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Showing papers on "Health care published in 1988"


Journal ArticleDOI
23 Sep 1988-JAMA
TL;DR: Assessing quality depends on whether one assesses only the performance of practitioners or also the contributions of patients and of the health care system, on how broadly health and responsibility for health are defined, and on whether the maximally effective or optimally effective care is sought.
Abstract: Before assessment can begin we must decide how quality is to be defined and that depends on whether one assesses only the performance of practitioners or also the contributions of patients and of the health care system; on how broadly health and responsibility for health are defined; on whether the maximally effective or optimally effective care is sought; and on whether individual or social preferences define the optimum. We also need detailed information about the causal linkages among the structural attributes of the settings in which care occurs, the processes of care, and the outcomes of care. Specifying the components or outcomes of care to be sampled, formulating the appropriate criteria and standards, and obtaining the necessary information are the steps that follow. Though we know much about assessing quality, much remains to be known. (JAMA1988;260:1743-1748)

5,353 citations


Journal Article
TL;DR: In this review of the theoretical and empirical work on patient satisfaction with care, the most consistent finding is that the characteristics of providers or organizations that result in more "personal" care are associated with higher levels of satisfaction.
Abstract: In this review of the theoretical and empirical work on patient satisfaction with care, the most consistent finding is that the characteristics of providers or organizations that result in more "personal" care are associated with higher levels of satisfaction. Some studies suggest that more personal care will result in better communication and more patient involvement, and hence better quality of care, but the data on these issues are weak and inconsistent. Further research is needed to measure specific aspects of medical care and the ways in which patient reports can complement other sources of information about quality. In addition, more research on the determinants of satisfaction and the relationship between quality and satisfaction among hospitalized patients is recommended.

1,143 citations


BookDOI
01 Jan 1988
TL;DR: This volume provides an overview of each component of the acute and long-term care service continuum, including managed health care, subacute care, nursing homes, community care case management, and private case management.
Abstract: The contributors to this volume provide an overview of each component of the acute and long-term care service continuum, including managed health care, subacute care, nursing homes, community care case management, and private case management. This volume is one of the first efforts to place these varied approaches side-by-side, highlighting the gaps and areas of duplication in the services delivery system. In addition, chapters address the emerging practices in long-term care financing and assisted living as well as the conceptual issues that need to be resolved to achieve acute and chronic care integration. This volume is of primary importance to professionals involved in long-term care, including administration, community nursing, social work, case management, discharge planning and policy.

1,108 citations


Journal ArticleDOI
TL;DR: A method was developed to derive the relative levels of patient satisfaction with 11 aspects of care, and it was demonstrated that different aspects of medical care are measured with extremely uneven frequencies in satisfaction instruments.

589 citations


Book
P. Ley1
01 Mar 1988
TL;DR: Patients' satisfaction patients' understanding of what they are told memory for medical information relationships between understanding, memory, satisfaction and compliance techniques for increasing patients' recall and understanding.
Abstract: Patients' satisfaction patients' understanding of what they are told memory for medical information the problem of patients' non-compliance relationships between understanding, memory, satisfaction and compliance techniques for increasing patients' recall and understanding another problem - non-compliance by health care professionals the use of written information selecting the content of communications the benifits of improved communication.

553 citations


Journal ArticleDOI
TL;DR: A model for interdependent demand for health insurance and health care under uncertainty is developed to throw light on the issue of insurance-induced distortions in thedemand for health care services.
Abstract: This paper develops a model for interdependent demand for health insurance and health care under uncertainty to throw light on the issue of insurance-induced distortions in the demand for health care services. The model is used to empirically analyse the determinants of the choice of health insurance type and seven types of health care services using micro-level data from the 1977–78 Australian Health Survey. Econometric implementation of the model involves, simultaneously, issues of discreteness of choice, selectivity and stochastic dependence between health insurance and utilization. Health status appears to be more important in determining health care service use than health insurance choice, while income appears to be more important in determining health insurance choice than in determining health care service use. For a broad range of health care services both moral hazard and self selection are found to be important determinants of utilization of health care services.

523 citations


Book
01 Jan 1988
TL;DR: The authors argue for the restoration of beneficence to its place as the fundamental principle of medical ethics and reject the current emphasis on rightsand duty-based ethical systems in favor of a virtue-based theory which is grounded in the physicianpatient relationship.
Abstract: In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thorough-going philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, quality-of-life determinations, the allocation of scarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician must perform a right and good healing action which is consonant with the individual patient 's values. In order to act in the patient 's best interests, or the patient 's good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honors the patient 's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient 's good rejects the assumption long held in medicine that what is considered to be the medical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the current emphasis on rightsand duty-based ethical systems in favor of a virtue-based theory which is grounded in the physicianpatient relationship. This book's provocative contributions to medical ethics will be of great interest not only to physicians and other health For t he Pat ient 's Good: T he Rest orat ion of Benef icence in Healt h Care    professionals, but also to ethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today.

508 citations


Journal Article
TL;DR: The authors report a study that identified work culture as a significant element in today's health care environment and identified the nursing administrator as a key player in promoting learning.
Abstract: Organizational culture is a significant element in today's health care environment. Understanding work culture can assist the nursing administrator in hiring personnel, orienting newcomers, facilitating organizational change, and promoting learning. The authors report a study that identified the wor

440 citations


Journal ArticleDOI
TL;DR: In this paper, a structured multivariate practice model is proposed for improving social workers' capabilities to effectively satisfy patients' psychosocial needs, which may enhance the professional authority social work needs but which the biomedical framework of existing health care delivery systems frequently threatens.
Abstract: A structured multivariate practice model is proposed for improving social workers' capabilities to effectively satisfy patients' psychosocial needs. The model bases practice activities on an explicit theoretical framework. Using this approach may enhance the professional authority social work needs but which the biomedical framework of existing health care delivery systems frequently threatens: to autonomously make informed decisions to meet the psychosocial needs of populations at risk. The approach can also contribute to the development of an indigenous professional body of knowledge.

434 citations


Journal ArticleDOI
TL;DR: A methodology is put forward to define indicators for participation in health care programmes as how wide participation is on a continuum developed for each of the five factors which influence community participation.

382 citations


Journal ArticleDOI
TL;DR: A large number of people, medical professionals and clinical researchers have expressed concern about the effectiveness and appropriateness of man's role in the world of medicine.
Abstract: ALTHOUGH modern medicine provides great benefits to large numbers of people, medical professionals and clinical researchers have expressed concern about the effectiveness and appropriateness of many current and emerging medical practices. For example, the evidence substantiating the effectiveness of many such practices is frequently questionable and in many instances entirely lacking.1 Research on medical interventions is often poorly designed and methodologically flawed.2 , 3 Many physicians lack the skills to interpret and critically evaluate medical literature,4 and they approach the same clinical problem with different theoretical assumptions, contributing to wide variations in practice patterns.5 , 6 Furthermore, physicians have difficulty incorporating information about probabilities . . .

Journal ArticleDOI
James Trostle1
TL;DR: It is argued that the popularity of compliance and the uncertainty over its determinants can be understood if compliance is analyzed as an ideology that assumes and justifies physician authority.

Journal Article
TL;DR: This paper attempts to advance the understanding and appreciation of the several contributions to this anthology by placing their more important features in a unifying framework and celebrates the rededication to quality in health care.
Abstract: In this paper I attempt to advance our understanding and appreciation of the several contributions to this anthology by placing their more important features in a unifying framework. In this way I hope to show their historical antecedents, their interrelationships, and their linkages to the central problems and purposes of quality assessment and assurance. But above all, I celebrate our rededication to quality in health care.

Journal ArticleDOI
TL;DR: The authors conclude that consumers can provide a valid assessment of quality and that bias from personal characteristics is not strong enough to undermine that assessment.
Abstract: Prologue: The voices of medical care consumers, never a major influence on providers, are beginning to enter the debate with increasing frequency. Despite our society's general acceptance of a market-driven economy, however, the question remains whether health care consumer data are a valid measurement of technical quality. Does the consumer have the knowledge base to make such a judgment? Opponents of consumers' ratings and data feel they reflect more about the interpersonal aspects of care and may be influenced by such factors as the quantity of services rather than technical quality. Here, Allyson Ross Davies and John Ware examine the assumption that consumers can provide valid information about the quality of medical care, specifically identifying those quality assessment and assurance activities that can rely on consumer data. After reviewing the research, the authors conclude that consumers can provide a valid assessment of quality and that bias from personal characteristics is not strong enough to ...

Journal ArticleDOI
TL;DR: The major theoretical explanations of the social transformation of medical work under advanced capitalism are outlined and the adequacy of the prevailing view of professionalism (Freidson's notion of professional dominance) is considered, and an alternative view is offered.
Abstract: Corporatization of health care is dramatically transforming the medical workplace and profoundly altering the everyday work of the doctor. In this article, the authors discuss recent changes in U.S. health care and their impact on doctoring, and outline the major theoretical explanations of the social transformation of medical work under advanced capitalism. The adequacy of the prevailing view of professionalism (Freidson's notion of professional dominance) is considered, and an alternative view, informed by recent changes, is offered. While the social transformation of doctoring is discussed with reference to recent U.S. experience, no country or health system can be considered immune. Indeed, U.S. experience may be instructive for doctors and health care researchers in other national settings as to what they may expect.

Book
03 Nov 1988
TL;DR: In this article, the Elementary Curriculum as a Code for National Communication (ECCNC) was used as a model for teaching children about the collectivizing process and its consequences.
Abstract: Chapter 1 Introduction Chapter 2 Local Charity, Regional Vagrancy and National Assistance Chapter 3 The Elementary Curriculum as a Code for National Communication Chapter 4 Medical Police, Public Works and Urban Health Chapter 5 Worker's Mutualism: An Interlude on Self-Management Chapter 6 Social Security as the Accumulation of Transfer Capital Chapter 7 Conclusion: The Collectivizing Process and Its Consequences Index.

Journal ArticleDOI
TL;DR: Home- and community-based health care services are shown to raise overall utilization and costs and recommendations are made for reaping this considerable benefit more efficiently.
Abstract: For almost three decades researchers have sought to quantify the benefits of home and community care for the elderly, invariably assuming that such care would be an economical substitute for institutionalization. Twenty-seven studies that met rigorous criteria of design, size, and subject were analyzed and the results were synthesized to address the effects on institutional utilization and expenditures, and patient health status and well-being. Home- and community-based health care services are shown to raise overall utilization and costs. Health status effects are limited primarily to patient and caregiver contentment and reduction of unmet needs. Recommendations are made for reaping this considerable benefit more efficiently.

Journal ArticleDOI
TL;DR: Results suggest that some consumers may take a more scientific approach to health care and prevention than others and that demographics, health status, and health consciousness are partial predictors of that consumer approach.
Abstract: Measures of attitudes of health care consumers toward their own health behaviors and health care institutions reveal the overall pattern of their views as well as their segmented views. Results suggest that some consumers may take a more scientific approach to health care and prevention than others and that demographics, health status, and health consciousness are partial predictors of that consumer approach. Policy makers for health care should formulate and target programs with different segments of the population in mind.

Journal ArticleDOI
TL;DR: It is suggested that quality of life in elderly outpatients with chronic disease is a multidimensional construct involving health, as well as social and other factors.
Abstract: Quality of life is an important consideration in medical decisions involving elderly patients and a clinical outcome measure of health care. Elderly outpatients (N = 126) with five common chronic diseases (arthritis, ischemic heart disease, chronic pulmonary disease, diabetes mellitus, and cancer) and their physicians were interviewed to better characterize patient quality of life. Patients generally perceived their quality of life to be slightly worse than "good, no major complaints" in each chronic disease. Physicians' ratings were generally worse than and only weakly associated with the patients' ratings of quality of life in each chronic disease. Significant independent correlates of patients' ratings of quality of life included the patients' perceptions of their health, interpersonal relationships, and finances. These results suggest that quality of life in elderly outpatients with chronic disease is a multidimensional construct involving health, as well as social and other factors. Physicians may misunderstand patients' perceptions of their quality of life.

Journal ArticleDOI
TL;DR: This paper provides a review, classification, and analysis of the literature on capacity management and specific problem areas not dealt with in the previous literature are targeted.
Abstract: Health care has undergone a number of radical changes during the past five years. These include increased competition, fixed-rate reimbursement systems, declining hospital occupancy rates, and growth in health maintenance organizations and preferred provider organizations. Given these changes in the manner in which health care is provided, contracted, and paid for, it is appropriate to review the past research on capacity management and to determine its relevance to the changing industry. This paper provides a review, classification, and analysis of the literature on this topic. In addition, future research needs are discussed and specific problem areas not dealt with in the previous literature are targeted.

Journal ArticleDOI
TL;DR: It is argued in this paper that much of the empirical research into the public's and patients' perceptions of the adequacy of health care has suffered from conceptual weaknesses and as a result of these weaknesses, a contradictory pattern of findings has emerged.

Book
01 Jan 1988
TL;DR: This book discusses the foundations of health psychology, the role of psychology in health care, and how to manage stress and pain.
Abstract: Part I: FOUNDATIONS OF HEALTH PSYCHOLOGY. 1. Introducing Health Psychology. 2. Conducting Health Research. 3. Seeking and Receiving Health Care. 4. Adhering to Healthy Behavior. Part II: STRESS, PAIN, AND COPING. 5. Defining, Measuring, and Managing Stress. 6. Understanding Stress, Immunity and Disease. 7. Understanding and Managing Pain. 8. Considering Alternative Approaches. Part III: BEHAVIOR AND CHRONIC DISEASE. 9. Behavioral Factors in Cardiovascular Disease. 10. Behavioral Factors in Cancer. 11. Living With Chronic Illness. Part IV: BEHAVIORAL HEALTH. 12. Smoking Tobacco. 13. Using Alcohol and Other Drugs. 14. Eating and Weight. 15. Exercising. Part V: LOOKING TOWARD THE FUTURE. 16. Future Challenges. Glossary.

Journal ArticleDOI
TL;DR: The rationale, conceptual models, program examples, and recent empirical evidence regarding the extent and effects of environ mental interventions to promote healthy eating, as well as the state of the art, are reviewed.
Abstract: Environmental interventions are an important part of efforts to improve health in populations. With respect to strategies to encourage positive nutrition behavior, environmental approaches help create opportunities for action by removing barriers to following a healthy diet. This article reviews the rationale, conceptual models, program examples, and recent empirical evidence regarding the extent and effects of environmental interventions to promote healthy eating. The state of the art is described for five types of interventions: (1) changes in the food supply; (2) point of choice nutrition information; (3) collaboration with private sector food vendors; (4) worksite nutrition policies and incentives; and (5) changes in the structure of health and medical care related to nutrition. Environmental approaches to dietary behavior change can reach large segments of the population through increased availability of nutritious foods, provision of quality nutrition services in workplace and health care settings, and accessible information about healthful food choices. Nutrition intervention can also serve as a model for other types of health promotion initiatives using multidimensional environmental and educational technologies.

Journal ArticleDOI
TL;DR: To evaluate outcome adequately, it is necessary to assess perceptions of life quality from patients who have received life-sustaining treatment, andObjective measures of patients’ material and social resources did not predict satisfaction.
Abstract: Evaluations of intensive care have largely focused on survival, cost, or functional status; however, these may not be the only outcomes of interest to patients, families, and health care providers. Quality of life is an important consideration in evaluating intensive care because it influences decisions about the use of life-sustaining treatment. A study was conducted to assess the quality of life of survivors of intensive care to determine the relationship of perceived quality of life to other outcomes of intensive care. Patients at least 55 years old who received medical intensive care during 1983 (n=69) were interviewed to determine social characteristics, functional status, psychological well-being, and their perceived quality of life using a new 11-item Perceived Quality of Life scale. Functional status correlated only moderately with perceived quality of life (r=0.49, p=0.0001). Objective measures of patients’ material and social resources did not predict satisfaction. To evaluate outcome adequately, it is necessary to assess perceptions of life quality from patients who have received life-sustaining treatment.

Journal ArticleDOI
01 Jan 1988-Bone
TL;DR: Study results suggest considerable potential future cost-savings of osteoporosis prevention and abatement.


Journal ArticleDOI
TL;DR: It is argued that reciprocal trust is a necessary component of satisfying, effective health care relationships when the illness is of an ongoing nature and it is imperative for health care professionals to alter their traditional beliefs with regard to sick role and trust.
Abstract: This paper examines the phenomenon of trust in health care relationships from a new perspective, that of the recipients of care for chronic illness. The authors argue that reciprocal trust is a necessary component of satisfying, effective health care relationships when the illness is of an ongoing nature. From the patient's perspective, reciprocal trust has a significant impact on the experience of being a receiver of health care and on the development of competency with illness management. Because of this, the authors claim that it is imperative for health care professionals to alter their traditional beliefs with regard to sick role and trust. With a new perspective, they may then develop the specific skills necessary to enact the caring aspect of the service they offer. The authors offer a number of suggestions for actualizing this reciprocal trust in clinical practice.

Journal ArticleDOI
TL;DR: The article considers the health policy implications of an apparent increase in demand for hysterectomy and argues the case for a thorough evaluation of the impact of this operation on quality of life.

Book
01 Jun 1988
TL;DR: The Goals of Policy and Managed Competition in the United States and The Netherlands and Competitive Medical Plans are compared.
Abstract: On the Goals of Policy. ``Guild Free Choice'', ``Market Free Choice'', and Competitive Medical Plans. Managed Competition. Converting to Competition in the United States and The Netherlands. Appendix. Bibliography.

Journal ArticleDOI
TL;DR: David Eddy and John Billings make a case for why it is imperative that the medical profession get on with the job of examining more closely the scientific basis of medical practice.
Abstract: Prologue: Most of the proposals advanced in the 1980s for rationalizing the use of medical care derived chiefly from an economic model —more consumer cost sharing, the development of alternative health delivery systems, and new financial incentives. One of the working assumptions of the analysts and policymakers who designed these proposals was that the scientific basis of medicine was solid. If purchasers of care could only determine how to make providers more efficient, they reasoned, the growth of medical costs could be moderated. In this paper, David Eddy and John Billings call into question that assumption. They make a case for why it is imperative that the medical profession get on with the job of examining more closely the scientific basis of medical practice. Eddy holds a medical degree from the University of Virginia and a doctor of philosophy degree in applied mathematics from Stanford University. Eddy, who currently directs the Center for Health Policy at Duke University, is the J. Alexander Mc...