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61.
BACKGROUND: Individual physicians who are paid prospectively, as in capitated health plans, might tend to encourage patients to avoid or to join these plans according to the patient's health status. Though insurance risk selection has been well documented among organizations paid on a prospective basis, such physician-level risk selection has not been studied. OBJECTIVE: To assess physician reports of risk selection in capitated health plans and explore potentially related factors. DESIGN AND PARTICIPANTS: National mailed survey of primary care physicians in 1997-1998, oversampling physicians in areas with more capitated health plans. RESULTS: The response rate was 63% (787 of 1,252 eligible recipients). Overall, 44% of physicians reported encouraging patients either to join or to avoid capitated health plans according to the patients' health status: 40% encouraged more complex and ill patients to avoid capitated plans and 23% encouraged healthier patients to join capitated plans. In multivariable models, physicians with negative perceptions of capitated plan quality, with more negative experiences in capitated plans, and those who knew at each patient encounter how they were being compensated had higher odds of encouraging sicker patients to avoid capitated plans (odds ratios, 2.0, 2.2, and 2.0; all confidence intervals >1). CONCLUSIONS: Many primary care physicians report encouraging patients to join or avoid capitated plans according to the patient's health status. Although these physicians' recommendations might be associated primarily with concerns about quality, they can have the effect of insulating certain health plans from covering sicker and more expensive patients. 相似文献
62.
The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review 总被引:1,自引:0,他引:1 下载免费PDF全文
Wolfstadt JI Gurwitz JH Field TS Lee M Kalkar S Wu W Rochon PA 《Journal of general internal medicine》2008,23(4):451-458
Context Computerized physician order entry (CPOE) with clinical decision support (CDS) has been promoted as an effective strategy
to prevent the development of a drug injury defined as an adverse drug event (ADE).
Objective To systematically review studies evaluating the effects of CPOE with CDS on the development of an ADE as an outcome measure.
Data Sources PUBMED versions of MEDLINE (from inception through March 2007) were searched to identify relevant studies. Reference lists
of included studies were also searched.
Methods We searched for original investigations, randomized and nonrandomized clinical trials, and observational studies that evaluated
the effect of CPOE with CDS on the rates of ADEs. The studies identified were assessed to determine the type of computer system
used, drug categories being evaluated, types of ADEs measured, and clinical outcomes assessed.
Results Of the 543 citations identified, 10 studies met our inclusion criteria. These studies were grouped into categories based on
their setting: hospital or ambulatory; no studies related to the long-term care setting were identified. CPOE with CDS contributed to a statistically significant (P ≤ .05) decrease in ADEs in 5 (50.0%) of the 10 studies. Four studies (40.0%) reported a nonstatistically significant reduction
in ADE rates, and 1 study (10.0%) demonstrated no change in ADE rates.
Conclusions Few studies have measured the effect of CPOE with CDS on the rates of ADEs, and none were randomized controlled trials. Further
research is needed to evaluate the efficacy of CPOE with CDS across the various clinical settings. 相似文献
63.
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65.
Debra K. Litzelman MD MA Dr. William M. Tierney MD 《Journal of general internal medicine》1996,11(8):497-499
The objective of this study was to assess reasons for physicians’ noncompliance with computer-generated preventive care reminders.
In an academic general internal medicine practice, a survey of physicians’ reasons for noncompliance found that 55% of reminders
were not complied with. Reasons included “not applicable” in 22.6% (test done elsewhere, patient too ill, no uterus), “next
visit” in 22.5% (physician too busy, patient too ill), and “patient refuses” in 9.9% (test not necessary or too costly, patient
too busy or fears result). We conclude that although noncompliance with reminders is sometimes appropriate, making time for
prevention and patient education may augment preventive care.
Received from the Department of Medicine, Wishard Memorial Hospital, and the Indiana University School of Medicine, the Regenstrief
Institute for Health Care, and the Health Services Research and Development Service, Richard L. Roudebush VA Medical Center,
Indianapolis, Ind.
Supported in part by grants HS07632, HS07763, and HS07719 from the Agency for Health Care Policy and Research (AHCPR). Dr.
Litzelman was supported in part by a Robert Wood Johnson Generalist Physician Faculty Scholar Award (022318).
The opinions expressed herein are solely those of the authors and do not necessarily represent the authors’ institutions,
AHCPR, or the Robert Wood Johnson Foundation. 相似文献
66.
Data from several sources, including consumer surveys, physician surveys, and medical record audits, indicate that consumers
do not receive cancer screening tests as recommended by the National Cancer Institute, the American Cancer Society, and the
U.S. Preventive Services Task Force. Performance rates are consistently below published standards for all tests except Pap
tests. Major reasons physicians do not perform the recommended tests include physician forgetfulness, disagreement with recommendations,
lack of time, and patient refusal. Physicians also tend to overestimate their own performance rates. Barriers to screening
test performance can be categorized into patient factors, physician factors, test factors, and health care delivery system
factors. Interventions, such as computerized reminder systems, physician audits with feedback, and patient education and reminders,
can be effective in promoting performance of such screening. Interventions that target both physician and patient may be particularly
effective.
Presented at the conference, Frontiers in Disease Prevention, The Johns Hopkins University, June 5–6, 1989. 相似文献
67.
目的探讨多模式整合教学法在医学影像学教学中的应用效果。方法选取我院2017年7月~2019年7月放射科50例住培医师作为观察对象,采用计算机随机数字表法将其分为对照组和试验组,分别给予传统教学法及多模式整合教学法,比较两组住培医师培训后的考核成绩及综合能力。结果培训后,试验组理论成绩与读片技能得分均高于对照组,其总成绩高于对照组(P<0.05);试验组自主学习能力、阅片能力、影像诊断思维、案例分析能力及信息检索能力得分均高于对照组,其综合能力总分高于对照组(P<0.05)。结论将多模式整合教学法应用于医学影像学的教学中可以提升住培医师的知识水平,对其综合能力的提升有较好的促进效果,值得推广应用。 相似文献
68.
Objective
Culture is known to impact expectations from medical treatments. The effects of cultural differences on attitudes toward Electronic Medical Records (EMR) have not been investigated. We compared the attitudes of Jewish and Bedouin responders toward EMR's use by family physicians during the medical encounter, and examined the contribution of background variables to these attitudes.Methods
86 Jewish and 89 Bedouin visitors of patients in a regional Israeli University Medical Center responded to a self-reporting questionnaire with Hebrew and Arabic versions.Results
T-tests and a linear regression analysis found that culture did not predict attitudes. Respondents’ self-reported health status, Internet and e-mail use, and estimates of their physician's typing speed explained a total of 18.6% of the variance in attitudes (p < 0.001).Conclusion
Bedouins respondents’ attitudes toward EMR use were better than expected and similar to those of their Jewish counterparts. The most significant factor influencing respondents’ attitudes was the physician's typing speed.Practice implications
(1) Further studies should consider the possible impact of cultural differences between the family physician and the healthcare client on attitudes. (2) Interventions to improve physicians’ skill in operating EMRs and typing will potentially have a positive impact on patients’ satisfaction with physicians’ EMR use. 相似文献69.
Christy J.W. Ledford Christopher C. Ledford Marc A. Childress 《Patient education and counseling》2013
Objective
Despite evidence-based recommendations, physical activity as a self-management technique is underutilized. Many physical activity interventions require significant resources, ranging from repeated phone follow-up with nursing staff to intensive sessions with cooperating physical therapists. This intervention, Extending Physician ReACH (Relationship And Communication in Healthcare), examined physician to patient communication tactics for promoting walking exercise to patients with type 2 diabetes, using limited clinic time and financial resources.Methods
This was a single-site, six-month prospective intervention, which implemented theoretically driven, evidenced-based information factor strategies. Of the 128 volunteers who participated in the initial clinic visit, 67 patients with type 2 diabetes completed the six-month intervention.Results
Significant intervention effects were detected risk perception, social norms, and patient activation.Conclusions
This study was designed to identify information factors that could affect physician success in motivating patients with type 2 diabetes to enact the ADA physical activity recommendations.Practice implications
The success of this intervention models a strategy through which clinicians can reach beyond “one-shot” persuasion without placing onerous time and resource demands on physicians. 相似文献70.