Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Data Sources”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 775 records · Page 43Linked to original sources
PubMed1999

Cost-effectiveness of diagnostic strategies for patients with chest pain.

BACKGROUND: Many noninvasive tests exist to determine whether patients should undergo coronary angiography. The routine use of coronary angiography without previous noninvasive testing is typically not advocated. OBJECTIVE: To determine the cost-effectiveness of diagnostic strategies for patients with chest pain. DESIGN: Cost-effectiveness analysis. DATA SOURCES: Published data. TARGET POPULATION: Patients who present with chest pain, have no history of myocardial infarction, and are able to perform an exercise stress test. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTIONS: No testing, exercise electrocardiography, exercise echocardiography, exercise single-photon emission computed tomography (SPECT), and coronary angiography alone. OUTCOME MEASURES: Quality-adjusted life expectancy, lifetime cost, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: The incremental cost-effectiveness ratio of routine coronary angiography compared with exercise echocardiography was $36,400 per quality-adjusted life-year (QALY) saved for 55-year-old men with typical angina. For 55-year-old men with atypical angina, exercise echocardiography compared with exercise electrocardiography cost $41,900 per QALY saved. If adequate exercise echocardiography was not available, exercise SPECT cost $54,800 per QALY saved compared with exercise electrocardiography for these patients. For 55-year-old men with nonspecific chest pain, the incremental cost-effectiveness ratio of exercise electrocardiography compared with no testing was $57,700 per QALY saved. RESULTS OF SENSITIVITY ANALYSIS: On the basis of a probabilistic sensitivity analysis, there is a 75% chance that exercise echocardiography costs less than $50,900 per QALY saved for 55-year-old men with atypical angina. CONCLUSIONS: Exercise electrocardiography or exercise echocardiography resulted in reasonable cost-effectiveness ratios for patients at mild to moderate risk for coronary artery disease in terms of age, sex, and type of chest pain. Coronary angiography without previous noninvasive testing resulted in reasonable cost-effectiveness ratios for patients with a high pretest probability of coronary artery disease.

Adult↗
PubMed1999

Emergency department triage strategies for acute chest pain using creatine kinase-MB and troponin I assays: a cost-effectiveness analysis.

BACKGROUND: Evaluation of acute chest pain is highly variable. OBJECTIVE: To evaluate the cost-effectiveness of strategies using cardiac markers and noninvasive tests for myocardial ischemia. DESIGN: Cost-effectiveness analysis. DATA SOURCES: Prospective data from 1066 patients with chest pain and from the published literature. TARGET POPULATION: Patients admitted with acute chest pain. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTIONS: Creatine kinase (CK)-MB mass assay alone; CK-MB mass assay followed by cardiac troponin I assay if the CK-MB value is normal; CK-MB mass assay followed by troponin I assay if the CK-MB value is normal and electrocardiography shows ischemic changes; both CK-MB mass and troponin I assays; and troponin I assay alone. These strategies were evaluated alone or in combination with early exercise testing. OUTCOME MEASURES: Lifetime cost, life expectancy (in years), and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: For patients 55 to 64 years of age, measurement of CK-MB mass followed by exercise testing in appropriate patients was the most competitive strategy ($43000 per year of life saved). Measurement of CK-MB mass followed by troponin I measurement had an incremental cost-effectiveness ratio of $47400 per year of life saved for patients 65 to 74 years of age; it was also the most cost-effective strategy when early exercise testing could not be performed, CK-MB values were normal, and ischemic changes were seen on electrocardiography. RESULTS OF SENSITIVITY ANALYSIS: Results were influenced by age, probability of myocardial infarction, and medical costs. CONCLUSIONS: Measurement of CK-MB mass plus early exercise testing is a cost-effective initial strategy for younger patients and those with a low to moderate probability of myocardial infarction. Troponin I measurement can be a cost-effective second test in higher-risk subsets of patients if the CK-MB level is normal and early exercise testing is not an option.

Biomarkers↗
PubMed2000

Cost-effectiveness of cholesterol-lowering therapies according to selected patient characteristics.

BACKGROUND: The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) recommends treatment guidelines based on cholesterol level and number of risk factors. OBJECTIVE: To evaluate how the cost-effectiveness ratios of cholesterol-lowering therapies vary according to different risk factors. DESIGN: Cost-effectiveness analysis. DATA SOURCES: Published data. TARGET POPULATION: Women and men 35 to 84 years of age with low-density lipoprotein cholesterol levels of 4.1 mmol/L or greater (> or =160 mg/dL), divided into 240 risk subgroups according to age, sex, and the presence or absence of four coronary heart disease risk factors (smoking status, blood pressure, low-density lipoprotein cholesterol level, and high-density lipoprotein cholesterol level). TIME HORIZON: 30 years. PERSPECTIVE: Societal. INTERVENTIONS: Step I diet, statin therapy, and no preventive treatment for primary and secondary prevention. OUTCOME MEASURES: Incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS: Incremental cost-effectiveness ratios for primary prevention with step I diet ranged from $1900 per quality-adjusted life-year (QALY) gained to $500000 per QALY depending on risk subgroup characteristics. Primary prevention with a statin compared with diet therapy was $54000 per QALY to $1400000 per QALY. Secondary prevention with a statin cost less than $50000 per QALY for all risk subgroups. RESULTS OF SENSITIVITY ANALYSIS: The inclusion of niacin as a primary prevention option resulted in much less favorable incremental cost-effectiveness ratios for primary prevention with a statin (>$500000 per QALY). CONCLUSIONS: Cost-effectiveness of treatment strategies varies significantly when adjusted for age, sex, and the presence or absence of additional risk factors. Primary prevention with a step I diet seems to be cost-effective for most risk subgroups but may not be cost-effective for otherwise healthy young women. Primary prevention with a statin may not be cost-effective for younger men and women with few risk factors, given the option of secondary prevention and of primary prevention in older age ranges. Secondary prevention with a statin seems to be cost-effective for all risk subgroups and is cost-saving in some high-risk subgroups.

Adult↗
PubMed2000

Cost-effectiveness of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor therapy in older patients with myocardial infarction.

BACKGROUND: 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy has proven efficacy in reducing the rate of coronary and cerebrovascular events in patients 75 years of age or younger with a history of myocardial infarction. However, in patients older than 75 years of age, the efficacy and potential cost-effectiveness of statins are unknown. OBJECTIVE: To estimate the incremental cost-effectiveness of statin therapy compared with usual care in patients 75 to 84 years of age with previous myocardial infarction. DESIGN: Cost-effectiveness analysis. DATA SOURCES: Published data from cohort studies. TARGET POPULATION: Patients 75 to 84 years of age with a history of myocardial infarction. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTION: Statin therapy. OUTCOME MEASURES: Life expectancy, quality-adjusted life expectancy, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: The incremental cost-effectiveness of statin therapy compared with usual care in patients 75 to 84 years of age with previous myocardial infarction was $18800 per quality-adjusted life-year (QALY). RESULTS OF SENSITIVITY ANALYSIS: On the basis of a probabilistic sensitivity analysis, there is a 75% chance that statin therapy costs less than $39800 per QALY compared with usual care. If the cost of statin therapy and efficacy of statin therapy at reducing myocardial infarction were set to their most favorable values, statin therapy cost $5400 per QALY; if cost and efficacy were set to their least favorable values, statin therapy cost $97800 per QALY. CONCLUSIONS: The cost-effectiveness ratios of statin therapy in older patients with previous myocardial infarction are reasonable under a wide variety of assumptions about drug efficacy, drug cost, and rates of cardiac and cerebrovascular events. Pending results of randomized, controlled trials of secondary prevention in patients in this age group, statin therapy seems to be as cost-effective as many routinely accepted medical interventions in this setting.

Aged↗
PubMed2004

Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure.

BACKGROUND: Heart failure is a common, costly, and debilitating illness. Resynchronization of ventricular contraction in patients with heart failure improves ejection fraction. The long-term morbidity and costs associated with such cardiac resynchronization therapy remain unclear. OBJECTIVE: To assess the incremental cost-effectiveness of cardiac resynchronization therapy. DESIGN: Markov model with Monte Carlo simulation. Future costs and effects were discounted at 3%. DATA SOURCES: Effects data were obtained from a concurrent systematic review. Health-related quality-of-life and cost data were obtained from publicly available data or from surveys. TARGET POPULATION: Patients with reduced ventricular function and prolonged QRS. TIME HORIZON: Lifetime. PERSPECTIVE: U.S. health care system. INTERVENTIONS: Cardiac resynchronization therapy versus medical therapy. OUTCOME MEASURES: Quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: Medical therapy yielded a median of 2.64 (interquartile range, 2.47 to 2.82) discounted QALYs and a median discounted lifetime cost of 34,400 dollars (interquartile range, 31,100 dollars to 37,700 dollars). Cardiac resynchronization therapy was associated with a median incremental cost of 107,800 dollars(interquartile range, 79,800 dollars to 156,500 dollars) per additional QALY. RESULTS OF SENSITIVITY ANALYSIS: Results were sensitive to changes in several variables, including the relative risk for death or hospitalization. LIMITATIONS: These results apply to patients who meet the inclusion criteria of the currently completed trials. CONCLUSIONS: The incremental cost per QALY for cardiac resynchronization is similar to that of other commonly used interventions but is sensitive to changes in several key variables. Resynchronization therapy should not be considered in patients with comorbid illness that shortens life expectancy.

Cardiac Pacing, Artificial↗
PubMed2005

Empirical anti-Candida therapy among selected patients in the intensive care unit: a cost-effectiveness analysis.

BACKGROUND: Mortality from invasive candidiasis is high. Low culture sensitivity and treatment delay contribute to increased mortality, but nonselective early therapy may result in excess costs and drug resistance. OBJECTIVE: To determine the cost-effectiveness of anti-Candida strategies for high-risk patients in the intensive care unit (ICU). DESIGN: Cost-effectiveness decision model. DATA SOURCES: Published data to 10 May 2005, identified from MEDLINE and Cochrane Library searches, ICU databases, expert estimates, and actual hospital costs. TARGET POPULATION: Patients in the ICU with suspected infection who have not responded to antibacterial therapy. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTIONS: Fluconazole, caspofungin, amphotericin B, or lipid formulation of amphotericin B given as either empirical or culture-based therapy and no anti-Candida therapy. OUTCOME MEASURES: Incremental life expectancy and incremental cost per discounted life-year (DLY) saved. RESULTS OF BASE-CASE ANALYSIS: Ten percent of the target population will have invasive candidiasis. Empirical caspofungin therapy is the most effective strategy but is expensive (295,115 dollars per DLY saved). Empirical fluconazole therapy is the most reasonable strategy (12,593 dollars per DLY saved) and decreases mortality from 44.0% to 30.4% in patients with invasive candidiasis and from 22.4% to 21.0% in the overall target cohort. RESULTS OF SENSITIVITY ANALYSIS: Empirical fluconazole therapy is reasonable for likelihoods of invasive candidiasis greater than 2.5% or fluconazole resistance less than 24.0%. For higher resistance levels, empirical caspofungin therapy is preferred. For low prevalences of invasive candidiasis, culture-based fluconazole is reasonable. For prevalences exceeding 60%, empirical caspofungin therapy is reasonable. For caspofungin to be reasonable at a prevalence of 10%, its cost must be reduced by 58%. LIMITATIONS: Less severe illness and limited use of broad-spectrum antimicrobial agents, typical of smaller hospitals, could result in a lower risk for invasive candidiasis. CONCLUSIONS: In patients in the ICU with suspected infection who have not responded to antibiotic treatment, empirical fluconazole should reduce mortality at an acceptable cost. The use of empirical strategies in low-risk patients is not justified.

Amphotericin B↗
PubMed2007

Incorporating quality of evidence into decision analytic modeling.

Our objective was to illustrate the effects of using stricter standards for the quality of evidence used in decision analytic modeling. We created a simple 10-parameter probabilistic Markov model to estimate the cost-effectiveness of directly observed therapy (DOT) for individuals with newly diagnosed HIV infection. We evaluated quality of evidence on the basis of U.S. Preventive Services Task Force methods, which specified 3 separate domains: study design, internal validity, and external validity. We varied the evidence criteria for each of these domains individually and collectively. We used published research as a source of data only if the quality of the research met specified criteria; otherwise, we specified the parameter by randomly choosing a number from a range within which every number has the same probability of being selected (a uniform distribution). When we did not eliminate poor-quality evidence, DOT improved health 99% of the time and cost less than 100,000 dollars per additional quality-adjusted life-year (QALY) 85% of the time. The confidence ellipse was extremely narrow, suggesting high precision. When we used the most rigorous standards of evidence, we could use fewer than one fifth of the data sources, and DOT improved health only 49% of the time and cost less than 100,000 dollars per additional QALY only 4% of the time. The confidence ellipse became much larger, showing that the results were less precise. We conclude that the results of decision modeling may vary dramatically depending on the stringency of the criteria for selecting evidence to use in the model.

CD4 Lymphocyte Count↗
PubMedDate not supplied

Calcium, phosphorus, and alkaline phosphatase values of elderly subjects.

OBJECTIVE: To determine if significant gender differences existed between subjects 65 years of age and older, with regard to calcium, phosphorus, and alkaline phosphatase levels. DESIGN: A retrospective chart review of laboratory procedures performed in six different physician practices. The data consisted of 178 subjects representing 92 males and 86 females over the age of 65. DATA SOURCES: Patient data were obtained from the charts housed in a cardiac care center. Subjects, with charts preceding them, were referred by a physician to the cardiac center. The laboratory procedures had been performed previously in the laboratories of the referring physicians. MAIN OUTCOME MEASURES: After accounting for variation between laboratories, mean values of calcium, phosphorus, and alkaline phosphatase were examined to establish if a gender difference existed in patients over the age of 65. A blocked analysis of variance (ANOVA) was conducted at the 0.05 significance level. RESULTS: ANOVA analysis yielded significant gender differences for calcium, phosphorus, and alkaline phosphatase (p < 0.05). Females over the age of 65 consistently showed higher levels than males over the age of 65 for all three variables in five of the six laboratories studied. CONCLUSION: A statistically significant difference was found between the mean levels of men and women 65 years of age and older for calcium, inorganic phosphorus, and alkaline phosphatase. Gender and age are important variables to consider when analyzing and interpreting calcium, phosphorus, and acid phosphatase levels.

Aged↗
PubMed1999

[Linking survey data with routine health and accident insurance data].

Data of the social security institutions, although gathered for administrative purposes, provide important information on work-related morbidity. The validity of the data can be improved by linking several data sources and data from questionnaires or medical examinations. Hence, within the framework of the "Cooperative Programme Occupation and Health" (KOPAG) a specific procedure for data linkage was developed. Data linkage was effected via an anonymous social security number on the one hand, and on the other hand a constructed short number using informations on birthday, sex, and the first letter of the surname of the employees. By means of this short number an average 62% of the questionnaires could be linked to the health insurance sickness leave data. Data linkage was particularly successful (85%) under specific advantageous conditions. Data linkage failed in 25% of all cases because the information necessary to construct the short number was obviously wrong. In general, this procedure to link survey data to routine data of the social security proves suitable for use in routine health reporting.

Accidents, Occupational↗
PubMed1999

Enhancing the quality of case studies in health services research.

OBJECTIVE: To provide guidance on improving the quality of case studies in health services research. DATA SOURCES: Secondary data, drawing from previous case study research. RESEARCH DESIGN: Guidance is provided to two audiences: potential case study investigators (eight items) and reviewers of case study proposals (four additional items). PRINCIPAL FINDINGS: The guidance demonstrates that many operational steps can be undertaken to improve the quality of case studies. These steps have been a hallmark of high-quality case studies in related fields but have not necessarily been practiced in health services research. CONCLUSIONS: Given higher-quality case studies, the case study method can become a valuable tool for health services research.

Data Collection↗
PubMed1999

Disparities in prescription drug insurance coverage.

OBJECTIVES: This article examines socioeconomic differences in supplementary insurance for prescription drugs among Canadians aged 15 or older and how the availability of such insurance affects prescription drug use. DATA SOURCE: The data on prescription drug insurance coverage and drug use are from the cross-sectional Health file of the 1996/97 National Population Health Survey (NPHS) conducted by Statistics Canada. The sample size of the population aged 15 or older was 70,884. ANALYTICAL TECHNIQUES: Rates of insurance coverage for prescription drug services were calculated. All summary estimates were age-adjusted using the 1996/97 population of Canada (both sexes). MAIN RESULTS: Among people aged 15 or older, 61% were covered for prescription medications in 1996/97. Sixty-five percent of workers reported coverage, while those who were not working were less likely to have benefits (52%). Only 38% of lower income groups had insurance compared with 74% of the highest income group. Regardless of the number of chronic diseases individuals had, those with drug insurance were more likely to report taking medication.

Adolescent↗
PubMed1999

Health care consequences of falls for seniors.

OBJECTIVES: This article examines falls that caused a serious injury among people aged 65 or older living in private households. Based on an analysis of people followed over a two-year period, it focuses on the association of a fall in 1994/95 with subsequent health care. DATA SOURCE: The data are from the household component of the 1994/95 and 1996/97 cycles of the National Population Health Survey conducted by Statistics Canada. Longitudinal and cross-sectional data are from a sample of 2,081 people aged 65 or older in 1994/95 for whom data were available and who were still alive in 1996/97. An additional 11,282 elderly people in this age group provided cross-sectional data in 1996/97, yielding a total sample of 13,363. ANALYTICAL TECHNIQUES: In addition to descriptive statistics, multivariate analyses were used to study the associations between injurious falls and subsequent entry into care, controlling for selected factors. MAIN RESULTS: After controlling for age, decline in ability to perform activities of daily living, and other factors, the odds of entry into care were three times as high for seniors who reported an injurious fall in 1994/95 as for those who did not.

Accidental Falls↗
PubMed1999

Birth outcome, the social environment and child health.

OBJECTIVES: This article examines the effects of birth outcome and selected social environmental factors on the health of young children. DATA SOURCE: The data are from the 1994/95 National Longitudinal Survey of Children and Youth. Information provided by the biological mothers of 5,888 children younger than age 3 is analyzed. ANALYTICAL TECHNIQUES: The analysis focuses on two measures of child health: the mother's perception of the child's general health and a diagnosis of asthma. Logistic regression was used to estimate the effects of birth outcome and selected social environmental factors on these measures. Birth outcome refers to gestational age and birthweight. Social environmental factors include maternal education, maternal smoking, maternal age at birth of child, family status and household income. MAIN RESULTS: Preterm low birthweight was associated with a higher risk of poor health and asthma among children when all the other selected risk factors were controlled. Poor maternal health and maternal smoking were important risk factors for poor child health. Maternal asthma and low maternal education were significantly associated with childhood asthma.

Asthma↗
PubMed1999

Long working hours and health.

OBJECTIVES: This article examines associations between long working hours, depression and changes in selected health behaviours. Based on an analysis of people followed over a two-year period, the relationship between changes in work hours and changes in health behaviours is explored. DATA SOURCE: The data are from the household longitudinal component of the 1994/95 and 1996/97 cycles of the National Population Health Survey, conducted by Statistics Canada. Results are based on 3,830 adult workers aged 25 to 54 (2,181 men and 1,649 women) who worked 35 hours or more per week throughout the year before their 1994/95 interview. ANALYTICAL TECHNIQUES: Multivariate analyses were used to estimate associations between working hours and depression, and changes in weight, smoking, drinking and exercise, while controlling for potential socioeconomic and work-related confounders such as education, income, occupation, shift work and self-employment. MAIN RESULTS: Women who worked long hours had increased odds of subsequently experiencing depression. Moving from standard to long hours was associated with unhealthy weight gain for men, with an increase in smoking for both men and women, and with an increase in drinking for women. No associations were detected for physical activity.

Adult↗
PubMed1999

Hormone replacement therapy and incident arthritis.

OBJECTIVES: This article provides estimates of the incidence of arthritis between 1994/95 and 1996/97 among women aged 38 or older. It also examines the association between hormone replacement therapy (HRT) and a new diagnosis of arthritis by 1996/97. DATA SOURCE: The data are from the household component of the National Population Health Survey, conducted by Statistics Canada. Results are based on a sample of 2,673 female respondents who reported that they did not have arthritis in 1994/95. This sample, when weighted, represents 4.3 million women. ANALYTICAL TECHNIQUES: Two-year incidence of arthritis was estimated using weighted bivariate frequencies. Associations of arthritis with HRT use and numerous covariates were examined using multivariate logistic regression. MAIN RESULTS: In the two years between 1994/95 and 1996/97, about 8% of women (338,600) aged 38 or older were newly diagnosed with arthritis. The odds of incident arthritis for current HRT users who had used hormones for five years or longer were twice as high as for non-users. These results persisted even after controlling for potential confounders including age, number of medical visits, and body mass index.

Adult↗
PubMed1999

Older drivers--a complex public health issue.

OBJECTIVES: This article provides estimates of the percentage of seniors who are licensed to operate a motor vehicle. It describes the health characteristics of these license holders and reviews research relating to older drivers. DATA SOURCES: The data are from the cross-sectional file of Statistics Canada's 1996/97 National Population Health Survey. The sample size of respondents aged 65 or older was 13,363, weighted to represent 3.4 million individuals. Supplementary data are from the 1991 Survey of Ageing and Independence, also conducted by Statistics Canada, and from Transport Canada. ANALYTICAL TECHNIQUES: The percentages of seniors with a license were calculated by age and sex. Percentages by presence of chronic conditions, disabilities and medication use were age-standardized to control for the increasing prevalence of illness at older ages. MAIN RESULTS: The percentage of seniors who had a driver's license declined with advancing age. The negative association between disability and license holding was pronounced. The percentage of seniors with a driver's license was also relatively low among those with heart disease, arthritis, stroke or cataracts, and among those who reported taking selected medications in the last month.

Accidents, Traffic↗
PubMed2000

Systemic inflammatory pseudotumor, an unusual cause of fever of unknown origin mimicking a malignant lymphomatous process: case-report and review of the literature.

BACKGROUND AND OBJECTIVE: In recent years, a new pathologic condition Eth called inflammatory pseudotumor Eth has been occasionally described to involve many different tissues or organs. However, evidence for systemic involvement is lacking and a review of the topic potentially useful, also considering the clinical features mimicking hematologic malignancies or other clinically relevant conditions. We report a case of systemic inflammatory pseudotumor and review the literature concerning the etiopathogenesis, differential diagnosis and treatment modalities of this particular pathology. DATA SOURCES AND METHODS: The data source for this topic was MEDLINE , searching all fields for inflammatory pseudotumor, inflammatory pseudotumor and lymph node or fever of unknown origin, pertaining to humans, published between 1970 and 1999. RESULTS AND CONCLUSIONS: Inflammatory pseudotumor should be considered in the differential diagnosis of malignant hematologic processes and of fever of unknown origin.

Diagnosis, Differential↗
PubMed2000

Comparing the agreement among alternative models in evaluating HMO efficiency.

OBJECTIVE: To describe the efficiency of HMOs and to test the robustness of these findings across alternative models of efficiency. This study examines whether these models, when constructed in parallel to use the same information, provide researchers with the same insights and identify the same trends. DATA SOURCES: A data set containing 585 HMOs operating from 1985 through 1994. Variables include enrollment, utilization, and financial information compiled primarily from Health Care Investment Analysts, InterStudy HMO Census, and Group Health Association of America. STUDY DESIGN: We compute three estimates of efficiency for each HMO and compare the results in terms of individual performance and industry-wide trends. The estimates are then regressed against measures of case mix, quality, and other factors that may be related to the model estimates. PRINCIPAL FINDINGS: The three models identify similar trends for the HMO industry as a whole; however, they assess the relative technical efficiency of individual firms differently. Thus, these techniques are limited for either benchmarking or setting rates because the firms identified as efficient may be a consequence of model selection rather than actual performance. CONCLUSIONS: The estimation technique to evaluate efficient firms can affect the findings themselves. The implications are relevant not only for HMOs, but for efficiency analyses in general. Concurrence among techniques is no guarantee of accuracy, but it is reassuring; conversely, radically distinct inferences across models can be a warning to temper research conclusions.

Efficiency, Organizational↗