Medical care
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One of the key issues in implementing prospective Medicare fee schedules is how to set prices that accurately reflect competitive market forces. Competitive bidding has long been used in government procurement efforts for nonhealth services. In this paper, we evaluate how provider behavior will be affected if Medicare uses competitive bidding to set Medicare fee schedules. ⋯ Third, the model demonstrates how competitive bidding will affect quality. It shows how quality may deteriorate if the bidding mechanism chooses an exclusive winner and why naming multiple winners can keep quality at acceptable levels. Finally, we identify criteria for determining whether a particular type of Medicare service is well-suited for competitive bidding.
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The role of dementia and other mental disorders in nursing home case-mix classification systems has been an area of controversy. The role of mental dysfunctions was considered in developing a new case-mix measurement system for facility payment in a national demonstration to understand staff time use in nursing homes. Nursing staff (nurses and aides) time and resident assessment data were collected for 6,663 nursing home residents in 6 states. ⋯ Depression is used to differentiate subgroups of residents with major medical conditions such as hemiplegia and aphasia. Delirium, when used together with other resident characteristics, was not found useful in explaining resource use. Case-mix groups defined by mental dysfunctions can foster improved care, but careful consideration must be given to appropriate incentives and documentation requirements for providers.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Relationship between functional status and health-related quality-of-life after myocardial infarction.
Despite increasing use in clinical and economic studies, no gold standard exists for the measurement of health-related quality of life (HRQL). One approach to assessing the validity of an HRQL instrument for a particular disease population is to examine the empirical relationship between HRQL patient scores and other accepted measures of health or functional status. In 185 patients (mean age 60 years, 79% male) at six months after myocardial infarction, we examined the relationship between patient responses to the Nottingham Health Profile (NHP), a generic HRQL instrument, and physician classification of patients by two widely used functional status indicators: the New York Heart Association (NYHA) classification and the Karnofsky Performance Status Scale. ⋯ A similarly consistent relationship was found between NHP and Karnofsky. We conclude that the NHP is able to discriminate between patients with differing levels of cardiac functioning as classified by NYHA and patient functioning as classified by Karnofsky. Demonstration of such discriminative properties is one important component in assessing the construct validity of HRQL measures.