Medical care
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This study examines the relationship between residential instability, including mobility and previous homelessness, and the use of medical care among previously sheltered and never-sheltered mothers in New York City. The study represents one of the first efforts to follow up on families after they are no longer homeless. ⋯ A history of residential instability, particularly previous shelter use, strongly predicts where poor mothers currently seek health care. Further research is needed to determine whether these patterns of health care use existed before mothers entered shelters. The study provides evidence that upon leaving shelters, mothers are not being well integrated into primary care services.
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Variations in the rates of major procedures by race and gender are well described, but few studies have assessed the quality of care by race and gender for basic hospital services. ⋯ Consistent racial differences in quality of care persist in basic hospital services for two common medical conditions. Physicians, nurses, and policy makers should strive to eliminate these differences. Gender differences in quality of care are less pronounced and may vary by condition and type of provider or service.
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The number of older patients enrolling in health maintenance organizations (HMOs) is increasing. Concerns have been raised that older patients may be targeted by HMOs for more stringent cost-containment mechanisms, including reduced access to expensive specialty care. ⋯ These data suggest that membership in an HMO was associated with reduced access to neurology care for older patients with acute stroke and that patients who received neurology care had a lower risk of death during the year after their stroke. It remains to be determined if these differences in outcome are caused by true differences in stroke management or by unmeasured characteristics.
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Comparative Study
Evaluation of the Washington State Workers' Compensation Managed Care Pilot Project II: medical and disability costs.
This study examined the effect of managed care on medical and disability costs as part of an evaluation of the Washington State Workers' Compensation Managed Care Pilot (MCP). ⋯ The results from the MCP suggest that substantial savings in workers' compensation medical and disability costs may be realized using the type of managed care intervention designed for this study. Delivering occupational health services through managed care arrangements whose design is based on an integrated, occupational health-centered delivery model may offer a viable approach for improving delivery systems, reducing costs and encouraging greater attention to disability prevention.
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Comparative Study
Effects of a behavioral health carve-out on inpatient-related quality indicators for major depression treatment.
To analyze the effects of the 1993 Massachusetts behavioral health carve-out for state employees on readmissions and follow-up treatment after hospitalization for major depressive disorder (MDD). ⋯ Under this behavioral health carve-out, follow-up treatment was more likely, and estimated risk of readmission did not change significantly for a seriously ill subgroup of enrollees. This was true even when controlling for patient variables and using data for extended time "at risk" for each indicator. Future research on carveouts should move toward direct clinical quality measurement.