MEDICAL CARE UTILIZATION IN TIME AMONG ELDERLY MEDICARE ENROLLEES IN AN HMO

Investigation into the medical care utilization of elderly Medicare enrollees in an HMO (Kaiser - Portland, Oregon): The specific research topics are: (1) The utilization of medical care by selected determinants such as: place of service, type of service, type of appointment, physician status, physician specialty and number of associated morbidities. (2) The attended prevalence of 3 chronic diseases: hypertension, diabetes and arthritis in addition to pneumonias as an example of acute diseases. The selection of these examples was based on their importance in morbidity/or mortality results among the elderly. The share of these diseases in outpatient and inpatient contacts was examined as an example of the relation between morbidity and medical care utilization. (3) The tendency of individual utilization patterns to persist in subsequent time periods. The concept of contagion or proneness was studied in a period of 2 years. Fitting the negative binomial and the Poisson distributions was applied to the utilization in the 2nd year conditional on that in the 1st year as regards outpatient and inpatient contacts.^ The present research is based on a longitudinal study of 20% random sample of elderly Medicare enrollees. The sample size is 1683 individuals during the period from August 1980-December 1982.^ The results of the research were: (1) The distribution of contacts by selected determinants did not reveal a consistent pattern between sexes and age groups. (2) The attended prevalence of hypertension and arthritis showed excess prevalence among females. For diabetes and pneumonias no female excess was noticed. Consistent increased prevalence with increasing age was not detected.^ There were important findings pertaining to the relatively big share of the combined 3 chronic diseases in utilization. They accounted for 20% of male outpatient contacts vs. 25% of female outpatients. For inpatient contacts, they consumed 20% in case of males vs. 24% in case of females. (3) Finding that the negative binomial distribution fit the utilization experience supported the research hypothesis concerning the concept of contagion in utilization. This important finding can be helpful in estimating liability functions needed for forecasting future utilization according to previous experience. Such information has its relevance to organization, administration and planning for medical care in general. (Abstract shortened with permission of author.) ^

Impact of racial differences in medical care on breast cancer survival: Findings from a large nationwide and retrospective cohort study

Background: No studies have attempted to determine whether nodal surgery utilization, time to initiation and completion of chemotherapy or surveillance mammography impact breast cancer survival. ^ Objectives and Methods: To determine whether receipt of nodal surgery, initiation and completion of chemotherapy, and surveillance mammography impact of racial disparities in survival among breast cancer patients in SEER areas, 1992-2005. ^ Results: Adjusting for nodal surgery did not reduce racial disparities in survival. Patients who initiated chemotherapy more than three months after surgery were 1.8 times more likely to die of breast cancer (95% CI 1.3-2.5) compared to those who initiated chemotherapy less than a month after surgery, even after controlling for known confounders or controlling for race. Despite correcting for chemotherapy initiation and completion and known predictors of outcome, African American women still had worse disease specific survival than their Caucasian counterparts. We found that non-whites underwent surveillance mammography less frequently compared with whites and mammography use during a one- or two-year time interval was associated with a small reduced risk of breast-cancer-specific and all-cause mortality. Women who received a mammogram during a two-year interval could expect the same disease-specific survival benefit or overall survival benefit as women who received a mammogram during a one-year interval. We found that while adjustment for surveillance mammography receipt and physician visits reduced differences in mortality between blacks and whites, these survival disparities were eliminated after adjusting for the number of surveillance mammograms received. ^ Conclusions: The disparities in survival among African American and Hispanic women with breast cancer are not explained by nodal surgery utilization or chemotherapy initiation and chemotherapy completion. Surveillance mammograms, physician visits and number of mammograms received may play a major role in achieving equal outcomes for breast cancer-specific mortality for women diagnosed with primary breast cancer. Racial disparities in all-cause mortality were explained by racial differences in surveillance mammograms to certain degree, but were no longer significant after controlling for differences in comorbidity. Focusing on access to quality care and post treatment surveillance might help achieve national goals to eliminate racial disparities in healthcare and outcomes. ^

Client-Provider Communication in Postabortion Care

Muchos trabajadores de la salud que tratan a las mujeres que sufren complicaciones de aborto inducido o espontáneo están dispuestos a admitir que estas mujeres necesitan asesoría, pero a menudo ven la consejería como una función no médica que requiere una formación específica, un tiempo especialmente designado, aparte de la prestación de servicios postaborto y otras instalaciones separadas y privadas. De este modo, los proveedores de servicios de atención postaborto a menudo creen que el asesoramiento no es una de sus responsabilidades de trabajo y que carecen de la formación y las instalaciones para hacerlo

New strategy can improve process for recovering certain medical care costs, Department of Defense : report to the Congress /

"B-133142."

Vendor payments for medical care under public assistance, by program and type of service : fiscal years 1951-1970.

Cover title.

White House Conference on Aging, January 9-12, 1961: background paper on health and medical care.

Cover title.

""Star of Life" - emergency medical care symbol: background, specifications, and criteria.

Mode of access: Internet.

Compulsory medical care and the welfare state; an analysis based on a special study of governmentalized medical care systems on the continent of Europe and in England.

"References by chapters": p. 147-152.

Compulsory medical care and the welfare state, an analysis based on a special study of governmentalized medical care systems on the continent of Europe and in England.

"References by chapters": p. 147-152.

Usual sources of medical care and their characteristics /

"September 1991"--P. [4] of cover.

First responders emergency medical care training: CIM course revision. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

The Quality of medical care : information for consumers.

"OTA-H-386."--P. [4] of cover.

Administration of medical care; problems and issues, based on an analysis of the medical-dental care program for the recipients of old-age assistance in the state of Washington, 1941-1945.

Mode of access: Internet.