Assuring the quality of home-delivered long-term care: the Ohio Quality Assurance Project.

Home-delivered care is an important development for functionally disabled clients and for the long-term care system. However, questions and concerns about home care quality have been raised. At this point, home care quality is not well understood, and most case management and provider agencies have very little experience designing and implementing quality assurance programs. This article reports on the Ohio Quality Assurance Project. During this 17-month pilot project, the Ohio Department of Aging and the Scripps Gerontology Center, Miami University, collaborated on a model quality assurance system for case managed, in-home care. Using two demonstration sites within Ohio's PASSPORT program, the Ohio Quality Assurance Project developed and tested quality assurance standards and strategies that could be applicable to home care and case management agencies nationwide.     

Assuring the quality of in-home supportive services: an evolving challenge

This article reports on the Ohio Quality Assurance Project, a two year demonstration. The project developed a model quality assurance system for in-home supportive services funded by Title III of the Older Americans Act including home health aide, personal care, homemaker, transportation and escort, home delivered meals, chore and home maintenance services. Using four planning and service areas in the state of Ohio comprising over 40 countries, the project developed, implemented and evaluated quality assurance standards and monitoring activities for Older Americans Act services. In addition, a second part of the project included in-depth case studies with consumers receiving in-home care.     

Preparing physicians to lead

The University of St. Thomas' Physician Leadership College is an 18-month program that trains physicians in leadership and management. It was started in 1999 in response to calls from within the health care industry for more training of physician leaders to guide reform efforts. This article makes the case that physicians need to not only participate in but also to lead change in health care. It also describes the program and reports findings from participants' evaluations.     

A Strategy to Increase the Number of Urban Family Practice Resident Physicians Who Enter Rural Practice

Physician geographic maldistribution is a problem in the United States health care system. Innovative strategies are needed to entice resident family physicians training in the larger, more numerous suburban and urban training programs to practice in rural areas upon completing their training. This paper describes a strategy used at St. Elizabeth Medical Center Family Practice Residency Program, Dayton, OH, to encourage rural practice. In the St. Elizabeth plan, the interested family practice resident moonlights in a rural practice provided by the local county hospital. The county medical staff covers the resident physician's practice during the frequent absences. The residency program faculty provide on-site supervision, telephone back-up coverage, and practice consultation. The county hospital provides billing services; the resident physician retains 100 percent of collections. The resident physician gains exposure to the knowledge, skills, and attitudes needed in rural practice. Upon completion of residency training, the physician remains in practice and is not required to pay back any expenses incurred by the hospital. Two resident physicians participate currently; three others have expressed interest in practicing in the community. A similar plan might work in parts of the United States where, like Ohio, training programs and rural communities are not far apart.     

Awarding faculty rank to non-tenured physician faculty in a consortium medical school

Many medical schools struggle to identify an appropriate system to award faculty rank to non-tenured physician faculty. A key element needs to be balanced recognition of teaching and scholarly activities. At the Northeastern Ohio Universities College of Medicine (NEOUCOM), clinical teaching is accomplished predominantly by volunteer physician faculty whose major responsibilities are patient care and teaching. In addition to our system for awarding rank to faculty in a tenure track, NEOUCOM devised a system for awarding faculty rank to volunteer, non-tenure physician faculty that equitably recognizes teaching, service, and scholarly activity with assigned "units" of accomplishment for each criterion. We now have an effective two-track system for our non-tenure physician faculty that objectively assesses and recognizes academic productivity in all three areas and standardizes requirements for promotion. This paper discusses 3 years of experience with this two-track system and its effect on the rank of physician faculty in the Department of Family Medicine.     

Comparison between Kanagawa Prefecture and Ohio state of factors related to health behavior among older adults

Factors related to health behavior of older adults in Japan and the United States were compared. A total of 900 persons from three age groups (45 to 59, 60 to 74 and 75 and over) were interviewed in three communities (major metropolitan, midsized city, and small town), in both Kanagawa Prefecture and Ohio State. To determine the reliability of the results, in addition to analysis for all subjects, each of communities were analyzed separately. Health behaviors were divided into 2 separate levels: 1) preventive health behaviors and 2) coping behaviors for symptoms which may be signs of a serious illness. The latter behaviors were classified into three types: 1) seeing a physician, 2) changing lifestyle and 3) taking OTC drugs. The following results were obtained: 1) In both Kanagawa Prefecture and Ohio State, good preventive health behaviors were unrelated to coping behaviors associated with potentially serious illness. Interviewees who used OTC drugs when experiencing a potentially serious illness had a low tendency toward seeing a physician. In Kanagawa Prefecture, individuals who saw a physician showed a strong tendency toward changing their lifestyle, for symptoms which were potential signs of a serious illness. 2) There were some differences in factors related to preventive health behaviors between Kanagawa Prefecture and Ohio State. In Kanagawa Prefecture, there were sex differences, with males exhibiting preventive health behaviors. In Ohio State, good preventive health behaviors were few among interviewees who were black. 3) There was little difference between Kanagawa and Ohio State as far as the tendency toward seeing a physician when experiencing potentially serious illness. In both places, interviewees with good self-rated health status and having strong self-treatment attitudes showed a lower tendency to see a physician when experiencing symptoms which were potential signs of a serious illness.     

Risky behaviors among Ohio Appalachian adults

This article describes the prevalence of risky behaviors known to be associated with increased cancer morbidity and mortality among Ohio Appalachian adults. These behaviors, or risk factors, include: 1) tobacco use; 2) energy imbalance (involving poor diet, obesity, and physical inactivity); and 3) sexual behaviors. We report current estimates of the prevalence of these behaviors among Ohio Appalachian adult residents and review social, psychological, and biological variables associated with these risky behaviors. We also present recent empirical studies that have been completed or are in progress in Ohio Appalachia. Finally, we discuss how these studies help bridge well-documented gaps in the literature.     

A physician productivity system that works

Too often, physician productivity becomes a contentious issue for medical practices. This article describes a system in which physician financial and lifestyle goals provide the impetus for setting and achieving meaningful productivity benchmarks. Although the system is developed from the physician's subjective goals, the structure is highly quantified. This enables physicians and administrators to model and assess the financial impact of alternative assumptions and scenarios. Through this modeling, targets can be set that best serve the needs of both the physicians and the practice. Because the system also provides for ongoing feedback and process improvement, this physician productivity plan can become a driving force for positive change throughout the practice.     

Peer Reviewed: Risky Behaviors Among Ohio Appalachian Adults

This article describes the prevalence of risky behaviors known to be associated with increased cancer morbidity and mortality among Ohio Appalachian adults. These behaviors, or risk factors, include: 1) tobacco use; 2) energy imbalance (involving poor diet, obesity, and physical inactivity); and 3) sexual behaviors. We report current estimates of the prevalence of these behaviors among Ohio Appalachian adult residents and review social, psychological, and biological variables associated with these risky behaviors. We also present recent empirical studies that have been completed or are in progress in Ohio Appalachia. Finally, we discuss how these studies help bridge well-documented gaps in the literature.     

Access to care under physician payment reform: a physician-based analysis

This article reports physician-based measures of access to care during the 3 years surrounding the 1989 physician payment reforms. Analysis was facilitated by a new system of physician identifiers in Medicare claims. Access measures include caseload per physician and related measures of the demographic composition of physicians' clientele, the proportion of physicians performing surgical and other procedures, and the assignment rate. The caseload and assignment measures were stable or improving over time, suggesting that reforms did not harm access. Procedure performance rates tended to decline between 1992 and 1993, but reductions were inversely related to the estimated fee changes, and several may be explainable by other factors.     

Cost-effectiveness of hospital discharge records for reaching selected endpoints in the surveillance of silicosis

Background The Sentinel Event Notification System for Occupational Risks (SENSOR) is a state/federal system for the surveillance and intervention of occupational conditions. The Ohio SENSOR program identifies silicosis cases from a number of data sources, although hospital discharge records have largely been considered the most successful means of carrying out SENSOR objectives. However, the cost-effectiveness of hospital discharge records has not been evaluated. Thus, a cost analysis was conducted to compare the effectiveness of hospital discharge records with other data sources for achieving prevention-related endpoints of silicosis surveillance. Methods Total costs of reaching three endpoints (obtaining case names, identifying work sites, and identifying silica problems in work sites) were estimated retrospectively and measured in 1996 dollars for four data sources: hospital discharge records, physician reports, workers' compensation claims, and death certificates. Total costs were then divided by output for each source/endpoint combination to produce estimates of average costs. Results The average cost per case was $30 for hospital records, $212 for physician reports, $19 for workers' compensation claims, and $7 for death certificates. However, for identifying problem work sites, hospital records were most expensive at $2,883 per work site, compared with $2,558 for physician reports, $1,318 for workers' compensation claims, and $1,310 for death certificates. Conclusions Hospital discharge records were least cost-effective for accomplishing prevention-related goals of surveillance. A change in the mix of resources applied to silicosis surveillance and intervention under SENSOR, i.e., a shift away from follow-up of hospital records toward more cost-effective methods for identifying work sites with silica problems may result in more efficient use of public health resources devoted to the prevention of silicosis. Am. J. Ind. Med. 34:484–492, 1998. © 1998 Wiley-Liss, Inc.     

Disability benefits: what is the Social Security Administration thinking?

This article briefly describes decision-making standards and procedures used by the Social Security Administration in adjudicating disability insurance benefits claims. Correlatively, the article addresses and dispels some of the myths surrounding various outcomes of disability claims. It also describes the role of the treating physician and how a treating physician who wants to help his or her patient obtain disability benefits should respond to Social Security's requests for medical records and written reports.     

Diagnostic risk adjustment for Medicaid: the disability payment system

This article describes a system of diagnostic categories that Medicaid programs can use for adjusting capitation payments to health plans that enroll people with disability. Medicaid claims from Colorado, Michigan, Missouri, New York, and Ohio are analyzed to demonstrate that the greater predictability of costs among people with disabilities makes risk adjustment more feasible than for a general population and more critical to creating health systems for people with disability. The application of our diagnostic categories to State claims data is described, including estimated effects on subsequent-year costs of various diagnoses. The challenges of implementing adjustment by diagnosis are explored.     

Comparing Apples with Apples in Clinical Populations: Applications of the Adjusted Clinical Group System in British Columbia

This article reviews the Adjusted Clinical Group Case-Mix System and describes how it is being applied in the management of physician services in British Columbia. Developed in the United States for management and research, adjusted clinical groups are used to measure the illness burden and health service needs of individuals and, when aggregated, of populations, by grouping the range of conditions coded on physician claims and hospital care records over a defined time period, typically one year. In Canadian and United States settings, adjusted clinical groups are up to five times more predictive of ambulatory resource use than are age and sex groups alone. The article describes how adjusted clinical groups are being applied to adjust capitation payments for physician groups in British Columbia's Primary Care Demonstration Project and profiles of physician practice activity.     

Nursing home and nursing home physician: the Dutch experience

Dutch nursing home care today includes a broad range of institutional and outreaching care functions. Medical care is an essential part of this care. Nursing home medicine in The Netherlands has developed as an officially acknowledged medical specialty. This is unique because The Netherlands is the only country in which nursing home medicine is a specific medical discipline. Because of this, a continuum in the medical care for the elderly has been developed: the family physician for medical care in the community, the nursing home physician for the institutionalized elderly, and the clinical geriatrician plus other medical specialists for elderly who require hospital care. This article describes the characteristics of Dutch nursing home care and nursing home medicine and the advantages of this system. The article also shows that the combination of the medical knowledge of family physician and nursing home physician can be expected to increase the quality of medical care for the disabled elderly in institutions and in the community.     

Projecting physician requirements in a two-county region in Ohio

A methodology for projecting physician requirements in a geographical region is presented. The procedure incorporates variables defining physician workloads, rates of retirement and estimated population changes to determine the future needs for health care practitioners. A case study using data from a two-county region of northeastern Ohio is included to illustrate the applicability of the projection methodology.     

Understanding and coping with the new HCFA physician incentives stop-loss insurance rules

The imposition of physician incentive regulations by the Health Care Financing Administration for Medicare risk and Medicaid managed care contracts has created disclosure and stop-loss reinsurance issues for both physician groups and their contracting health maintenance organizations. This article summarizes the key points of the stop-loss requirements of the new rules, describes the current types of stop-loss reinsurance purchased prior to the effective date of the regulations, and the practical problems of conforming current physician group contracting practices to these rules. The article also provides several suggested steps that physician groups should take to manage the changes required.     

MATCH: a maternal and child health information network

The Maternal and Child Health Information Network--MATCH--was begun in 1984 as a demonstration project with support from the Division of Maternal and Child Health of the Health Resources and Services Administration, Public Health Service. The primary purpose of the project was the development of a system to manage data related to prenatal, child health, family planning, and genetic services that are delivered with State support in clinics in the State of Ohio. The design of MATCH enables the same data base to be used at both the State and local levels. Because it allows all participants, central and district, to manipulate the raw data, it is called an end-user--as opposed to a batch retrieval--system. Data recorded on individual forms during each client's visit to local service clinics are collected and entered into a microcomputer whose software package is a commercial data base. The clinic can then use the data for its purposes: program planning, management, evaluation, client referrals, appointment followup, quality control, and billing. The same data are also uploaded by central office staff to the State's DEC mainframe from data-filled disks mailed in by the clinics. Personnel who staff local projects can access their own data on the mainframe computer to generate reports for local use and send and receive messages electronically. That is, the system is "interactive."(ABSTRACT TRUNCATED AT 250 WORDS)     

Developing a physicians' palliative care pain hotline in Maryland

Physicians have had relatively little formal training in pain management and palliative care. For this reason, a telephone consultation service was offered, the physicians' palliative care pain hotline, that would allow physicians to call a toll-free number and, within 15 minutes, speak to a board-certified physician in hospice and palliative medicine. To our knowledge, this is the first program of its kind. This article describes the process involved in creating such a pain hotline and reports on some data collected on its use in the first 10 months. This report should help others who have an interest in establishing a similar program.