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The purpose of this study was to develop and validate a reliable measure ofsatisfaction with care among homeless clients. The study was conducted in two phases with phase one being a phenomenological study using face-to-face inter...
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The purpose of this study was to develop and validate a reliable measure ofsatisfaction with care among homeless clients. The study was conducted in two phases with phase one being a phenomenological study using face-to-face interviews with 17 homeless individuals to explore their experiences of satisfaction with health care. Five themes that represent the lived experiences of satisfaction with health care were defined and were the basis for development of the 30 item Homeless Satisfaction with Care Scale (HSCS). Phase two of this study was a descriptive cross-sectional comparison of the HSCS and two established satisfaction measures in a sample of 168 homeless clients using a rural nurse-managed clinic or an urban Health Department clinic. The HSCS had good internal consistency reliability and correlated significantly with scores on the other two measures. Factor analysis found that negatively stated items loaded together on one factor, suggesting that negatives in general are meaningful to homeless clients. Black homeless clients had significantly lower satisfaction scores than white homeless clients, suggesting the need to evaluate the saliency of items on satisfaction scales for black clients, as well as the appropriateness of primary care services for homeless clients who are black.
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The purpose of the report is to assess the relationship between managed care organizations (MCOs) organizational features on children with special health care needs' (CSHCN): (1) use of health care services and (2) families' exper...
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The purpose of the report is to assess the relationship between managed care organizations (MCOs) organizational features on children with special health care needs' (CSHCN): (1) use of health care services and (2) families' experiences with their children's medical home. 2,223 Children enrolled in a State Children's Health Insurance Program (SCHIP) who had a diagnosis indicative of a chronic condition and were experiencing consequences from those conditions. We examined the relationship between child sociodemographic/health and MCO characteristics and outpatient use rates, inpatient admissions, emergency room (ER) visits, outpatient specialty use, and families' experiences with their children's medical homes. More pediatricians in the network were associated with decreased outpatient use and inpatient admissions. Children cared for in MCOs (1) with lower percentages of PCPs paid fee-for-service, (2) with higher percentages of pediatricians in the PCP network, and (3) offering financial incentives for meeting quality of care standards, had higher odds of outpatient physician specialist visits. African-American children had lower odds of specialty care compared to White children. For the CSHCN medical home analyses, higher percentages of PCPs who were pediatricians in the MCO networks were associated with less access to providers, comprehensive care, compassionate care, and family-centered care. The use of prior authorization for outpatient services was associated with higher ratings of primary care service availability. The use of fee-for-service to reimburse the PCPs was associated with reports of more compassionate care and the use of financial incentives for meeting quality of care standards was associated with lower reports of culturally-competent care.
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The use of cesarean procedures in obstetrical care rose from 5.5 percent of all deliveries in 1970 to 16.5 percent in 1980. Using the 1977 Hospital Cost and Utilization (HCUP) Hospital Sample, 300 hospitals were cross-classified a...
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The use of cesarean procedures in obstetrical care rose from 5.5 percent of all deliveries in 1970 to 16.5 percent in 1980. Using the 1977 Hospital Cost and Utilization (HCUP) Hospital Sample, 300 hospitals were cross-classified according to whether each had a neonatal intensive care unit (NICU) and whether each had a medical school affiliation. For each of the four resulting groups the average proportion of deliveries by cesarean section was related to differences in the mother's age, race, and source of payment; medical complications of mother or fetus; and hospital characteristics. Even after age, race or source of payment are held constant, affiliated hospitals and hospitals with NICUs typically show higher cesarean section rates than comparison group hospitals. However, with regard to the various maternal and fetal complications, hospitals with NICUs or medical school affiliations may be either more or less likely than comparison group hospitals to choose the cesarean option, depending on the specific complication.
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Examining how Americans use health care services and determining national patterns of health expenditures and insurance coverage are the goals of a landmark study by the National Center for Health Services Research (NCHSR). This d...
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Examining how Americans use health care services and determining national patterns of health expenditures and insurance coverage are the goals of a landmark study by the National Center for Health Services Research (NCHSR). This data preview from the National Health Care Expenditures Study (NHCES) presents estimates of public and private health insurance coverage, access to a usual source of care, and use of selected health services by those with activity limitations caused by chronic health conditions. Data on the presence and type of activity limitation are shown by selected population characteristics, as are expenditures of health insurance and health services. The findings are based on 1977 data from the National Medical Care Expenditure Survey (NMCES).
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Examining how Americans use health care services and determining national patterns of health expenditures and insurance coverage are the goals of a landmark study by the National Center for Health Services Research (NCHSR). This r...
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Examining how Americans use health care services and determining national patterns of health expenditures and insurance coverage are the goals of a landmark study by the National Center for Health Services Research (NCHSR). This report from the National Health Care Expenditures Study is the first in a series presenting national estimates from the Health Insurance/Employer Survey (HIES) component of the National Medical Care Expenditure Survey (NMCES). It provides an overview of the number of people in the U.S. population holding private health insurance, and examines the financing of this type of insurance by employers, employees, and their families. The estimates are based on data provided by the employers and insurance carriers of members of the NMCES household sample, in conjunction with information on sociodemographic characteristics of the members of this sample.
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This paper combines information on expenditures and health care use patterns with responses to hypothetical questions about willingness to pay. The analysis of the survey is largely with two exploratory regression estimates, and s...
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This paper combines information on expenditures and health care use patterns with responses to hypothetical questions about willingness to pay. The analysis of the survey is largely with two exploratory regression estimates, and should be readily understood by people considering policy changes in Belize. It is divided into the following parts: (1) Prenatal and birth utilization of providers and costs. (2) Recent utilization and costs to care for sick family members. (3) Expenditures for specific childhood illnesses. (4) Willingness to pay for government-provided health care. The analysis is based on simple cross tabs associating utilization patterns and expenditures with several household socioeconomic variables. In addition, the willingness-to-pay data are analyzed using a simple regression model.
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The purpose of the report is to examine the factors that explain use of dental health services by nonaged adults and children. Data from RAND's Health Insurance Experiment was used to test prospective multivariate models to explai...
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The purpose of the report is to examine the factors that explain use of dental health services by nonaged adults and children. Data from RAND's Health Insurance Experiment was used to test prospective multivariate models to explain probability of use and expenditures by users. In addition to sociodemographic characteristics, oral health status (clinically assessed and self-report), perceived health in general, satisfaction with dental care, health-related beliefs and attitudes, and continuity of care were significantly related to use. Those less likely to use were in poorer oral health (probably reflecting absence of prior use), had less favorable attitudes, and less provider continuity. Variations in the probability of use by adults differing in gender, ethnicity, and family size were completely explained by differences in oral health, health-related beliefs, and continuity; such differences accounted in part for variations in use by those of different ages, incomes, and educational levels.
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This is the training manual used with the Standardized Medreview Instrument (SMI) in the data abstraction for National Estimates of Nonacute Hospital Utilization for 1981. The manual includes introductory material, logic of the in...
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This is the training manual used with the Standardized Medreview Instrument (SMI) in the data abstraction for National Estimates of Nonacute Hospital Utilization for 1981. The manual includes introductory material, logic of the instrument, instructions for selecting records and applying the instrument. Reference materials include class 1 ICD-9-CM operation codes and titles, Class 2 ICD-9-CM procedure codes and titles, and major drugs by type. The SMI is a medical utilization review tool for assessing the appropriateness of an admission and a day of care within the stay. The instrument has been applied by registered nurses and medical record technicians (ARTs). ARTs achieved 98.7% agreement rates on days and a 97.6% agreement rate for admissions.
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Objective: To determine whether managed care controls were associated withreduced access to specialists and worse outcomes of care among primary care patients with pain and depressive symptoms. Methods: In a prospective cohort des...
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Objective: To determine whether managed care controls were associated withreduced access to specialists and worse outcomes of care among primary care patients with pain and depressive symptoms. Methods: In a prospective cohort design, 17,187 patients were screened in the waiting rooms of 261 primary physicians in the Seattle area to identify 2,850 English-speaking adult patients with pain and/or depressive symptoms. Patients were followed for 6-months to measure referral, specialist utilization, and outcomes. The intensity of managed care was measured for health insurance plans, offices, and physicians. Multiple regression tested for associations between managed care variables, access to specialists, and outcomes. Results: Referrals and specialists utilization were common and similar in less vs. more managed plans and offices. However, for pain patients and low income depression patients, a financial withhold for referral was associated with fewer referrals. Referred depression patients had fewer referrals to psychiatrists. Health outcomes were similar in less vs. more managed settings, but patient dissatisfaction with their primary physicians was greater in more managed plans and offices. Conclusions: Managed care generally was not associated with reduced access to specialists and adverse health outcomes, but reductions in patient satisfaction with primary physicians were detected.
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This research brief presents information on adopted children with special health care needs, using data from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN). The analysis takes advantage of ques...
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This research brief presents information on adopted children with special health care needs, using data from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN). The analysis takes advantage of questions in the NS-CSHCN that allow adopted children in the sample to be grouped and compared by adoption type, that is, foster care adoptions, international adoptions, and domestic adoptions through sources other than the public child welfare system. Findings provide a descriptive profile of adopted children with special health care needs (CSHCN); explore ways in which adopted CSHCN are similar to and different from other CSHCN; and describe their health status, health conditions and health care access and utilization across adoption types.
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