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At least 469 records · Page 26Linked to original sources
PubMed2000

Insurance and education determine survival in infantile coarctation of the aorta.

Health outcomes are determined by case severity, physician decisions, and patient variables. In a population-based study between 1981 and 1989, 103 cases of infant coarctation of the aorta were diagnosed before one year of age. The goal of this study was to determine whether patient race, gender, income, and insurance status had effects on outcome of coarctation of the aorta that were distinct from the effect of case severity. Survival of infants with coarctation of the aorta, a common congenital cardiovascular malformation, is associated with greater maternal education and with having any health insurance but not with measures of severity. Infants without health insurance are 12.8 times more likely to die than infants with any health insurance. Fifty-five percent of all deaths in infant coarctation occur prior to surgical treatment. One-third of deaths occur without diagnosis. Outcome measures require knowledge of the entire population and of insurance status to inform policy.

Analysis of Variance↗
PubMedDate not supplied

The accessibility of abortion services in the United States, 2001.

CONTEXT: A woman's ability to obtain an abortion is affected both by the availability of a provider and by access-related factors such as cost, convenience, gestational limits and the provision of early medical abortion services. METHODS: In 2001-2002, The Alan Guttmacher Institute surveyed all known abortion providers in the United States, collecting information on their delivery of abortion services and on the number of abortions performed. RESULTS: A minority of abortion providers offer services before five weeks from the last menstrual period (37%) or after 20 weeks (24% or fewer), but the proportions have increased since 1993. Providers estimate that one-quarter of women having abortions in nonhospital facilities travel 50 miles or more for services, and that 7% are initially unsure of their abortion decision. The majority of providers (59%) say that these clients usually receive abortions during a single visit. An average self-paying client was charged $372 for a surgical abortion at 10 weeks in 2001, up from $319 in 1997; only 26% of clients receive services billed directly to public or private insurance. Early medical abortions are becoming increasingly available but are more expensive than surgical abortions. More than half (56%) of providers experienced antiabortion harassment in 2000, but types of harassment other than picketing have declined since 1996. CONCLUSIONS: Abortion at very early and late gestations and early medical abortion are more available than before, but charges have increased and antiabortion picketing remains at high levels. Thus, many women still face substantial barriers to obtaining an abortion.

Abortifacient Agents, Steroidal↗
PubMed1984

The conversion of claims files to an episode data base: a tool for management and research.

The construction of an episode-of-care file based on utilization data from the insurance claims system of Blue Cross and Blue Shield of North Carolina was undertaken for its subscribers and Medicare beneficiaries, a data base that includes 60% of the hospital days in North Carolina. The conversion was accomplished without interfering with the integrity of the accounting system, and the resulting file provides essential data for management decisions and epidemiological research. Among the uses to which the information in the file can be put are the promotion of ambulatory surgery, the redesign of group insurance benefits by employers, and the support of statewide health planning programs.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Prediction of outcome in cardiac surgery.

There has been growing interest in defining and measuring outcomes for cardiac surgical patients. Outcomes measures have been used in many hospitals as tools for measuring the quality of care, although it is difficult to infer from them how care might be improved. Traditionally, the major outcome endpoints used in cardiac surgery have been the 30-day mortality and morbidity rates. Recently, more innovative intermediate outcomes, including health-related quality of life, functional status, and patient satisfaction 6 months to one year after surgery, have received more attention. A significant proportion of the variance in health care outcomes is affected by patient-related risk factors. By using outcome prediction tools and making conclusions based on preoperative risk factor information, surgeons and anesthesiologists are able to make better decisions about treatment strategies. Additionally, operating room and intensive care unit personnel can use these data to schedule cases and allocate resources more efficiently. These data are also very important for hospital administrators and insurance providers.

Cardiac Surgical Procedures↗
PubMed2004

The state of ED on-call coverage in California.

The ED provides initial treatment, but failure of specialists to respond unravels the safety net. To assess the scope of problems with on-call physicians in California. A mailed anonymous survey to all CAL/ACEP physician members (1876) asking patient, physician and ED demographics, specialist availability for consultation, insurance profile, and availability of follow-up care. 608/1876 physicians responded (32.4%), representing 320/353 California EDs (90.6%). The seven specialties in which the greatest proportion of EDs reported trouble with specialty response were: plastic surgery (37.5%), ENT (35.9%), dentistry (34.9%), psychiatry (26.0%), neurosurgery (22.9%), ophthalmology (18.4%) and orthopedics (18.0%). 71.6% of responder EDs reported that their medical staff rules required ED on-call coverage. However, the percentage of responders who stated that hospitals paid each specialty for call was low: neurosurgery (37.3%), orthopedics (34.4%), ENT (17.9%), plastic surgery (15.1%) and ophthalmology (13.1%). On-call problems were more acute at night (77.2%) or on weekends (72.4%). Patient insurance negatively affected (69.9%) willingness of on-call physicians to consult for at least a quarter of patients. Regarding follow-up, 91% reported some trouble, whereas 64% reported a problem at least half the time. Surgical sub-specialists are the most problematic on-call physicians. Insurance status has a major negative effect on ED and follow-up care. The on-call situation in California has reached crisis proportions.

After-Hours Care↗
PubMed1991

Second opinions and cost-effectiveness: the questions continue.

For nearly 20 years, second surgical opinion programs have been promoted as a means of containing health care costs. Since their introduction, debate has continued over their cost-effectiveness. This article provides a historical perspective of second surgical opinion programs, with a particular emphasis on the federal government's past and current involvement in these programs. Also included are a summary of recent reports on employers' and insurers' involvement in these programs and the College's views on second surgical opinion programs.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1990

Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years.

BACKGROUND: Atrial septal defects have been surgically correctable for more than 30 years. The long-term survival rates among patients treated in the early era of cardiac surgery are poorly documented, but such data are of critical importance to the future medical care, employability, and insurability of these patients. METHODS: To determine the natural history of surgically corrected atrial septal defects, we studied all 123 patients who underwent repair of an isolated defect (ostium secundum or sinus venosus) at the Mayo Clinic between 1956 and 1960, 27 to 32 years after the procedure. The follow-up status of all patients was determined by written questionnaires and telephone interviews. Hospital records and death certificates were obtained if interim hospitalization or death had occurred. RESULTS: The overall 30-year actuarial survival rate among survivors of the perioperative period was 74 percent, as compared with 85 percent among controls matched for age and sex. The perioperative mortality was 3.3 percent (four deaths). Actuarial 27-year survival rates among patients in the younger two quartiles according to age at operation (less than or equal to 11 years and 12 to 24 years) were no different from rates among controls--97 percent and 93 percent, respectively. In the two older quartiles (25 to 41 years and greater than 41 years), 27-year survival rates were significantly less (P less than 0.001)--84 percent and 40 percent, respectively--than in controls (91 and 59 percent). Independent predictors of long-term survival according to multivariate analysis were age at operation (P less than 0.0001) and systolic pressure in the main pulmonary artery before operation (P less than 0.0027). When repair was performed in older patients, late cardiac failure, stroke, and atrial fibrillation were significantly more frequent. CONCLUSIONS: Among patients with surgically repaired atrial septal defects, those operated on before the age of 25 have an excellent prognosis, but older patients require careful, regular supervision.

Actuarial Analysis↗
PubMed1982

The medieval medical third party: compulsory consultation and malpractice insurance.

Medical third-party intervention was a venerable medieval tradition. Fifteenth century London's medical malpractice legislation and court cases contained forms of peer review, compulsory consultation for critical cases, and a malpractice insurance "floater" policy for conditions likely to lead to death, maiming, or accusations of malpractice. A four-part Latin document from 1415 and a few earlier and later manuscript rules demonstrate the role of politics in medical ethics; civil enforcement of surgical guild regulations; and ingenious forms of protection for patient, practitioner, the surgical profession, and the English citizenry. Pairing compulsory consultation with malpractice insurance policies for high-risk cases offers inspiration for alleviating some modern malpractice perils.

Consultants↗
PubMed1999

Possibilities and limitations in the functional use of medical practice profiles.

The first use of medical practice profiles in the Belgian healthcare organization goes back to 1980 with the creation of practice pattern evaluation at the National Institute of Health and Invalidity Insurance (RIZIV). Since then, detailed information on the provision and on the utilization of healthcare has become increasingly important in the planning, budgeting and financing of the nation healthcare. The RIZIV uses practice profiling predominantly as a means to control aberrant prescription (e.g. clinical chemistry, medical imaging, pharmaceuticals) and provision of care (diagnostic tests). In 1991, the Federal Ministry of Health started using data on diagnosis and medical performance for hospital admissions in order to adapt the per diem price and the yearly quotum of admission days attributed to each hospital. At the level of the health insurer (sickness funds) there is growing interest to share the information derived from the extremely detailed patient claims for reimbursement of intramural and ambulatory care. These billing data allow the evaluation of medical care provision per physician, per hospital or provision center and per patient for a given period of time. The lack of specific diagnosis indication restricts mainly the use of these data as medical performance parameter to surgical procedures. The purpose of this profile information for the health insurer is to point to the physician the important medical practice variability in identical clinical situations in order to stimulate the design and implementation of practice guidelines and reduce aberrant differences in practice patterns. The use of medical practice profiles, in close collaboration of insurers and providers is considered extremely valuable as a means to improve the quality of healthcare provision.

Ambulatory Care↗