HMO practice最新文献

This paper presents an overview of the Mother-Baby Chemical Health Program (MBCHP), which was designed to decrease preterm births among pregnant women who use and abuse drugs. Three hundred and fifty-two patients enrolled in the program between January 1990 and December 1992 were followed. More than 90% of the women involved in the MBCHP did not use substances during their pregnancies. Approximately 93% of the participants delivered at 37 or more weeks gestation, and over 91% of the infants weighed 2500 grams or more.

A survey of 399 women between 50 and 59 years of age was conducted to learn how we could improve their compliance with mammography screening guidelines. Our results showed that 78% of the women surveyed believed their physician would tell them if they needed a mammogram. Women who had not had a mammogram were more likely to be misinformed about indications for mammography than women who had had a mammogram. Women who had not had a mammogram were less likely to visit a health center than were women who had had a mammogram. A multifaceted approach including patient education to correct misinformation, reminder systems for women not seen regularly in health centers, and physician reminders may have the most impact.

The wide variation in hysterectomy rates may reflect professional uncertainty as to the appropriateness of the procedure for managing benign uterine disease. This is thought to be due to diagnostic difficulties and especially to a lack of outcomes data. Many patients experience symptomatic relief after hysterectomy, but the long-term costs and benefits remain uncertain. Alternative treatments are available that spare the uterus and/or ovaries and appear to be as effective as hysterectomy. Vaginal hysterectomy is also associated with significantly reduced hospitalization and convalescent time and a lower rate of post-operative complications compared to abdominal hysterectomy, yet most hysterectomies continue to be performed abdominally. Based on the review, a number of steps are proposed for dealing with the problem of excess hysterectomy rates within a managed care setting.

The introduction of four endoscopic surgical procedures into the gynecology department at Fallon Community Health Plan (FCHP) is discussed. The use of these endoscopic procedures reduced average length of stay (ALOS), hospital days/1OOO members, and rate of postoperative complications compared to the open (laparotomy) method. These minimally invasive procedures are popular with patients and physicians, and their use has the potential to decrease an HMO's overall operational costs.

Comprehensive clinical genetic services are offered to 2.4 million members by the Kaiser Permanente Medical Care Program (KP), a not-for-profit HMO, in its Northern California region. Four genetics centers are staffed by clinical geneticists, genetic counselors, nurses, and laboratory technologists, who together provide patient and physician education, genetic screening, and prenatal, infant, and adult evaluation. Besides offering lectures and teleconferences, the geneticists publish a newsletter on how to use the genetic services for approximately 1200 pediatricians, obstetricians, and other relevant specialists. Clinical services offered to members include individual, group, and telephone consultations, and easy access to geneticists is provided for primary care providers with genetic care questions. In-house laboratory services include blood and tissue cytogenetic analysis, DNA testing, and prenatal blood and amniotic fluid testing. A large database and a comprehensive and cost-effective program of genetic services have been developed. An interregional genetics data system is being established to link Northern and Southern California and the Northwest (Portland and Hawaii regions). Steps are also underway to include other regions in the database and to encourage utilization of regionalized KP genetic laboratories by smaller regions.

The prevention of preterm birth has been widely recognized as a means of improving health outcomes as well as reducing medical care costs. Group Health, Inc. (now HealthPartners), a large HMO in Minneapolis/St. Paul, Minn, developed a comprehensive preterm birth prevention program. The cost savings of the program were estimated through retrospective review of medical records. The impact of the program on birth outcomes was used to project the estimated reduction in expenses. The results suggest a probable savings of $615,000 for the 33 babies born full-term, who might otherwise have been preterm. There is a significant need for improved methods to assure that this kind of cost estimate is valid.