedures and indicated the potential to improve the integration and outcome of care.

Choice Behavior↗