The American journal of managed care
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Comparative Study
The impact of an inpatient physician program on quality, utilization, and satisfaction.
To evaluate an inpatient physician system initiated in June 1996 for all patients of a health maintenance organization admitted to the general medicine service of an urban teaching hospital. In the new program, attending physician duties were transferred from the patient's own general internist to another internist serving on a hospital-based rotation. ⋯ Implementation of an inpatient physician program at this institution significantly decreased resource utilization while maintaining or improving quality of care. Satisfaction with the program was high among primary care internists and housestaff.
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To project the impact of maintaining long-term glycemic control (i.e., a sustained reduction in glycosylated hemoglobin (hemoglobin A1c [HbA1c]) on the lifetime incidence and direct medical costs of complications in persons with type 2 diabetes. ⋯ Maintaining long-term glycemic control reduces complication rates and costs for medical care for all ethnic groups regardless of age at diagnosis. Relatively greater benefit is achieved by interventions targeting Hispanics and younger, newly diagnosed persons.
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To identify the resource use and costs associated with the diagnosis of common problems in primary care practice and to investigate the influence of physician characteristics, practice organization, and financial incentives on physician behavior. ⋯ Multispecialty group practice and compensation by salary consistently predict lower costs for evaluation of common problems in primary care practice. Financial incentives such as capitation, withholds, and bonuses were not associated with an effect on costs of diagnostic evaluation.
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To assess the effects of health need, enabling factors, and predisposing factors on entry into any type of care, volume of care, use of emergency services, hospitalization, and receipt of preventive services. ⋯ Access to care for Hispanics remains a major problem, significantly affected by structural and financial factors, personal experiences with the healthcare system, and predisposing factors. Policy solutions that address the health service needs of the uninsured will largely benefit Hispanics. In addition, as managed care plans compete for contracts and become more multicultural, access to care for Hispanics, including the uninsured, may improve through market forces.
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To gauge women's flexibility about seeing a nurse or an unfamiliar physician, to assess their interest in telephone visits, and to identify the characteristics of women who are least flexible. ⋯ The flexibility of most women regarding redesigned models of healthcare is encouraging. More attention needs to be paid, however, to education of women about multidisciplinary roles, enhancement of coordination of care, and customization of care to match patients' preferences.