HMO practice最新文献

Objective: The goal was to identify differences in the type of work and amount of work performed by male and female family HMO physicians.

Design: Data were collected by self-administered physician surveys, retrospective analysis of encounter forms, ambulatory care group (ACG) analysis of physicians' patient panels, and participant observation.

Setting: A large HMO-based clinical facility. PARTICIPANTS. Family practitioners (n = 21) at one HMO clinic.

Main outcome measures: Measures included patient encounters/day, self-assessed and encounter-form-based workload, ambulatory care group panel evaluation and qualitative observation of practice patterns and team functioning.

Results: These data show that the kind of work male and female physicians did at this site differed, when compared on the basis of encounter-form-based diagnoses, ambulatory care group panel assessments and participant observation. However, the amount of work performed by each gender did not appear to different when evaluated by age-sex-adjusted panel size, patient encounters per unit time, a subjective magnitude estimation workload questionnaire and an encounter-form-based workload assessment.

Conclusion: In this study, multiple measures for evaluating physician workload revealed distinct differences in the kind of clinical work performed by male and female HMO family physicians. These findings have implications for clinicians, managers, planners, researchers and educators.

A well-planned, proactive case management program that focuses on the identification and management of high-risk/high/cost patients can prove to be a valuable investment. FHP, Inc., implemented a pilot Patient Care Management program in the Long Beach/Orange County, California region. The program produced an estimated cost savings of nearly 4 million dollars in its first full year of operation. Results also included improved patient satisfaction, increased quality of care and decreased medical-legal risks. The program is currently expanding to all states where FHP has staff model operations. This article examines the steps utilized in the development of the program, and identifies keys to success.

A large primary care HMO health care center in Chandler, Ariz, has utilized a comprehensive computerized patient record for the past 2 years. The patient flow through the center is described in detail. Patients (n = 126) completing an automated medical record office visit were surveyed at random to determine their response to the computerized record. Results indicate patients are convinced that our use of the automated record helps us be more familiar with their medical history, providing a strong mandate to continue the project. The patients expressed some concerns about confidentiality of automated records, and about computer-related distractions that may occur during a visit.

Increasing attention has been devoted to the urgent need for identifying depressive symptomatology at the primary care point of contact for older individuals to prevent more serious disease and potential negative behavioral outcomes. Delivering medical care services in a system that is sensitive to the symptoms of depression may lead to greater cost-effectiveness and improved quality of life. This paper examines the correlates of depression in a random sample of 1800 Medicare beneficiaries enrolled in a risk-sharing HMO. Ten percent of the total sample reported a high degree of depressive symptoms, as measured by the CES-D score. The prevalence of depressive symptoms was significantly higher for those who were not married, reported less well-developed social support networks, had low perceived ability to control future health, or had poorer health status. Depressive symptoms were also associated with a greater number of physician office visits and higher ambulatory charges, although no significant relationship was found for inpatient use or total charges. Practical approaches to monitoring depressive symptomatology at the primary care level in an HMO are suggested.

Objective: To evaluate an automated system of quality monitoring for psychiatric outpatients.

Design: Cross-sectional study.

Setting: Large outpatient psychiatry clinic in Kaiser Permanente--Northern California.

Participants: Approximately 1500 new psychiatric patients and 20 clinicians.

Interventions: This system gave clinicians data on new patients from validated instruments before their intake interviews, measured outcomes for the depressed and panic-disordered patients, and monitored the clinic's case-mix.

Main outcome measures: Clinic case-mix: Axis II disorders (Personality Disorder Questionnaire--Revised); emotional, social and physical functioning (Health Status Questionnaire 2.0); Axis I symptoms (Symptom Checklist-90); depression and panic disorder (Health Outcomes Institute Modules). Clinician reaction to system (telephone interview).

Results: The study population was 62.4% female; 73.9% Caucasian; 70% employed; 15.9% had evidence of personality disorder; 63% reduced daily activities because of emotional problems; 18% had depression; 7% had panic disorder. Over 75% of clinicians used the data reports and found them helpful; criticism focused on questionnaire length, inadequate training, numerous false-positives, and insufficient administrative support.

Conclusion: An automated patient monitoring system can be implemented; clinician involvement needs to be significant; more research is needed to establish the usefulness of standardized data and outcomes management.