Medical care
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Comparative Study
Identifying and measuring hospital characteristics using the SEER-Medicare data and other claims-based sources.
The context in which health care is delivered may have an impact on the outcomes and processes of care. Researchers analyzing claims data that reflect care rendered at many institutions may wish to identify hospital characteristics such as bed size, teaching status, degree of specialization, and case volume to evaluate their influence on outcomes. The authors describe the resources available from administrative data for characterizing hospitals. ⋯ First, the authors focus on assessment of hospital case volume, which is the principal hospital attribute that can be obtained directly from the SEER-Medicare data files. Second, they assess the information regarding hospital characteristics that can be gleaned from the American Hospital Association (AHA) survey and the annual cost reports submitted to the Center for Medicare and Medicaid Services (CMS) by all certified hospitals. From a comparison of the responses of 4,434 hospitals to 1994 AHA and CMS surveys, the authors conclude that the two data sources contain very similar information, but that for most investigators, use of data from CMS cost reports will be preferable to use of AHA data because of higher survey-completion rates and public availability.
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Increasingly, investigators are using administrative databases to answer research questions requiring physician characteristics information. This article provides a roadmap for investigators who use Medicare data to answer such questions, focusing on use of the Surveillance, Epidemiology, and End Results (SEER)-Medicare files. ⋯ Administrative databases, such as SEER-Medicare data linked to AMA Masterfile or UPIN Registry data, are an important resource for investigators interested in assessing the relationship between physicians' personal and practice characteristics and the content or outcomes of clinical care.
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Comparative Study
Evaluation of the Department of Veterans Affairs community-based outpatient clinics.
This paper describes the history of the Department of Veterans Affairs (VA) Community-Based Outpatient Clinics (CBOCs), CBOC Performance Evaluation Project, and characteristics of CBOCs within the VA, and summarizes the findings and implications of the CBOC Performance Evaluation Project. ⋯ CBOCs appear to be performing comparably to their parent medical centers but will benefit from ongoing monitoring.
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Comparative Study
Effects of managed care on the length of time that elderly patients spend with physicians during ambulatory visits: National Ambulatory Medical Care Survey.
To examine the factors related to the length of time that elderly patients spend with physicians during ambulatory visits and explore specifically the association between managed care and visit duration. ⋯ The effects of managed care on the duration of ambulatory visits by elderly patients appear to be related to the structure of the managed care plan rather than managed care reimbursement per se.
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Underuse of coronary angiography is common among patients with acute myocardial infarction (AMI) and the magnitude of underuse varies across geographic areas. ⋯ At the patient-level, rates of necessary angiography may be improved if we address disparities in care related to sociodemographic characteristics and to the technological capabilities of hospitals. In addition, practice guidelines should be updated to reflect clinical concerns about the risks and benefits of angiography and subsequent revascularization in certain patient sub-groups, both to provide appropriate guidance to physicians and to facilitate better estimates of underuse. The causes of regional variation in underuse do not appear to be related to regional differences in patient or hospital characteristics, and therefore, require further study.