The Journal of ambulatory care management
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J Ambul Care Manage · Jul 1998
Comparative StudyEnd-of-life care for persons age 80 years or older.
At age 80, about 4 of every ten 10 men and 3 of every 10 women will die within 5 years. What should the very old expect of the dying experience? National data reveal that very old adults experience considerable variation in the use of the hospital during their last 6 months of life. Physicians report these patients most often need assistance with self-care, emotional support, nutrition, and pain control. In order to minimize unnecessary and expensive hospitalization and improve home management, specific terminal care guidelines are proposed and illustrated.
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J Ambul Care Manage · Apr 1998
Case ReportsCaring for survivors of torture in an urban, municipal hospital.
Survivors of torture can present with multiple health consequences, both physical and psychological, which can persist even years after the abuse. The authors developed a multidisciplinary program in the primary care medical clinic of an urban municipal hospital in New York City serving an ethnically diverse population to provide multidisciplinary care to survivors of torture and their families.
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J Ambul Care Manage · Oct 1997
Conducting clinical and health economic outcome studies in an ambulatory setting.
Increasingly, health care practitioners are addressing economic (health care resource utilization) and nonclinical (patient satisfaction and quality of life) outcomes along with traditional clinical outcomes (morbidities, mortalities, cure rates, etc.) in assessing the impact and quality of care provided to their patients. These additional outcomes also are collected to assist health care providers to meet accreditation standards and to aid in the selection of alternative health care interventions in an environment of limited resources. ⋯ In addition, relevant resource utilization and outcome measures are identified based on a variety of provider/payer perspectives. Finally, a framework to develop a strategic operating plan for measuring and valuing outcome measures in an ambulatory setting is presented.
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J Ambul Care Manage · Oct 1996
The measurement of physician work and alternative uses of the resource based relative value scale.
On January 1, 1992, the Medicare program implemented a new payment system for physician services based on the Resource Based Relative Value Scale (RBRVS). The RBRVS has been widely accepted as a rational and systematic approach to measuring the resource costs associated with physician services. In addition to deriving physician payment rates, the RBRVS provides a useful metric that allows the measurement and comparison of provider utilization rates and productivity across physicians performing a varied mix of services. In this study we describe the measurement of physician work, discuss alternative ways in which work values can be used to monitor physician service utilization (e.g., profiling physician practice patterns), measure physician productivity, and determine physician compensation.
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J Ambul Care Manage · Jan 1996
Quality of life and quality of care data from a 7-year pilot project for home ventilator patients.
A research demonstration pilot project for hospitalized adult and pediatric long-term ventilator-dependent patients was conducted by Kaiser Permanente Southern California Region from 1985 until 1992. The purpose of the pilot project was to investigate if home care was a realistic alternative to continued hospital care. Many aspects of home care as compared to hospital care were studied. ⋯ Respondents were asked to measure perceptions of quality of life and quality of care at home versus at the hospital in regard to health status, life satisfaction, emotional well-being, caregiver ability, and professional care and services. Quality of care was found to be similar to hospital care. Quality of life was judged to be better at home.