25'. 1$371 $3: :{CHSR (Annotated Bibliography ofNCHSR Pubficaflons 1980-84 US. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Center for Health Services Research and Health Care Technology Assessment ‘EIKELEY UBRARY NCHQR Annotated Bibliography of NCHSR Publications 1980-84 Compiled by DonnaFlae Castillo A 20th Anniversary Publication DHHS Publication No. (PHS) 89-3433 US. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Center for Health Services Research and Health Care Technology Assessment Acknowledgment is made to William LeVee and Randie Siegel for their contributions to this project. Copies of this bibliography are available from the NCHSR Publications and Information Branch, 5600 Fishers Lane——Room 18—12, Rockville, MD 20857; phone 301/443—4100. Reports annotated in this bibliography that include a National Technical Information Service order number (see introductory note, page iii) may be purchased in both paper and microfiche formats from the National Technical Information Service, 5285 Port Royal Road, Springfield, VA 22161; phone 703/487—5650. ii Introductory Note The National Center for Health Services Research and Health Care Technology Assessment (NCHSR) has supported research on problems related to the quality, cost, and delivery of health services since its inception in 1968. This bibliography, published as a historical reference during NCHSR's 20th anniversary year, is the first comprehensive compilation of all NCHSR intramural and extramural publications for the years 1980 to 1984. Annotations from nearly 800 reports are included in this document and are arranged alphabetically by principal author in a general reference section and 12 specific subject areas. Examples of topics covered in the subject areas are listed at the beginning of each chapter. When applicable, the NCHSR grant or contract number is included in the citation. Reports which may be purchased from the National Technical Information Service (NTIS) are annotated with the appropriate NTIS order number. The bibliography is indexed both by abbreviated title and by principal author and up to two coauthors. Current plans call for the publication of an additional comprehensive bibliography that will annotate works from NCHSR's earliest years, thereby providing complete documentation of the wide scope of NCHSR’s health services research during the last two decades. iii Contents Chapter I—‘l—‘I—‘H wNHowmqmmwat-l General References Computer Science Applications Financing, Costs, and Expenditures Health Care Professionals Health Promotion and Disease Prevention Hospitals (includes care, services, and operations) Long-Term and Nursing Home Care Medical Technology Assessments Planning, Evaluation, and Regulation Primary Care Quality Assurance and Quality of Care Research Methods and Models Service Delivery, Access, and Utilization Author Index Index of Abbreviated Titles Page 11 35 45 59 67 77 89 101 113 127 139 155 159 1. General References 0 National Center for Health Services Research. (1984). Bibliography of Publications Resulting From NCHSR Extramural Research, 1983-84. Rockville, MD: Public Health Service. (NTIS Order No. P885—132413), 10 pp. Publications resulting from grants supported by NCHSR's Division of Extramural Research are listed. 0 National Center for Health Services Research. (1980—83). NCHSR Fact Sheets, Program Notes, and Technical Notes. Rockville, MD: Public Health Service. (NTIS Order No. PB84—119684), 28 pp. General information on issues addressed in NCHSR research is provided through fact sheets, program notes, and technical notes published by the Center. This compilation includes summaries of reports on catastrophic illness, emergency medical services systems, health promotion, and manpower issues in health care. 0 National Center for Health Services Research. (1984). NCHSR Program Notes-—NCHSR Reports Available From NTIS. Rockville, MD: Public Health Service. (NTIS Order No. P385—159788/AS), 12 pp. Reports resulting from NCHSR-supported research that were submitted to the National Technical Information Service from September 30, 1983, through June 8, 1984, are listed. 0 National Center for Health Services Research. (1980—84, yearly). NCHSR Research Activities. Rockville, MD: Public Health Service. (1980, NTIS Order No. PBB4—200211, 19 pp.; 1981, NTIS Order No. P884-200203, 44 pp.; 1982, NTIS Order No. P884—199967, 32 pp.; 1983, NTIS Order No. PBB4—199959, 36 pp.; 1984, NTIS Order No. PB85—174753/AS, 46 pp.). Newsletters published monthly by the National Center for Health Services Research describe research results and activities of the Center. The newsletters range from 4 to 12 pages and are made available in a consolidated format at the end of each calendar year. 0 National Center for Health Services Research. (1981, April). NCHSR Summary of Grants and Contracts Active on September 30, 1978. Research Management Series, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PB81-207375), 254 pp. Grants and contracts supported by NCHSR at the end of fiscal year 1978 are described. 0 National Center for Health Services Research. (1981, July). NCHSR Summary of Grants and Contracts Active on September 30, 1979. Research Management Series, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P382—182528), 320 pp. Grants and contracts supported by NCHSR at the end of fiscal year 1979 are described. 0 National Center for Health Services Research. (1982, October). NCHSR Summary of Grants and Contracts Active on September 30, l 1980. Research Management Series, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PBB3—172148), 249 pp. Grants and contracts supported by NCHSR at the end of fiscal year 1980 are described. 0 National Center for Health Services Research. (1982, April). NCHSR Summary of Grants and Contracts Active on September 30, 1981. Research Management Series, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PBB3-218552), 250 pp. Grants and contracts supported by NCHSR at the end of fiscal year 1981 are described. 0 National Center for Health Services Research. (1982, September). NCHSR Summary of Grants and Contracts Active on September 30, 1982. Research Management Series, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P883—233692), 162 pp. Grants and contracts supported by NCHSR at the end of fiscal year 1982 are described. 0 National Center for Health Services Research. (1983, September). NCHSR Summary of Grants and Contracts Active on September 30, 1983. Research Management Series, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PB84—205921), 130 pp. Grants and contracts supported by NCHSR at the end of fiscal year 1983 are described. 0 National Center for Health Services Research. (1984, September). NCHSR Summary of Grants and Contracts Active on September 30, 1984. Research Management Series, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PBBS—174811/AS), 150 pp. Grants and contracts supported by NCHSR at the end of fiscal year 1984 are described. 0 National Center for Health Statistics and National Center for Health Services Research. (1980, December). Health United States, 1980 (DHHS Publication No. (PHS) 81—1232). Rockville, MD: Public Health Service. (NTIS Order No. PBal—180200), 323 pp. Statistics on recent trends in the health care sector and discussions of current (1980) health issues are presented. The report includes analytical articles, 78 detailed tables with a tabular guide, descriptions of data sources, a glossary of health—related terms, and a prevention profile. 2. Computer Science Applications Topics covered in this section include the following: automated record system development; standardization of data systems; computer drug profiling; software package specifications; development of specific data banks; computer model evaluations; and effects of using computerized record systems. 0 Barnett, G. (1984, June 21). The application of computer—based medical—record systems in ambulatory practice. The New England Journal of Medicine 310(25), pp. 1643—1650. (NCHSR Grants H500240 and HSO4073). This article compares manual and computer—based medical—record systems, discusses computer—based systems as they function in office practice, and presents some considerations for future implementation of automated systems. The author details issues in capturing and reporting medical data, justifying support costs, and assuring quality. The need to address physicians’ security concerns is also discussed. o Barnett, G. (1983, April). A computer-based monitoring system for follow—up of elevated blood pressure. Medical Care 21(4), pp. 400—409. (NCHSR Grants H800240, HSO3588, and H802142). The COSTAR automated surveillance system is discussed in terms of its ability to improve followup of patients with newly identified elevated diastolic blood pressure. It was found that followup was significantly improved in a group of patients that received computer—generated reminders, both in terms of rate of followup visits attempted or achieved by the responsible physician and in the repeated recording of blood pressure. 0 Bleich, H. (1982). Analysis of Clinical and Managerial Data (NCHSR Grant HSO4050). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PB84—121706), 19 pp. Results of a survey of users of the Medical Information Storage and Retrieval System (MISAR) data base are described. In addition, the report summarizes experience with PaperChase-—a program that provides rapid searching of over 400,000 citations in a medical library. 0 Blum, R. (1982). Discovery, confirmation, and incorporation of causal relationships from a large time—oriented clinical data base: The Rx project. Computers and Biomedical Research 15(2), pp. 164—187. (NCHSR Grant HSO4389). The RX computer program and its modules are detailed. The modules include a knowledge base, a discovery module, a study module, and a clinical data base. Both objectives and instruments are explained. 0 Brian, E. (1981). Development of an Automated Hospital Information Systems Workbook (NCHSR Contract 233—79-3015). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PBB3—121905), 297 pp. The process of developing a two—volume 3 workbook and associated materials for use by hospital decisionmakers is described. The workbook was devised by the University of Southern California (USC) Center for Health Services Research and is available from USC’s Center Publications, Inc. 0 Cohen, S. (1981). Development, Implementation, and Evaluation of the Monitoring and Evaluation of Drug Interactions by a Pharmacy Oriented Reporting System (MEDIPHOR) (NCHSR Grant HSOO739). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB82—140757), 812 pp. The computer—based MEDIPHOR system used by pharmacists to alert physicians about potential adverse drug reactions is detailed. Descriptions of earlier system prototypes, the current system configuration at Stanford University Medical Center, a user’s manual, and an evaluation of MEDIPHOR at two Indiana hospitals are presented. 0 Cohen, S. (1983). Present limitations in the availability of statistical software for the analysis of complex survey data. Review of Public Data Use 11, pp. 338—344. The author points out that as the level of sophistication for selected analytical procedures increases, the availability of appropriate software decreases markedly. Analytical concerns arising from the National Medical Care Expenditure Survey are used as a basis for a discussion on limitations in statistical software availability. (An earlier version of this paper, by S. Cohen and G. Gridley, was presented at the 1981 annual meeting of the American Statistical Association--Statistical Computing Section and published in its Proceedings, pp. 20—24.) 0 Cooley, P. and B. Cox. (1981, August). An automated procedure for matching record check and household-reported health care data. In American Statistical Association——Survey Research Methods Section. Proceedings (pp. 418—423). Washington, DC: American Statistical Association. The authors used data from the National Medical Care Expenditure Survey to develop a matching algorithm that would identify the same set of provider visits reported from two different data sources (provider and consumer). The matching program provided for point and interval matching capabilities, the use of tolerances, and minimum acceptance criteria. 0 Cox, J. (1984). A Medical Information Systems Design Methodology (NCHSR Grant HSO3792). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P386—212388/AS), 364 pp. The development and testing of the Abstract Database System are described. 0 Davis, L. (1981). Export, Expansion, and Dissemination of PROMIS (NCHSR Contract 233—78—3011). Rockville, MD: Public Health Service. (Executive Summary, Final Report, and Report on Effort to Upgrade the Brown III PROMIS Demonstration, NTIS Order No. P382—161811), 290 pp. Modifications, improvements, and demonstrations of the Problem Oriented Medical Information System (PROMIS) as developed at the University of Vermont are described. Included is a report on the subcontract to upgrade the Brown III Medical Ward Demonstration at the Medical Center Hospital of Vermont. Improvements designed to make the system more usable to medical staff and thereby increase its acceptance by physicians are emphasized. o Dittmann, J. (1981). Health Information System Transferability Evaluation (NCHSR Grant HSO3672). Rockville, MD: Public Health Service. (Dissertation Final Report, NTIS Order No. P881—206500), 398 pp. The author develops a predictive evaluation model designed to help estimate the costs of transferring a computerized information system to a specific setting. The research methodology uses the opinions of medical information system practitioners to assist in model development. o Ellinoy, B. and G. Gilroy. (1984, September). Future health care and hospital pharmacy practice: Perspectives based on a unique experience. American Journal of Hospital Pharmacy 41(9), pp. 1851—1854. (NCHSR Grant HSOOl75 and Contracts 230—76—0099 or 233—78—3011). The PROMIS pharmacy model as developed at the University of Vermont is briefly described. The authors maintain that a computerized drug information system such as PROMIS enhances the opportunities for role expansion for the institutional pharmacist. o Fortress, E. (1982). Models To Assist Cardiac Diagnostic Test Decisions (NCHSR Grant HSO4231). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P383—218487), 194 pp. Efforts to implement and evaluate a Bayesian computer model are discussed. The objectives were to combine data on prior probability of coronary artery disease with test results in order to estimate posterior probability of disease for various patient types. It was found that the model could discriminate between groups of persons with and without coronary artery disease and could distinguish among levels of severity. o Fries, J. (1984, May). The chronic disease data bank: First principles to future directions. Journal of Medicine and Philosophy 9(2), pp. 161—180. (NCHSR Grant HSO3802). A model for clinical investigation of contemporary disease is presented, data are systematically accrued and analyzed, and collected data are modified based on anticipation of future needs. The strategies underlying the development of the American Rheumatism Association Medical Information System are used as an illustration of a chronic disease data bank. o Gardner, R. (1980). Computerized Protocols Applied to Emergency Care (NCHSR Grant HSOZ463). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P382—128695), 174 pp. The report discusses the rationale for and development of computerized triage and treatment protocols in deciding whether to admit patients to intensive care units. o Gittelsohn, A. (1981). Obstetrical Practice and Perinatal Outcome (NCHSR Grant HSO3576). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB4—205723), 3 pp. The technical approaches used to store, reduce, and abstract information from large-scale natality data bases are briefly described. o Koepsell, T. (1983, August). The Seattle evaluation of computerized drug profiles: Effects on prescribing practices and resource use. American Journal of Public Health 73(8), pp. 850—855. (NCHSR Grant 8803892). The results of a controlled trial showed that prescription of two interacting drugs on the same visit was significantly more common for patients for whom a computer—generated profile of their current and past medication history was available. It was found that profiles had no effect on prescribing volume or coordination of drug refill and visit schedules, but profile group patients made abut 5 percent fewer clinic visits than those in the no—profile group. o Koepsell, T. and others. (1983, May). The Seattle evaluation of computerized drug profiles: Effect on provider activities. Medical Care 21(5), pp. 497—507. (NCHSR Grant HSO3892). Whether furnishing care providers with computer—generated summaries of patients' medication would reduce the time spent on various drug—related tasks during patient visits was investigated. Results suggested that record reading time was reduced for first patient/provider encounters in high—volume medical clinics; but in other situations, no effect was evident. o Kokiko, E. (1983). A Guide to COSTAR: An Innovative Computer Stored Ambulatory Record System——A Description of System Capabilities and Applications in Local Health Departments (NCHSR Contract 233-80—4004). Rockville, MD: Public Health Service. (NTIS Order No. P384—111376), 28 pp. The capabilities of the COSTAR computerized records management and revenue recovery system are described in terms of the system's applications in various health care settings. The characteristics of COSTAR which enable it to support a wide range of public health programs are also summarized. o Lambert, W. and J. Walsh. (1984). Data Needs of Local Health Departments (NCHSR Grant H505126). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P385—187243/AS), 31 pp. A survey of computer use in California’s local health departments was made and a symposium on determining data needs and framing a minimum data set for these departments was held. The results of these activities are summarized and a theoretical framework is discussed. o Maturi, V. and R. DuBois. (1981). Recent Trends in Computerized Medical Information Systems for Hospital Departments. Rockville, MD: Public Health Service. (NTIS Order No. PB8l—167660). The authors examine the state of commercially available department—specific medical information systems and their relationship to the hospital—wide communication system. Current systems are compared with those of 2 years ago. 0 McDonald, C. and others. (1984, January). Reminders to physicians from an introspective computer medical record: A two—year randomized trial. Annals of Internal Medicine 100, pp. 130-138. (NCHSR Grants H802485 and 8504080). The investigators developed a computer-stored medical record system containing a limited set of the total clinical data base in order to study the effect of physician—authored reminder rules on physician behavior. o MEDIPHOR Editorial Group (R. Mangini, Ed.). (1983). Drug Interaction Facts. St. Louis, MO: J.B. Lippincott. (NCHSR Grant HSOO739). This reference book is a derivative of the MEDIPHOR--Monitoring and Evaluation of Drug Interactions by Pharmacy Oriented Reporting——drug interaction data base developed at Stanford University Medical Center. The book presents each drug interaction in single—page monograph form with the following information: interacting drugs, clinical significance (onset, severity, and documentation), pharmacologic effects, pharmacodynamic or pharmacokinetic mechanism, and clinical management suggestions. Relevant studies are reviewed in a brief discussion. 0 Pass, T. (1983, June). LAMP: A data management and analysis system for patient registries and clinical studies. Journal of Medical Systems 7(3). pp. 267—271. (NCHSR Grants H802063 and HSO4066). Features of the LAMP (Laboratory for the Analysis of Medical Practices) computer system are summarized. The author points out that the delivery of cost—effective medical care can be accomplished only through identifying patient-specific clinical strategies. This requires a data management system such as LAMP that can collect and extract predictive information from a clinical data base. 0 Rappoport, A. (1980). Development and Assessment of Computer Voice Answerback in Health Care (NCHSR Grant H800060). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB82—157017), 44 pp. The report summarizes the development, implementation, and impact of a centralized, automated, and computerized clinical laboratory serving geographically separate units of the Youngstown, Ohio, Hospital Association. o Shoemaker, W. and others. (1980). Clinical trials of a computerized algorithm for measurement of the severity of illness and prediction of outcome in postoperative shock. In J. O'Neill (Ed.). Proceedings —— The Fourth Annual Symposium on Computer Applications in Medical Care (pp. 1594—1600). Long Beach, CA: Institute of Electrical and Electronics Engineers. (NCHSR Grant H501833). An algorithm that analyzed postoperative patient cardiorespiratory data was used to develop a severity—of—illness predictive index which was then tested prospectively on a new series of patients. The usefulness of the index was demonstrated by tracking the clinical course of the prospective series. 0 Siegel, C. (1982). The Effects of a Computerized Drug Order Review System (NCHSR Grant HSO3879). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884—156199), 270 pp. A quasi—experimental study was carried out to investigate the impact of the computerized drug prescription monitoring system known as DERS (Drug Exception Reporting System) on clinicians' prescribing behaviors and on their knowledge of pharmacotherapy. It was shown that such a system may affect prescribing behavior of institutional clinicians by reducing the number of orders written in exception to guidelines. But only slight changes in clinicians' pharmacotherapeutic knowledge could be attributed to use of the DERS. o Simborg, D. (1983). Evaluation of a Summary Record System (NCHSR Grant HSO3582). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB4—100247), 225 pp. The Summary Time Oriented Record (STOR) is evaluated in terms of its information flow cababilities. It was shown that when STOR was added to The Medical Record (TMR) in outpatient visits to an arthritis clinic, there was increased information flow to clinic care providers as measured by improved predictive accuracy for future patient—specific clinical events. o Simborg, D. and others. (1982). A hospital local area communication network: The first year's experience. In B. Blum (Ed.). Proceedings —— The Sixth Annual Symposium on Computer Applications in Medical Care (pp. 479-482). Long Beach, CA: Institute of Electrical and Electronics Engineers. (NCHSR Grant H504196). A computer-based communications network is discussed in terms of its ability to integrate patient identification and registration information within a large teaching hospital. The feasibility of the technology to simplify the integration of diverse hardware and software systems is explained. o Stead, E. (1983). A Medical Database Approach to Evaluate Technology (NCHSR Grant HSO3834). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P384-200559), 66 pp. Results of a project to refine and expand a clinical data bank for coronary artery disease are reported. The data base was extended to the outpatient area, patient characteristics were expanded to include noninvasive test results, and statistical models were formulated and validated for diagnostic and prognostic predictions. 0 Tompkins, R. and T. Koepsell. (1982). Experimental Evaluation of Computerized Drug Profiles (NCHSR Grant HSO3892). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB82—262257), 43 pp. The benefits of computerized drug profiles are assessed as they are related to improved prescribing practices and time savings for providers and patients. Part of the evaluation deals with costs associated with generating computer profiles, both in terms of system operating expenses and changes in drug expenditure and resource utilization patterns. 0 Wagner, D., W. Knaus, and E. Draper. (1982). Decision analysis in intensive care: Identification of non—operative low—risk monitored ICU admissions using a computerized algorithm. In B. Blum (Ed.). Proceedings —— The Sixth Annual Symposium on Computer Applications in Medical Care (pp. 727-731). Long Beach, CA: Institute of Electrical and Electronics Engineers. (NCHSR Grant HSO4857). The hospital course of 806 consecutive nonoperative admissions to intensive care units was investigated to test the feasibility of identifying patients suitable for early transfer. A multivariate logistic regression analysis was used to analyze which of the monitored admissions received active treatment prior to discharge. Out of 323 such admissions, 179 had predicted risks of requiring active intensive therapy of less than 10 percent; only 5 percent actually received such treatment. o Waxman, B. (1983). Implementation of the COSTAR System in San Diego and Other California County Health Departments. Rockville, MD: Public Health Service. (NTIS Order No. PBB4—145879), 32 pp. The report represents a case study of a number of primary care and public health installations in California that have implemented the Computer Stored Ambulatory Record medical information system. 0 Wiederhold, G. and others. (1982). Automated Ambulatory Medical Record Systems in the 0.8. (NCHSR Grant HSO4152). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB4—118884), 69 pp. An overview of the developments in automated ambulatory medical record systems from 1975 through 1982 is presented. The authors maintain that since 1975 no significant advances in system design have been made, but progress has been substantial in achieving production goals. o Wiederhold, G. and R. Blum. (1981). Integrated Medical Knowledge and Clinical Data Banks: Discovery and Representation of Causal Relations From a Large Time-Oriented Clinical Database: The RX Project (NCHSR Grant HSO3650). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB81—227233), 33 pp. This report details the efforts of the RX Project to develop methods for (1) increasing the validity of medical knowledge derived from large time-oriented data bases that contain routine nonrandomized clinical data; (2) providing knowledgeable assistance to research investigators in their study of medical hypotheses with large data bases; and (3) fully automating the process of hypothesis generation and exploratory analysis by computer. 0 Wilson, E. (1982). Optimization Models for Management Decision—Makin (NCHSR Grant H502738). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB82—229329), 34 pp. Results are reported from a project that developed a methodology for a computer—based medical information system. The system was designed to aid physicians in problem 10 solving while also accommodating a wide range of user preferences. The process of developing, validating, and evaluating an algorithm for the prototypical problem of acute diarrhea in adults is described. 0 Wilson, 6., C. McDonald, and G. McCabe. (1982, July). The effect of immediate access to a computerized medical record on physician test ordering: A controlled clinical trial in the emergency room. American Journal of Public Health 72(7), pp. 698—702. (NCHSR Grant HSO4080). The investigators performed a randomized clinical trial to test the effect on test ordering rates when emergency room physicians were provided with computer summaries of patients' medical records. Surgeons who received summaries ordered fewer tests than those who did not, but the results were not statistically significant. o Zimmerman, J. (1980). Specification and Building of Ambulatory—Care Records (NCHSR Grant HSOZ760). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PBBl—134140), 41 pp. The Multi—Environment Scheme (MESCH) software package that facilitates the specification and production of computer applications for primary care is described. Sources for the MESCH questionnaire record are also identified. 3. Financing, Costs, and Expenditures Topics covered in this section include the following: cost accounting; cost control incentives; hospital capital expenditures and corporate costs; hospital reimbursement mechanisms—-fee for service, capitation, diagnosis related groups; catastrophic and long—term care insurance issues; employment—related health insurance benefits and premiums; charges for physician and dental services; sources of payment for health care—~public and private; and cost effectiveness in health care. 0 Adamache, K. and F. Sloan. (1983). Competition between non-profit and for—profit health insurers. Journal of Health Economics 2(3), pp. 225—243. (NCHSR Grant HSO4665). Results are reported from an investigation of the effects of tax, regulatory and reimbursement policies, and other factors outside the health insurance market on Blue Cross expenditures for hospital care relative to commercial insurers, administrative expenses, profits, and premiums. o Avorn, J. (1984, May 17). Benefit and cost analysis in geriatric care: Turning age discrimination into health policy. The New England Journal of Medicine 310(20), pp. 1294-1301. (NCHSR Grant HSO4933). The author maintains that cost-benefit and cost—effectiveness analyses as they are usually applied to allocation of health care resources exhibit an antigeriatric bias, especially when measured by the "human capital" approach. It is suggested that similar types of measurements based on "willingness to pay" and "quality of life" are also flawed. The article calls for "more intelligent" allocation of resources by physicians and "more responsible" use by patients. 0 Barzel, Y. (1981). Competitive Tying Arrangements: The Case of Medical Insurance (NCHSR Grant H802995). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P381—191728). Results are presented from a test of the hypothesis that adverse selection and moral hazard losses would be reduced by insuring substitute medical services together and by insuring only one of complementary pairs of services. o Beazoglou, T. (1982). Determinants of Price Variation in Dental Services (NCHSR Grant H804678). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PB84—120500), 139 pp. Price variation in dental services is examined using an industrial organization approach applied to primary and secondary data sources over a 12—month period. Price variation was found to be significantly and systematically affected by the aggregation of the level of service and the size of the geographic market areas employed. 11 12 o Berk, M., G. Cafferata, and M. Hagan. (1984). Persons with limitations of activity: Health insurance, expenditures, and use of services. National Health Care Expenditures Study Data Preview 19, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3363, NTIS Order No. PB85—124758), 16 pp. Estimates of public and private health insurance coverage, access to a usual source of care, and use of health services by persons with activity limitations are provided. The source of data is the National Medical Care Expenditure Survey. o Berk, M. and A. Taylor. (1983, November 11—16). Women and divorce: Health insurance coverage, utilization, and health care expenditures. Paper presented at the annual meeting of the American Public Health Association, Dallas TX. (NTIS Order No. PB84-208123), 16 pp. This paper examines how divorce affects women’s health insurance coverage, health care utilization, and expenditures with data from the National Medical Care Expenditure Survey. Divorced women were found to be twice as likely as married women to be uninsured, to have somewhat poorer health status, and to depend more on Medicaid assistance. 0 Berk, M. and A. Taylor. (1984, November). Women and divorce: Health insurance coverage, utilization, and health care expenditures. American Journal of Public Health 74(11), pp. 1276—1278. This article was developed from a conference paper of the same title (see previous citation) which examined the effect of divorce on women’s health insurance coverage. o Berki, S. and others. (1983). High Cost Illness Among Hospitalized Patients (NCHSR Contract 233—81—3032). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB84—239110), 281 pp. Financially catastrophic episodes of hospitalization are examined with data from Maryland hospitals and discharge data from the Commission on Professional and Hospital Activities Study of Patient Charges. The implications of the project fundings are discussed, including the disproportionate share of catastrophic illness charges paid by Medicare for the elderly and by Medicaid for the newborn. o Bly, J., R. Jones, and J. Levy. (1980). Short Procedure Units: Impact and Performance Factors (NCHSR Grant HSO3542). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P881—195851), 121 pp. Results are reported from a study of the productivity and use of short procedure units to determine case savings based on length of stay and laboratory costs. o Burkett, G. (1980). The Effect of Cost Control Incentives in an IPA—HMO (NCHSR Grant HSO3485). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBBO-199946), 110 pp. Results are reported from a study of the effects of cost control incentives, including capitation, on practice patterns in an independent practice association. It was l3 hypothesized that physicians with longer experience as providers in this type of health maintenance organization would exhibit greater responsiveness to the cost control objectives, but the findings did not prove the hypothesis. 0 Bush, P. (1984). Evaluation of a Formulary and Pharmacy at an HMO (NCHSR Grant HSO3961). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB84—205707), 62 pp. The costs of starting and operating a drug formulary and an inhouse pharmacy are compared to health plan savings on drug expenditures for enrollees who obtained drugs elsewhere. o Cafferata, G. (1984, September). Knowledge of their health insurance coverage by the elderly. Medical Care 22(9), pp. 835—847. (NTIS Order No. PBBS-139921). Multivariate analysis is used to identify factors associated with high and low levels of knowledge about personal insurance coverage in the population aged 65 and older. 0 Cafferata, G. (1984). Private health insurance coverage of the Medicare population. National Health Care Expenditures Study Data Preview 18, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3362, NTIS Order No. P385—114171), 30 pp. Data from the National Medical Care Expenditure Survey are used to present estimates of the proportion of Medicare enrollees with private health insurance. Premiums and benefits are discussed according to demographic, socioeconomic, and health—related characteristics. o Cafferata, G. (1983). Private health insurance: Premium expenditures and sources of payment. National Health Care Expenditures Study Data Preview 17, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3364, NTIS Order No. PBB4-157593), 20 pp. Data from the health insurance/employer survey component of the National Medical Care Expenditure Survey are presented. Costs of financing private health insurance by both employers and employees and their families are estimated. o Cafferata, G. and J. Kasper. (1983). Psychotropic drugs: Use, expenditures, and sources of payment. National Health Care Expenditures Study Data Preview 14, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 83—3335, NTIS Order No. P883—173658), 16 pp. The authors use data from the National Medical Care Expenditure Survey to provide estimates for utilization of and expenditures for prescribed psychotropic medicines. The data, which are presented by selected sociodemographic and health—related characteristics, show that patterns of sources of payment for psychotropic drugs differed from those for prescribed medicines in general. o Cafferata, G. and M. Meiners. (1984, November 11—15). Public and private insurance and the Medicare population's out—of—pocket l4 expenditures: Does Medigap make a difference? Paper presented at the annual meeting of the American Public Health Association, Anaheim, CA. Data from the National Medical Care Expenditure Survey were used to study the effect of public and private insurance supplements on both utilization of health services and out—of—pocket expenditures. Private insurance was found to result in a lower share of personal income spent directly on health care. 0 Coffey, R. (1980). How a Medical Information System Affects Hospital Costs: The El Camino Hospital Experience (NCHSR Contract 110—73—0331). Rockville, MD: Public Health Service. (Research Summary, DHHS Publication No. (PHS) 80—3265, NTIS Order No. PB80-178551), 24 pp. Findings and analysis are presented from an assessment of how implementing the Technicon Medical Information System affected one hospital’s costs. Implications for other hospital settings are also described. o Coffey, R. and M. Goldfarb. (1984). DRGs and disease staging for reimbursing Medicare patients [Working paper]. Hospital Studies Program, National Center for Health Services Research. This paper uses 1979—81 data for Maryland Medicare patients to compare the diagnosis—related group (DRG) system with disease staging in terms of structure, ability to explain resource consumption, and effect on reimbursement. Results showed that large hospitals fared better under a DRG—based reimbursement system than under one based on disease staging. o Conrad, D., P. Milgrom, and A. Kiyak. (1984, May). Insurance plan effects on dental provider treatment patterns for elderly patients: An experimental economics approach. Medical Care 22(5), pp. 430—445. (NCHSR Grant H802179). Results are reported from a controlled experiment in which dentists planned treatments, given a particular dental insurance plan and patient financial status. Findings suggested that increasingly comprehensive insurance coverage does not lead to uniform monotonic increases in total dental expenditures. It is suggested that careful design of improved insurance benefit plans could widen the range of services without necessarily increasing total costs. 0 Conrad, D. and G. Sheldon. (1981). Competition as a Means To Contain Dental Care Costs (NCHSR Grant H803603). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB81—181497), 113 pp. This report discusses how dental care prices are affected by five State dental practice act provisions: limits on reciprocal licensure between States, dental advertising, number of offices a dentist may own and operate, number of hygienists that can be employed by one dentist, and tasks that can be delegated to auxiliary personnel. o Copeland, R. and P. Jacobs. (1981, Fall). Cost of capital, target rate of return, and investment decision making. Health Services Research 16(3), pp. 335—341. This article provides background and discusses problems on the development of investment 15 decision critera for nonprofit hospitals that follow the criteria for for—profit hospitals. 0 Cummings, V. and others. (1980). An Evaluation of a Day Hospital Service in Rehabilitation Medicine (NCHSR Grant H801043). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P381—209553, 189 pp.; Documentation, NTIS Order No. P382—134982, 558 pp.). A rehabilitation day hospital was evaluated as an alternative to intensive inpatient rehabilitation care. Findings indicated that there was no essential difference between the study groups in functional or physical outcome; however at full capacity and with research costs removed, the day hospital method proved to cost less than the inpatient method. o Cummings, V. and others. (1980). An Evaluation of a Day Hospital Service in Rehabilitation Medicine: Appendix 3. Periodic Progress Reports and Special Studies (NCHSR Grant H801043). Rockville, MD: Public Health Service. (NTIS Order No. P882—134990), 464 pp. Quarterly, semiannual, and yearly progress reports are presented along with background studies done as part of a 6—year day hospital study (see preceding citation). The report includes an analysis of patient outcome at discharge, a discussion of the impact of utilization levels on program costs, and a task inventory analysis. o Deprez, R., B. Curran, and M. Spindler. (1983). A Study of Maine's Catastrophic Illness Program 1975—1980 (NCHSR Grant HSO4507). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB4—207737, 25 pp.; Final Report, NTIS Order No. P884—158054, 113 pp.). Six years of experience with Maine’s catastrophic illness program were analyzed in terms of recipient characteristics, claims, and expenditures for various medical and pharmaceutical services. Findings suggested that the Maine program acted as a public health insurance program for persons without private health insurance, disproportionately serving the poor, unemployed, and uninsured aged 18—44. o DeVito, C. (1982). Economic Impact of the State of Kentucky's Generic Drug Substitution Legislation (NCHSR Contract 233—81—3034). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PBB4—145416), 351 pp. Findings are presented on cost savings resulting from generic drug substitution laws in Kentucky. The author reports savings of about 13—14 percent to consumers when substitution occurred, somewhat less with generic prescribing. Applying the "maximum allowable cost—estimated acquisition cost" payment method to the State’s Medicaid program effected a reduction of 13—15 percent per prescription compared with the usual—and—customary price. o Drazen, E. (1980). Methods for Evaluating Costs of Automated Hospital Information Systems (NCHSR Contract 233-79—3000). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P380—178593), 200 pp. How automated 16 hospital information systems affect costs is assessed by means of a review of the methodological literature. Recommendations for research in improving cost assessment methods are also detailed. o Farley, P. and D. Walden. (1983, November 13—16). The privately insured under 65: Cost—sharing, depth of benefits, and other aspects of their health insurance. Paper presented at the annual meeting of the American Public Health Association, Dallas, TX. National estimates are provided for the proportion of the population under age 65 with specific private health insurance benefits according to specified sociodemographic and employment characteristics. A discussion of the extent of benefits under group versus independently purchased coverage is included. 0 Farley, P. and G. Wilensky. (1983). Household wealth and health insurance as protection against medical risks [Working paper]. Rockville, MD: Public Health Service. (NTIS Order No. P385—119444), 51 pp. The authors develop a theory of household behavior that describes the choice between health insurance and wealth as protection against uncertainty of medical expense. The implicit subsidy associated with the exclusion of employer—paid premiums from an employee’s taxable income is presented as biasing the choice in favor of insurance. 0 Farley, P. and G. Wilensky. (1983). Options, incentives, and employment-related health insurance coverage. In R. Scheffler and L. Rossiter (Eds.). Advances in Health Economics and Health Services Research 4. Greenwich, CT: JAI Press. (NTIS Order No. P885-119964), 26 pp. This article discusses health insurance provided through employment, including choices available to employees, premium costs, and employee cost-sharing requirements. Results suggested that where options were offered, the cost containment potential of making less expensive plans available was partly subverted because employers tended to pay a fixed share of the premium for any given plan. o Farley, P. and G. Wilensky. (1983, Spring). Private health insurance: What benefits do employees and their families have? Health Affairs 2(1), pp. 92—101. (NTIS Order No. P385—109221). This article describes benefits for hospital and outpatient physician care under employment—related group insurance plans. Findings showed that comprehensive benefits were much less common for physician visits than for hospital care. Substantial regional differences in the pattern of hospital benefits were found, however, and their comprehensiveness was related to the size of the insurance group. 0 Gabel, J. and A. Monheit. (1983, Fall). Will competition plans change insurer—provider relationships? Milbank Memorial Fund Quarterly/Health and Society 61(4), pp. 614—640. (NTIS Order No. P384—164896). Whether competition proposals are likely to provide sufficient stimuli to change existing payment relationships between insurers and providers is examined. The authors suggest 17 that more than consumer cost sharing and reduced tax subsidies would be required to create more competitive provider behavior. 0 Gagnon, J. (1980). Cost Accounting for Pharmaceutical Services. Research Proceedings Series, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 80—3215, NTIS Order No. P880—157936), 77 pp. Proceedings from a symposium sponsored in part by the Academy of Pharmaceutical Sciences are presentd. The report includes four methodologies for costing pharmaceutical services in community pharmacies and a separate critique. 0 Gay, C. (1982). Women's Community Health Care Survey: Data Processing, Coding, Editing (NCHSR Contract 230—76-0299). Rockville, MD: Public Health Service. (Final Report, volume 3, NTIS Order No. P882—157231), 151 pp. Procedures for coding, keypunching, and editing of responses to the survey instrument are detailed for a project that investigated the indirect costs of obtaining medical care services——costs which include expenditures for travel, child care, and time. The data processing phase included removal of all personal identifiers of individual respondents. 0 Gay, C. (1982). Women's Community Health Care Survey: Instructions for Listers, Interviewers, and Supervisors (NCHSR Contract 230—76—0299). Rockville, MD: Public Health Service. (Final Report, volume 2, NTIS Order No. PB82—157256), 188 pp. Instructions for administering the survey instrument are detailed for a project that investigated the indirect costs of obtaining medical care services-—costs which include expenditures for travel, child care, and time. Besides the cost questions, the survey questionnaire also contained questions on female health services utilization, health status, attitudes, and family demographic and economic characteristics. 0 Gay, C. (1982). Women’s Community Health Care Survey: Project Overview and Design (NCHSR Contract 230—76—0299). Rockville, MD: Public Health Service. (Executive Summary and Final Report, volume 1, NTIS Order No. P882—157249), 152 pp. The background and survey design are detailed for a project that investigated the indirect costs of obtaining medical care services—-costs which include expenditures for travel, child care, and time. Interviews were completed by 960 eligible female respondents aged 13—44 in a low-income, high density area in Dallas, Texas. 0 Gay, C. (1982). Women's Community Health Care Survey: Tape Documentation (NCHSR Contract 230-76—0299). Rockville, MD: Public Health Service. (Final Report, volume 4, NTIS Order No. P382-157223), 97 pp. Data file documentation is presented for a project that investigated the indirect costs of obtaining medical care services——costs which include expenditures for travel, child care, and time. (The computerized records, which were created for both household information and individual responses, are available separately under NTIS Order No. PBBZ—157264.) 18 o Gaynor, M. (1983). The Effect of Income Distribution Method on Equilibrium Price in Medical Group Practice (NCHSR Grant H5042387L Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884—122845), 196 pp. How the method of distributing income among group practice physicians affects price is discussed. The author develops a model predicting increases in both price and quality if physician income were based strictly on productivity. Empirical results were consistent with the model; price increased by 11 percent and quality by 7 percent with productivity-based income distribution. 0 Ginsburg, P. and H. Frech. (1982). Economics of Nursing Home Care: Ownership and Financing (NCHSR Grant H502675). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB83—253815), 71 pp. The authors studied determinants of variation in nursing home costs. Private nonprofit homes appeared to be more costly than for-profit homes in States with flat—rate reimbursement; government—owned homes were the most costly. The type of reimbursement was also found to influence wage rates, with government-owned facilities paying the highest wage rates compared with rates for similar workers in for—profit homes. 0 Ginsburg, P. and F. Sloan. (1984, April 5). Hospital cost shifting. The New England Journal of Medicine 310(14), pp. 893—898. (NCHSR Grant HSO4665). The effects of "cost shifting" are examined. Cost shifting results when insurers such as Medicare/Medicaid and certain Blue Cross plans pay less than the actual treatment costs for their beneficiaries, thus resulting in charge-paying patients and/or their insurers paying more. The sources and extent of such payment differentials are summarized along with possible policy options to be considered in addressing the problem. 0 Goldberg, T. (1981). Evaluation of the Impact of State Generic Drug Substitution Legislation (NCHSR Grant H802132). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PB82—229600), 12 pp. Findings are reported from a longitudinal study that assessed the effectiveness of generic drug substitution laws in lowering costs. Results of a randomly drawn sample from four States showed that higher rates of substitution were associated with positive formularies or approved guidelines for drug equivalents. The study concludes that pharmacists may need financial incentives to increase the substitution of less costly generic drugs for those prescribed by physicians. o Goldfarb, M. and others. (1980). Health care expenditures. In National Center for Health Statistics and National Center for Health Services Research. Health United States, 1980. Rockville, MD: Public Health Service. (NTIS Order No. PB84—167766), 16 pp. Trends in health care spending are summarized and reasons for the high costs of health care are outlined. 19 o Grembowski, D. and D. Conrad. (1984, June). Insurance effects on employer group dental expenditures. Medical Care 22(6), pp. 501-510. (NCHSR Grant HSO3772). Results are summarized from a study of how insurance rates affect dental expenditures by employer groups and their insureds. A consistently positive relationship was found between basic insurance rates and expenditures. Implications of these findings for plan design are included. (An earlier version of this paper is available under NTIS Order No. PBB4—206143.) o Hagan, M. (1982). Medical equipment and supplies: Purchases and rentals, expenditures, and sources of payment. National Health Care Expenditures Study Data Preview 10, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 82—3321, NTIS Order No. P883—173690), 16 pp. Differences among selected population groups in the likelihood and frequency of purchases and rentals of medical equipment and supplies are examined. Mean charges and out-of—pocket expenditures for such items as wheelchairs, hearing aids, syringes, and supportive devices are estimated with data from the National Health Care Expenditure Survey. 0 Harrington, C. and J. Swan. (1984, Fall). Medicaid nursing home reimbursement policies, rates, and expenditures. Health Care Financing Review 6(1), pp. 39—49. (NCHSR Grant HSO4042). Data from a study of Medicaid reimbursement showed that States which used reimbursement systems other than those based solely on retrospective payment had lower reimbursement rates for nursing home services than States with the retrospective systems alone. The authors also found that these lower rate effects appeared to translate into lower expenditures per recipient. o Hemelt, M. (1980). Impact of Insurance Issues on Physician Practice (NCHSR Grant HSO3049). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBBl-203549), 62 pp. Data on malpractice insurance claims in Maryland are analyzed. Physician practice information, patient diagnosis, bill payment sources, and judgment amOunt are included in the analysis. o Horgan, C. and P. Farley. (1981, November 1—5). Private health insurance coverage for mental health services. Paper presented at the annual meeting of the American Public Health Association, Los Angeles, CA. Estimates are given for the number of people in the Nation who have insurance coverage for mental health services of inpatient hospitalization, inpatient physician visits, and outpatient visits. Distinctions in coverage among group plans, nongroup plans, and health maintenance organizations are made. 0 Horgan, C., A. Taylor, and G. Wilensky. (1982, December 28—30). Overlapping insurance coverage: The case of veterans. Paper presented at the annual meeting of the American Economic Association, New York, NY. The authors discuss the insurance characteristics of veterans and their use of the Veterans' 20 Administration (VA) health care system. Findings showed that most veterans did not use the VA system for their medical care but that uninsured veterans were more likely than others to use it. o Hornbrook, M. (1983, July). Allocative medicine: Efficiency, disease severity, and the payment mechanism. In Annals of the American Academy of Political and Social Science 468, pp. 12—29. (NTIS Order No. PB84—239623). Types of disease and medical care outputs are classified and used as a basis for examining three payment mechanisms——capitation, fee for service, and payment by diagnosis. Incentives offered to patients and providers to alter health services utilization by each mechanism are considered. 0 Hornbrook, H. and J. Rafferty. (1982). The economics of hospital reimbursement. In Advances in Health Economics and Health Services Research 3, pp. 79—115. (NTIS Order No. PBB4—160464). The economic impact and implications of various modes of hospital reimbursement are analyzed. Prospective reimbursement and capitation arrangements are discussed in detail. o Hornbrook, n. and others. (1982, November 18). Reducing the incidence of non—A and non—B hepatitis by testing donor blood for alanine aminotransferase: Economic considerations. The New Engand Journal of Medicine 307(21), pp. 1315—1321. This article assesses the potential economic benefits of screening donor blood for alanine aminotransferase as a means of reducing hepatitis in patients who receive such blood. Although the results suggest that the net economic impact may be positive, major uncertainties about the medical consequences of non—A and non-B hepatitis make the benefit estimates too broad to affect policy decisions. 0 Jones, D. and others. (1980). Targeted Study of Catastrophic Illness Addressing Spinal Injury (NCHSR Contract 230—75—0156). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P881—128878, 18 pp; Final Report, P881—128860, 186 99-). Expenditures related to spinal injury were reviewed and a study was made of alternative public investments in spinal injury treatment. The goal was to facilitate the preparation of actuarial cost estimates for national catastrophic health insurance programs. o Kasper, J. (1982). Prescribed medicines: Use, expenditures, and sources of payment. National Health Care Expenditures Study Data Preview 9, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 82—3320, NTIS Order No. P882-257056), 14 pp. Prescription drug use, out—of—pocket expenditures, and payment sources are analyzed with data from the National Medical Care Expenditure Survey. Utilization differences by selected demographic patient characteristics are included. o Kasper, J., D. Walden, and G. Wilensky. (1980). Who are the uninsured? National Health Care Expenditures Study Data Preview 1, National Center for Health Services Research. Rockville, MD: 21 Public Health Service. (DHHS Publication No. (PHS) 80—3276, NTIS Order No. P382—257064), 10 pp. Estimates are provided on the extent of the Nation's uninsured, utilizing data from the National Medical Care Expenditure Survey. It was found that about 87 percent of the civilian noninstitutionalized population was covered by public or private health insurance in 1977 and that coverage varied by age, education, and place of residence. 0 Katz, S., J. Papsidero, and R. Stevens. (1982). Cost of incontinence [Unpublished working paper]. National Center for Health Services Research. The problems and costs associated with the management and treatment of incontinence are discussed. 0 Kirchner, C. (1984). Third-Party Financing of Low Vision Services: A National Study (NCHSR Grant HSO3610). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P885—164317/AS, 9 pp.; Final Report, NTIS Order No. PB85-164325/AS, 205 pp.). Financial coverage of low vision services by both public and private insurance programs is examined. Findings indicate that only about one—fourth of the commercial insurers surveyed offered low vision coverage while half of the State vocational rehabilitation agencies reported paying full costs for low vision services for over 75 percent of their clients who received services. o Kominski, G. and others. (1984, November; Annual Supplement). Unrecognized redistributions of revenue in diagnosis—related group based prospective payment systems. Health Care Financing Review, pp. 57-69. (NCHSR Grant HSO4916). The effects of the methods of adjusting costs and calculating payment rates under Medicare's prospective payment system are measured in terms of their effect on revenue redistributions. The authors concluded that such effects lead to discrepancies between costs and payments that may affect hospital incentives and Medicare's total payment. 0 Lanning, J. and R. Juster. (1980). Criteria for Selecting HSA Cost Containing Strategies: Political Implications for Implementation (NCHSR Grant HSO3490). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P882—208026, 15 pp.; Final Report, volume 2, NTIS Order No. PBBZ—208042, 205 pp.; complete set, including revised volume 1 (see next citation), NTIS Order No. P382—208018). Results are summarized from an examination of 18 cost containment approaches for health planning based on interviews with health systems agency personnel, surveys of health systems agencies, and extensive review of relevant social science literature. Details of a questionnaire survey of 41 health agencies in the southeastern United States are included in volume 2. o Lanning, J. and R. Juster. (1981). Selecting Health Cost Containment Strategies: Political Implications for HSA Implementation (NCHSR Grant HSO3490). Rockville, MD: Public Health Service. (Final Report, revised volume 1, NTIS Order No. P382-208034), 239 pp. This report identifies, describes, and 22 provides brief bibliographies for 18 cost containment approaches to health planning. Interviews with 24 health systems agency personnel are summarized. It is maintained that most approaches would require adjustments in the reimbursement system to provide incentives for implementing changes in delivery. 0 Lawson, W. (1980, July). Children and dental care: Charges and probability of a visit by individual characteristics. Journal of the American Dental Association 101, pp. 32—37. This article provides information about how dental care is financed for U.S. children by selected demographic characteristics. Data show that children from families with less education receive less preventive care than children in more educated households despite paying a lower proportion of the total charges. 0 Lawson, W. (1980). Health insurance coverage of veterans. National Health Care Expenditures Study Data Preview 4, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 81-3290, NTIS Order No. P882—257015), 10 pp. Preliminary estimates are presented for the types of health insurance coverage veterans have and how their coverage compares with that of the general adult male population. Coverage by public insurance mechanisms such as Medicare and Medicaid was found to be relatively infrequent among veterans, except for disabled veterans. Overall, a slightly higher percentage of veterans than other adult males was insured. 0 Long, M. and others. (1983). Profile of the Financial Burden of High Cost Illness (NCHSR Contract 233—81—3032). Rockville, MD: Public Health Service. (NTIS Order No. PBB4—239128), 192 pp. Results are reported from a study of financially catastrophic hospitalizations using data from Maryland hospitals and discharge information from the Commission on Professional and Hospital Activities Study of Patient Charges. The study found that catastrophic charges were more likely to occur for persons who were discharged dead, had multiple discharges, were over age 55, or were newborn infants with immaturity—related problems. o Lovett, J. (1980). Cost Containment Through Sharing Hultihospital Systems and Health Systems Agencies (NCHSR Grant HSO3438). Rockville, MD: Public Hea th Service. (Executive Summary, NTIS Order No. P384—224203; Final Report (3 volumes), NTIS Order Nos. PBB4—224211, P884—224229, and PB84—224237), 1,015 pp. Building on a literature review, an operational definition of shared services and consequent benefits is described for one multihospital system. An overview of issues (volume 1), detailed case study (volume 2), and indexed bibliography (volume 3) comprise the final comprehensive report of the study. o Luft, H. (1983, Summer; Part 2). The Professional Activity Study of the Commission on Hospital and Professional Activities: A user's perspective. Health Services Research 18(2), pp. 349—352. (NCHSR Grant HSO4329). The author points out some advantages of the Professional Activity Study which allow it to be used to 23 compare casemix patterns over time in States with and without diagnosis related group reimbursement mechanisms. 0 Meiners, M. (1983, Summer). The case for long—term care insurance. Health Affairs 2(2), pp. 55—79. (NTIS Order No. P383-254250). The potential for private financing of long-term care for the elderly is examined. Types of financing mechanisms and potential barriers to long—term care insurance are included in the discussion. 0 Meiners, M. (1982). An econometric analysis of the major determinants of nursing home costs in the United States. Social Science and Medicine 16(8), pp. 887-898. The author investigates factors which affect nursing home costs, using data from the 1973—74 National Nursing Home Survey to estimate statistical cost functions. Flat-rate reimbursement systems and other systems that set rates prospectively were shown to be associated with significantly lower nursing home costs when compared with cost—based system incentives and private financing incentives. o Meiners, M. (1982, March). Shifting the burden: The potential role of the private sector in long term care insurance for the elderly. American Health Care Association Journal 2(20), pp. 20—22. This article introduces a study undertaken by the National Center for Health Services Research to determine the market potential for private health insurance coverage of long—term care for the aged. Both the rationale for the study and questions to be addressed are outlined. o Meiners, M. (1984, January). The state of the art in long-term care insurance. Paper prepared for a national conference on long—term care financing sponsored by the Health Care Financing Administration, Washington, DC. (NTIS Order No. PBB4—206093), 46 pp. Examples of extended insurance coverage for nursing home and home health care are detailed. The author also discusses the market potential for private long-term care insurance. 0 Meiners, M. and J. Gollub. (1984, March). Long—term care insurance: The edge of an emerging market. Healthcare Financial Management, pp. 58—60, 62. This article provides an overview of some issues related to long—term care insurance. The authors point out that Medicare was not designed to finance long-term care benefits, that regulations in each State will affect insurance policies in various ways, and that future prospects for long—term care insurance may improve as Medicaid Spending is reduced. o Meiners, M. and G. Trapnell. (1984, October). Long—term care insurance: Premium estimates for prototype policies. Medical Care 22(10), pp. 901—911. The authors specify a prototype insurance policy covering long—term care services and estimate premiums for such a policy. Substitution of home health benefits for nursing home care is also considered in the estimates. 24 o Milgrom, P., D. Conrad, and H. Kiyak. (1981). Provider Response and Cost of Dentistry for the Elderly (NCHSR Grant H502179). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBBl—215857, 5 pp; Final Report, NTIS Order No. P881—215865, 171 pp.). The costs of providing dental care to the elderly are estimated. Findings suggest that incremental changes in copayment levels and comprehensiveness of insurance coverage do not lead to increases in cost. o Monheit, A. and others. (1983, November 13‘16). Unemployment, health insurance, and medical care use. Paper presented at the annual meeting of the American Public Health Association, Dallas, TX. (NTIS Order No. P884—145424), 46 pp. The authors explore the extent to which unemployment leads to loss of private health insurance and to reduced medical care use and expenditures. Findings from the National Medical Care Expenditure Survey indicate that most unemployed workers retain their health insurance coverage. 0 Mueller, C. (1984, November 11—15). Medicaid and use of dental services by children. Paper presented at the annual meeting of the American Public Health Association, Anaheim, CA. (NTIS Order No. P885—138139), 36 pp. Data from the National Medical Care Expenditure Survey and the supplementary health insurance employer survey are used to explore how Medicaid affects children’s use of dental services. The cost—effectiveness and cost-containment potential of the diagnostic and preventive components of dental services were of particular interest. 0 Needleman, J., M. Anderson, and R. Jaffe. (1983). State Options for Addressing Catastrophic Health Expense (NCHSR Contract 233—79—3018). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB4—206333, 24 pp.; Synthesis (2 volumes), NTIS Order No. PBB4-154129, 292 pp.). Information is presented on the incidence of high expense illness and patterns of insurance and underinsurance for such illness. Issues of financing and cost control are addressed, and three potential ways for States to deal with catastrophic health expense—-mandated employer—based health insurance, specific catastrophic expense programs, and risk-sharing pools—-are detailed. o Neumann, B. and J. Kelly. (1984, May). Prospective Reimbursement of Hospital Capital Costs (monograph series ed.). Oak Brook, IL: Healthcare Financial Management Association. Three methods for reimbursing capital costs are reviewed——a planning approach, an option based on diagnosis related groups (DRGs), and a prospective capital reimbursement system that combines elements of the planning and DRG—based methods. Selected criteria on access, efficiency, quality, and feasibility are used to evaluate anticipated effects of each approach on the hospital’s utilization of both physicial and financial capital. o Neumann, B. and J. Kelly. (1984, July). The three components of a prospective capital reimbursement system. Heathcare Financial 25 Management 14(7), pp. 92—100. A prospective capital reimbursement system compatible with Medicare's prospective payment system is presented. The authors detail three elements of such a system: a physical capital allowance, a financial capital allowance, and a transitional capital fund. 0 Ouslander, J. and R. L. Kane. (1984, January). The costs of urinary incontinence in nursing homes. Medical Care 22(1), pp. 69—79. The contribution of urinary incontinence to the costs of nursing home care is calculated using data gathered from nursing homes, medical supply companies, and a large laundry. The authors estimate that management of incontinence and its complications accounts for 3 to 8 percent of nursing home costs and that more active evaluation and treatment could effect considerable savings. 0 Rice, T. (1984, Summer). Determinants of physician assignment rates by type of service. Health Care Financing Review 5(4), pp. 33—42. (NCHSR Grant HSO4729). The determinants of physician assignment rates under Medicare are examined for medical, surgical, laboratory, and radiology services. Results showed a significant positive relationship between changes in reimbursement and changes in assignment rate for all but surgical services. 0 Rice, T. (1982). Economic Incentive and Physician Practice: An Examination of Medicare Participation Decisions and Physician— Induced Demand (NCHSR Grant HSO4729). Rockville, MD: Public Health Sérvice. (Executive Summary and Final Report, NTIS Order No. P583—208132), 211 pp. Results are presented from a study of how economic incentives affect physician participation in Medicare, as measured by changes in assignment rates for various services, and physician-induced demand, as measured by changes in service quantity and intensity. A significant and positive relationship was found between changes in reimbursement and changes in assignment rates for medical, laboratory, and radiology services; in each case, the reimbursement rate for medical services was found to be the most important determinant. Decreases in reimbursement resulted in an increase in the intensity of medical and surgical services and in the number of laboratory tests. 0 Rice, T. (1983, August). The impact of changing Medicare reimbursement rates on physician—induced demand. Medical Care 21(8), pp. 803—815. (NCHSR Grant HSO4729). This article discusses how changes in financial incentives, as represented by Medicare reimbursement rates, affect physician—induced demand for medical services. 0 Rossiter, L. (1982). Dental services: Use, expenditures, and sources of payment. National Health Care Expenditures Study Data Preview 8, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 82—3319, NTIS Order No. P883-172205), 16 pp. Household data from the National Medical Care Expenditure Survey are useC to provide estimates for the use of and expenses for dental services. Mean charges per visit, annual expenditures per person, percent paid by 26 each source of payment, and percent distribution of persons by out—of-pocket expense are shown by various sociodemographic and employment characteristics. 0 Rossiter, L. (1983). Expenditures for dental services: Findings from the 1977 National Medical Care Expenditure Survey. Journal of the American Dental Association 106, pp. 189—193. Estimates are presented for use, charges, expenditures, and sources of payment for dental services by type of service and selected demographic characteristics of survey respondents. It was found that the family paid about 75 percent of the average charge per dental visit. 0 Rossiter, L. (1983, November). Prescribed medicines: Findings from the National Medical Care Expenditure Survey. American Journal of Public Health 73(11), pp. 1312—1315. This article discusses differences in utilization, sources of payment, and expenditures for prescribed medicines by age, sex, ethnic/racial background, family income, and perceived health status. Findings showed that more than 20 percent of expenditures were for cardiovascular—renal agents. o Rossiter, L. (1984, January). Prospects for medical group practice under competition. Medical Care 22(1), pp. 84—92. (NTIS Order No. P385—115251). The author points out that there is little evidentiary difference in productivity or fee level between individual and group practice physicians. Thus it seems unlikely that competition proposals would result in cost reductions. o Rossiter, L. and W. Lawson. (1980). Charges and sources of payment for dental visits with separate charges. National Health Care Expenditures Study Data Preview 2, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 80—3275, NTIS Order No. P882—256991), 10 pp. The authors use data from the National Medical Care Expenditure Survey to report on differences in separate dental charges and the extent to which third parties (public and private) pay for such charges. It was found that a separate fee was charged for about two-thirds of all dental visits. Of an average charge of $31.71, the family paid $24.42, private insurance paid $4.12, and public sources paid the remainder. o Rossiter, L. and M. Salomon. (1981). Charges and sources of payment for visits to physician offices. National Health Care Expenditures Study Data Preview 5, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 81—3291, NTIS Order No. P382—257023), 9 pp. The authors use data from the National Medical Care Expenditure Survey to report on differences in charges for visits to a doctor’s office and the extent to which third parties (public and private) pay for such visits. It was found that of a mean charge of $21.29, the patient or the patient's family paid an average $14.69, private insurance paid $3.41, Medicaid paid $1.49, and Medicare and other public sources each paid $.85. 27 o Rossiter, L. and A. Taylor. (1982). The effects of unionism on the provision of health insurance benefits. Industrial Relations 21, pp. 167-177. Aggregate estimates of the average total health insurance premium per eligible employee and the average employer contribution per eligible employee are shown for employees in union and nonunion firms. The data, which were obtained from an employer survey as part of the National Medical Care Expenditure Survey, showed that unionism was associated with higher total premium benefits and a higher dollar amount and percent contribution by employers toward employee health insurance. 0 Rossiter, L. and G. Wilensky. (1982). Out-of—pocket expenditures for personal health services. Nationa Health Care Expenditures Study Data Preview 13, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 82—3332, NTIS Order No. PBB3—173708), 20 pp. Individual and family out—of—pocket expenses for personal health care services are estimated with data from the National Medical Care Expenditure Survey. Average expenditures by service performed, patient demographic characteristics, and perceived health status are included. o Rupp, A., D. Steinwachs, and D. Salkever. (1984, May). The effect of hospital payment methods on the pattern and cost of mental health care. Hospital and Community Psychiatry 35(5), pp. 456—459. (NCHSR Grant HSO3831). Results are reported from a study of how charges and services for mental health care are affected by a prospective method of payment. The authors concluded that the effect of a per case payment method on total cost over a specific time period was insignificant but that the payment method might influence the pattern of care. o Salkever, D. (1984, December). Cost implications of hospital unionization: A behavioral analysis. Health Services Research 19(5), pp. 639—664. (NCHSR Grant HSO3016). This article presents estimates of cost effects due to growth in hospital unions in four States. Cross—sectional regressions yielded positive effects of 3.3 percent on total costs, 4.1 to 5.9 percent on cost per case, and 6.1 percent on cost per day accounted for by unionization. o Salkever, D. (1982). The Impact of Collective Bargaining on Hospital Costs (NCHSR Grant H803016). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PB84—243427), 268 pp. This study on how the increase of hospital unionization in the mid—19705 affected costs and productivity in hospitals found that the impact of unionization on costs was greater in areas where cost—based reimbursement predominated. The average impact of unionization on hospital costs ranged from 4 to 9 percent. o Salkever, D. (1984). Morbidity Costs: National Estimates and Economic Determinants (NCHSR Grant HSO4369). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P885-207454/AS), 194 pp. Data from the National Health Interview Survey are used in 28 the development of morbidity cost estimates and examination of trends in disability and labor-force participation for males aged 17—64. Debility costs accounted for almost one-fourth of the annual morbidity cost for 1974—78 when education, occupation, and industry were held constant. 0 Sall, L. (1983). National Health Care Expenditures Study Annotated Bibliography. Rockville, MD: Public Health Service. (NTIS Order No. P884—145598), 43 pp. Studies done by the National Center for Health Services Research during the first 5 years of the National Health Care Expenditures Study are summarized. o Sapolsky, H. and others. (1980). Corporate Attitudes Toward Health Care Costs (NCHSR Grant HSO3447). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P382—119157), 41 pp. Results are reported from a study of the extent to which corporations were concerned with the need to control health care costs. The authors concluded that businesses believed such costs were, for the most part, beyond corporate control and also accounted for only 2 to 3 percent of corporate expenditures. o Sapolsky, H. and others. (1981, Fall). Corporate attitudes toward health care costs. Milbank Memorial Fund Quarterly/Health and Society 59(4), pp. 561—585. (NCHSR Grant HSO3447). This article was developed from a final report of the same title (see previous citation) which found it unlikely that corporations would play a large role in controlling health care costs. o Scheffler, R. (1984, March). The United Mine Workers' health plan: An analysis of the cost—sharing program. Medical Care 22(3), pp. 247-254. (NCHSR Contract 233—79—3024). Results of introducing cost sharing to the United Mine Workers health care plan are summarized. Hospital admissions, probability of seeing a doctor, and expenditures per hospital stay decreased after cost sharing was implemented. 0 Sheiner, L. and others. (1983). Reducing Clinical Laboratory Costs (NCHSR Grant HSO4111). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P384—183094), 134 pp. The authors used a large retrospective data base to determine that only 0.3 percent of certain routine preoperative tests without clear medical reasons for them revealed clinical results worthy of medical action. o Sloan, F. and E. Becker. (1984, Winter). Cross-subsidies and payment for hospital care. Journal of Health Politics, Policy, and L3! 8(4), pp. 660—685. (NCHSR Grant HSO4665). The effects of discounts and third—party reimbursement on hospital costs and profitability are assessed. The authors found that although cost—containment efforts of dominant payers have reduced total hospital payments, a substantial amount of cost shifting remains and the savings overall have been in profits not costs. 29 o Steinwachs, D. and D. Salkever. (1984). Impact of "Per Case" Versus "Per Service" Hospital Payment in Maryland (NCHSR Grant HSO3831). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P885~164747/AS, 15 pp.; Final Report, NTIS Order No. PB85-164739/AS, 131 pp.). Two forms of prospective hospital payments in Maryland are compared—-one that pays for individual services and the other for discharged cases. Except for three high-cost hospitals, per case payment showed no overall effect on total, routine, ancillary, or per case costs; physician fees; or ancillary charges. The authors concluded that per case reimbursement may provide incentives for cost reductions in any single hospital stay but such savings may be offset by higher readmission rates or charges. o Sytkowski, P. (1983). Impact of the Predictive Instrument on Cardiac Care Cost: Effect of Treatment Setting on Resource Use, Patient Outcome, and Hospital Cost (NCHSR Grant HSO4341). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB84—219872), 66 pp. Results are reported from a review and comparison of patient outcomes, resources used, and costs incurred in the care of potentially acute cardiac patients in three treatment settings within the hospital. 0 Taylor, A. (1983). Inpatient hospital services: Use, expenditures, and sources of payment. National Health Care Expenditures Study Data Preview 15, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 83—3360, NTIS Order No. P883—221457), 15 pp. Data from the National Medical Care Expenditure Survey are used to present population estimates of use and expenses for inpatient hospital services. The report includes information on mean charges per admission, average proportion of charges paid by different payment sources, annual hospital expenditures per person, and distribution of the population by out-of-pocket hospital expense. 0 Taylor, A., P. Farley, and C. Horgan. (1984, November 11—15). Medigap insurance: Friend or foe in reducing Medicare deficits. Paper presented at the annual meeting of the American Public Health Association, Anaheim, CA. The authors use data from the National Medical Care Expenditure Survey to analyze supplementary (Medigap) insurance and its effect on the use of medical services by the elderly and on Medicare program expenditures. Both aggregate effects and distributional effects for specific subgroups are considered. 0 Taylor, A. and W. Lawson. (1981). Employer and employee expenditures for private health insurance. National Health Care Expenditures Study Data Preview 7, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 81—3297, NTIS Order No. PB82—257049), 15 pp. Employment—related health insurance expenses are examined with data from the National Medical Care Expenditure Survey. Information is provided on insurance—related payroll expenses, 30 mean insurance premiums, and benefits (especially in firms with large numbers of low-wage workers). 0 Taylor, A. and G. Wilensky. (1983). The effect of tax policies on expenditures for private health insurance. In J. Meyer (Ed.). Market Reforms in Health Care: Current Issues, New Directions, Strategic Decisions. Washington, DC: American Enterprise Institute. This chapter focuses on the effects of various "procompetitive" legislative proposals designed to contain health care costs. Estimates are presented for both the shortrun revenue effects and the expected longrun behavioral responses to changes in the tax treatment of health benefits. o Valiante, J. (1980). An Analysis of Programs To Limit Hospital Capital Expenditures (NCHSR Contract 233—79—3002). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P381—137408), 252 pp. This report describes the experiences of several States that have proposed or implemented controls on direct capital expenditures by hospitals. The authors found that limits on capital expenditures would have little effect on operating costs nationally but measurable impact on costs and on condition and age of facilities in selected States. o Vogt, T. and S. Schweitzer. (1984). Medical Costs of Cigarette Smoking (NCHSR Grant HSO3601). Rockville, MD: Public Health Service. (Revised Executive Summary and Final Report, NTIS Order No. PBB4—199504), 179 pp. A home interview survey was used to gather data on differences in medical care use between smoking and nonsmoking households; estimates of the total costs of care attributable to smoking were then made and were found to be lower than most projections. o Wagner, D., T. Wineland, and W. Knaus. (1983, Fall). The hidden costs of treating severely ill patients: Charges and resource consumption in an intensive care unit. Health Care Financing Review 5(1), pp. 81—86. (NCHSR Grant HSO4857). Results of a survey of resources used to treat patients in an intensive care unit showed that the actual resource costs of treating the sicker patients were nearly twice their billed charges. The authors suggest these results should be considered when proposing changes in hospital reimbursement policies. 0 Wagner, J. (1982). The Committee Resource Allocation Process: Implications for Health Care Capital Expenditure Limits (NCHSR Grant HSO3423). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P883—172130), 137 pp. Issues inherent in resource allocation by committee are examined in the context of limiting capital expenditures by hospitals. An extensive literature review on group decisionmaking is included. o Walden, D. (1982). Eyeglasses and contact lenses: Purchases, expenditures, and sources of payment. National Health Care Expenditures Study Data Preview 11, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS 31 Publication No. (PHS) 82-3322, NTIS Order No. PBB3—173674), 13 pp. The author uses data from the National Medical Care Expenditure Survey to summarize information on expenses and payment sources for vision aids. Rates of purchase and repair of contact lenses and eyeglasses, mean charges, annual expenditures per person, and distribution of the population by out—of—pocket expense for vision aids are included in the report. 0 Walden, D. (1984, November). Paying several physicians for treating an episode of illness. Paper presented at the annual meeting of the American Public Health Association. (NTIS Order No. P885—169704/AS), 33 pp. This paper examines how reimbursing physicians according to "ambulatory condition packages" affects the costs of outpatient services. Information is presented on the number of physicians providing services to patients who received only ambulatory care in an episode of illness and the percent of total charges reimbursed to physicians in such episodes. Also included are estimates for the total number of ambulatory packages where physician reimbursement by an ambulatory condition packaging scheme would differ substantially from reimbursement by a fee-for—service method. 0 Walden, D., G. Wilensky, and J. Kasper. (1980, August). Multiple health insurance coverage: The overlap of dread disease and extra cash policies with other types of coverage. In American Statistical Association——Social Statistics Section. Proceedings (pp. 266-270). Washington, DC: American Statistical Association. The authors used data from the National Medical Care Expenditure Survey to study the extent of multiple health insurance coverage. Findings showed that age was directly related to the percent of the population covered and persons with Medicare were most likely to also hold dread disease or extra cash policies. 0 Wennberg, J., K. McPherson, and P. Caper. (1984, August). Will payment based on diagnosis—related groups control hospital costs? The New England Journal of Medicine 311(5), pp. 295—300. (NCHSR Grant H504932). The authors classified all nonobstetrical medical and surgical hospitalizations in Maine during 1980-82 into diagnosis-related groups (DRGs) and measured the variations in admission rates among 30 hospital market areas. High variation in admission rates was found, suggesting that professional discretion plays a large part in determining hospitalization for most DRGs. The authors concluded that to be successful, cost containment programs based on fixed, per admission hospital prices would need to ensure effective control of hospitalization rates. 0 Wheeler, J. and others. (1983, December). The effects of burn severity and institutional differences on the costs of care. Medical Care 21(12), pp. 1192—1203. (NCHSR Grant HSO3261). The components of burn care costs are identified. It was found that in specialized facilities (which have higher costs of care), significant cost differences remained even after adjusting for patient severity. 32 o Wilensky, G. (1982, May). Government and the financing of health care. American Economic Review 72(2), pp. 202—207. This article examines indirect government health care subsidies that result from tax exclusions of employer—provided health insurance and other indirect subsidies (such as Medicaid) received primarily by the poor. The author discusses which income groups benefit from such policies and how expenditures are proportioned. o Wilensky, G. and M. Berk. (1983, Summer). Poor, sick, and uninsured. Health Affairs 2, pp. 91—95. (NTIS Order No. P885—109239). This article examines the cost of providing care to the uninsured poor through a Medicaid—type program. Data from the National Medical Care Expenditure Survey are used for the estimates. 0 Wilensky, G. and A. Bernstein. (1983). Contacts with physicians in ambulatory settings: Rates of use, expenditures, and sources of payment. National Health Care Expenditures Study Data Preview 16, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 83-3361, NTIS Order No. P884‘157585), 19 pp. The authors use data from the National Medical Care Expenditure Survey to provide estimates on various aspects of the most frequently used health care service-—contacts with physicians in ambulatory settings. The data show that although levels of use remained relatively stable over the study period, expenditures nearly tripled. o Wilensky, G., P. Farley, and A. Taylor. (1984, Winter). Variations in health insurance coverage: Benefits versus premiums. Milbank Memorial Fund Quarterly/Health and Society 62(1), pp. 53—81. This article examines how offering employees more options in their choice of insurance plans and taxing a portion of employer—paid health insurance would affect employee benefits. o Wilensky, G. and A. Taylor. (1982, September—October). Tax expenditures and health insurance: Limiting employer—paid premiums. Public Health Reports 97(5), pp. 438—444. Some effects of placing limits on the portion of health insurance premiums that employers can provide on a tax-free basis are presented. Revenue amounts at risk under various tax—free limits are also discussed. o Wilensky, G., D. Walden, and J. Kasper. (1980, August). The changing Medicaid population. In American Statistical Association——Social Statistics Section. Proceedings (pp. 165—170). Washington, DC: American Statistical Association. The authors discuss movements on and off the Medicaid rolls in 1977 and the insurance status of the part~time Medicaid population when not on Medicaid. Comparisons with the privately insured population according to selected health and sociodemographic characteristics are also made. 0 Yesalis, C. and others. (1984, August). Capitation payment for pharmacy services: I. Impact on drug use and pharmacist dispensing behavior. Medical Care 22(8), pp. 737—745. (NCHSR Grant H502658). 33 Major changes in drug use levels and pharmacist dispensing behavior under capitation financing were observed in a two-county pilot study but not in a 32—county expanded program. The authors discuss pharmacist attitudes relative to this finding. 0 Yesalis, C. and others. (1984, August). Capitation payment for pharmacy services: II. Impact on costs. Medical Care 22(8), pp. 746—754. (NCHSR Grant HSOZGSB). The authors analyze four areas of cost in an expanded capitation drug reimbursement program: total program costs, drug costs, escrow account distribution, and administrative costs. Drug costs were lower but total program costs were higher than under fee-for—service reimbursement. Some modifications of the present capitation model are outlined. o Zimmerman, H. and J. Buechner. (1981). The Rhode Island Catastrophic Health Insurance Program: The First Three Years (NCHSR Grant HSOZ786). Rockville, MD: Public Health Service. (Research Summary, DHHS Publication No. (PHS) 81—3260, NTIS Order No. P882—184565 or P881—178519), 35 pp. Experience under Rhode Island's State—sponsored catastrophic insurance program is summarized. Expenses covered by the program are related to family income and private health insurance coverage; various medical conditions are included in the analysis. o Zucker, L. (1980). Hospital Cost Containment and County Budget Crises (NCHSR Grant HSO3405). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P882—195785), 8 pp. California’s constitutional amendment to reduce taxes (proposition 13) is examined in terms of its effect on hospital service delivery and cost containment efforts. The study found a net reduction in escalation of county health costs and a first—time reversal in the upward trend in county expenditures for public health. 4. Health Care Professionals Topics covered in this section include the following: development of medical specialty programs and examinations; physician and nursing manpower issues; licensing of health professionals; job satisfaction and quality of worklife for hospital personnel; medical career/specialty choice concerns; gender and specialty distributions for physicians; acceptance of nurse practitioners and physician extenders; geographic distribution of physicians; subspecialty development; medical education, including foreign medical graduates; hospital unionism, including labor and wage concerns; hospital/medical school affiliations; and physician attitudes toward service delivery. 0 Anwar, R. (1981). Socialization: EMS and Other Residency Programs (NCHSR Grant H502129). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PB82—203944, 43 pp.; Final Report, NTIS Order No. PB82—203951, 212 pp.). The process of professional socialization in graduate medical education is discussed. What characterizes and differentiates specialty choice by residents and what career goals, expectations, and values they have are also investigated. 0 Barley, S. (1984). The Professional, the Semi—Professional, and the Machine: The Social Ramifications of Computer—Based Imaging in Radiology (NCHSR Grant H805004). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBe6—214970/AS), 10 pp. Results of a study of two radiology departments during the first year of operation of a full—body computed tomography scanner are reported. The relationships and work roles of radiologists and technologists were the focus of the investigation. 0 Bennett, M. and L. Biener. (1983). Determinants of Effectiveness of Physician—Nurse Practitioner Teams (NCHSR Grant HSO4104). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB3—205252, 45 pp.; Final Report, NTIS Order No. PB83—205260, 134 pp.). This study documents the various styles of relationships that have developed between physicians and nurse practitioners who practice as one—to—one teams in a large health maintenance organization. It was found that nurse practitioners on the most effective teams have a broad scope of activity in addition to the traditional nursing roles of teaching and counseling. 0 Berk, H. and S. Meyers. (1980, August). Reasons for nonresponse on the physicians’ practice survey. In American Statistical Association—-Social Statistics Section. Proceedings (pp. 202—205). Washington, DC: American Statistical Association. The authors discuss reasons cited by physicians themselves for not 35 36 participating in the physician's practice survey, a component of the National Medical Care Expenditure Survey. It was found that most physicians gave time constraints——not ideology or privacy——as the reason for not responding to the survey. 0 Carey, S. (1982). Relationship of Role Expectation Congruence to Institutional Size, Work Context, and Need Fulfillment in Nurse Supervisors (NCHSR Grant HSO4445). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P885—157999), 248 pp. Work experiences and outlook among nurses in mid—level management positions were explored. Hospital size and role dissonance resulting from a disparity between expectations gained in training and experiences on the job were found to most influence motivation. 0 Carter, R., J. Emelio, and H. Perry. (1984, April). Enrollment and demographic characteristics of physician's assistant students. Journal of Medical Education 59, pp. 316—321. (NCHSR Grant HSO4862). Enrollment trends and demographic information for a representative sample of physician's assistant students are presented for the years 1978—82. 0 Carter, R., H. Perry, and D. Oliver. (1984). Secondary Analysis: 1981 National Survey of Physician Assistants (NCHSR Grant HSO4862). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P885—165660/AS), 126 pp. Recent trends in the personal background and practice characteristics of physician’s assistants are analyzed. The impact of increasing numbers of women in the field and the involvement of physician's assistants in specialties outside of primary care are also discussed. o Colombotos, J. and C. Kirchner. (1984). Physicians View Social Change in Medicine (NCHSR Grant H800117). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P386—174240/AS), 28 pp. Long-term changes in physicians’ attitudes toward major health care issues (including Medicare) are reported. Results were derived from two studies--a telephone survey of physicians in New York prior to Medicare's effective date and a questionnaire mailed to physicians and medical students in 1973. o Dewey, D. (1980). Foreign Medical Graduates: Sources, Growth, Geographic Distribution and Locational Factors in Metropolitan Chicago, 1950—1974 (NCHSR Grant H802916). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB81—155103), 176 pp. The changing distribution and demographic characteristics of foreign medical graduates in Chicago in 1950, 1960, 1970, and 1974 are described. Comparisons with the rest of the Nation are also included. o Dusansky, R. (1980). The Market for Non—Physician Hospital Personnel (NCHSR Grant H502787). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. 37 PBBl—135402), 38 pp. This econometric study uses State aggregated data to estimate equations for stocks, labor force participation rates, and wages of registered and licenced practical nurses. 0 Feldman, R. and L. Lee. (1980). Hospital Employees' Wages and Labor Union Organization (NCHSR Grant HSO3649). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P881—145054, 11 pp.; Final Report, NTIS Order No. P881—145062, 136 pp.). Hospital and individual data were analyzed to determine the extent to which unionization affected the wages of registered nurses, licensed practical nurses, hospital clerical workers, and service and maintenance employees. Data from the hospital survey indicated that for all four occupations studied, the probability of a collective bargaining contract increased significantly as the potential wage gain from unionization increased. o Feldstein, P. (1982). An Economic Analysis of Health Legislation (NCHSR Grant HSO4504). Rockville, MD: Public Health Serv1ce. (Executive Summary, NTIS Order No. PB83—231845), 7 pp. This study reports on how medical, dental, and nursing political action committees allocate their contributions among Members of Congress. Congressional voting behavior on four hospital issues was also analyzed. o Feldstein, P. and G. Helnick. (1982, Winter). Political contributions by health PACs to the 96th Congress. Inguiry 19(4), pp. 283—294. (NCHSR Grant HSO4504). Political contributions from the perspective of the health interest group were analyzed. Of specific interest was how health political action committees (PACs) allocated funds during 1977—78 among candidates for the 96th Congress. 0 Freund, C. (1981). The Economic Impact of Nurse Practitioner—Patient Delegation Patterns (NCHSR Grant HSO4255). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB3—134833), 36 pp. The combination of nurse practitioners and physicians that effects the most efficient delivery of services was examined. Four practice patterns were compared representing a physician—only practice and three others which used nurse practitioners in various ways. Productivity and cost savings were found with the parallel and consultive patterns of nurse practitioner utilization. o Garnick, D. (1983). The impacts of rate regulation and unionization on the demands for hospital labor. Unpublished doctoral dissertation supported by the National Center for Health Services Research, Johns Hopkins University, Baltimore, MD. The effects of prospective ratesetting and unionization on the staffing levels and patterns of hospitals in the late 19705 are examined. Analysis of data from four States shows that unionization of service workers and increases in the proportion of employees covered positively influenced the demand for nurses during that time. 38 o Garnick, D. and S. Maerki. (1984, August). Activities of physicians in urban hospitals. Urban Health 13(7). PP- 36-37, 50. (NCHSR Grant HSO4329). The authors report some results of a 1983 survey of non—Federal/short-term and other special hospitals in the United States. Among the findings: (1) hospitals continue to recruit specialists who are "experts" in sophisticated procedures; (2) physicians often maintain simultaneous practices in several hospitals; and (3) contractual arrangements are becoming formalized in hospital departments where such relationships have traditionally been uncommon. 0 Gray, L. (1980). Location and Career Practices of Black Physicians. Rockville, MD: Public Health Service. (NTIS Order No. P382—180126), 156 pp. Available literature on black physicians as compared with the general physician population was assessed. Perspectives of health manpower research, the sociology of professionals, and intergroup relations were also examined. o Halpern, S. (1982). Segmental Professionalization Within Medicine: The Case of Pediatrics (NCHSR Grant HSO3687). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P385—191500/AS), 319 pp. The evolution of pediatrics as a specialty since the 18805 and the development of pediatric subspecialties after the 19405 were examined to explain why and how medical fields evolve. The author identifies social structures underlying medical specialty systems and accounts for social processes through which such structures were forged. o Hay, J. (1980). Occupational Choice and Occupational Earnings: Selectivity Bias in a Simultaneous Logit—OLS Model (NCHSR Grant HSO3150). Rockville, MD: Public Health Service. (Dissertation Final Report, NTIS Order No. P881—133605), 159 pp. The author investigates whether specialty income has an effect on specialty choice. Empirical results are reported from an analysis of data from the American Medical Association’s periodic survey of physicians and suggest that income is a strong determinant of specialty choice. 0 Jackson, G. (1981). A Selected Bibliography on Nurse Practitioners and Physician Assistants. Rockville, MD: Public Health Service. 25 pp. This bibliography from the National Center for Health Services Research annotates selected literature on the roles and utilization of physician assistants and nurse practitioners and points out that these fields were not well understood until the mid—19705. o Juris, H. (1981). The Impact of Hospital Unionism (NCHSR Grant H501557). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P382—180118), 327 pp. An analysis of hospital unions is reported at three levels: (1) a national comparison of hospital labor contracts with contracts in other industries; (2) a study of the impact of hospital unions on the hospital as an organization; and (3) a case study of the usage of interest arbitration by hospitals. 39 o Kidder, D., G. Gaumer, and S. Mennemeyer. (1981). Review and Synthesis of Research Findings on the Distribution and Effectiveness of Health Professional Manpower (NCHSR Contract 233—79-3614). RocEville, MD: Public Health Service. (Final Report, NTIS Order No. P382—240722), 201 pp. Shortage and surplus among health professionals are explored in relation to physicians’ practice and nurses’ employment experience, government regulations and equity issues. 0 Lawler, E. and others. (1980). Failure at Parkside: A Labor—Management Quality of Work Life Project in a Hospital Setting (NCHSR Contract HRA 230—75—0179). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P381-179863; Final Report, NTIS Order No. PBBl—178444). Qualitative and quantitative data are presented which assess the failure of the Parkside Hospital Quality of Work Life Project. A discussion of the project’s history and intervention design is included. o Lichtenstein, R. (1984, January). Measuring the job satisfaction of physicians in organized settings. Medical Care 22(1), pp. 56—68. (NCHSR Grant HSO4127). The article reports on the validity and reliability of measures of job satisfaction that were developed and field tested on physicians working in prison health settings. 0 Lichtenstein, R. (1981). Physician Job Satisfaction and Retention in Correctional Health Programs (NCHSR Grant HSO4127). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P382—146101), 454 pp. The personal and organizational factors associated with physicians’ decisions to leave or continue practice in the prison setting are examined. o Maatsch, J. (1980). Model for a Criterion—Referenced Medical Specialty Test (NCHSR Grant H502038). Rockville, MD: Public Health Service. (Final Report for first 2 years of grant, NTIS Order No. P384-178276), 170 pp. This report details the development of the first specialty board examination for physicians specializing in emergency medicine. (Also see following annotation.) o Maatsch, J. (1983). Predictive Validity of Medical Specialty Examinations (NCHSR Grant H502038). Rockville, MD: Public Health Service. (Final Report for last 2 years of grant with Executive Summary, NTIS Order No. P384-176445), 109 pp. A test of the validity of scores on the specialty examination developed during the first 2 years of the grant to predict actual physician performance is reported. (Also see preceding annotation.) o Manard, B. and L. Levin. (1983). Physician Supply and Distribution: Issues and Options for State Policy Makers (NCHSR Contract 233—79-3018). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P885—124733), 30 pp. The report presents a series of analytic questions to address physician manpower issues. 40 0 Marshall, R. (1981). The Career Development of Physicians in Organizational Context (NCHSR Grant HSO3704). Rockville, MD: Public Health Service. (Dissertation Executive Summary, NTIS Order No. PBBl—206518, 13 pp.; Final Report, NTIS Order No. P381—206526, 447 pp.). Selected career outcomes of physicians are measured 16 years after medical school graduation. The model proposed for career development in medicine identifies four simultaneous processes: self—determination, organizational determination, joint determination, and external constraint. Hypotheses are tested using ordinary least squares multiple regression analysis for three of the four developmental processes. o Monheit, A. (1982). Occupational licensure and the utilization of nursing labor: An economic analysis. Advances in Health Economics and Health Services Research 3, pp. 117—142. (NTIS Order No. P384—160456). The study uses an econometric model to examine the effects of occupational licensure on the utilization of registered and practical nurses and to investigate the implications of potential restrictive effects. o Morlock, L. and others. (1982). Follow-up Study of Public Service Employment in Health (NCHSR Grant H803046). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PB84—240662, 14 pp.; Final Report, NTIS Order No. P884—240670, 539 pp.). The role of the health care sector in providing opportunities for upward mobility among minorities and the disadvantaged was investigated in a long—term study in the Baltimore metropolitan area. Comparisons between individuals who occupied health— and nonhealth-related public service jobs revealed few significant differences between the two groups with respect to regularity of employment, career mobility, and earnings. 0 Murphy, J. (1980). Hospital—Medical School Affiliation Agreements: An Organizational Analysis (NCHSR Grant HSO3195). Rockville, MD: Public Health Service. (Dissertation Executive Summary and Final Report, NTIS Order No. PBSl—133365), 309 pp. An organizational analysis of affiliation relations between medical schools and hospitals in a geographically bounded region is reported. A model of networking is developed based on three levels of stratification within classes of medical schools. The import of the findings with regard to the trend toward regionalizing medical education is also discussed. 0 Newhouse, J. and others. (1982, May 7). Where have all the doctors gone? Journal of the American Medical Association 247(17), pp. 2392—2398. (NCHSR Grant HSO3808). How competitive forces play a major role in determining where physicians choose to practice is examined. Implications for location patterns of new cohorts of physicians are also discussed. 0 Oliver, D., R. Carter, and J. Conboy. (1984, December). Practice characteristics of male and female physician assistants. 41 American Journal of Public Health 74(12), pp. 1398—1399. (NCHSR Grant 8504862). Results of a national survey of civilian physician assistants showed that differences between men and women by specialty, practice setting, size of community, and hours of work were similar in nature but smaller in magnitude than those reported for physicians. 0 Perry, H. (1980). Deployment and Career Trends of Physician Assistants (NCHSR Grant HSO3014). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBBl-206534, 20 pp; Final Report, NTIS Order No. P881—206542, 112 pp.). Results of a survey of physician assistants, surgical department chairmen, and new health practitioners in Maine are reported in order to describe the current status of the physician assistant profession. It was found that 32 percent of physician assistants compared with 14 percent of physicians were working in nonurban areas at the time of the survey. 0 Price, J. and C. Mueller. (1984). Absenteeism and Turnover of Hospital Employees (NCHSR Grant HSO4031). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P385—137198), 14 pp. This study at five community hospitals tested a causal model of factors believed to influence turnover and absenteeism. The authors found no support for the traditional View of turnover and absenteeism as different responses by hospital employees to the same working conditions. o Reverby, S. (1982). The Nursing Disorder: A Critical History of the Hospital—Nursing Relationship, 1860—1945 (NCHSR Grant 8502879). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB3—141259), 9 pp. This report summarizes the results of an extensive literature review of nursing—related journal articles, studies, personal papers, and hospital and nursing school records. The author tested the hypothesis that heterogeneity of class background, training, and work experiences of various groups within the nursing field divided nurses on critical issues of how to achieve professional status and improve working conditions in the field. o Romm, J. (1980). Evaluation of Findings From Nurse Practitioner and Physician Assistant Studies (NCHSR Contract 233—78—3015). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBBl—196479; Final Report, NTIS Order No. P381—196461, 554 pp.). The training and employment of nurse practitioners and physician assistants are discussed in terms of the potential for introducing innovative methods in the provision of health care and solving problems of geographic distribution of primary care physicians. o Schwartz, W. and others. (1980, November). The changing geographic distribution of board-certified physicians. The New England Journal of Medicine 303(18), pp. 1032—1038. (NCHSR Grant HSO3808). Some results from a grant report of like title (see next citation) are summarized. 42 o Schwartz, W. and others. (1983). The Changing Geographic Distribution of Board—Certified Physicians: Facts, Theory, and Im lications (NCHSR Grant H80§808). RoEkville, MD: Public Health Serv ce. Executive Summary and Final Report, NTIS Order No. P384—157577), 40 pp. Findings from a study of the changes in distribution of board—certified specialists among cities and towns of various sizes revealed that the percentage increase in the numbers of specialists in small towns significantly exceeded that in cities although the absolute increase was greater in the metropolitan areas. o Shukla, R. (1983, Winter). Technical and structural support system and nurse utilization: Systems model. Inquiry 20(4), pp. 381—389. (NCHSR Grant HSO3635). Four hospital studies that used different combinations of technical and structural support systems were compared for the amount of time registered nurses were able to spend on activities directly related to patient care. It was found that a structural support system based on the primary nursing model, coupled with a decentralized technical support system, maximized the direct patient care time. o Trivedi, V. (1982, February). Measurement of task delegations among nurses by nominal group process analysis. Medical Care 20(2), pp. 154—164. (NCHSR Grant HSO3410). Task delegations among different nursing skill levels were empirically measured with nominal group process analysis and specially designed questionnaires instead of time study and work sampling techniques. 0 Trobe, J. (1982). The Impact of Ophthalmic Technicians on Outpatient Eye Care (NCHSR Grant HSO3647). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB3-110882), 108 pp. The proficiency of ophthalmic medical assistants is assessed and their acceptance by physicians and patients is evaluated. A digital computer simulation model of eye clinic provider patterns was also developed and validated. 0 Ward, M., J. Predhomme, and J. Swart. (1982). Nursing Directors' Perceptions of Commercial Supplemental Nurses (NCHSR Grant HSO4340). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884—183334), 81 pp. The utilization patterns of commercial temporary nursing personnel by hospitals and long—term care facilities were investigated. How the temporary personnel were perceived by nursing service administrators and the implications of such perceptions for management, planning, budgeting, and staffing purposes were also evaluated during the study. o Weed, L. (1981, April 9). Physicians of the future. The New England Journal of Medicine 304(15), pp. 903-907. (NCHSR Contracts 230—76—0099 and 233—78—3011). The author asks the question "What is the best combination of systems, tools, and people for solving any health-care problem in the context of the individual patient’s life?" and discusses how the physician fits into the overall 43 scheme. Six tasks of medical practice are described: (1) expand basic understanding; (2) develop safe means of monitoring the body's structure and processes; (3) establish feedback loops; (4) develop new treatments; (5) provide and nurture leadership; and (6) ensure rigorous application. 0 Weisman, C. (1982). Gender and Physician Specialty Distribution (NCHSR Grant HSO4299). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB4-160092), 6 pp. The effects of the gender composition of medical schools and of medical school graduating classes on the specialty choices of graduates during residency were investigated. The study found that the increase in the number and percent of women entering medical education during the 19705 was accompanied by diminished sex differences in specialty selection. 0 Weston, J. (1984, January). Ambiguities limit the role of nurse practitioners and physician assistants. [Editoria]. American Journal of Public Health 74(1), pp. 6-7. The author points out that the scope of practice for nurse practitioners and physician assistants has been broadened beyond primary care. o Weston, J. (1980, Hay—June). Distribution of nurse practitioners and physician assistants: Implications of legal constraints and reimbursements. Public Health Reports 95(3), pp. 253—258. Data on the distribution of nurse practitioners and physician assistants in medically underserved areas are presented. The author points out that State policies regulating the employment of nurse practitioners and physician assistants are greater determinants of their utilization than reimbursement policies. o Weston, J. (1984). NPs and PAs: Changes--where, whether and why. [Unpublished paper]. Division of Extramural Research, National Center for Health Services Research. Changes in the geographic distribution of nurse practitioners and physician assistants are discussed, including changes in legal constraints and reimbursement policies affecting them. 0 Wilensky, G. and L. Rossiter. (1983). Economic advantages of board certification. Journal of Health Economics 2, pp. 87—94. Using data from a nationwide survey of physicians, the authors provide estimates of the empirical relationship between income and board certification. Holding other factors constant, being board certified was found to increase a physician’s annual income by almost $13,000. 0 Wilson, 8., F. Stancavage, and L. Wise. (1980). Career Development of the Project TALENT Physicians (NCHSR Grant H502626). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB82—130469), 330 pp. Data from a number of sources, including the Project TALENT Longitudinal Study, were used to identify individual and institutional characteristics related to medical career choices for TALENT's 44 nationally representative sample of over 1,600 physicians. The report suggests the existence of a need to concentrate efforts on altering the composition of the pool of medical school applicants. 0 Wilson, 5., F. Stancavage, and L. Wise. (1981). Synthesis of Recent Research on Medical Career Decisions: A Comparative Study of Physicians From Two Decades (NCHSR Grant HSO4153). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P382—133737), 296 pp. The career development patterns of two cohorts of physicians were compared. Profiles of personal characteristics and educational experiences of physicians in nine specialty groups and six practice community sizes were drawn. Results of the analyses were incorporated into a model of medical career decisionmaking. 5. Health Promotion and Disease Prevention Topics covered in this section include the following: health practices as related to mortality risk; health hazard appraisal programs; preventive self—care practices; family psychosocial predictors of health care use; cultural factors in disease prevalence and management; behavior modification through education; vaccination and screening programs; baseline descriptors as predictors of outcome; and the politics, economics, and effectiveness of prevention. 0 Aaronson, L. (1983). Health Behavior in Pregnancy: Testing a General Model (NCHSR Grant HSO4440). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884—205756), 314 pp. The author developed a model to test three pregnancy—related behaviors——abstinence from smoking, caffein, and alcohol. The findings showed that the women’s knowledge about health recommendations concerning these behaviors was positively related to the women's decisions to abstain. o Altman, D. (1984). Evaluation of the Cancer Information Service: Implications for Health Behavior and Health Services Research (NCHSR Grant HSOSO63). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P385—183937/AS), 11 pp. The postcontact behavior of persons who called the Cancer Information Service was studied. Three—fourths of the sample contacted a health professional after their initial call to the Service. o Asher, C. (1984, April). The impact of social support networks on adult health. Medical Care 22(4), pp. 349—359. (NCHSR Grant H502577). Social support networks are evaluated in terms of their effectiveness in providing information on health care and disease prevention. Findings showed that networks had almost no impact on outcomes for illnesses over which the individual has little control; but when a broader range of illnesses was considered, the networks did play a role in producing better health. 0 Beery, W. and others. (1981). Description, Analysis, and Assessment of Health Hazard/Health Risk Appraisal Programs (NCHSR Contract 233—79—3008). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P881—239055, 16 pp.; Final Report (revised 1984), NTIS Order No. PB84—244508, 493 pp.). Programs for assessing health hazard/health risk behaviors are evaluated. The investigators found that such programs are used primarily to promote behavioral change and provide health—related education. o Bentkover, J. (1981). Estimated Economic Costs of Selected Medical Events Known or Suspected To Be Related To the 45 46 Administration of Common Vaccines (NCHSR Contract 233—78—3013). Rockville, MD: Public Health Service. (Research Summary, DHHS Publication No. (PHS) 80—3272, NTIS Order No. PB81-192171), 43 pp. The Government's potential liability in the conduct of wide—scale immunization programs is evaluated. Ranges of clinical outcomes and their consequent direct and indirect costs are detailed. o Berkman, L. and L. Breslow. (1983). Health and Ways of Living: The Alameda County Study (NCHSR Grant H800368). New York, NY: Oxford University Press. This monograph assembles data collected over a 9—year period as part of the Human Population Laboratory project in Alameda County, California. Mortality risk among persons 30 to 69 years of age during the 1965—74 period was examined in relation to daily health practices and the nature and extent of social networks. Trends over time were also noted. It was found that both health practices and social networks were strongly related to health over the time of the study, independently of each other and of socioeconomic status. o Berwick, D., S. Cretin, and E. Keeler. (1981, November). Cholesterol, children, and heart disease: Analysis of alternatives. Pediatrics 68(5), pp. 721—730. (NCHSR Grant HSO3508). Proposed cholesterol—screening programs are compared in terms of cost effectiveness. Sensitivity analysis showed that at a discount rate of 5 percent, a screening program for 10—year-olds would cost about $10,000 per year of life saved; rescreening would not improve efficiency. The cost per year of life saved was found to be insensitive to stability of cholesterol rank order. 0 Bohm, L. (1983). Social Support and Well—Being in Older Adults: The Impact of Perceived Control (NCHSR Grant H504423). Rockville, MD: Public Health Service. (Dissertation Executive Summary, NTIS Order No. P884—176056), 8 pp. In a study of persons aged 62 and older who lived alone, it was found that differences in feelings of efficacy in relationships explained the association between social support and well—being. Those who did not deal well with illness tended to be persons who felt less control overall and especially in their interpersonal relationships. 0 Branch, L. and A. Jette. (1984, October). Personal health practices and mortality among the elderly. American Journal of Public Health 74(10), pp. 1126—1129. (NCHSR Grant HSO3815). The authors investigated the correlation between certain personal health practices and reduced mortality for elderly men and women. Never having smoked was the only one of five practices studied that achieved a statistically significant relationship with lower mortality for the women; the relationship was not found for men. 0 Braun, P. (1984). Elective Hysterectomy: Benefits, Risks, and Costs (NCHSR Grant HSO4867). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PBB4—240134), 41 pp. Elective hysterectomy was compared with alternative management methods in terms of its effect on life expectancy, quality of life, and direct costs. Data and analysis showed that women with relatively 47 high operative risk or low expected cancer risks (beyond thresholds estimated in sensitivity analysis) and women under 35 not teated with placement estrogens after hysterectomy and oophorectomy were found to have net losses in life expectancy. 0 Braun, P. (1984). Hysterectomy: Cost—Effectiveness Analysis (NCHSR Grant HSO4867). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB4—240126), 10 pp. Results are summarized from a comparative study of the effect of elective hysterectomy (see previous citation) on life quality and costs. o Budetti, P. and P. Newacheck. (1984, July). Chronic disease and disability in children: Are the risks increasing? MOBIUS 4(3), pp. 14—19. (NCHSR Grant HSO4399). Possible explanations are offered for the doubling of chronic disabling conditions among children in the last 25 years. The authors propose to use future data analysis to focus on how to improve health promotion programs to identify factors that contribute to this problem. 0 Califf, R. and others. (1982, July). Prognostic implications of ventricular arrhythmias during 24—hour ambulatory monitoring in patients undergoing cardiac catheterization for coronary artery disease. The American Journal of Cardiology 50, pp. 23—31. (NCHSR Grant HSO3834). The prognostic importance of ventricular arrhythmias in identifying patients at high risk of sudden death was evaluated in patients with and without coronary artery disease. When only noninvasive characteristics were considered, the ventricular arrhythmia score was found to provide independent prognostic information; but when invasive measurements were included, the score had no effect. 0 Cohen, S. and others. (1982). Perceived influence of different information sources on the decisionmaking of internal medicine house staff and faculty. Social Science and Medicine 16, pp. 1361—1364. (NCHSR Grant H502485). The authors investigated the extent to which different information sources influence physician decisions relating to primary prevention (vaccination), secondary prevention (screening), and drug therapy. Analysis of data showed that primary prevention decisions were least influenced by prevailing information sources; therapeutic decisions were most influenced by subspecialists and the physician's past experience. 0 Cox, C. (1980). Illness Behavior in Mid—Life Women (NCHSR Grant HSO3667). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P381—125536). Results are reported from a study of the relationship between specific sociopsychological factors and women’s behavior during illness. Illness behavior was found to be significantly related to the quality of social supports (as defined by the closeness of relationships), life satisfaction, level of self—esteem, feelings of success, and recent illness or death of a close friend or relative. 48 o Dibner, A., L. Lowy, and J. Morris. (1982). Usage and acceptance of an emergency alarm system by the frail elderly. The Gerontologist 22(6), pp. 538—539. (NCHSR Grant HSOl788). This demonstration project found that acceptance and utilization of the Lifeline telephone emergency system were associated with an attitude of active participation by frail elderly persons in addressing and solving their health—related problems. 0 Eckenrode, J. (1984). Impact of chronic and acute stressors on daily reports of mood. Journal of Personality and Social Psychology 46(4), pp. 907—918. (NCHSR Grant HSO3029). Major life events, chronic stressors, and minor daily stressors were compared to determine their effect on mood. Results showed the most important direct determinants of mood were previous levels of psychological well-being and concurrent daily stressors and physical symptoms. o Eckenrode, J. (1983). The mobilization of social supports: Some individual constraints. American Journal of Community Psychology 11(5), pp. 509—528. (NCHSR Grant H803029). Ways in which help—seeking beliefs and locus of control affect an individual’s support mobilization efforts were studied. Results confirmed that an internal locus of control and positive belief in the benefits of seeking help were each associated with more support mobilization, independent of the number of available supporters. o Fleming, G. and others. (1984, October). Self—care: Substitute, supplement, or stimulus for formal medical care services? Medical Care 22(10), pp. 950—966. (NCHSR Grant HSO4106). This article examines the relationship between selected self-care practices and the use of formal medical care during an episode of illness. The results of a multiple classification analysis of secondary data suggest that self—care users may visit the physician less often and stay fewer days in the hospital than others. 0 Foltz, A. (1980). The Politics of Prevention: Child Health Under Medicaid (NCHSR Grant H802852). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P882-116880), 445 pp. Medicaid’s early and periodic screening, diagnosis, and treatment program is evaluated. The author discusses problems in program implementation (such as institutional constraints at both Federal and State levels) and the lack of consensus among health professionals on minimum standards for child health care. The need for a national program of comprehensive health care for all children is also advocated. o Fowles, J. and J. Bunker. (1981). Informed Consent and Medical Information Seeking (NCHSR Grant HSO357S). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P883—105429), 330 pp. Results are presented from a randomized controlled trial of informed consent in elective surgery. The experimental group received written information on the risks, 49 benefits, and alternatives to surgery as well as opportunities for feedback. Although this group showed increases in knowledge and information—seeking behavior, there were no differences in anxiety levels either before or after surgery. 0 Gallo, F. (1982). Social Support Networks and Elderly Health (NCHSR Grant 8804430). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P882-255332), 11 pp. Characteristics of the relationship between social support networks and health of elderly persons are summarized. Social support and demographic dimensions when taken independently were only slightly or moderately correlated with health variables; but when both dimensions were combined, the correlation with the health variables was high. o Garber, A. (1982). Costs and Control of Antibiotic Resistance (NCHSR Grant HSO4254). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P383—204388), 7 pp. Results are summarized from a project that developed a methodology for analyzing resistance to antibiotics and the social costs of antibiotic use. The author found that antibiotic use increased the proportion of infections caused by resistant bacteria but decreased the total probability of infection. 0 Giachello, A., G. Fleming, and R. Andersen. (1982). Self—Care Practices in the United States (NCHSR Grant HSO4106). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P385-171205/AS, 18 pp.; Final Report, NTIS Order No. P385—171213/AS, 209 pp.). This report documents the level and types of prevalent self-care practices among the U.S. population and some major subgroups. Data on preventive care practices, health status, and access to and satisfaction with health care were gathered in three time periods. Results showed that younger persons and ethnic minorities were more interested in further self-care knowledge. 0 Gilson, B. and others. (1984). Physician Effectiveness in Preventive Care (NCHSR Grant HSO4387). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P885—208684/AS, 19 pp.; Final Report, NTIS Order No. P885—208692/AS, 204 PP-). Results are reported from two randomized controlled trials that tested strategies physicians could use to increase consumer participation in colorectal screening and smoking cessation. Significantly higher compliance rates were found between intervention groups and the control group in the colorectal screening trial; in the smoking cessation trial, however, there were no significant differences in the quit rate between intervention groups. o Goldman, L. and F. Cook. (1984, December). The decline in ischemic heart disease mortality rates. Annals of Internal Medicine 101(6), pp. 825-836. (NCHSR Grant HSO4920). Changes in lifestyle, specifically reductions in serum cholesterol levels and cigarette smoking, are estimated by the authors to be related to 50 more than half of the decline in ischemic heart disease mortality rates from 1968 to 1976. o Gortmaker, S., J. Eckenrode, and S. Gore. (1982, March). Stress and the utilization of health services: A time series and cross—sectional analysis. Journal of Health and Social Behavior 23, pp. 25—38. (NCHSR Grant HSO3029). The authors employed a prospective diary method with 96 female users of a neighborhood health center to study the relationship between stress and health services utilization. Analysis showed that the presence of stress on a given day was associated with an approximate doubling of the probability of a health care contact on that day. 0 Grossman, M. (1981). Determinants of Children's Health (NCHSR Grant H802917). Rockville, MD: Public Health Service. (Research Summary, DHHS Publication No. (PHS) 81-3309, NTIS Order No. P883-221481), 32 pp. This report was developed from the grant final report with like title (see next citation) that studied the environmental (home and community) variables affecting the health of children. o Grossman, H. and others. (1980). Determinants of Children's Health (NCHSR Grant H502917). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P380—163603), 291 pp. The particular home and local environment variables that act as determinants of children’s health were investigated, specifically family income, parents' education, health manpower availability, and preventive medical care. Preventive dental care was found to significantly affect children's health. An increased availability of dentists had a positive impact on dental health, but a greater availability of pediatricians did not alter the physical health measure. o Hadley, J. (1981). Does Medical Care Affect Health? An Economic Analysis of Geographic Variations in Mortality Rates (NCHSR Grant H802790). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P882-181660), 22 pp. The author investigated the relationship between mortality rates (defined as an inverse indicator of health) and medical care use. Except for middle—aged males, a lO—percent increase in medical care use was estimated to reduce mortality rates by about 1.5 percent. Various prohealth policies were also compared. o Hadley, J. (1982). Does medical care improve your health? Policy and Research Report (pp. 9—11). Washington, DC: The Urban Institute. (NCHSR Grant H502790). In this study, mortality rates were assumed to depend on lifestyle/behavior, environment, heredity, and the use of medical care. The major finding was that variations in medical care use have a negative and statistically significant effect on mortality rates. 0 Harris, P. and others. (1980, December). Nonfatal myocardial infarction in medically treated patients with coronary artery disease. The American Journal of Cardiology 46(6), pp. 937—942. 51 (NCHSR Grant 8803834). This article identifies patient characteristics associated with nonfatal myocardial infarction as the first event after cardiac catheterization. Left ventricular function, specific coronary anatomy, previous infarction, and patient's age were found to be the most important discriminators. 0 Harris, P. and others. (1980, October). Outcome in medically treated coronary artery disease. Ischemic events: Nonfatal infarction and death. Circulation 62(4), pp. 718—726. (NCHSR Grant HSO3834). This article presents nonfatal infarction and death together as ischemic events in a study of the characteristics of outcome in over 1,200 heart patients. In patients with one-, two—, or three-vessel disease and normal left ventricular function, nonfatal infarction accounted for at leat half of initial events. In patients with left main disease or severe left ventricular function however, death was the predominant event. 0 Harris, P. and others. (1980, August). The prognostic significance of 50 percent coronary stenosis in medically treated patients with coronary artery disease. Circulation 62(2), pp. 240—248. (NCHSR Grant HS03834). Patients with at least 50-percent coronary stenosis were divided into those in whom all diseased vessels were three-quarters or more narrowed and those in whom at least one vessel was only half narrowed. In every category the latter group had a better outcome, as measured by rates of survival and freedom from later coronary events. 0 Jansen, G. and P. Kendall. (1984). Increasing Compliance With Diet Regimens (NCHSR Grant HSO4843). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P385—152692/AS), 153 pp. Two dietary instruction programs, the nutrient standard method and the exchange list method, were compared in terms of how effective they were in helping diabetic patients adhere to diet regimens. Unlike the exhange list group, the group that was instructed in the nutrient standard method showed a significant decline in fat intake and a significant increase in dietary knowledge. 0 Johnson, L. (1980). Parents of Diabetic Children and Medical Compliance (NCHSR Grant H802863). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PBBl—207482), 106 pp. Family influences on the medical regimen of young diabetic children were studied. Results suggested that parents who had no family history of diabetes and who experienced stressful onset of the disease were more compliant with the prescribed regimen than parents who had diabetic relatives. 0 Katz, S. and others. (1983, November). Active life expectancy. The New England Journal of Medicine 309, pp. 1218—1224. (NCHSR Grant HS03760). The authors demonstrate the feasibility of forecasting years of functional health and well—being for the elderly by using life—table techniques. Applications for using information on active life expectancy for purposes such as identifying high—risk populations in need of preventive health care are outlined. 52 o Lewit, E. (1982). The Potential for Using Excise Taxes to Reduce Cigarette Smoking (NCHSR Grant H803738). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB3—172155), 71 pp. Results are reported from an investigation of the effect of different prices, as represented by varied State and local cigarette taxes, on smoking. Price elasticities of demand for cigarettes were found to be much larger for teenagers (especially males) than for adults. o Lewit, E. and D. Coate. (1982, February). The potential for using excise taxes to reduce smoking. Journal of Health Economics 1, pp. 121—145. (NCHSR Grant HSO3738). In this article developed from a grant report with similar title (see previous citation), the authors examine the potential for reducing cigarette smoking through increases in excise taxes. 0 Lewit, E., D. Coate, and M. Grossman. (1981, December). The effects of government regulation on teenage smoking. Journal of Law and Economics 24, pp. 545—569. (NCHSR Grant HSO3738). The authors present initial estimates of the impact of the Fairness Doctrine and advertising ban policies on the demand for cigarettes by U.S. teenagers. The extent to which an increase in the Federal excise tax on cigarettes would reduce teenage smoking is also critically examined. Findings suggest that the Fairness Doctrine had its largest impact in the first year of its existence. o Lubeck, D. (1981). An Application of Benefit—Cost Analysis: Heart Disease Research and Prevention (NCHSR Grant HSO4249). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB82—194556), 409 pp. This report compares a treatment-oriented strategy for combating heart disease with a community-based preventive strategy in terms of associated costs and effectiveness in increasing life expectancy and reducing coronary risk. Best and worst case estimates are included. o Madoff, J., J. Hyde, and D. Dean. (1983). Primary Care Practice Study (NCHSR Grant H804538). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P885—168797/AS), 100 pp. The attitudes and practices of primary care'physicians with respect to disease prevention and health promotion practices were investigated. Physician attitudes regarding the importance of preventive approaches were favorable despite the perceived existence of inadequate reimbursement and other barriers. o Meyers, T. (1982). Stress and the Amish Community in Transition (NCHSR Grant HSO4244). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P884—199686), 9 pp. Stressors, social supports, and coping strategies were compared for Amish farmers and factory workers. Results of interviews with both groups of men showed that for factory workers, stressors most strongly associated with neuroses were noxious agents (such as dirt and dust) in the workplace. But for farmers, the stressors 53 most strongly associated with psychological impairment were role conflict, responsibility pressure, and workload. 0 National Center for Health Services Research. (1984). Annotated Bibliography of the Health Status and Health Promotion Studies Program. Rockville, MD: Public Health Service. (NTIS Order No. P385—138147), 10 pp. Journal articles and conference papers describing NCHSR intramural research on health status/health risk and health promotion are listed and annotated. 0 National Center for Health Services Research. (1983). NCHSR Research on Health Status Measures. Rockville, MD: Public Health Service. (NTIS Order No. PB84-119684), 8 pp. NCHSR studies on severity indexes and other health status indicators are described. A bibliography and a list of examples of corresponding studies are included. 0 Nations, M. (1982). Illness of the Child: The Cultural Context of Childhood Diarrhea in Northeast Brazil (NCHSR Grant HSO4437). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBS4—145440), 14 pp. Sociocultural behavioral patterns and belief systems that affect the management of children’s diarrheal disease in northeastern Brazil are examined. The author proposes a three—tiered, community—based model incorporating both traditional and modern methods for the prevention, referral, and treatment of gastrointestinal infections. o Nikias, M. and N. Budner. (1981). Compliance in Dental Health Education and Prevention (NCHSR Grant H802167). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P383-178186), 12 pp. The extent to which adult dental patients complied with preventive oral home care regimens was examined over time. Large proportions of patients from private offices and a dental clinic who received plaque removal instruction were found to observe those parts of the regimen which were effectively communicated and reinforced. 0 Parsons, D., B. Fleisher, and H. Marvel. (1980). Economic Responses to Poor Health in Older Males (NCHSR Grant H502818). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P380—187644), 318 pp. The differential labor—market response of men to poor health was investigated as a function of their household situation. It was found that unmarried men in poor health worked substantially less than married men. o Peoples, M. (1981). Impact Evaluation of Programs for Mothers and Infants: Implications From an Evaluation of the Maternity and Infant Care Project in North Carolina (NCHSR Grant HSO4242). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P882—145103), 638 pp. The North Carolina Maternity and Infant Care Project was evaluated to determine its impact on women's use of prenatal care services. Results showed that the project was successful in increasing the proportion of 54 women who initiated care during the first two trimesters of pregnancy. Additionally, the incidences of fetal mortality and low birthweight deliveries declined. o Potter, L. (1984). Family Psychosocial Predictors of Child Health Care Utilization (NCHSR Grant H505039). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB6—174257/AS), 12 pp. Life events, maternal locus of control, and social support were examined in terms of their ability to predict children’s use of health care. Results showed that utilization and these three family psychosocial characteristics were not strongly enough associated to make them valid predictors of the type or amount of care children receive. o Pryor, D. and others. (1983, November). Estimating the likelihood of significant coronary artery disease. The American Journal of Cardiology 75, pp. 771—780. (NCHSR Grant H803834). This article identifies clinical characteristics that can be used for estimating the likelihood of a patient having significant coronary artery disease. A model using these characteristics accurately estimated the likelihood of disease when applied prospectively to over 1,800 patients. Further applications of the model to diagnostic practice and research are suggested. 0 Reed, W. (1983, Summer). Physical health status as a consequence of health practices. Journal of Community Health 8(4), pp. 217—228. (NCHSR Grants H502468 and HSO3125). In a study of the relationship between health practices and physical health, those practices described as good were correlated with higher health status. 0 Ross, C. (1980). An Approach to Increasing Lead Poisoning Followup Screening in an Urban Lower Income Population (NCHSR Grant H803715). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P381—211146, 14 pp.; Final Report, NTIS Order No. PBBl—211153, 114 pp.). In a population at risk for lead poisoning, an experimental group received a prevention—oriented presentation on screening for lead poisoning that was organized around the group members’ knowledge, beliefs, and experience. A control group did not receive the presentation. Results showed that parents in the experimental group were more likely than those in the control group to obtain followup screening for their children. 0 Russell, L. (1984). The economics of prevention. Health Policy 4, pp. 85—100. (NCHSR Grant HSO4392). After reviewing prevention studies, the author concludes that few prevention programs reduced medical expenditures; and even when prevention cost less per person than acute care, its medical costs per unit of health benefit could be as great or greater than the comparable acute care cost. 0 Russell, L. (1984). Evaluating Preventive Medical Care as a Health Strategy (NCHSR Grant HSO4392). Rockville, MD: Public 55 Health Service. (Executive Summary, NTIS Order No. P385—208155/AS, 11 pp.; Final Report, NTIS Order No. PB85—208163/AS, 218 PP-). The potential of specific preventive measures—-smallpox and measles vaccines, drug therapy for hypertension, and regular exercise-—for improving health and reducing cost is examined. The author suggests that certain measures in cost—effectiveness studies of prevention be standardized to permit wider opportunity for comparative analyses. These measures include a common set of assumptions and approach; an agreed—upon discount rate; inclusion of institutionalization costs; presentation of earnings; use of the year of healthy life as a measure of health effects; and agreement on when to include medical costs incurred during added years of life. 0 Saint Louis, P., W. Carter, and H. Eisenberg. (1982, October). Prescribing CPR: A survey of physicians. American Journal of Public Health 72(10), pp. 1158—1160. (NCHSR Grants HSOZ456 and HSO4000). Cardiologists, internists, and family practitioners were interviewed to determine attitudes and practices regarding cardiopulmonary resuscitation counseling. Although there was unanimous support for CPR among the physicians, only 40 percent of them recommended CPR training to spouses of patients with heart disease and 58 percent provided counseling about cardiac arrest. The investigators suggest that the doctor's office could be better utilized in the promotion of CPR education. 0 Showstack, J., P. Budetti, and D. Hinkler. (1984, September). Factors associated with birthweight: An exploration of the roles of prenatal care and length of gestation. American Journal of Public Health 74(9), pp. 1003—1008. (NCHSR Grant H502975). The authors found that adequate prenatal care was associated with an increase in average birthweight of nearly 200 grams. The effect was greater for black infants. For babies of short gestation (280 or fewer days), the addition of length of gestation to the equation halved the association of prenatal care with birthweight. o Slesinger, D. and Y. Okada. (1984, Fall). Fertility patterns of Hispanic migrant farm women: Testing the effect of assimilation. Rural Sociology 49(3), pp. 430—440. (NCHSR Grant HSO4368). The fertility patterns of a sample of migrant Hispanic farm women were studied. Results showed that the variable most associated with live births was age; controlling for age, education was the main predictor. The authors concluded that the women's high fertility patterns were likely to continue until education level improved for the children, thus increasing the degree of assimilation (as measured by bilingualism) and improving their opportunities. 0 Spielberg, L. (1981). Impact of Early and Periodic Screening, Diagnosis, and Treatment Upon Health Services Utilization by Maryland Medicaid Children (NCHSR Grant HSO3720). Rockvi 1e, MD: Public Health Service. (Executive Summary, NTIS Order No. PB81—195844; Final Report, NTIS Order No. P881—195836), 271 pp. Results are reported from a study of how early and periodic 56 screening, diagnosis, and treatment of children on Medicaid affects the children's use of health services. Maryland children screened under the program received more care for functional conditions such as hearing, vision, and dental problems than a comparably eligible but unscreened group; however, most of the screened children referred for followup care did not receive it. 0 Steel, K. and C. Crescenzi. (1984). Iatrogenic Disease: An Annotated Bibliography (NCHSR Grant HSO4835). Rockville, MD: Public Health Service. (NTIS Order No. P385—202992/AS), 37 pp. This bibliography was compiled in conjunction with a l—day conference on iatrogenic disease. Selected references reflect the varied types of iatrogenesis as well as the diverse approaches to its study. 0 Steel, K. and C. Crescenzi. (1984). Iatrogenic Disease and Geriatric Medicine Conference (NCHSR Grant HSO4835). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P885—203008/AS), 20 pp. Proceedings from a May 16, 1984, conference on iatrogenesis are summarized. Topics include injury prevention and diagnosis. Research priorities are also addressed. 0 Stiles, G., R. Rosati, and A. Wallace. (1980, December). Clinical relevance of exercise—induced S—T segment elevation. The American Journal of Cardiology 46, pp. 931—936. (NCHSR Grant HSO3834). Angiographic data were compared for patients with S-T elevation and patients with S—T depression induced by treadmill exercise. For patients with S-T elevation who had not had a previous myocardial infarction, the severity of coronary disease and ventricular dysfunction did not differ from the severity in patients with S—T depression. For patients who had suffered previous infarction, exercise—induced S—T elevation appeared to be a marker of depressed left ventricular function. 0 Unterharnscheidt, A. (1984). Risk Factors for Diabetic Retinopathy (NCHSR Grant 8504450). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBBS—l78960/AS), 6 pp. Results are summarized from a descriptive study of risk factors for diabetic retinopathy in black women with noninsulin—dependent diabetes mellitus. The study also tested whether groups characterized by high and low rates and degrees of diabetic retinopathy differed significantly as a function of one or more of the factors. 0 Vogt, T. (1984, January). Effects of parental smoking on medical care utilization by children. American Journal of Public Health 74(1), pp. 30—34. (NCHSR Grant HSO3601). Parental smoking patterns were analyzed for their effect on children’s medical care use. Children in nonsmoking homes were found to use significantly more outpatient services than children in smoking homes, a difference primarily due to more well—child examinations among the nonsmoking households. The author points out that assuming utilization differences are produced by equivalent illness differences may be unfounded. 57 o Wagner, E. and others. (1982, April). As assessment of health hazard/health risk appraisal. American Journal of Public Health 72(4), pp. 347—352. (NCHSR Contract 233—79—3008). This article summarizes results of a state—of—the—art review of programs in health risk and health hazard appraisal. The authors conclude that the importance of this particular health promotion technique appears to have been exaggerated. 0 Warner, K. (1981). The Benefits and Costs of Antismoking Policies (NCHSR Grant HSO3634). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P883—186569), 254 pp. The effects of antismoking policies on cigarette smoking are assessed. It is estimated that 200,000 premature deaths were avoided as a result of the 1964—78 antismoking campaign. In terms of dollars saved, the difference between campaign-induced benefits and expenditures may have been as high as $16.5 billion. 0 Warner, K. and H. Hurt. (1983, June). Premature deaths avoided by the antismoking campaign. American Journal of Public Health 73(6). pp. 672—677. (NCHSR Grant HSO3634). This article summarizes results from a cost/benefit review of the Nation’s 12-year antismoking campaign. The authors point out that the 200,000 premature smoking—related deaths avoided because of the campaign were only a small percentage of the 4 million deaths attributable to smoking that occurred during the same period. 0 Weinberger, M. and others. (1982). Physician's ratings of information sources about their preventive medicine decisions. Preventive Medicine Information Sources 11, pp. 1—7. (NCHSR Grant H502485). Sources of information rated valuable by physicians in making preventive and therapeutic decisions are examined. Past experience was not rated important for most primary and secondary prevention decisions; reading was rated highly across all procedures. The authors suggest ways by which medical educators might ameliorate deficits in information sources about prevention. 0 Zalkind, D. and R. Shachtman. (1980, January). A decision analysis approach to the swine influenza vaccination decision for an individual. Medical Care 18(1), pp. 59-72. (NCHSR Grant HSOl971). A method is presented to analyze the decision by an individual on whether to receive the swine influenza vaccine. The analysis constitutes a prototype for cases where informed consent requirements have prompted increased involvement by patients in their personal medical decisions. The article includes approaches for health care personnel to use in informing an individual about personal costs, benefits, probabilities, and indicated actions associated with such decisions. 6. Hospitals (includes care, services, and operations) Topics covered in this section include the following: coordination of hospital services; multihospital systems; hospital operations and productivity; competition and procompetition strategies; comparative studies of hospital claims administration; and hospital/community relations. 0 Argote, L. (1982). Input uncertainty and organizational coordination in hospital emergency units. Administrative Science Quarterly 27, pp. 420—434. (NCHSR Grant H802§38). Relationships among input uncertainty, means of coordination, and criteria for organizational effectiveness of hospital emergency units are explored. Means are suggested for how the units could best solve their coordination problems under varying conditions. 0 Brian, E. (1982). Evaluation of Automated Hospital Data Management Systems in 100—300 Bed Hospitals (NCHSR Grant H802777). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB83-153437), 515 pp. Results of an examination of the automated hospital data management systems of eight hospitals are reported to determine how the systems affect hospitals’ operating costs. 0 Calderone, G. and others. (1984). Synthesizing Empirical Hospital Organization Research (1960-1979) (NCHSR Contract 233—80—3003). Rockville, MD: Public Health Service. (NTIS Order No. P884-243930), 30 pp. This report presents findings on the main substantive research topics, independent and dependent variables studied, and research characteristics and emphases of empirical hospital organization research published during the 19605 and 19705. The authors conclude that such research became more concentrated in its subject matter with quality and cost emerging as the major emphases by the end of the period. 0 Calderone, G., S. Queen, and J. Smale. (1984). Empirical Hospital Organization Research Codes and Abstracts File (1960—1979) (NCHSR Contracts 233—80—3003 and 110-69—207). Rockville, MD: Public Health Service. (Documentation, NTIS Order No. P884—183888), 126 pp. This report contains the documentation of the research codes and abstracts file developed under two separate NCHSR—supported contracts. Over 2,000 articles, books, public reports, and dissertations produced between 1960 and 1979 on the subject of hospital organization research are documented. (The data file——divided into 19605 codes, 19605 abstracts, 19705 codes, and 19705 abstracts—-i5 available separately under NTIS Order No. PB84—l77286.) 0 Cardiac procedures study released. (1984, September 1). Hospitals 58(17), p. 42. (NCHSR Grant HSO4329). Announcement is 59 60 made of the results of a 1983 study of the distribution of specialized facilities within hospitals, including cardiac care procedures. According to the study, cardiac catheterization was performed at only 19.2 percent and open heart surgery at only 12.8 percent of responding hospitals. 0 Christianson, J. (1980). Economic Issues in Reduction of Rural Hospital Capacity (NCHSR Grant HSO3374). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P881—206153), 217 pp. Adverse effects of rural hospital closures are evaluated and the relationship between community income and rural hospital spending is estimated. o Christianson, J. and L. Faulkner. (1981, Spring). The contribution of rural hospitals to local economies. Inguiry 18(1), pp. 46—60. (NCHSR Grant HSO3374). To estimate the contribution of rural hospitals to the income of their communities, the authors formulate a model; apply it to a cross section of short—term, rural hospitals; and construct estimates for three measures of how hospital expenditures affect the local economy. 0 Coffey, R. (1983). Patients in public general hospitals: Who a 5? How sick? Hospital Cost and Utilization Project Reseatchfi Note 2, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 83—3344, NTIS Order No. P884—200245), 24 pp. Characteristics of patients admitted to public general hospitals are compared with those admitted to voluntary hospitals to assess whether public hospitals treat poorer and sicker patients than private hospitals. 0 Conrad, D. and G. Sheldon. (1984). Pooled Cross—Section Time Series Anal sis, 1970—1982: In acts of Rate Re ulation on Hos ital Vo umes, Nursing Mix, Labor Intensity, Revenues, and Faci ities (NCHSR Grant HSO4472). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P385—169589/AS), 46 pp. This report summarizes the results of a four—way comparison on how rate review programs affected various hospital characteristics over the 1970—82 period. Results showed that rate review programs resulted in increased occupancy rates and had a posititve effect on outpatient visits per capita. o Daniels, C. and A. Wertheimer. (1981). Evaluation of Hospital Formulary Effects on Cost Control (NCHSR Grant HSO3968). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P881—206567, 34 pp.; Final Report, NTIS Order No. PBBl—206559, 53 pp.). The role of various formulary system procedures in the general medical/surgical hospital is reviewed and the influence of the procedures on both drug acquisition costs and drug inventory value is examined. 0 Dolan, A. and I. Moscovice. (1980, Summer). A comparison of hospital and state agency efficiency in processing Medicaid claims in Washington State. Health Services Research 15(2), pp. 93—104. (NCHSR Grant HSOl978). The performance of the Washington State 61 Medicaid Agency in processing Medicaid claims was compared with that of hospital providers for 1 year. The authors found that the inhospital processing time was approximately twice that of the Medicaid processing agency. 0 Draper, E., D. Wagner, and W. Knaus. (1981, December). The use of intensive care: A comparison of a university and community hospital. Health Care Financing Review 3(2), pp. 49—64. (NCHSR Grant HSO4857). Intensive care unit (ICU) admissions at a university hospital were compared with ICU admissions at a community hospital with similar resource and treatment capabilities. The authors found that the university hospital patients had a substantially higher acute severity of illness and the community hospital patients were more often admitted for monitoring. 0 Ermann, D. and J. Gabel. (1984, Spring). Multihospital systems: Issues and empirical findings. Health Affairs 3(1), pp. 50—65. (NTIS Order No. P384—206853). More than 400 articles and empirical studies relating to the Nation's multihospital systems are summarized. Topics addressed include the technical advantages (and disadvantages) of systems compared to independent hospitals and the impact of systems on hospital costs, quality, and access to care. 0 Farley, D. (1982). A Study of Investment Behavior in Community Hospitals (NCHSR Grant HSO3674). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB3—205666), 22 pp. The determinants of decisions by hospitals to acquire new capital equipment and facilities are examined theoretically and empirically. The investigation includes interhospital nonprice competition, institutional objectives, and physician behavior. 0 Franzese, R. (1980). Comparison of Alternate Market Forms of Hospital Foods (NCHSR Grant HSO3680). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBBO-184443), 283 pp. The market forms in which hospitals purchase menu items for patients are described. The author compared cost, nutrient value, and quality for selected items. Findings indicated that nutrient value and food quality were not related to cost. 0 Goldfarb, M. (1984). Who receives cesareans? Patient and hospital characteristics. Hospital Cost and Utilization Project Research Note 4, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3345, NTIS Order No. P885-124766), 18 pp. The use of cesarean procedures is described for 300 hospitals which were cross classified as to whether they had a neonatal intensive care unit and a medical school affiliation. Affiliated hospitals and those with neonatal ICUs showed higher rates for cesarean deliveries than comparison hospitals. 62 o Goldfarb, M., M. Hornbrook, and C. Higgins. (1983, January). Determinants of hospital use. Medical Care 21(1), pp. 48—66. The effects of personal, clinical, physician, and hospital characteristics are estimated in a simultaneous—equations model of length of stay and use of ancillary services for five conditions: tonsillectomy and adenoidectomy, gastroenteritis and colitis, inguinal hernia, coronary heart disease, and cholelithiasis. Results showed that length of stay and utilization of ancillary services were significantly interrelated for all of the medical/surgical conditions studied. 0 Goldfarb, M., M. Hornbrook, and J. Rafferty. (1980). Behavior of the multiproduct firm: A model of the nonprofit hospital system. Medical Care 18(2), pp. 185—201. (NTIS Order No. P384—165232). The article presents and describes a hospital model that recognizes the multiproduct nature of hospital output and incorporates tradeoffs among various competing hospital goals. Policy implications of the predicted variations are illustrated. o Herdman, B. (1982). Hospital Services Coordination: A Comparative Case Study of Triad and Care Program Management Systems (NCHSR Grant HSO4247). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P882—224395), 326 pp. Two hospital management systems are compared in terms of how they function in large, complex hospitals which have a medical school affiliation. Applications to both the research— and practice-oriented medical staff are also addressed. o Hornbrook, M. (1981). Economic incentives and control: Some issues for research in the Veterans Administration medical care system. Journal of Medical Systems 5(1/2), pp. 69—96. The author discusses four major areas of hospital performance in need of economic research: estimating hospital cost functions, devising models of the nonprofit hospital, developing better measures of hospital output, and analyzing determinants of hospital use. o Hornbrook, M. (1982, Spring). Hospital case mix: Its definition, measurement, and use: Part I. The conceptual framework. Medical Care Review 39(1), pp. 1-43. (NTIS Order No. PB84-158575). A conceptual framework for hospital casemix measurement is presented. Various purposes requiring casemix measures are highlighted including those related to policy, administration, and research. Hospital output measurement is also addressed in the context of economic theory. o Hornbrook, M. (1982, Summer). Hospital case mix: Its definition, measurement, and use: Part II. Review of alternative measures. Medical Care Review 39(2), pp. 73-123. (NTIS Order No. PBB4-158583). The article discusses seven diagnosis classification systems that provide alternative methods of defining and classifying hospital cases. Single—dimensional measures created by a weighted aggregation of individual cases are described in terms of the applicability of each measure to 63 hospital reimbursement, monitoring of quality, and estimating of aggregate cost functions. 0 Hornbrook, M. (1983). Project overview. Hospital Cost and Utilization Project Research Note 1, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 83-3343, NTIS Order No. PB84—111566), 23 pp. The background and objectives of the Hospital Cost and Utilization Project are described. The report details the structure and contents of the data base as well as its limitations. Abstracts of ongoing studies are also included. 0 Hornbrook, M. and M. Goldfarb. (1981, August). Determinants of differences in mortality rates among hospitals. In American Statistical Association——Social Statistics Section. Proceedings (pp. 70—79). Washington, DC: American Statistical Association. The paper discusses the development of an econometric model that explains cross-sectional differences in hospital death rates as functions of various factors. Some implications for use of the crude death rate in monitoring and evaluating hospital performance are illustrated. o Hornbrook, M. and M. Goldfarb. (1983). A partial test of a hospital behavioral model. Social Science and Medicine 17(10), pp. 667—680. (NTIS Order No. P884—164821). This article examines the influence of hospital and community characteristics on hospital output behavior as measured by the level of emergency standby capacity, the total number of admissions, the diagnosis mix of admissions, and the hospital’s practice style with regard to ancillary services and length of stay. o Hornbrook, M. and M. Goldfarb. (1981, January). Patterns of obstetrical care in hospitals. Medical Care 19(1), pp. 55—67. This article examines the determinants of length of stay and use of ancillary services for women who experience deliveries without complications. With maternal medical and socioeconomic characteristics held constant, it was found that the size, teaching status, method of control, and location of the hospital and the physician's mode of practice and relationship to the hospital were important determinants of hospital use. 0 Jones, P., S. Jones, and H. Halliday. (1980, January). Evaluation of television consultations between a large neonatal care hospital and a community hospital. Medical Care 18(1), pp. 110—116. (NCHSR Grant HSOl390). Two—way television consultations between community hospital nurses and neonatologists at a nearby teaching hospital were evaluated over a period of 2—1/2 years. Findings suggested that the consultations facilitated the formation of appropriate criteria for transfer of sick babies from the community hospital to the teaching hospital and that routine clinical screening tests were performed more consistently. 0 Kelly, J. (1981, August). Hospital capital stock: Comparison of Medicare cost report and American Hospital Association annual 64 survey data. In American Statistical Association——Social Statistics Section. Proceedings (pp. 80—89). Washington, DC: American Statistical Association. This report uses Medicare cost data and American Hospital Association survey data to identify and examine the determinants of hospital investment and how they vary across hospital types, market conditions, time, and capital components. 0 Kelly, J. and J. O'Brien. (1983). Characteristics of financially distressed hospitals. Hospital Cost and Utilization Project Research Note 3, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 83—3352, NTIS Order No. P884—111574), 19 pp. Chronic hospital financial distress is defined and analyzed across hospital locations, and causes for chronic deficits are proposed and examined in terms of differences in patient casemix and treatment patterns. o Kingsdale, J. (1981). The Growth of Hospitals: An Economic History in Baltimore (NCHSR Grant HSO3695). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBBl—207672, 28 pp.; Final Report, NTIS Order No. P881-207508, 527 pp.). The report chronicles the development of Baltimore's hospitals into a three—tiered sector composed of teaching, voluntary, and municipal hospitals each serving specific populations and needs after World War I. 0 Lee, H. (1983). Spatial Distribution of Hospital Utilization in a Region (NCHSR Grant HSO4718). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P883—254268), 9 pp. The author develops a model of hospital utilization that incorporates the demand processes of the customers being served. 0 Luft, H. and S. Maerki. (1984—85, Winter). Competitive potential of hospitals and their neighbors. Contemporary Policy Issues 3, pp. 89—102. (NCHSR Grant HSO4329). The potential for hospital competition is measured in terms of the geographic distance between neighboring hospitals. According to data from 6,520 hospitals in 48 States, nearly 50 percent of hospitals have no other hospital within a 5—mile radius. The data suggest that the potential for competitive hospital markets might not exist in many sections of the United States. 0 Luke, R. and M. Hornbrook. (1983). Conceptual foundations for hospital classification. In Proceedings of the Second International Conference on Systems in Health. (NTIS Order No. P884—164847), 9 pp. This paper summarizes the potential and reasons for using hospital classification in mechanisms for the reimbursement of hospitals based on the outputs they produce. o Moscovice, I. and R. Rosenblatt. (1982). The Viability of the Rural Hospital (NCHSR Contract 233—79—3025). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P384—111442), 185 pp. Findings from health services research 65 on rural hospitals are synthesized. The report identifies and examines external factors which affect rural hospitals and outlines strategies for improving their financial strength. 0 Nathanson, C. and L. Morlock. (1980, December). Control of structure, values, and innovation: A comparative study of hospitals. Journal of Health and Social Behavior 21, pp. 315—333. (NCHSR Grant HSOl964). Twelve hospitals in one metropolitan area were compared to investigate the organizational determinants of social—~as opposed to technological—-innovations. Variables tested included the centralization of influence on hospital decisionmaking; relative influence of administrators, trustees, and medical staff; and social change values of decisionmakers. o Pierskalla, W.'and J. Levy. (1982). Evaluating the Performance of Multi—Institutional Systems (NCHSR Grant HSO4524). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB82—265422), 69 pp. This monograph from a national conference held May 14—16, 1981, presents general recommendations on how to evaluate the performance of systems with multiple institutions. Participants encountered difficulty with methodology and design of evaluation measures and felt that the precise definition of performance remained elusive, probably because of inadequate consideration of system aims and philosophy. o Selden, J. (1980). Specialized Versus General Unit Systems in Psychiatric Hospitals (NCHSR Grant H503183). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P881—206492), 160 pp. The effectiveness of general over specialized psychiatric treatment wards was compared in two veterans' hospitals. The effect on length of stay found for some patients was thought to result from specific aspects of the reorganization from general to specialized units in one of the hospitals and the coincidental changes in administrative policies. o Valinsky, D., M. Dumas, and M. Rabinowitz. (1980). Optimum Utilization of Hospital Ancillary Services (NCHSR Grant H500236). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P381-145419, 26 pp.; Final Report: Part 1, NTIS Order No. P381—147779, 223 pp.). The report details findings from a study of the interaction of factors that impede patient flow in a hospital. Factors examined included admission policies, bed allocation, and operating room capability. o Valinsky, D., M. Dumas, and M. Rabinowitz. (1980). Optimum Utilization of Hospital Ancillary Services: Appendix I. A Simulator—Based Planning Model for Hospital Microscopy Laboratories (NCHSR Grant HSOOZ36). Rockville, MD: Public Health Service. (Final Report: Part 2, NTIS Order No. PBBl-147720), 214 pp. This part of a final report on hospital services utilization describes the decision rules to be employed in order to produce more effective scheduling of laboratory services in the hospital. 66 o Valinsky, D., M. Dumas, and M. Rabinowitz. (1980). O timum Utilization of Hospital Ancillary Services: Appendix II. Hospital Blood Banking: An Evaluation of Inventory Control Policies (NCHSR Grant HSOOZ36). Rockville, MD: Public Health Service. (Final Report: Part 3, NTIS Order No. P381—147738), 330 pp. This part of a final report on hospital services utilization evaluates the hospital’s blood bank operations and its procedural policies for maintaining sufficient supplies of whole blood and plasma. o Valinsky, D., M. Dumas, and M. Rabinowitz. (1980). Optimum Utilization of Hospital Ancillary Services: Appendix III. Simulation—Based Scheduling Model for Radiology (NCHSR Grant HS—002363. Rockville, MD: Public Health Service. (Final Report: Part 4, NTIS Order No. PBBl—l47746), 59 pp. This part of a final report on hospital services utilization describes the decision rules to be employed in order to produce more effective scheduling of radiology services in the hospital. o Valinsky, D., M. Dumas, and M. Rabinowitz. (1980). Optimum Utilization of Hospital Ancillary Services: Appendix IV. Total Hospital System Model (NCHSR Grant HSOOZ36). Rockville, MD: Public Health Service. (Final Report: Part 5, NTIS Order No. PBBl-147753), 74 pp. This part of a final report on hospital services utilization describes the construction and testing of a mathematical model that incorporates factors impeding patient flow in a hospital. o Valinsky, D., M. Dumas, and M. Rabinowitz. (1980). Optimum Utilization of Hospital Ancillary Services: Appendix VII. Determination of Transfers for Misplaced Patients: An Analytical Optimization Procedure (NCHSR Grant HSOOZ36). Rockville, MD: Public Health Service. (Final Report: Part 8, NTIS Order No. PBBl—147761), 54 pp. This part of a final report on hospital services utilization describes the procedures to be employed in order to produce more effective transfers of misplaced patients in the hospital. 7. Long—Term and Nursing Home Care Topics covered in this section include the following: long—term care utilization; State long-term care programs; nursing home operations; outcome assessment in nursing homes; terminal illness care; geriatric home day care; nursing home supply/demand issues; team and community care; social support networks as related to institutionalization; homemaker and home health services for the chronically ill; and program and policy development in long—term care. 0 Birkel, R. (1984). Sources of Caregiver Strain in Long—Term Home Care (NCHSR Grant HSOSOOZ). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBBS—214278/AS), 13 pp. Results of a study of those who care for the elderly at home showed that different types of strain are associated with the type of disability-—physica1 or cognitive——that affects the aged person. The findings also suggest that type of interpersonal and household pattern established in the home is also affected by the type of disability. 0 Branch, L. and A. Jette. (1983, February). Elders' use of informal long-term care assistance. The Gerontologist 23(1), pp. 51—56. (NCHSR Grant HSO3815). A study of noninstitutionalized persons over age 70 showed that almost one—fifth needed others’ assistance to perform basic activities of daily living. 0 Branch, L. and A. Jette. (1982). A prospective study of long-term care institutionalization among the aged. American Journal of Public Health 72, pp. 1373-1379. (NCHSR Grant 3303815). In a study of determinants of long—term care institutionalization, five independent variables were found to be significantly related to institutionalization: advancing age, use of ambulatory aids, mental disorientation, living alone, and need of assistance in performing instrumental activities of daily living. o Brody, E., M. Lawton, and B. Liebowitz. (1984, December). Senile dementia: Public policy and adequate institutional care. American Journal of Public Health 74(12), pp. 1381—1383. (NCHSR Grant HSOOlOO). This article discusses the possibility that avenues of care may be shrinking for aged persons suffering from senile dementia of the Alzheimer's type. o Groth—Juncker, A. (1982). Home Healthcare Team: Randomized Trial of a New Team Approach to Home Care (NCHSR Grant HSO3030). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884~163955), 336 pp. A study of a team approach to patient care in the home found no significant trends in change of physical, mental, or functional disability that favored either the team or the control patients. Team patients, 67 68 however, experienced both lower costs and fewer days of institutionalization in hospitals and nursing homes. 0 Groth—Juncker, A. and J. McCusker. (1983, June). Where do elderly patients prefer to die? Place of death and patient characteristics of 100 elderly patients under the care of a home health care team. Journal of the American Geriatrics Society 31(8), pp. 457—461. (NCHSR Grant HSO3030). Psychosocial and medical characteristics of patients who died at home are compared with those of patients who died in an institution. o Harkey, P. and H. Traxler. (1982, June). SHARE—A—HOHE: A unique community—based residential alternative for the dependent elderly. Journal of Applied Gerontology 1, pp. 90-94. (NTIS Order No. P384—165265). This article introduces a residential program in which elderly persons provide social and emotional support to each other within a nonstructured, family-type setting. o Hielema, F. (1981). The Care and Cure of Hip Fracture in Nursing Homes (NCHSR Grant H504237). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P884—205715), 4 pp. Results are summarized from a study of how the extent and quality of nursing and physical therapy services affect patient recovery from hip fracture in skilled nursing facilities. 0 Hughes, 5., D. Cordray, and A. Spiker. (1983). Evaluation of a Long—Term Home Care Program (rev. ed.; NCHSR Grant HSO3152). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PB85-137214/AS), 37 pp. Mortality, functional status, and rates of institutionalization (including hospitalization) of elderly persons served by a long— term care program were examined. Significant reductions in the number of nursing home admissions and nursing home days were found among experimental group clients. 0 Hughes, 5., D. Cordray, and A. Spiker. (1984, May). Evaluation of a long—term home care program. Medical Care 22(5), pp. 460—475. (NCHSR Grant HSO3152). This article was developed from a grant report of the same title (see previous citation) that reported the outcomes of a 9—month evaluation of Chicago’s comprehensive Five Hospital Homebound Elderly Program. 0 Jarvis, M. (1980). Effects of an Emergency Alarm and Response System for the Aged: Factors Associated With the Acceptance of an Emergency Alarm System for the Elderly (NCHSR Grant HSOl788). Rockville, MD: Public Health Service. (Final Report, part 5, NTIS Order No. PB81— 137291), 170 pp. Effects of an emergency alarm and response system were evaluated for three groups of elderly people. Findings suggested that those who could be served most appropriately by the system were functionally disabled persons who were not socially isolated. 0 Kane, R.A. and R.L. Kane. (1981). Assessing the Elderly: A Practical Guide to Measurement. Lexington, MA: Lexington Books. (NCHSR Grant HSO3275). The purposes, sources, and components of 69 measurements in long—term care of the elderly are examined. Measures of physical, mental, and social functioning, as well as multidimensional measures, are described. The authors address questions pertaining to research versus clinical assessment and to the choice and use of measurements in geriatric care decisions. 0 Kane, R.L. and others. (1983). Assessing the outcomes of nursing home patients. Journal of Gerontology 38(4), pp. 385-393. (NCHSR Grant H803275). Multidimensional measures of the functional abilities of nursing home patients are described. Six domains are included: physiologic, affective, cognitive, social, satisfaction, and activities of daily living. 0 Kane, R.L. and others. (1983). Outcome-Based Reimbursement for Nursing Home Care (NCHSR Grant H803275). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884—200583), 95 pp. The development of a reliable and valid instrument with which to measure the functional status of nursing home residents is chronicled. 0 Kane, R.L. and others. (1982). Predicting the Course of Nursingmflome Patients: A Progress Report (NCHSR Grant HSO3275). Rockville, MD: Public Health Service. (NTIS Order No. P882—249616), 139 pp. This report traces the evolution of a questionnaire designed to capture the multidimensional functioning of nursing home patients to reliably predict patient outcomes. 0 Kane, R.L. and R.A. Kane. (1982). Values and Long—Term Care. Lexington, MA: Lexington Books. (NCHSR Grant H503275). Edited proceedings of a conference on the relationship of long-term care and value measurements are presented. Utility weight measures are given to various values in order to examine how patient values affect personal treatment choices. o Katz, S., J. Papsidero, and D. Hahalak. (1983). Development of a Data Archive for Use in Policy Analysis in Long—Term Care (NCHSR Grant HSO3760). Rockville, MD: Public Health Service. (NTIS Order No. P883—196980), 50 pp. Results are reported from a 2-year effort to develop a data base on aging and long-term care. Information on how services affect health status is included. o Kurowski, B. and L. Breed. (1981). Client Needs Assessment and Quality Assurance Programs in Long Term Care (NCHSR Contract 233—79—3025). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P384—207752, 9 pp.; Synthesis, NTIS Order No. PB82-105917, 234 pp.). Research on the delivery of long-term care is synthesized in terms of approaches to the assessment of client needs and measurement of quality of care. Implications for States to consider in developing long-term care programs are also discussed. o Meiners, M., G. Heinemann, and B. Jones. (1982, December). An evaluation of nursing home payments designed to encourage appropriate care for the chronically ill: Some preliminary 70 findings. Paper presented at the annual meeting of the American Economic Association, New York, NY. Preliminary results are presented from a demonstration project that tested the efficacy of an incentive reimbursement system for Medicaid nursing home services. The paper includes descriptions of the project's admission, discharge, and patient outcome objectives and a summary of the attitudes toward and knowledge of the study by nursing home administrators and directors of nursing. o Morrisey, M. (1980). The Effects of Medicaid Reimbursement on Nursing Home Services (NCHSR Grant H503333). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P881—242935, 25 pp.; Final Report, NTIS Order No. P881—242943, 182 pp.). Results are reported from a study of how State Medicaid reimbursement incentives affect the services provided in skilled nursing homes. Cost-based and flat-rate payment systems were found to provide different incentives for the delivery of patient services, but these differences were empirically small. 0 National Center for Health Services Research. (1984). Abstracts of Extramural Long—Term Care Research Supported by NCHSR. Rockville, MD: Public Health Service. (NTIS Order No. PBB4—206945), 72 pp. Studies on long—term care supported by grants or contracts from the National Center for Health Services Research are summarized. 0 National Center for Health Services Research. (1984). Annotated Bibliography of the Long—Term Care Studies Program. Rockville, MD: Public Health Service. (NTIS Order No. PBB4—138121), 10 pp. This report annotates intramural research on long—term care conducted by NCHSR staff. 0 Papsidero, J., M. Kroger, and n. Rothert. (1980). Preparing health assistants for service roles in long—term care. The Gerontologist 5, pp. 534—546. (NCHSR Grant H501059). An_intensive program that prepares health assistants to serve chronically ill elderly persons in the home is described. The planning process, instructional design and objectives, and implementation of the program in five communities are summarized. o Risley, T. (1983). Procedures Manual for Planning and Monitoring Nutrient Intake of Nursing Home Residents (NCHSR Grant HSOZSIO). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P383-246074), 114 pp. This report contains a 4—week cycle of menus designed to provide adequate nutrition for nursing home residents based on their expected consumption of foods rather than the amounts they are served. A consumption monitoring system that may be used in conjunction with the menus is also described. 0 Risley, T. (1983). An Empirical Basis for Nursing Home Meal Service (NCHSR Grant HSOZSlO). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P884—118868, 27 pp.; Final Report, NTIS Order No. PB83-246066, 95 pp.). The problems 71 of measuring nutrient intake of institutionalized elderly persons are discussed as part of a study designed to develop techniques for monitoring food consumption and conducting dietary analyses. 0 Ruchlin, H. and J. Morris. (1981, Spring). Cost—benefit analysis of an emergency alarm and response system: A case study of a long—term care program. Health Services Research 16(1), pp. 65—80. (NCHSR Grant HSOl788). This article demonstrates the utility of applying cost—benefit analysis to a long—term care program developed to monitor disabled persons in their homes. o Scanlon, W. (1980, Spring). A theory of the nursing home market. Inguiry 17(1), pp. 25—41. (NCHSR Grant H502620). This article describes the operation of the nursing home market, analyzes how public policy affects the demand side of the market, and estimates the magnitude of these effects. The composition and determinants of demand as well as the behavior of suppliers form part of the discussion. 0 Scanlon, W. and J. Feder. (1981). Regulation of Investment in Long Term Care Facilities (NCHSR Grant HSOZGZO). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PB82—115262), 185 pp. The effect of public policy on the expansion of nursing homes, changes in composition of the industry, and the adequacy of nursing home bed supply relative to the demand for care are examined in this report. The authors maintain that Medicaid reimbursement policy is the most effective mechanism for promoting efficient allocation of beds. o Sherwood, S. and J. Morris. (1981). Effects of an Emergency Alarm and Response System for the Aged (NCHSR Grant HSOl788). Rockville, MD: Public Health Service. (Revised Executive Summary, NTIS Order No. P384—159078, 24 pp.; Final Report, part 1, NTIS Order No. PB81—137259, 356 pp.). This report summarizes the results of a study of the effects of an alarm—and—response system on elderly public housing residents in Boston. Potential benefits of the alarm system are also identified. o Sherwood, S. and J. Morris. (1980). Effects of an Emergency Alarm and Response System for the Aged: Operational Manual for an Emergency Alarm and Response System for Older Adults and Handicapped Persons (NCHSR Grant HSOl788). Rockville, MD: Public Health Service. (Final Report, part 4, NTIS Order No. PB81—137283), 141 pp. Procedures for implementing an emergency alarm—and—response system for elderly and functionally impaired persons are described in detail. o Sherwood, S. and J. Morris. (1980). Effects of an Emergency Alarm and Response System for the Aged: Service Needs of Elderly Persons Living Alone in Publicly Managed (Age—Integrated) or Leased Community Housing (NCHSR Grant HSOl788). Rockville, MD: Public Health Service. (Final Report, part 3, NTIS Order No. PBBl—137275), 61 pp. The medical and personal service needs of aged public housing residents are discussed in this part of a 72 report on the effects of implementing an emergency alarm system for the noninstitutionalized elderly. 0 Sherwood, S. and J. Morris. (1980). Effects of an Emergency Alarm and Response System for the Aged: Standardized Scales Relating to the Physical Health, Social Contacts, and Mental Status of LTC Populations (NCHSR Grant H801788). Rockville, MD: Public Health Service. (Final Report, part 2, NTIS Order No. P381-137267), 70 pp. This report describes measures of elderly persons’ physical, social, and mental status that were developed as part of a study on the implementation effects of an emergency alarm—and—response system. 0 Smith, D. (1980). An Evaluation of Changing Patterns of Control of Nursing Homes (NCHSR Grant H502694). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PB82—143595), 10 pp. Trends in the management and control of New York nursing homes during the late 1970s are Summarized. The discussion includes an assessment of how consumer—spurred reforms affected professional standards, reimbursement mechanisms, and criminal enforcement. o Steiner, P. and J. Needleman. (1981). Cost Containment in Long Term Care: Options and Issues in State Program Design (NCHSR Contract 233—79-3018). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P384—206580, 8 pp.; Final Report, NTIS Order No. PB82—105107, 128 pp.). This report reviews available research on long—term care, examines the impact of various alternative arrangements, and assesses the possible fiscal and personal consequences if specific options are pursued. o Steiner, P. and J. Needleman. (1981). Expanding Long Term Care Efforts: Options and Issues in State Program Design (NCHSR Contract 233—79-3018). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P384—207786, 10 pp.; Research Synthesis, NTIS Order No. PB82—110743, 107 pp.). This report synthesizes findings from health services research and demonstration projects on how to control long—term care costs while increasing the numbers of elderly being served. Options discussed in the report are (1) to increase direct support for specific services, (2) to improve linkages between clients and services, and (3) to expand financial resources. o Steiner, P. and J. Needleman. (1981). Long Term Care——Options and Issues in State Programs: A Bibliography (NCHSR Contract 233—79—3018). Rockville, MD: Public Health Service. (NTIS Order No. PB82—104258), 145 pp. This bibliography lists and describes the studies cited or reviewed in two separate research syntheses, Cost Containment in LongiTerm Care: Options and Issues in State Program Design and Expanding Long Term Care Efforts: Options and Issues in State Program Design. o Trapnell, G. and others. (1982). Private Health Insurance for Long-Term Care——Manua1 of Study Procedures (NCHSR Contract 73 233-81—3033). Rockville, MD: Public Health Service. (NTIS Order No. P884—187699), 654 pp. The methodology used in developing premium estimates for prototypical long—term care policies is documented. The report describes the premium calculation formula and covers the critical components in actuarial formulas, the principal types of formulas considered, and the variables needed for a long—term care policy, as well as the assets share formula used in the calculations. 0 Traxler, H. (1982, November—December). Determinants of nursing home costs in Florida: Policy implications and support in national research findings. Public Health Reports 97(6), pp. 537—544. Medicaid cost reports from nursing homes in Florida were analyzed for the years 1971—76 to identify the major nonquality—related determinants of nursing home costs. It was found that per diem costs and occupancy rate were inversely related, suggesting that reductions in per diem costs could be achieved by higher occupancy rates, especially in urban areas. o Traxler, H. (1983, December). SHARE-A—HOME: Economics and logistics of unrelated elderly living as a "family." Journal of Applied Gerontology 2, pp. 61—69. (NTIS Order No. P884—165265). This article addresses problems and political considerations (such as zoning issues) involved in starting and operating a shared living program for the elderly. o Tynan, E., D. Holub, and R. Schlenker. (1981). Nursing Home Reimbursement: A Synthesis of Findings From Health Services Research and Demonstration Projects (NCHSR Contract 233—79—3025). Rockville, MD: Public Health Service. (NTIS Order No. P382—105784), 131 pp. Health services research on Medicaid reimbursement for nursing home care of the elderly is explored. Policy and program issues, study and demonstration methods, and project findings are discussed in terms of developing strategies for meeting the future long-term care needs of the aged. Information is also presented on the impact of the nursing home reimbursement system on quality, access, and costs of care as well as on patient needs. o Tynan, E., D. Holub, and R. Schlenker. (1981). Nursing Home Reimbursement: A Synthesis of Research (NCHSR Contract 233-79—3025). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB4—207778), 10 pp. Research on Medicaid reimbursement of nursing home care of the elderly is summarized. o Wan, T. and W. Weissert. (1981, June). Social support networks, patient status, and institutionalization. Research on Aging 3(2), pp. 240—256. Relationships among social support networks, elderly persons’ physical and mental functioning levels, and the likelihood of institutionalization were explored in an experimental study of geriatric day care and homemaker services. Findings showed that informal social networks do play an important role in mitigating the effects of deteriorating health status and also reduce the risk of institutionalization. (An earlier version 74 of this paper was presented at the 1980 meeting of the American Public Health Association, Detroit, MI.) 0 Wan, T., W. Weissert, and B. Livieratos. (1980). Geriatric day care and homemaker services: An experimental study. Journal of Gerontology 35(2), pp. 256—274. Geriatric day care and homemaker services are examined in terms of how they affect specified patient outcomes. When outcomes were compared between experimental and control groups, significant differences were found in physical functioning and activity level for the day care samples, in physical functioning and contentment level for the homemaker study sample, and in all of these outcome measures for the combined services group. 0 Weissert, W. and others. (1980, Fall). Cost—effectiveness of homemaker services for the chronically ill. In uir 17(3), pp. 230—243. Results are reported from a randomized experiment that tested the effects and costs of providing homemaker (home health aide) services to an elderly, chronically ill population. Results showed that patients who were over age 74, severely dependent, or both had significantly fewer deaths in the group who received services than in the control group. 0 Weissert, W. and others. (1980, June). Effects and costs of day—care services for the chronically ill: A randomized experiment. Medical Care 18(6), pp. 567—584. Results are reported from a randomized experiment that tested the effects and costs of providing day care services to an elderly, chronically ill population. The authors assessed patients' physical, psychological, and health functions. Multistage analysis of outcomes at the end of the study showed that day care had few beneficial effects. 0 Willemain, T. (1981). Second thoughts about outcome incentives for nursing homes. Research in Public Policy Analysis and Management 2, pp. 3—10. (NCHSR Grant HSO4672). The author maintains that outcomes of nursing home care need not be directly tied to individualized reimbursement and that, instead of promoting diversity, outcome reimbursement actually restricts styles of care. o Zimmer, J. and A. Groth—Juncker. (1983, Spring). A time—motion study of patient care activities of a geriatric home care team. Home Health Care Services Quarterly 4(1), pp. 67—78. (NCHSR Grant HSO3030). This article reports the results of a self-administered time—motion study of a home care team that consisted of physician, nurse practitioner, and social worker. Time spent on travel, home visits, and team conferencing and consultation activities was included. It is suggested that a truer estimate of the actual costs of providing team services to home—bound patients can be calculated in this way than by the usual calculation of charges based only on actual home visits. 75 o Zimmer, J., A. Groth—Juncker, and J. McCusker. (1984, April). Effects of a physician-led home care team on terminal care. Journal of the American Geriatrics Society 32(4), pp. 288—292. (NCHSR Grant HSO3030). Results of a randomized controlled study of the efficacy of a physician/nurse practitioner/social worker home care team were analyzed. It was found that of 21 team and 12 control patients who died during the study but had at least 2 weeks of utilization experience, team patients had about half the number of hospital days during the terminal 2 weeks and only 69 percent of the estimated total health costs of the control patients. Satisfaction with care received was significantly greater among the team patients, and especially among their family caregivers, than among the controls. __"'___ _._ __‘[__ _ — _ _. _ _ __ . 8. Medical Technology Assessments Topics covered in this section include the following: issues in medical technology evaluation; the medical technology industry and government policies; and the safety and efficacy of specific diagnostic and therapeutic devices. Among the various devices and procedures described are computer enhanced perimetry, cardiokymography, negative pressure respirators, streptokinase infusion, laser trabeculoplasty, apheresis, external counterpulsation, and transillumination light scanning. o Broida, J. (1983). Closed-loop blood glucose control device. Health Technology Assessment Report No. 6, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385-195246/AS), 20 pp. The closed-loop blood glucose device temporarily infuses insulin to patients with diabetes mellitus. The evidence reviewed in this assessment appears to support the use of this device in crisis situations related to stress, surgery, or other trauma. 0 Carter, E. (1983). Computer enhanced perimetry. Health Technology Assessment Report No. 17, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P886-127719/AS), 9 pp. Computer—assisted perimetry (the measuring and quantifying of visual field loss) is judged to be more effective in identifying small visual field defects than manual methods. 0 Carter, E. (1983). Liver transplantation. Health Technology Assessment Report No. 16, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885—121747/AS), 47 pp. The present state of the art in liver transplantation is reviewed in terms of indications, donor selection, organ preservation and transport, transplant techniques, immunosuppression, outcomes, complications, and costs. 0 Carter, E. (1984). Transplantation of the pancreas. Health Technology Assessment Report No. 19, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385—153724/AS), 30 pp. Pancreas transplantation is evaluated as the most physiologically compatible approach to the treatment of hyperglycemia associated with diabetes mellitus. Significant improvements in patient and graft survival have been made, but it remains unclear whether patients are better suited for transplantation early or late in the course of their diabetes. 0 Carter, E. and J. Broida. (1984). Noninvasive method of monitoring cardiac output by Doppler ultrasound. Health Technology Assessment Report No. 5, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. 77 78 P385—151363/AS), 19 pp. The Doppler method is proposed for use during cardiac surgery, for patients in coronary and intensive care units, and for followup as a monitoring device after surgery. 0 Carter, E., B. Waxman, and J. Broida. (1983). The implantable chemotherapy infusion pump for the treatment of liver cancer. Health Technology Assessment Report No. 19, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P886—127735/AS), 18 pp. The safety, clinical effectiveness, and acceptability of the implantable chemotherapy infusion pump in the treatment of liver cancer is reviewed. 0 Chow, R. (1983). Cardiokymography. Health Technology Assessment Report No. 12, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PB8S—192813/AS), 14 pp. The cardiokymograph senses and records endocardial wall tissue movement in an electromagnetic field to detect coronary artery disease. The report states after a review of the literature that it is still "equivocal" as to whether the technique can detect cardiac wall motion directly inside the chest. 0 Chow, R. (1983). Electroversion therapy for the treatment of alcoholism. Health Technology Assessment Report No. 4, National Center for Health Services Research. Rockville MD: Public Health Service. (NTIS Order No. PBBS—195261/AS), 4 pp. This literature review finds that electrical aversion therapy is no more effective than other treatments in modifying behavior of patients under treatment for alcoholism. o Chow, R. (1983). Photokymography. Health Technology Assessment Report No. 11, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385-192771/AS), 5 pp. Photokymography uses cardiac fluoroscopy and image intensification to assess epicardial segmental myocardial wall motion. This report states that data are insufficient to assess the safety and effectiveness of this diagnostic test. 0 Cotter, D. (1983). EEG monitoring during open heart surgery. Health Technology Assessment Report No. 1, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PB85—192789/AS), 17 pp. Electroencephalography records the electrical activity of the brain. This report assesses its value during open heart surgery and finds the procedure infrequently used and not widely accepted. o Cotter, D. (1983). Fully automated ambulatory blood pressure monitoring of hypertension. Health Technology Assessment Report No. 9, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885—191781/AS), 15 pp. According to this report, no evidence exists that ambulatory monitoring of blood pressure (BP) is superior to HP monitoring in the physician’s office. 79 o Cotter, D. (1983). Negative pressure respirators. Health Technology Assessment Report No. 13, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385—206019/AS), 19 pp. This assessment of a breathing support device that expands the lungs or promotes mucus mobilization states that primary benefits of this technology appear to be reducing days of hospitalization, managing respiratory failure at home, and stabilizing the clinical course. 0 Cotter, D. (1983). Plasma perfusion of charcoal filters for treatment of pruritis of cholestatic liver disease. Health Technology Assessment Report No. 7, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885—195238/AS), 7 pp. This technology was developed as an alternative method of treating intractable pruritis. It appears that this treatment is without significant complications and provides symptomatic relief. o Cummins, R. and others. (1984, August 11). Sensitivity, accuracy, and safety of an automatic external defibrillator. The Lancet 11, pp. 318—320. (NCHSR Grant HSO4894). An automatic —_- defibrillator was used by paramedics to detect ventricular fibrillation and deliver countershocks to 39 persons with out—of—hospital cardiac arrests. The device was found to be 81 percent sensitive to persons in ventricular fibrillation and 100 percent specific to nonventricular-fibrillation rhythms. o Erlichman, H. (1984). Ambulatory electroencephalographic (EEG) monitoring. Health Technology Assessment Report No. 6, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PB85—150738/AS), 30 pp. Ambulatory EEG monitoring is considered a safe and clinically effective method to evaluate some patients with syncope, suspected transient ischemic attack, and poorly defined seizure disorders, especially when a patient’s history, examination, and routine EEG do not provide a diagnosis. o Erlichman, H. (1984). Intraoperative ventricular mapping. Health Technology Assessment Report No. 12, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PB85—152999/AS), 24 pp. Intraoperative mapping techniques, which are used to direct the surgical treatment of patients with refractory ventricular arrhythmias, are assessed in a number of studies that show decreased patient mortality and increased cure rates. o Erlichman, H. (1984). Nd: YAG laser for posterior capsulotomies. Health Technology Assessment Report No. 21, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385—151421/AS), 19 pp. Use of the Nd:YAG laser in the treatment of opacified posterior capsules after cataract surgery is assessed. This noninvasive 80 technique is found to be safer and at least as effective in opening the posterior capsule as surgical invasion of the eye. 0 Erlichman, M. (1984). Percutaneous transluminal angioplasty for obstructive lesions of arteriovenous dialysis fistulas. Health Technology Assessment Report No. 26, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PB85—179547/AS), 16 pp. Percutaneous transluminal angioplasty (PTA) uses fluoroscopically guided balloon-tipped catheters to remove or relieve stenotic or occlusive lesions of the vascular system. This assessment maintains that more controlled studies with PTA in failing arteriovenous dialysis fistulas and shunts are needed to better define the safety and clinical effectiveness of the procedure. 0 Erlichman, M. (1984). Percutaneous transluminal angioplasty for obstructive lesions of the aortic arch vessels. Health Technology Assessment Report No. 25, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PB85—179539/AS), 21 pp. This assessment maintains that more dilations with PTA are needed before the safety and clinical effectiveness of the procedure in the carotid, subclavian, and vertebral arteries can be defined and compared with conventional surgery outcomes. 0 Erlichman, H. (1984). Streptokinase infusion for acute myocardial infarction. Health Technology Assessment Report No. 20, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385—157428/AS), 19 pp. This assessment reports that because clinical applications and methods of streptokinase therapy have varied, there is a need to establish the optimal dosage and duration of infusion before the therapy can be considered safe and effective. o Feigenbaum, E. (1984). Diagnostic endocardial electrical stimulation (pacing). Health Technology Assessment Report No. 14, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385—151405/AS), 16 pp. Available evidence and consensus of scientific opinion on endocardial electrical stimulation procedures are favorable and its use is accepted as an important element of cardiology. o Feigenbaum, E. (1984). External open—loop pump for the subcutaneous infusion of insulin in diabetics. Health Technology Assessment Report No. 22, National Center for Health Services Research. Rockville, HD: Public Health Service. (NTIS Order No. P385—151439), 34 pp. Available data do not demonstrate the superiority of continuous subcutaneous infusion methods when compared with the results of equally intensive regimens using multiple manual insulin injections. Because questions remain on appropriate insulin preparations, therapeutic goals and pump regimens, this technology is still considered investigational. ‘ 3.x- ,. .2» '.- . 81 o Feigenbaum, E. (1984). Laser trabeculoplasty (LTP) for open angle glaucoma. Health Technology Assessment Report No. 23, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885—163111/AS), 20 pp. when used by ophthamologists experienced in LTP, argon laser trabeculoplasty is appropriate for treating patients with open—angle glaucoma that has remained uncontrolled despite maximal tolerated medical treatment. The assessment maintains that LTP is a reasonable therapeutic alternative for such glaucoma patients because of its relatively low level of risk as compared with directly invasive conventional surgery. o Feigenbaum, E. (1984). Neuromuscular electrical stimulation in the treatment of disuse atrophy in the absence of nervous system involvement. Health Technology Assessment Report No. 15, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385—151413/AS), 13 pp. The existing medical literature concerning the use of neuromuscular electrical stimulation in the absence of nervous system involvement, although limited, suggests that this technology has achieved substantial clinical acceptance and application. o Feigenbaum, E. (1984). Transcutaneous electrical nerve stimulation for acute pain treatment for ambulatory patients. Health Technology Assessment Report No. 8, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885-153377/AS), 12 pp. Based on previously published evidence, transcutaneous electrical nerve stimulation (TENS) is considered a safe and effective way for controlling pain and reducing the use of narcotic analgesics. However, data on comparative efficacy and safety of all FDA—approved TENS units do not exist. o Fineberg, H. and H. Marks. (1984). Development and diffusion of automated clinical chemistry analyzers (NCHSR Grant HSO3314). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PB85-150696/AS), 208 pp. The process of development and diffusion of automated clinical chemistry analyzers is described as an example of technological change in medicine. The emerging developmental theory that assigns a more prominent and active role to the user is discussed. o Fries, J. (1983). Assessment of Technology in Chronic Disease (NCHSR Grant HSO3802). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884—200237), 44 pp. This project used an operational, nationally available arthritis data bank (ARAMIS) to show that a chronic disease data bank can serve as an appropriate resource for longitudinal study of outcomes in health technology applications. Its utilization as an appropriate community—based resource to study health technology assessment is also described. o Gibbons, R. and others. (1983, October). The use of radionuclide angiography in the diagnosis of coronary artery 82 disease: A logistic regression analysis. Circulation 68(4), pp. 740—746. (NCHSR Grant H503834). Ten clinical variables were used in a logistic regression model to estimate the pretest probability of disease for 736 patients. To estimate each patient's posttest probability, a second model considered these variables and the parameters of exercise ejection fraction, exercise heart rate, ischemia score, and the presence of a regional wall motion abnormality at exercise. When the models were applied prospectively to a group of 76 patients with chest pain who did not have a high pretest probability of disease, 56 were diagnosed with 85—percent probability or better. 0 Gohagen, J. and others. (1980). Individual and combined effectiveness of palpation, thermography, and mammography in breast cancer screening. Preventive Medicine 9, pp. 713—721. (NCHSR Grant HSO3256). Detection data generated at a national breast cancer detection demonstration project over a 4—year period are discussed. It was found that multimodality screening protocols can increase sensitivity of detection among asymptomatic women to almost 90 percent. Mammography, however, is the single most sensitive detection modality with a true positive rate of 74 percent. o Hallstrom, A., M. Eisenberg, and L. Bergner. (1984, December). The potential use of automatic defibrillation in the home for management of cardiac arrest. Medical Care 22(12), pp. 1083—1087. (NCHSR Grant HSO4000). The effectiveness of home defibrillation is compared with an equally costly upgrade in existing emergency medical system (EMS) services. The comparisons suggest that home defibrillation is an appropriate option to be considered in many circumstances, but the rate at which a home defibrillator would be used appropriately partly influences the comparisons. o Handelsman, H. (1983). Apheresis for the treatment of Goodpasture's syndrome and membranous proliferative glomerulonephritis. Health Technology Assessment Report No. 2—3, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385—192797/AS), 10 pp. This assessment reviews the effectiveness of plasmapheresis as a treatment for two renal disorders. Patients who exhibit the best response to this therapy are those with antiglomerular basement membrane antibodies. o Handelsman, H. (1984). Apheresis in the treatment of chronic relapsing polyneuropathy. Health Technology Assessment Report No. 13, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PBBS-151397/AS), 9 pp. Existing evidence from nonrandomized trials on the use of apheresis for treating chronic relapsing polyneuropathy suggests that it may improve the clinical course of some patients with severe or life—threatening symptoms who have failed to respond to steroids and/or immunosuppression. Convincing data of its efficacy, however, must await the results from appropriate randomized clinical trials. 83 o Handelsman, H. (1984). Apheresis used in preparation for kidney transplant. Health Technology Assessment Report No. 9, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885-151371/AS), 8 pp. The efficacy of apheresis used in kidney transplant preparation to prevent or modify rejection episodes continues to be controversial because of limited application. Conclusions regarding its efficacy cannot be made until randomized clinical trials comparing it to alternative treatments are available. 0 Handelsman, H. (1984). Carbon dioxide lasers in head and neck surgery. Health Technology Assessment Report No. 10, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885-151389/AS), 8 pp. An abundance of published literature has demonstrated the success of the continuous—wave carbon dioxide laser in head and neck surgery. 0 Hendrix, T. and G. Saba. (1980). The radiographic examination of the colon. Rockville, MD: Public Health Service. (NTIS Order No. P883—14I911), 14 pp. This overview provides medical and scientific background on the use of barium enema to examine the colon. 0 Holland, D. (1983). Anti-gastroesophageal reflux implantation. Health Technology Assessment Report No. 5, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385-195253/AS), 6 pp. This report states that available data cannot confirm the effectiveness of the Angelchik Anti-Reflux Prosthesis as a treatment for sliding hiatal hernia with associated gastroesophageal reflux. o Lemperle, B. (1984). légg breath test for diagnosing bile acid malabsorption. Health Technology Assessment Report No. 4, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385—154540/AS), 12 pp. The assessment reports that the published literature andlghe medical community unanimously support the safety of the CO breath test. Because of its relative nonradioactivity, it ig especially acceptable for diagnostic use with children and pregnant women. o Lemperle, B. (1984). 1§C02 breath test for diagnosing fat malabsorption. Health Technology Assessment Report No. 7, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Ordeg No. P885-154094/AS), 16 pp. The published literature on the CO breath test for fat malabsorption includes two clinical studies on the clinical application of the test. Further studies with a sufficient number of subjects and with an adequate design are necessary to establish its clinical effectiveness as a diagnostic tool within the appropriate population. 84 o Lemperle, B. (1983). Diathermy as a physical therapy modality. Health Technology Assessment Report No. 14, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PB85—206027/AS), 21 pp. Diathermy—-which uses shortwave, microwave, or ultrasound energy to produce localized deep heating of tissue-—appears to be widely accepted in the treatment of musculoskeletal disorders and certain subacute and chronic joint diseases. However, the assessment also points out that the three diathermy modalities have not been compared with each other in well controlled clinical trials. o Lemperle, B. (1984). External counterpulsation. Health Technology Assessment Report No. 18, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PBBS—150399/AS), 15 pp. Neither published clinical evidence nor the opinion of the medical community supports the clinical utility of external counterpulsation as a therapeutic device in the treatment of heart failure or cardiogenic shock. The technology appears to increase diastolic pressure and may increase coronary blood flow and alter abnormal myocardial metabolism. But there is less evidence that it reduces systolic pressure. 0 Lemperle, B. (1983). Hyperbaric oxygen for treatment of actinomycosi . Health Technology Assessment Report No. 10, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PBBS—191773/AS), 11 pp. Hyperbaric oxygen therapy is the exposure of the patient to short—term, intermittent, high doses of oxygen under elevated barometric conditions. Because of a lack of published clinical evidence on its effectiveness, the medical community considers the -therapy still experimental. o Lemperle, B. (1984). Hyperbaric oxygen for treatment of chronic peripheral vascular insufficiency. Health Technology Assessment Report No. 16, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885—152916/AS), 11 pp. The assessment states that although hyperbaric oxygen therapy appears to be relatively safe when used for the treatment of the types of wounds discussed in this report, data to support its clinical effectiveness are lacking. o Lemperle, B. (1983). Hyperbaric oxygen for treatment of crush injury and acute traumatic peripheral ischemia. Health Technology Assessment Report No. 15, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385—192763/AS), 12 pp. This assessment states that there appears to be a rational theoretical basis for using hyperbaric oxygen therapy to treat crush injury and acute traumatic ischemia; this therapy has been administered safely for many years by trained medical and other technical personnel. However there have been no controlled clinical trials on its effectiveness, and its use by the medical community is not widespread. 85 o Lemperle, B. (1984). Hyperbaric oxygen in treatment of severed limbs. Health Technology Assessment Report No. 17, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885-153393/AS), 12 pp. Hyperbaric oxygen therapy as an adjunctive treatment in the replantation of limbs is not widespread and thus the medical community has been hindered in its use for both clinical research and treatment. o Lemperle, B. (1984). Hyperbaric oxygen therapy for acute cerebral edema. Health Technology Assessment Report No. 11, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P385-153385/AS), 20 pp. The physiological basis for the effect of hyperbaric oxygen therapy for treatment of cerebral edema has been investigated at length, but questions remain regarding its action. It is reported that although evidence from studies of animals with experimental brain lesions suggests a beneficial effect, clinical trials in the literature are hampered by problems of patient selection. o Lemperle, B. (1983). Lactose breath hydrogen test for the diagnosis of lactose malabsorption. Health Technology Assessment Report No. 18, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PBB6—127727/AS), 15 pp. The peer—reviewed published literature evaluated in this assessment supports the rationale for using the lactose breath hydrogen test for diagnosing malabsorption safely and accurately. o Lemperle, B. (1983). Lactulose breath hydrogen test for small bowel bacterial overgrowth and small bowel transit time. Health Technology Assessment Report No. 21, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P886—127750/AS), 16 pp. Evidence in support of clinical utility of the lactulose breath hydrogen test to measure small bowel bacterial overgrowth and transit time is lacking. Better validation is also needed to explain false results observed. o Lemperle, B. (1984). Local hyperthermia for treatment of superficial and subcutaneous malignancies. Health Technology Assessment Report No. 24, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885-179554/AS), 28 pp. The use of local hyperthermia (LHT) alone or as an adjuvant in the treatment of superficial lesions has been given extensive coverage in the published literature. Early studies of combined LHT and radiation therapy in treating surface and subsurface lesions demonstrate a greater response rate than the use of the same dose of radiation alone. However, randomized clinical trials of LHT are lacking. o Lemperle, B. (1983). Topical oxygen therapy in the treatment of decubitus ulcers and persistent skin lesions. Health Technology Assessment Report No. 8, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PB85—192805/AS), 14 pp. This assessment points out that applying 86 topical oxygen (under elevated atmospheric pressure) to treat decubitus ulcers (pressure sores) and other skin lesions has not been tested rigorously in controlled trials. 0 Manny, E. (1980). An Overview of Dental Radiology/A Primer on Dental Radiology. Rockville, MD: Public Health Service; (NTIS Order No. PBB3—141903), 68 pp. This paper, one of several overviews commissioned by the National Center for Health Care Technology, describes current efforts in quality assurance and referral criteria directed at minimizing unnecessary radiation exposure to the population. Other program planning issues in dental radiology are also discussed. 0 McNeil, B. (1983). Cranial CT scan use found appropriate in NCHSR study. NCHSR Technical Note, National Center for Health Services Research. Rockville, MD: Public Health Service. (NCHSR Grant HSO364S), 4 pp. The use of cranial computer tomography (CT) is evaluated and its use found appropriate. Also discussed in the report are the results of a new statistical technique that can reduce by about 30 percent the number of cranial CT studies requiring marker dyes. 0 National Center for Health Services Research. (1981). Health Technology Assessment Reports, 1981. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3370, NTIS Order No. PB85—114049). Twenty—five separate assessments from 1981 are compiled. Each assessment includes a description of the technology, rationale, review of available information, discussion, summary, and bibliography. (These reports are no longer available separately.) 0 National Center for Health Services Research. (1982). Health Technology Assessment Reports, 1982. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3371, NTIS Order No. P885—121754). Twenty—six separate assessments from 1982 are compiled. Each assessment includes a description of the technology, rationale, review of available information, discussion, summary, and bibliography. (These reports are no longer available separately.) 0 National Center for Health Services Research. (1983). Health Technology Assessment Reports, 1983. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3372, NTIS Order No. PBBS—121762). Twenty—two separate assessments from 1983 are compiled. Each assessment includes a description of the technology, rationale, review of available information, discussion, summary, and bibliography. 0 National Center for Health Services Research. (1984). Health Technology Assessment Reports, 1984. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 85—3373, NTIS Order No. P385—203784/AS). Twenty—six separate assessments from 1984 are compiled. Each assessment includes a description of the 87 technology, rationale, review of available information, discussion, summary, and bibliography. 0 National Center for Health Services Research. (1983). Public Health Service Procedures for Evaluating Health Care Technologies for Purposes of Medicare Covera e. Rockville, MD: Public Health Service. (NTIS Order No. P883—2 3823), 22 pp. The Public Health Service develops recommendations on the appropriateness of coverage for various health care technologies under the Medicare program and transmits them to the Health Care Financing Administration. The process is described in this report. 0 Perry, 8. and others. (1981). Coronary Artery Bypass Surgery (Proceedings from the Technical Assessment Forum). Rockville, MD: Public Health Service. (NTIS Order No. P382—137936), 545 pp. Reports are presented from the consensus development conference held in April 1981 and cosponsored by the National Center for Health Care Technology and the National Heart, Lung, and Blood Institute. o Pryor, D. and others. (1984, January). Prognostic indicators from radionuclide angiography in medically treated patients with coronary artery disease. The American Journal of Cardiology 53, pp. 18-22. (NCHSR Grants HSO3834 and HSO4873). Findings from this investigation suggest that the radionuclide angiogram is useful in predicting future events in patients with stable coronary artery disease. It is pointed out, however, that examination in conjunction with other clinical descriptors will be necessary to further quantify this contribution. o Waxman, B. (1984). Electrotherapy for treatment of facial nerve paralysis (Bell's Palsy). Health Technology Assessment Report No. 3, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. PB85—150407/AS), 9 pp. This review of studies on electrotherapy for treatment of Bell's Palsy maintains that clinical trials do not demonstrate the treatment's effectiveness. Information is also insufficient as to suggest which subgroups of patients are most likely to benefit from electrotherapy or the number, frequency, and duration of treatments. o Waxman, B. (1983). External infusion pump for heparin. Health Technology Assessment Report No. 20, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P886-127743/AS), 7 pp. The conclusion that external infusion of heparin by pump is safe and effective is supported by many well designed studies. Careful management of the drug is necessary to reduce the risk of excessive bleeding or recurrence of thromboembolic complications. 0 Waxman, B. (1984). Implantable pump for chronic heparin therapy. Health Technology Assessment Report No. 2, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885—150720/AS), 9 pp. The implantable 88 pump for chronic heparin therapy has seen relatively little clinical application and only a few studies support its use. Although the Food and Drug Administration has determined that the technology is safe, there are not enough data to establish its clinical effectiveness for the general population. 0 Waxman, B. (1984). Transillumination light scanning for the diagnosis of breast cancer. Health Technology Assessment Report No. 1, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P885—150712/AS), 16 pp. The assessment points out that while the safety of transillumination light scanning is not questioned, its efficacy remains undetermined. o Waxman, B. (1983). Thermography for breast cancer detection. Health Technology Assessment Report No. 22, National Center for Health Services Research. Rockville, MD: Public Health Service. (NTIS Order No. P886—127768/AS), 24 pp. The author points out that clinical usefulness of heat—sensing devices in cancer of the breast has not been demonstrated and evidence does not support continued utilization of this technology as a primary diagnostic technique. o Wenchel, H. (1981). A Profile of the Medical Technology Industry and Governmental Policies (NCHSR Contract No. 233-79-3011). Rockville, MD: Public Health Service. (Final Report——volume I, NTIS Order No. P882—222837, 264 pp.; volume II, NTIS Order No. P882—222845, 87 pp.; appendix A, NTIS Order No. P382-222852, 117 pp.; complete set, NTIS Order No. P382-222829). The medical technology industry is discussed in terms of industrial organization economics. Structure, conduct, and performance are detailed in volume I. Volume II (subtitled A Study of Medicare/Medicaid Reimbursement and the 1976 Medical Device Amendments on the Pacemaker Industry) applies the industrial organization methodology to a case study of the cardiac pacemaker industry. Appendix A (subtitled Review and Assessment of Secondary Data Sources for Developing a Profile of the Medical Technology Industry) analyzes the adequacy and availability of various aggregated, firm—specific, and specialized data bases. o Yeaton, W., P. Wortman, and N. Langberg. (1983, December). Differential attrition: Estimating the effect of crossovers on the evaluation of a medical technology. Evaluation Review 7(6), pp. 831—840. (NCHSR Grant HSO4849). The authors state that the problem of differential attrition of persons from comparison groups restricts the inferences that may be drawn from evaluative research results. A procedure that uses "worst case" assumptions to permit researchers to estimate maximum effects of differential attrition is developed. Generalizability and limitations of the procedure are also discussed. 9. Planning, Evaluation, and Regulation Topics covered in this section include the following: health care policy and program development; health systems agency planning and implementation; operations research, including productivity improvement; deregulation of the health care industry; health planning and antitrust law; mandatory licensure issues; physician self—regulation; evaluation of specific categorization or hospital classification schemes; regulation of hospital capital investment; goal programming models for resource planning; and hospital rate review and certificate—of-need regulation. 0 Batey, M. (1982). Prescribing Practices of Nurse Practitioners in Relation to the Degree of Structural Autonomy Granted with Their Prescriptive Authority (NCHSR Grant HSO4336). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884—199496), 211 pp. A five—State study of the prescriptive authority of nurse practitioners found that no systematic differences in the prescribing practices of nurse practitioners could be attributed to legal requirements. o Batey, M. and J. Holland. (1983, Summer). Impact of structural autonomy accorded through state regulatory policies on nurses' prescribing practices. Image: The Journal of Nursing Scholarship 15(3), pp. 84—90. (NCHSR Grant HSO4336). The authors point out that most State licensure bodies (as well as third—party reimbursement policies) require that nurse practitioners act under physician supervision, a requirement which can result in a duplication of effort and a limiting of nurse practitioner autonomy. o Begley, C., M. Schoeman, and H. Traxler. (1982, June). Factors that may explain interstate differences in certificate-of—need decisions. Health Care Financing Review 3(4), pp. 87—94. The empirical relationship between various characteristics of certificate—of-need programs and program decisions is examined. Aggregate data on approvals for hospital capital expenditures and changes in number of new hospital beds in 28 States are correlated with a previously developed index of each State's regulatory characteristics. In a multivariate analysis, variables reflecting the need for new hospital capital in a State seemed to be more important than regulatory characteristics in explaining the relative amount of capital approvals. o Begun, J. and R. Feldman. (1980). A Social and Economic Analysis of Professional Regulation in Optometry (NCHSR Grant HSO3085). Rockville, MD: Public Health Service. (NCHSR Research Digest, DHHS Publication No. (PHS) 80-3285, NTIS Order No. P381—128860, 31 PP.; Executive Summary and Final Report, NTIS Order No. P881—160541, 234 pp.). The study addressed two major 89 90 issues: first, how professional regulatory power is gained by a health occupation (specifically, optometry); and second, what costs and benefits are incurred by the public as a result of professional regulation. The authors report that higher prices due to regulation cause a "transfer of wealth from consumers to optometrists" of about $140 million annually. 0 Begun, J. and R. Feldman. (1981). A Social and Economic Anal sis of Professional Regulation in Optometry (NCHSR Grant HS 5). Rockville, MD: Public Health Service. (NCHSR Research Report, DHHS Publication No. (PHS) 81—3295, NTIS Order No. PB81—210759), 82 pp. This report was developed from an NCHSR grant of the same title (see previous citation) which investigated the social, economic, and political aspects of regulation in the field of optometry. o Bentkover, J. (1982). Development of an Evaluation Methodology for Use in Assessing Data Available to the Certificate of Need (CON) and Health Planning Programs (NCHSR Contract 233—79—4003). Cambridge, MA: Arthur D. Little, Inc.; and Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P882—249111, 219 pp.). The study used five State case studies to determine that CON review was effective in limiting the amount of capital expenditures undertaken by hospitals. Other portions of the study investigated capital expenditure planning and investment. 0 Bergner, M. and others. (1981, August). The sickness impact profile: Development and final revision of a health status measure. Medical Care 19(8), pp. 787—805. (NCHSR Grant H501769). The planning, early work, and final phases of developing the sickness impact profile are summarized. o Bice, T. (1980, Spring). Social science and health services research: Contributions to public policy. Milbank Memorial Fund Quarterly/Health and Society 58(2), pp. 173—200. (NCHSR Grant §§01978). Questions of how and if social science and health services research have contributed materially to improved public policy are examined. 0 Bios, T. and N. Urban. (1982). Effects of Regulation on the Diffusion of Computed Tomography Scanners (NCHSR Grant HSO3750). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB4—243104), 117 pp. The study examines the effects of regulation on computed tomography diffusion during the 19705 through investigation of certificate of need, hospital ratesetting programs, professional standards review organizations, and other regulatory mechanisms. 0 Bovbjerg, R. (1981). Judicial Review of Health Care Planning and Capital Expenditures Review: Its Development and Significance for Regulatory Policy (NCHSR Grant HSO3363). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P381—211385, 22 pp.; Final Report, NTIS Order No. PBBl—211401, 382 pp.). Health 91 planning as it evolved through litigation was examined through analysis of judicial decisions up to September 1980. The analysis focuses on judicial oversight of capital expenditure reviews under certificate-of—need statutes and the Federal "section 1122" program. 0 Branch, L. and A. Jette. (1983). Understanding the Needs of People Over Age 70: Third Wave Prevalence Findings From the Massachusetts Health Care Pane Study NCHSR Grant H503 . Roc vi 1e, MD: Public Hea th Service. (Executive Summary and Final Report, NTIS Order No. PBB4—219856), 190 pp. The findings and conclusions from a study of elderly persons are synthesized in terms of their contributions to gerontological theory, program policy, and the expressed needs of people over age 70. (A SAS data tape with documentation of the study is also available under NTIS Order No. P885—116168.) o Caper, P. (1980). Conference on Incentives for Improving Productivity in Health Care (NCHSR Grant H50 097). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P382-229006), 74 pp. The objectives of the subject conference were to develop a program for improving productivity in health care and to recommend relevant research priorities and policy options. The report presents productivity improvement as a major factor in containing health care costs. o Caper, P. (1984, Summer). Variations in medical practice: Implications for health policy. Health Affairs 3(2), pp. 110—119. (NCHSR Grant H805563). The author maintains that there is substantial variation in medical care consumption whether the measure is per capita rates, surgical procedures, dollars spent, or hospital admissions. Also discussed is the need to use epidemiologic techniques to compare medical practices among geographic areas in order to learn more about medical care patterns for intelligent policy development and decisionmaking. o Churgin, S. (1984). Plan Implementation in Health Systems Agencies (NCHSR Grant HSO4264). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P884—241546, 11 pp.; Final Report, NTIS Order No. P885—109213, 674 pp.). Six health systems agencies were studied in terms of success in implementing their programs. The successful agencies were found to be more likely to build problem—solving linkages and community affiliations with other organizations than the less effective agencies. 0 Coburn, A. (1981). A Comparative Study of the Implementation of Child Health Policy (NCHSR Grant HSO3664). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P882—143561), 506 pp. The transition from Federal to State administration of the Maternal and Infant Care Project and the Children and Youth Project is examined by means of an analysis of legislative intent and case studies in four States. Study results demonstrate considerable variation in State responses due to several factors 92 including the design of the legislation, the degree of State support, and interagency cooperation in implementation. 0 Conrad, D. (1984). Hospital Response to Economic Regulation (NCHSR Grant H804472). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P385—173532), 14 pp. Factor analysis was performed on information from a survey of State agencies and secondary sources. Dimensions of regulation were developed for certificate—of-need programs and rate review, including restrictiveness of the implied constraints and level of program enforcement. o Conrad, D. and H. Emerson. (1981, Winter). State dental practice acts: Implications for competition. Journal of Health Politics, Policy and Law 5(4), pp. 610—629. (NCHSR Grant HSOl978). This article analyzes the effects of State regulations affecting dental practices on competition in the market for dental services. Three types of provisions are examined: (1) restraints on advertising and soliciting for patients; (2) limits on scope of practice and number of dental hygienists per dentist; and (3) restrictions on the form of dental practice organization and ownership. 0 Conrad, D. and G. Sheldon. (1982, Spring). The effects of legal constraints on dental care prices. Inguiry 19, pp. 51—67. (NCHSR Grant HSO3603). Presented is a conceptual framework for understanding the market effects of legal constraints on specific provisions of State dental practice acts. Five legal constraints are analyzed: (1) reciprocal licensing agreements; (2) statutory constraints on advertising of dental services; (3) limits on the number of offices a dentist may own and operate; (4) explicit specifications of those tasks a dentist may delegate to hygienists and dental assistants; (5) and limits on the number of hygienists a dentist may employ. 0 Cook, K. and others. (1983). A theory of organizational response to regulation: The case of hospitals. Academ of Management and Review 8(2), pp. 193—205. (NCHSR Grant HSO4472). Two major forms of hospital regulation——certificate of need and rate review-—are examined. How hospitals adjust internally to regulatory contraints is also discussed. 0 Cunningham, F. (1982). Factors Influencing Progress Towards Viability of Health Maintenance Organizations (NCHSR Grant HSO4432). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P384—101989), 12 pp. The author summarizes the results of a test of several hypotheses on the planning, development, and operation of health maintenance .organizations. 0 Dean, R. (1980). A Synthesis of Research Studies on Hospital Productivity (NCHSR Contract 233—79—3001). Rockville, MD: Public Health Service. (Executive Summary and Final Report: Volume 1, NTIS Order No. PB81—145112, 98 pp.; Final Report: Volume 2, NTIS 93 Order No. PB81—145120, 86 pp-)- Through an extensive literature review and examination of monitoring systems, the author assesses the state of hospital productivity measurement in terms of its applicability and utility for health planning. 0 Dunham, A. (1981). Health and Politics: The Impact of Certificate of Need Regulation (NCHSR Grant H502847). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P382—255282), 316 pp. Data from 1960—76 were analyzed in an effort to measure the impact of State certificate-of-need regulation on the supply of hospital beds. The theoretical aspects of regulation were also examined. 0 Feder, J. and W. Scanlon. (1980, Winter). Regulating the bed supply in nursing homes. Milbank Memorial Fund Quarterly/Health and Society 58(1), pp. 54-88. (NCHSR Grant HSOZGZO). After examining data from eight States, the authors maintain that limiting the supply of nursing home beds without refining conflicting standards of eligibility, quality control, and reimbursement policies effectively discriminates against persons most in need of medical care. 0 Ford, A. and P. Mabe. (1983). EMS and health planning: An opportunity for integrating research and policy. Emergency Health Services Quarterly 1(4), pp. 27—36. (NCHSR Grant H502702). The authors maintain that emergency medical services (EMS) research has been marked by inadequate integration with the policy decisionmaking process and that health planning has traditionally lacked reliable empirical data to support program development. They present mechanisms to coordinate EMS research with the health planning process to promote better exchange between planners and EMS researchers. o Gaumer, G. (1984, Summer). Regulating health professionals: A review of the empirical literature. Milbank Memorial Fund Quarterly/Health and Society 62(3), pp. 380—416. (NCHSR Contract 233—79—3014). The article surveys a number of published studies on how credentialing and other regulatory mechanisms in the health care field affect professional competence and quality of care. The author maintains that research does not suggest that existing systems of regulation have effectively controlled initial or subsequent competency of professionals and may even be limiting citizens' access to services. o Greenberg, J. and others. (1980). A Diagnosis—Based Study of the Planning of Cardiac Care Units (NCHSR Grant HSO3538). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884—219526), 413 pp. Researchers developed a method through which hospital chart abstracts were used to create need criteria reflective of cost—effective, current clinical practice. o Greenberg, J. and R. Kropf. (1981, November). A case—mix method for developing health planning criteria for hospital 94 services. Medical Care 19(11), pp. 1083-1094. (NCHSR Grant HSO3538). To address perceived inadequacies in health planning criteria, the authors used chart abstract data from New Jersey to create a list of diagnoses eligible for treatment in a cardiac care unit (CCU) and analyzed the relationship between CCU bed need and CCU clinical practice in a sample of hospitals. 0 Habermacher, J. (Ed.). (1980). Hispanic Health Services Research Conference (NCHSR Grant HSO3268). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P382—250200), 100 pp. Proceedings are reported from the first Hispanic Health Services Research Conference held at Albuquerque, New Mexico, in September 1979. The conference addressed health problems of the Hispanic populations in the United States, identified needed areas of research, and recommended appropriate methodologies. o Havighurst, C. (1980, Winter). Antitrust enforcement in the medical services industry: What does it all mean? Milbank Memorial Fund Quarterly/Health and Society 38(1), pp. 89—124. (NCHSR Grant H501539). The article suggests that strengthened competition in the health services industry offers a way to bring stability to health policy and resolve some of the conflicts between persons for and against increased regulation. 0 Havighurst, C. (1983). The contributions of antitrust law to a procompetitive health policy. In J. Meyer (Ed.). Market Reforms in Health Care (pp. 295-322). Washington, DC: American Enterprise Institute. (NCHSR Grant HSO4089). This article documents an antitrust movement affecting the health care industry which began in 1975 with Goldfarb vs. Virginia State Bar. Also reviewed are other Supreme Court decisions that reflect a gradual clarification of antitrust doctrine to the point that the author feels the Federal Government's policy toward the industry may be thought of as "procompetitive." o Havighurst, C. (1982). Deregulating the Health Care Industry: Planning for Competition (NCHSR Grant HSO4089). Cambridge, MA: Ballinger. A detailed explanation of the procompetition provisions of the 1979 health planning amendments is provided. Also addressed are competition's potential for inducing effective private action on the cost problem and methods for health system planners and regulators to develop and implement procompetition programs. o Havighurst, C. (1983, Fall). The doctor's trust: Self—regulation and the law. Health Affairs 2(3), pp. 64—76. NCHSR Grant HSO4089). The author maintains that much quality—related self-regulation activity in the health care industry should not of itself raise serious antitrust issues because it is concerned with accreditation of institutions and certification of personnel. However, he feels professional peer review of the reasonableness of fees and the appropriateness of care may in fact be open to antitrust challenge. 95 o Havighurst, C. (1983). Health planning and antitrust law: The implied amendment doctrine of the Rex Hos ital case. North Carolina Central Law Journal 14(1), pp. 5—74. (NCHSR Grant HSO4089). The author discusses a 1982 U.S. Court of Appeals decision that relaxed current antitrust standards to forestall hospital competition. Facts and rulings of the Rex Hospital case are summarized; previous legislative acts and judicial opinions are discussed in the context of health planning laws; and the principle of "implied amendment" made explicit by the Rex Hospital case is assessed. 0 Havighurst, C. (1982). Increasing the role of competition in the market for health services (NCHSR Grant HSO4089). In I. Erlich (Ed.). National Health Policy: What Role for Government? Stanford, CA: Hoover Institution. The author discusses public law 96—79, the Health Planning and Resources Development Amendments of 1979, in terms of its deregulatory aspects for health maintenance organizations. Proposals for future legislation are also discussed. 0 Havighurst, C. (1982). Legal Issues in Health Care (NCHSR Grant H501539). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PBe4—157080), 14 pp. The report summarizes a 6-year research effort on regulation as a mechanism for addressing problems in health care. Public policy goals as they relate to health care are also discussed. 0 Havighurst, C. (1984, Winter). Reforming malpractice law through consumer choice. Health Affairs 3(4), pp. 63—70. (NCHSR Grant H804089). The article highlights possible private—sector options for dealing with medical malpractice outside of the current legal methods. Three options discussed are requiring arbitration of claims, limiting recovery amounts, and contracting for altered standards of care. 0 Hetherington, R., G. Calderone, and D. Frey. (1982). The Production and Utilization of Social Science Research in Mental Health: A Canadian Survey. Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P384—157502), 215 pp. Findings are reported from a study that examined characteristics of information generation in the mental health field; investigated the use of such information by policymakers and administrators; and surveyed the attitudes of policymakers, administrators, and social scientists toward the place of social science research in the formation of mental health policy. 0 Hodge, H. (1981). Health Planning Review of Medical Information Systems (NCHSR Grant H503347). Rockville, MD: Public Health Service. (NCHSR Research Report, DHHS Publication No. (PHS) 81-3303, NTIS Order No. PB81—223018), 66 pp. This report is a guidebook for two audiences: hospital executives who must prepare certificate—of—need applicatiOns for medical information systems, and health systems agency personnel who must review such applications. 96 o Howell, J. (1980). Regulating Hospital Capital Investment: The Experience in Massachusetts (NCHSR Grant H502862). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P381—130551), 148 pp. This study assessed the impact of certificate—of-need regulation on hospital capital investment in Massachusetts over a 10-year period. A profile of hospital capital expenditures for fiscal years 1967—76 was developed from State ratesetting commission data which showed that by 1976, certificate-of—need review had reduced all dimensions of project scale and cost by as much as two-thirds of that originally proposed. o Howell, J. (1981). Regulating Hospital Capital Investment: The Experience in Massachusetts (NCHSR Grant H502862). Rockville, MD: Public Health Service. (NCHSR Research Summary, DHHS Publication No. (PHS) 81—3298, NTIS Order No. P881—176786), 30 pp. This report was developed from an NCHSR grant of the same title (see previous citation) which examined how certificate-of~need regulation in Massachusetts affected capital expenditures of hospitals. 0 Kelly, J. (1984). Determinants of Capital Acquisition by Nonprofit Hospitals. Rockville, MD: Public Health Service. (Dissertation, NTIS Order No. BESS—124220), 155 pp. Data for 42 short—term general nonprofit hospitals in Maryland are used for analysis of determinants of investment in fixed assets. Investment in four different Maryland hospital regulation programs is shown to be a function of the ratio of existing to desired or optimal capital stock and the unique speed with which the hospital reduced its ratio under each regulation program. The study showed that the speed of the hospitals’ investment in fixed assets increased during Maryland rate regulation. o Kristein, M. and S. Jonas. (1980). A Cost—Effectiveness Manual for HSA Planning (NCHSR Grant HSO3342). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB4—205749), 242 pp. The authors developed a manual for assisting health systems agencies to meet cost—effectiveness mandates in their program planning and certificate—of—need review activities. A greater orientation toward both basic and applied research is emphasized. o Ladimer, I. (1981). Malpractice Arbitration: Comparative Case Studies (NCHSR Grant H502654). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P883—228858), 267 pp. This study developed a data base on medical malpractice claims entering the arbitration forum. The report compares the effects (and effectiveness) of arbitration and litigation as methods of resolving such claims. Arbitration was found more efficient as measured in terms of time for reporting and processing but the two methods were judged equivalent in terms of frequency and amount of award. ,. x 97 0 Martin, J. and C. Johnston. (1980). Impact of Administrative Technology on Acute Bed Need (NCHSR Grant HSOBElB). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P881—160525), 277 pp. This report discusses the development and testing of a computerized planning model called ADTECH. The model was designed to predict the effect of admission scheduling systems, outpatient surgery programs, and preadmission testing programs on the acute care bed complement of a study hospital. o Morrisey, H. and others. (1984). Hospital rate review: A theory and an empirical review. Journal of Health Economics 3, pp. 25—47. (NCHSR Grant H804472). A theory of the effects of rate review on hospital operations and organization is presented for the purpose of explaining how hospitals have responded to regulation. An agenda for further empirical work is also presented. o Nichols, A. (1981). Border Health Focused Research Agenda Development Conference——Proceedings (NCHSR Grant HSO4527). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB3—186619), 152 pp. This report summarizes the proceedings from a conference of legislators, health commissioners, and policy researchers from the four southwestern States that border Mexico. Major research issues singularly important to this region were identified, including the changing nature of the border region and the problem of undocumented immigrants. o Plaska, n. and W. Hanseau. (1980). A Community Health Center Information Guide (NCHSR Grant HSO3404). Rockville, MD: Public Health Service. (Final Report: Part 1, NTIS Order No. P881-215543, 39 pp.; Final Report: Part 2, NTIS Order No. PB81—215550, 109 pp.). This guide is designed for planners and administrators who must assess the cost effectiveness of community health centers. It includes evaluation criteria to be used in both project planning and review. o Plaska, M. and W. Manseau. (1980). Cost Effectiveness of Community Health Centers (NCHSR Grant HSO3404). Rockville, MD: Public Health Service. (Final Report: Part 3, NTIS Order No. P882—195827), 8 pp. Parts 1 and 2 of the study's final report (see previous citation) are summarized. o Puskin, D. (1982). Development and Use of Expenditure Data for HSAs (NCHSR Grant HSO3459). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P383—172700), 330 pp. This study developed small area expenditure profiles to be used in health systems agency planning. Techniques were devised for translation of provider—specific data into residence—specific data. The report includes recommendations for future conduct of small area expenditure studies. 98 o Raskin, I., R. Coffey, and P. Farley. (1980). Controlling health care costs: An evaluation of strategies. Evaluation and Social Plannin 3(1), pp. 1—4. This article identifies cost-containment strategies and evaluates their effectiveness. The authors point out the need for more empirical and analytical information on incentives, provider and regulatory decisionmaking, costs of direct regulation, and the dynamics of negotiation to facilitate program planning and design. 0 Rettig, R. (1982, June). The federal government and social planning for end—stage renal disease: Past, present and future. Seminars in Nephrology 2(2), pp. 111—133. (NCHSR Grant HSO3264). This article was developed from an NCHSR grant of the same title (see following citation) which focused on issues directly confronting the Federal Government in its policy toward end-stage renal disease. o Rettig, R. and E. Marks. (1983). The Federal Government and Social Planning for End—Stage Renal Disease: Past, Present, and Future (NCHSR Grant HSO3264). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P883—228866), 67 pp. This report summarizes lessons from two decades of experience with end—stage renal disease and discusses policy and ethical issues pertaining to the disease as "tragic choices." 0 Rice, D. and C. Estes. (1984, Winter). Health of the elderly: Policy issues and challenges. Health Affairs 3(4), pp. 25—49. (NCHSR Grant HSO4042). This article describes how declines in mortality have changed the age distribution of the U.S. population. Projections are given on how the elderly’s health status, use of medical care services, and expenditures for care may change by the year 2000; how such changes may affect long—term health policy is also discussed. 0 Ruth, R. (1981). A Mixed Integer Programming Model for Regional Planning of a Hospital Inpatient Service (NCHSR Grant H502312). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PB81—207656), 9 pp. _The development of a model to aid in the planning of a regional hospital service is summarized. o Sherman, M. (1980). A Guide to Investment Criteria for Critical Care Units (NCHSR Grant HSO3569). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P882—170408, 11 pp.; Final Report, NTIS Order No. P882—170416, 140 pp-). Criteria relevant to the planning of institutional and regional critical care units are identified and discussed. Structural validity, measurability, and reliability of these "investment" criteria are also reviewed. 0 Silver, G. (1980). Priorities for Research in Maternal and Child Health Services: A Literature Review (NCHSR Grant HSO4145). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P881—197162), 406 pp. Problems relating to 99 the field of maternal and child health are reviewed and evaluated, including health care needs, resources, and service availability. Several priorities for research——with specific attention to organizational factors-—are recommended. 0 Sloan, F. (1983). Rate Regulation as a Strategy for Hospital Cost Control: Evidence From the Last Decade (NCHSR Grant H804665). Rockville, MD: Public Health Service. (NTIS Order No. P884-145481), 32 pp. The report explores a number of reasons for the unique success of mandatory rate regulation programs in containing rises in spending for hospital care during the 19705. 0 Sloan, F. (1982). Regulation, Reimbursement, and Hospital Finances (NCHSR Grant HSO4665). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P883—207878), 139 pp. The effects of regulatory programs, ownership, and reimbursement practices on hospital costs and profitability are assessed. 0 Storbeck, J. (1982). Slack, natural slack, and location covering. Socio-Economic Planning Sciences 16(3), pp. 99—105. (NCHSR Grant HSO3722). A goal programming approach to "location covering" is presented that incorporates natural slack into the definition of coverage relations. Policy applications are also discussed. o Storbeck, J. and T. Ruefli. (1982). Behaviorally linked location hierarchies. Environment and Planning Bulletin 9, pp. 257—268. (NCHSR Grant HSO3722). Multilevel models that express the functional interdependence between service levels are detailed. The authors maintain that it is necessary to distinguish between two broad categories of hierarchical systems-—those that are technologically linked and those that are behaviorally linked. o Trivedi, V. (1981). A Goal Programming Model for Nursing Service Budgeting (NCHSR Grant HSO3410). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P882-225103, 5 pp.; Final Report, NTIS Order No. PB82-225111, 63 pp.). This study developed and tested a comprehensive model for planning budgets in hospital nursing departments. It includes measurements of task delegations and substitutability among nursing personnel. o Trivedi, V. (1983). A Stochastic Model for Primary Health Care Manpower Planning (NCHSR Grant HSO4102). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P885-166452/AS), 138 pp. This research developed a model that could be used to determine the future supply of health care providers in a specific geographic region. o Weiner, S. and P. Bass. (1982). Eggal Issues in Hospital Planning Decisions (NCHSR Grant HSO3755). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P884-212182, 12 pp.; Final Report, NTIS Order No. P384-180496, 496 pp.). Legal 100 issues that confront hospitals when they consolidate services or structures or when they close or convert facilities are described. Various topics related both to institutional and regulatory aspects of contraction planning are discussed. 0 White, W. (1981). Mandatory Licensure of Nurses: Introduction and Impact (NCHSR Grant HSO3596). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P881—191694). The study investigated why nursing licensure laws after 1940 have become mandatory in most States. 10. Primary Care Topics covered in this section include the following: emergency medical systems; freestanding versus hospital emergency services; ambulatory care, including mental health services; protocols in medical/surgical emergencies; parent-child—physician communication in family practice; rural emergency services; diagnostic tests in primary medical encounters; telephone emergency care systems; and utilization of ambulatory care by specific groups. 0 Bergner, L. (1983). Health Status of Survivors of Cardiac Arrest (NCHSR Grant H803058). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P385-107761), 178 pp. Results are reported from a study of long—term quality of life of patients resuscitated with advanced cardiac life support systems. The study found that the shorter the time to initiation of cardiopulmonary resuscitation or defibrillation by emergency personnel, the better the functional status of the cardiac arrest patient. 0 Bergner, L. and others. (1981, December). Evaluation of Paramedic Services for Cardiac Arrest (DHHS Publication No. (PHS) 82—3310; NCHSR Grant H502456). Research Report Series, National Center for Health Services Research. Rockville,HD: Public Health Service. A quasi—experiment evaluated the impact of paramedic services on mortality from out-of—hospital cardiac arrest. The addition of paramedic services to basic life support was accompanied by increased rates of hospital admission (from 19 to 34 percent) and discharge (from 7 to 17 percent). 0 Carter, W. and others. (1984, September; Part I). Development and implementation of emergency CPR instruction via telephone. Annals of Emergency Medicine 13(9), pp. 695—700. (NCHSR Grant HSO4000). The investigators developed and evaluated a cardiopulmonary resuscitation (CPR) message that could be communicated from an emergency dispatcher via telephone to a person reporting a cardiac arrest. The quality of CPR administered was judged to be comparable to that of formally trained persons. o Cayten, C. (1980). Clinical Algorithms for EMT Performance Assessment (NCHSR Grant H802418). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P883—180497), 32 pp. A set of clinical algorithms was developed to improve the performance of paramedics in managing prehospital cardiac emergencies. Paramedics who used algorithms were found to be better able to correctly identify life-threatening arrhythmias and electrocardiogram patterns than paramedics who did not use the algorithms. 101 102 o Cayten, C. (1984). The Effect of Telemetry on Advanced Life Support Care (NCHSR Grant HSO3555). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P385—139939), 178 pp. Results are reported from a 3—year controlled trial of telemetry use in the prehospital care of cardiac patients. Telemetry was not found to affect the ability of paramedics to interpret electrocardiograms in either test or field situations. o Charnes, A. and J. Storbeck. (1980). A goal programming model for the siting of multilevel Ens systems. Socio—Economic Planning Sciences 14, pp. 155—161. (NCHSR Grant HSO3722). The development of a technique for the locational planning of a sophisticated system for emergency medical services is discussed. The goal program——which includes both basic and advanced life support capabilities in a two—tiered hierarchical system——incorporates behavioral mechanisms into an access—oriented location context. o Charney, E. and others. (1981). Evaluation of Emergency Room Referral S stem (NCHSR Grant HSO4005). Rockville, MD: Public Healt Service. (Executive Summary, NTIS Order No. PB81-211161, 16 pp.; Final Report, NTIS Order No. P881—211179, 30 pp.). Factors associated with successful referral of patients with nonurgent conditions from a hospital emergency room to alternative primary care providers are investigated. o Cobb, L. and others. (1980). Community cardiopulmonary resuscitation. Annual Review of Medicine 31, pp. 453—462. (NCHSR Grant HSOl943). The development of a community-wide cardiopulmonary resuscitation program in Seattle is summarized. o Cobb, L. and A. Hallstrom. (1982). Community—based cardiopulmonary resuscitation: What we have learned. In H. Greenberg and E. Dwyer (Eds.). Sudden Coronary Death. Annals of the New York Academy of Sciences 382, pp. 330—342. (NCHSR Grant H801943). The article reports on how bystander-administered cardiopulmonary resuscitation (CPR) affects the survival of persons experiencing sudden coronary attack. CPR was administered by trained bystanders who had participated in a community CPR program. Results showed that victims who received immediate CPR had substantially improved rates of survival. In 1 year, 43 percent of patients who had experienced ventricular fibrillation survived to hospital discharge when bystanders initiated CPR. o Cobb, L., J. Werner, and G. Trobaugh. (1980, June). Sudden cardiac death I. A decade's experience with out—of—hospital resuscitation. Modern Concepts of Cardiovascular Disease 49(6), pp. 31—36. (NCHSR Grant HSOl943). Prehospital management and long—term followup of persons who have suffered sudden cardiac death syndrome are detailed. The application of a comprehensive emergency care system and characteristics of both survivors and nonsurvivors of ventricular fibrillation are included in the discussion. 103 o Cobb, L., J. Werner, and G. Trobaugh. (1980, July). Sudden cardiac death II. Outcome of resuscitation, management, and future directions. Modern Concepts of Cardiovascular Disease 49(7), pp. 37—42. (NCHSR Grant H501943). The authors discuss the complex problems involved in managing survivors of sudden cardiac death syndrome. The need to consider social, psychological, and financial consequences of cardiac arrest, resuscitation, and hospitalization along with the patient's underlying cardiovascular status is stressed. Also discussed is the potential for treatment and prevention of ventricular fibrillation. o D'Agostino, R., M. Pozen, and P. Sytkowski. (1982). Myocardial Infarction Prediction in Emergency Rooms (NCHSR Grant H802068). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P384—169812), 367 pp. This report discusses the development of a mathematical function designed to assist emergency room physicians in diagnosing heart disease. By decreasing the false positive rate for coronary admissions to critical care units, the function proved superior in diagnostic accuracy in both prospective and retrospective test results. o Eisenberg, M. and others. (1980, March 14). Management of out—of—hospital cardiac arrest: Failure of basic emergency medical technician services. Journal of the American Medical Association 243(10), pp. 1049—1051. (NCHSR Grants H301943 and 8802456). The authors maintain that emergency medical technicians, who provide basic life support (such as CPR) and transportation to a hospital, cannot provide effective therapy for patients with cardiac arrest in the absence of paramedics (who can deliver advanced care directly at the scene). o Eisenberg, M. and others. (1980, June). Treatment of out—of—hospital cardiac arrests with rapid defibrillation by emergency medical technicians. The New England Journal of Medicine 302(25), pp. 1379—1383. (NCHSR Grant 3501943). Outcomes from cardiac arrest due to underlying heart disease were studied before and after introduction of defibrillation training for emergency technicians. During a 2—year predefibrillation period, 4 of 100 patients with cardiac arrest were resuscitated and discharged alive from the hospital; in a l—year period with technicians trained in defibrillation, 10 of 54 patients were successfully resuscitated and discharged. o Eisenberg, M. and others. (1984, April). Treatment of ventricular fibrillation: Emergency medical technician defibrillation and paramedic services. Journal of the American Medical Association 251(13), pp. 1723—1726. (NCHSR Grant H503215). This article reports on a study of how rapid defibrillation by emergency medical technicians combined with paramedic care affected survival rates for patients with out—of—hospital cardiac arrest. It was found that when the time interval between EMT and paramedic arrival was greater than 4 minutes, Survival rates were significantly improved for patients treated with EMT 104 defibrillation combined with paramedic care as opposed to those treated with basic EMT combined with paramedic care. 0 Eisenberg, M., L. Bergner, and A. Hallstrom. (1983, November). Epidemiology of cardiac arrest and resuscitation in children. Annals of Emergency Medicine 12(11), pp. 672—674. (NCHSR Grant 8504000). A study of out—of—hospital cardiac arrest among children in King County, Washington, found that in contrast to resuscitation from cardiac arrest in adults, the likelihood of successful resuscitation in children is poor. Only 6 percent of patients treated with basic EMT and 7 percent of those treated with basic EMT plus paramedic services were discharged alive. o Eisenberg, M., L. Bergner, and A. Hallstrom. (1980, April 12). Out—of—hospital cardiac arrest: Improved survival with paramedic services. The Lancet, pp. 812—814. (NCHSR Grant H502456). Patient survival after out—of-hospital cardiac arrest was studied in a suburban community before and after addition of paramedic services. Paramedic services improved the rate of live admission to the coronary care or intensive care unit from 19 percent to 34 percent and the rate of discharge from 7 percent to 17 percent. 0 Eisenberg, M., A. Hallstrom, and L. Bergner. (1981, July 3). The ACLS score: Predicting survival from out—of—hospital cardiac arrest. Journal of the American Medical Association 246(1), pp. 50-52. (NCHSR Grant H502456). The investigators developed a score predictive of survival following out—of—hospital cardiac arrest that took into account four factors: witnessed arrest (A); cardiac rhythm (C); cardiopulmonary resuscitation by a lay bystander (L); and speed with which a paramedic unit responded (S). Among 22 patients with favorable findings on all four variables, 15 were later discharged alive from the hospital. o Eisenberg, M., A. Hallstrom, and L. Bergner. (1983). Defibrillation by Emergency Medical Technicians (NCHSR Grant HSO3215). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBBS—163632/AS), 120 pp. Outcomes from cardiac arrest were compared among patients who received basic services from emergency medical technicians (EMTs), EMT defibrillation, and basic EMT plus paramedic services. Patient survival from ventricular fibrillation was 7 percent with basic EMT, 26 percent with EMT defibrillation, and 19 percent with basic EMT plus paramedic service. o Eisenberg, M., A. Hallstrom, and L. Bergner. (1982, June 3). Long—term survival after out—of—hospital cardiac arrest. The New England Journal of Medicine 306, pp. 1340—1343. (NCHSR Grant HSO4000). Factors associated with long—term survival of out—of—hospital cardiac arrest are identified. 0 Fine, E. (1982). Implementation of a 911 System: An Analysis of Community Response (NCHSR Grant 3804370). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P383—137968), 60 pp. The effect of introducing a 911 105 single-number telephone access capacity on prehospital emergency care was evaluated. It was found that the number of emergency calls increased but the number of inappropriate calls to a fire department decreased. 0 Garnick, D. and others. (1984, October 1). Survey reflects emergency care changes. Hospitals 58(19), p. 65. (NCHSR Grant 8504329). Some preliminary results from a 1983 survey of specialized clinical services are reported. Findings showed that 5.5 percent of responding hospitals delivered emergency services on a freestanding basis. Almost a fifth of the hospitals reported that they had a nonhospital—based physicians' group on contract to provide staffing for emergency services. 0 Gelfand, H. and others. (1981). A Critical Examination of the Illinois Trauma System (NCHSR Grant H802118). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PB82—106170), 149 pp. The comprehensive emergency medical services of the Illinois Trauma System are evaluated, including the completeness of the Illinois Trauma Registry. Admissions for trauma relative to available beds were found to be about 50 percent greater in designated trauma centers as opposed to other hospitals. o Georgopoulos, B. (1981). Hospital Emergency Services (NCHSR Grant HSOZS38). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P884—159060, 11 pp.; Final Report, NTIS Order No. PBB4—205699, 686 pp.). The effectiveness of 30 hospital emergency units is assessed in terms of organization, structure, and problem—solving behavior. Among the factors evaluated in the study were hospital size, teaching affiliation, staffing patterns, patient volume, personnel training programs, intrahospital relations and coordination, and adaptation to surroundings. o Goldberg, J. and others. (1980, May). An evaluation of the Illinois trauma system. Medical Care 18(5), pp. 520—531. (NCHSR Grant H502118). The authors attempted to link cases at 33 Illinois trauma centers with those in the Illinois Trauma Registry to determine completeness of case reporting. Analysis revealed that the registry was substantially underreported. Guidelines are suggested to improve the development and management of future registries. o Grossman, H. and F. Goldman. (1983). An Economic Analysis of Community Health Centers (NCHSR Grant HSO4047). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB4-159185), 162 pp. This report evaluates how economically efficient community health centers are in delivering ambulatory care and if changes in infant mortality rates may be attributed to care received from such centers. The study found that about 12 percent of the overall decline in death rates for black infants was attributable to community health centers. o Hallstrom, A., H. Eisenberg, and L. Bergner. (1981, March). Modeling the effectiveness and cost—effectiveness of an emergency 106 service system. Social Science and Medicine 15C(1), pp. 13—17. (NCHSR Grant HSOZJSG). The effectiveness (percent survival) and the cost effectiveness (cost divided by effectiveness) of four different emergency medical service systems were examined in terms of such factors as ratio of paramedic to other emergency vehicles, percentage of laypersons trained in cardiopulmonary resuscitation, and response time in emergency situations. The study found that compared to the basic EMT system, the paramedic system was both more effective and more cost effective. A proposed system using rapid defibrillation by EMTs was found less effective but more cost effective than the paramedic system. A proposed system using rapid defibrillation by EMTs with paramedic backup was found to be both most effective and most costly. 0 Hopkins, J. and others. (1983). Clinical trial of an emergency resuscitation algorithm. Critical Care Medicine 11(8), pp. 621— 629. (NCHSR Grant H801833). Results are reported from clinical trials of a resuscitation protocol for acutely hypotensive patients entering a surgical emergency department. The protocol group's mean resuscitation time was found to be significantly less than that of a control group which did not use the algorithm. Patients with trauma, hemorrhage, and sepsis whose care complied satisfactorily with the algorithm also had lower mean arterial pressure time deficits and fewer shock-related complications. 0 Hopkins, J., W. Shoemaker, and others. (1980, June). Treatment of surgical emergencies with and without an algorithm. Archives of Surgery 115, pp. 745—750. (NCHSR Grant H501833). Preliminary resu ts are presented from ongoing clinical trials of a patient care algorithm in a university hospital. This protocol was developed for resuscitation of patients entering the surgical emergency department because of hypotension. Results showed that patients managed under the care protocol were resuscitated in less time than patients whose care deviated greatly from it. o Horgan, C. (1984). The Demand for Ambulatory Mental Health Services From Specialty Providers. Rockville, MD: Public Health Service. (NTIS Order No. P885—124741), 36 pp. Demand equations are estimated for the annual consumption of ambulatory mental health services. The role played by price sharing is explicitly incorporated into the model. o Komaroff, A., T. Pass, and H. Sherman. (1981). Cost—Effective Strategies in Ambulatory Care (NCHSR Grant HSO4066). RocEville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBBS—135358; Final Report, NTIS Order No. P385—135366), 118 pp. Twelve clinical problems common to ambulatory care settings were studied. Based on common presenting symptoms, options for alternative diagnostic or therapeutic measures were identified, costs were factored in, and strategies having the greatest cost—effective yield were compared to typical current practice. o Kronenfeld, J. (1980, Spring). Sources of ambulatory care and utilization models. Health Services Research 15(1), pp. 3—20. 107 (NCHSR Grant H501241). The author demonstrates the value of incorporating into any model of ambulatory care utilization variables that account for providers and patterns of care as well as patient characteristics and needs. 0 Ledley, R. (1981). Applications of Decision Theory to the Triage Process (NCHSR Grant HSO3626). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P381—191736), 37 pp. Rationales and methods are outlined for applying scientific decisionmaking principles to the problem of identifying the appropriate receiving hospital for persons injured in accidents. 0 MacKenzie, E. (1984, November). Injury severity scales: Overview and directions for future research. American Journal of Emergency Medicine 2(6), pp. 537-549. (NCHSR Grant HSO3606). This article details two trauma severity indexes endorsed by the Severity Index Conference for use in programming and evaluating emergency medical services. o McDonald, C. (1981). Action—Oriented Decisions in Ambulatory Medicine (NCHSR Grant H802485). Chicago, IL: Year Book Medical Publishers. Medical practice definitions for patient management in an outpatient setting are presented for subspecialties of internal medicine. The twofold description of each practice includes (1) a commentary of background information, literature references, and scientific rationale for the practice prescribed; and (2) a formal statement written in the CARE language which governs the computer's analysis of the patient's medical record and the practice recommended. 0 Moore, P. (1984). Utilization of Ambulatory Health Care Services by Hispanics (NCHSR Grant HSOSOll). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P385—243095/AS), 384 pp. Data from the National Health Interview Survey were used in an analysis of Hispanic persons' use of health care services. Demographic, socioeconomic, residential, and health status characteristics were among those studied. o Mudgett, C. (1983). Navajo Ambulatory Care Utilization Patterns (NCHSR Grant HSO4270). Rockville, MD: Public Health Service. (Revised Executive Summary, NTIS Order No. P883-248674), 7 pp. Intratribal variations in the use of outpatient services by Navajos are described. No general differences were found for clinic visits due to problems of poor nutrition, chronic diseases, alcoholism, or automobile accidents. However, the more isolated areas of the reservation showed higher rates for outpatient visits related to infective and parasitic diseases. o Myrick, J. (1981). Rural Volunteer Emergency Medical Coordinators (NCHSR Grant H802507). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P883-141242), 177 pp. A program in which volunteers were used as emergency medical coordinators in 36 rural communities is described. Results indicated that the emergency response time for 108 the coordinators averaged less than 4.5 minutes as compared with an ambulance response time of about 20 minutes. 0 Nagel, E. (1983). Complications of Prehospital Cardiac Resuscitation (NCHSR Grant H502567). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P385—109163), 85 pp. The number, rate, type, and severity of complications resulting from administration of cardiopulmonary resuscitation in the field are detailed. Results of data analysis of medical examiner reports, hospital and ambulance records, and interviews with emergency personnel showed that the complications were rarely life—threatening injuries in themselves. The author advocates improvements in CPR instruction. o Nagel, E. and others. (1981). Complications of CPR. Critical Care Medicine 9(5), p. 424. (NCHSR Grant H802567). Preliminary data are presented on complications of prehospital cardiopulmonary resuscitation. As shown by internal autopsy, the largest proportions of complications were found to be rib or sternal fractures, pulmonary edema, and gastric dilation. 0 National Center for Health Services Research. (1981). Emergency Medical Services Systems Research Projects, October 1979—March 1981. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 81—3304, NTIS Order No. P381—218026), 96 pp. Research projects authorized under the Emergency Medical Services Systems Act and funded by NCHSR between October 1979 and March 1981 are summarized. A list of publications resulting from NCHSR—supported research on emergency medical services is also included. 0 National Center for Health Services Research. (1984). Health Services Research on Primary Care. Rockville, MD: Public Health Service. (NTIS Order No. P884—206903), 13 pp. This report briefly describes topics in primary care and gives examples of research projects in the area supported by the National Center for Health Services Research. o Newman, M. (1983, January). CPR Q a A. Journal of Emergency Medical Services 8(1), pp. 74—78. (NCHSR Grants HSOl943 and HSO32155. Twenty—one questions and answers on cardiopulmonary resuscitation (CPR) are presented. They range from general questions on the extent of awareness of CPR in the United States to specific ones on knowledge of techniques in administering CPR. o Podgorny, G. (1980). Evaluation of an EMS Algorithm System (NCHSR Grant HSO3094). Rockville, MD: Public Health Service. (Revised Executive Summary and Final Report, NTIS Order No. P381—227241), 66 pp. A method for evaluating algorithms for emergency medical services by peer review and field testing is described. The report also summarizes the research design and includes recommendations for revising the evaluation process. 109 o Pozen, M. (1980). Confirmation Parameters To Assess EMT Decisions (NCHSR Grant HSOZiOZ). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P382—113192), 112 pp. Results are reported from a study of the effectiveness and appropriateness of prehospital care delivered by paramedics and emergency medical technicians. o Pozen, M. (1980). Effectiveness of Advanced EMTs Versus Basic EMTs (NCHSR Grant H502536). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P882—180464), 202 pp. Symptom recognition, appropriate treatment, hospital admission, and long—term patient survival were measured to compare the effectiveness of emergency medical technicians with that of paramedics in providing prehospital care. Results showed that survival was positively related to a short reponse time and paramedic care. 0 Scheib, B. (1983, January). Costs vs. benefits of ALS. Journal of Emergency Medical Services 8(1), pp. 79—82. (NCHSR Grants 3501907, H803569, and HSO3819). The benefits and costs of implementing advanced life support (ALS) services are analyzed with regional survey data. The author notes a relationship between regions with a large percentage of volunteer emergency services and the lack of advancement in ALS. o Sherman, H., E. Pappius, and A. Komaroff. (1983). The Dollar Rank Order of Diagnostic Tests Used With Specific Problems in Primary Medical Encounters (NCHSR Grant HSO4360). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P385—113843), 120 pp. Results are reported from a study that used the computer—stored ambulatory record to identify common medical problems for which specific diagnostic tests were most often ordered at three primary care sites. The medical problems most likely to be coded by providers when the tests were ordered were identified; the test—problem combinations were ranked by their dollar charges (a product of the probability of the test—problem combination and the test charges); and the probabilities for each combination were standardized to a common ambulatory population. Implications of the resultant ranking to primary care research are outlined. o Shoemaker, W. (1983, Spring). Comparison of emergency resuscitation with colloids and crystalloids. Disaster Medicine 1, pp. 10—17. (NCHSR Grant H501833). As part of a 30—month study? 600 hypotensive patients treated in a surgical emergency department were studied to determine the responses of those patients resuscitated with crystalloids as compared with those given one-third to one—fifth colloids. Patients were stratified by illness severity, by fluid volume given and estimated fluids lost, and by adherence to the resuscitation algorithm. Mean resuscitation times were found to be shorter with a regimen of about one—fourth colloids than they were with crystalloids exclusively. 110 o Shoemaker, W. and others. (1981, July). Comparison of the relative effectiveness of colloids and crystalloids in emergency resuscitation. American Journal of Surgery 142, pp. 73-84. (NCHSR Grant H801833). The fluid resuscitation of hypotensive patients in a surgical emergency department was studied over a period of 2-1/2 years. Results are reported from a comparison of conventional crystalloid resuscitation with that consisting of about one—fourth colloids. The investigators found shorter mean resuscitation times and lower arterial pressure time deficits occurred for the group that had the colloid therapy. 0 Shoemaker, W. and J. Hopkins. (1983). Clinical aspects of resuscitation with and without an algorithm: The relative importance of various decisions. Critical Care Medicine 11(8), pp. 630—639. (NCHSR Grant H801833). Clinical description was made of a series of hypotensive emergency room patients who were resuscitated with and without an algorithm. Multiple deviations from the algorithm were associated with longer resuscitation times and higher incidence of shock-related complications. The authors also found that patients with severe associated illnesses for whom the algorithm was satisfactorily followed also had shorter hospitalizations and decreased mortality. 0 Stewart, T. and others. (1982). Child, Physician, and Parent Communication in a Family Medicine Setting (NCHSR Grant H804373). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PBB4—219518), 69 pp. The communication process during routine pediatric visits to a family practice center was analyzed from 115 taped encounters each including a child, parent (or guardian), and physician. Results showed that physicians communicated with the children more actively in the symptom—eliciting phase than in the treatment phase, communicated more with older children, and communicated more often with boys than with girls. 0 Stokes, J. (1983). Impact of EMS System Development in Rural Areas (NCHSR Grant HSO3826). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P385—199727/AS), 135 pp. This report discusses the development of a model that relates cardiac patient survival to four classes of interactive variables describing the rural community, the patient, and various inputs and processes of the emergency medical system. Nine descriptive variables were found to be consistently and significantly related to the probability of patient survival after heart attack or cardiac arrest. Among the variables noted were the presence of a paramedic, response time, and availability of community health care resources to the emergency medical system. 0 Storbeck, J. (1981). Location Analytic Models in Emergency Medical Systems Management (NCHSR Grant HSO3722). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB4—176411), 151 pp. Development of both single—level and multilevel goal—oriented location covering models is described. The report illustrates contexts in which several 111 versions of these models may be applied to emergency medical services planning and system administration. 0 Sytkowski, P. and others. (1984, March). Testing a model that evaluates options for rural emergency medical service development. Medical Care 22(3), pp. 202—215. (NCHSR Grant HSO3826). The authors present data from 92 rural EMS systems to develop and test a model relating survival from heart attack or cardiac arrest to various community, patient, and system variables. 0 Sytkowski, P., M. Pozen, and R. D'Agostino. (1981, May). An analytic method for the evaluation of rural emergency. Medical Care 19(5), pp. 526—546. (NCHSR Grant H803826). An analytic method is presented for assessing how incremental changes in rural emergency medical services affect cardiac mortality, morbidity, process and performance of the EMS system, and utilization of the health care system. Outcome variables are measured for three groups: persons who used the emergency medical system, patients hospitalized with acute ischemic heart disease (AIHD) independent of EMS system use, and persons who died from AIHD on a community—wide basis. 0 Wagner, G. (1983). The Effectiveness of Mobile Intensive Care (NCHSR Grant HS04356). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P385—191211/AS), 15 pp. Results are presented from a prospective study that compared an intensive care ambulance system with a conventional ambulance system in terms of effectiveness of response to cardiac emergencies. 11. Quality Assurance and Quality of Care Topics covered in this section include the following: developing and validating explicit quality assessment criteria; team versus individual approaches in patient care; organizational strategies as related to quality of ambulatory care; quality assessment in dental practices; issues in medical practice variations; evaluating treatment modalities, protocols, and intensive care outcomes; developing criteria for medical audit demonstrations; and improving medical decisionmaking and prescribing procedures. 0 Aronson, M. and A. Komaroff. (1983). Cough and community—acquired pneumonia. In E. Kass and R. Platt (Eds.). Current Therapy in Infectious Disease, 1983—1984 (pp. 71—74). Philadelphia, PA: B.C. Decker. (NCHSR Grants H802063 and HSO4066). The authors suggest diagnostic and therapeutic considerations in evaluating and treating patients with pneumonia. Considerations specific to mycoplasmal pneumonia and influenza are also offered. o Bailit, H. (1980). Dental Practice Profiles: A Quality Assessment Model (NCHSR Grant H501545). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P883—205245), 218 pp. Insurance claim data were used to construct profiles of the patterns of services provided by dental practices in order to determine the relationship between practice profiles and quality of care. The highest average quality scores were found in practices emphasizing preventive, periodontal, and crown and bridge services. o Bailit, H. (1980). Third Party Quality Assurance Systems (NCHSR Grant H801824). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PB81—182081). This report evaluates the effectiveness of a prospective pretreatment review system in monitoring the cost and quality of dental care. Results suggest that a model system concerned with monitoring quality rather than costs increases program expenditures. o Barkan, H. (1981). Certain Concepts Useful in Designing Problem—Oriented Assessments of the Quality of Medical Care (NCHSR Grant H802838). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PB81—217556, 4 pp.; Final Report, NTIS Order No. PB81—217564, 537 pp.). The author uses data from two studies to analyze the relationship between medical care and patient outcome in terms of medical risk. Problem—oriented methods for assessing the quality of patient care are developed 'and evaluated along with alternative assessment techniques. o Baruffi, G. (1982). Evaluation Study of an Alternative Birthing Center (NCHSR Grant HSO3762). Rockville, MD: Public 113 114 Health Service. (Executive Summary and Final Report, NTIS Order No. PBB4—200591), 191 pp. Maternal and neonatal patient outcomes in two different types of obstetric facilities were evaluated. Findings showed that pregnancy outcomes for low—risk women were better at a maternity center than at a university hospital when measured by neonatal morbidity and length of stay in the nursery and by incidence of maternal infection. 0 Baruffi, G. (1984, September). A study of pregnancy outcomes in a maternity center and a tertiary care hospital. American Journal of Public Health 74(9), pp. 973—978. (NCHSR Grant HSO3762). Results from a study that compared pregnancy outcomes at a maternity center with those at a university hospital are summarized. Outcome differences between the two facilities were found mainly among women with low intrapartum risk. 0 Beardsley, R. (1981). Pharmacokinetic Laboratory's Impact on Physician Prescribing (NCHSR Grant 8803918). Rockville, MD: Public Health Service. (Abstract, NTIS Order No. P384-198175), 1 p. This abstract briefly summarizes the effect on physician prescribing and subsequent patient outcomes of providing laboratory analysis of blood samples taken from adult epileptic outpatients who received selected anticonvulsant drugs. o Beardsley, R., J. Freeman, and F. Appel. (1983, June). Anticonvulsant serum levels are useful only if the physician appropriately uses them: An assessment of the impact of providing serum level data to physicians. Epilepsia 24, pp. 330—335. (NCHSR Grant 8503918). A retrospective stu y of adults with epilepsy was conducted to evaluate how serum anticonvulsant determinations were used by physicians in treatment. Results indicated that the availability of test results did not improve the degree of seizure control and that when physicians did appropriately use serum level information, the degree of seizure control improved significantly. 0 Berry, C. (1982). Bias in Comparing Outcomes of Burn Units (NCHSR Grant 3503785). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884-175751), 105 pp. Inherent bias in commonly used methods for comparing outcomes of burn patients in different facilities was assessed. The study found that comparisons of mortality rates "spuriously" suggest higher quality of care in community hospitals than in specialized burn centers where more severely burned patients are treated. 0 Brand, D. (1984). Validation of Quality Assessment Measures in §§§ (NCHSR Grant H502149). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PB85—171148/AS), 409 pp. Results are reported from a study that developed and evaluated an emergency room quality assurance system called OPCARE (online patient care report). Results showed that the most dramatic improvements in patient care occurred when patient volumes were high and feedback was frequent. 115 0 Brand, D. (1982, revised). An x—ray Screening Protocol for Extremity Injuries (NCHSR Grant H503625). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P384—111384), 46 pp. Results are reported from a project which developed and tested a patient selection protocol for extremity radiographs. The study demonstrated that up to 14 percent of upper and lower extremity x—rays in the emergency department of a major teaching hospital were unnecessary. 0 Brand, D. and others. (1983, September 15). Adequacy of antitetanus prophylaxis in six hospital emergency rooms. The New England Journal of Medicine 309(11), pp. 636-640. (NCHSR Grant H802149). In a study of tetanus prevention treatment given to over 600 patients with open soft tissue injuries, the authors found that nearly a fourth were treated incorrectly. Patients at highest risk for tetanus had the lowest likelihood of receiving appropriate antitetanus treatment. 0 Brand, D. and others. (1982, February). A protocol for selecting patients with injured extremities who need x—rays. The New En land Journal of Medicine 306(6), pp. 333—339. (NCHSR Grant HSO3623). To help curb excessive radiography in patients with injured extremities, a patient selection protocol was developed and tested prospectively in 848 patients. Results showed that strict adherence to the protocol would have reduced x-ray usage by 12 and 19 percent for upper and lower extremities respectively. 0 Breslau, N. (1981, November). What do patient statements regarding doctors and medical care signify? Medical Care 19(11), pp. 1069-1070. (NCHSR Contract 110—72-0299). The author advocates devoting more effort to the improvement of measures of patient satisfaction. 0 Bunker, J. (1983). Criteria for Medical Audit (NCHSR Grant HSO3295). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB84—205731), 210 pp. Criteria were developed for an audit of medical records in three areas: (1) use of allopurinol for the treatment of gout and other conditions, (2) inpatient treatment of women undergoing hysterectomy for endometrial carcinoma, and (3) use of theophylline for acute asthma care. o Daniels, N. (1984, April). Is rationing by age ever morally acceptable? Business and Health 1(5), pp. 29—32. (NCHSR Grant HSO3097). The perception that age groups are competing for scarce medical resources, with the elderly taking a greater share, is discussed. The author maintains that, if questions about competition for resources are not answered by principle, they will be answered by default. It is suggested that prudent deliberators consider the merits of a scheme that gives each individual an increased chance to reach a normal life span. 0 Dikmen, S. (1984). Behavioral Outcome in Head Injury (NCHSR Grant HSO4146). Rockville, MD: Public Health Service. (Executive 116 Summary, NTIS Order No. PBBS—176329/AS, 13 pp.; Final Report, NTIS Order No. P885—176337/AS, 300 pp.). This report discusses the relative capabilities of different severity indexes to predict behavioral outcome following head injury and outlines some ways to improve the Sickness Impact Profile’s sensitivity to head injury. 0 Donabedian, A. (1981, Winter). Advantages and limitations of explicit criteria for assessing the quality of health care. Milbank Memorial Fund Quarterl /Hea1th and Societ 59(1), pp. 99—106. (NCHSR Grant HSOZO81). The author outlines the rationales for and limitations of the use of explicit criteria in assessing quality of medical care. How explicit criteria act as instruments of social control is also discussed. 0 Donabedian, A. (1980). Explorations in Quality Assessment and Monitoring: Volume 1. The Definition of Quality and Approaches to its Assessment (NCHSR Grant HSOZOBl). Ann Arbor, MI: Health Administration Press. This report covers several topics in the quality assessment area: definition, program evaluation, benefits and risks, cost, accessibility, continuity, and coordination. o Donabedian, A. (1982). Explorations in Quality Assessment and Monitorin : Volume 2. The Criteria and Standards of Qualit (NCHSR Grant H502081). Ann Arbor, MI: Health Administration Press. This report covers the quality assessment process, nomenclature, standards, and outcome criteria. 0 Donabedian, A. (1981, Summer). Using decision analysis to formulate process criteria for quality assessment. Inguiry 18, pp. 102—119. (NCHSR Grant H802081). Some pathways that connect the formal specification of the clinical decisionmaking process to quality assessment criteria are detailed. The purpose of clinical algorithms and procedures for constructing criteria maps are described. Issues in the process of placing values on diagnostic procedures——including the relationship between the test and the thing tested for——are also critically examined. 0 Button, D. (1982). Children's Health, Access to Services, and Quality of Care (NCHSR Grant H802816). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P383—232652), 28 pp. Empirical analyses of national data and data from a Washington, DC, sample showed that by most measures, poor children experienced disproportionate morbidity and mortality. Yet certain ear and vision problems were found to exhibit a U—shaped relation to family income in the national statistics as well as in the Washington sample. o Eisenberg, J. and E. Sussman. (1982). Harder data for the soft science of quality assurance. [Editorial]. Medical Decision Making 2(1), pp. 7—11. (NCHSR Grants H802068 and H502081). The authors discuss the relationship between decision analysis methods and quality assurance criteria. They review several studies in which such techniques as decision trees, multivariate analysis, and 117 criteria mapping were employed to establish standards of care and measure its quality. 0 Flood, A. and others. (1982, Winter). Effectiveness in professional organizations: The impact of surgeons and surgical staff organizations on the quality of care in hospitals. Health Services Research 17(2), pp. 341—377. (NCHSR Contract PH—42-63—65). A study of how different professional units in a hospital influence surgical outcomes found that features of the hospital had more impact on organizational effectiveness, as measured by surgical outcomes, than characteristics of the surgeons themselves. 0 Flood, A., W. Scott, and W. Ewy. (1984, February). Does practice make perfect? Part I: The relation between hospital volume and outcomes for selected diagnostic categories. Medical Care 22(2), pp. 98—114. (NCHSR Contract PH—42—63—65). The relationship between volume of patients treated and outcomes achieved was evaluated for selected medical and surgical diagnoses. The authors found strong and consistent evidence that high volume is associated with better outcomes for surgical patients; evidence for medical patients was mixed. 0 Flood, A., W. Scott, and W. Ewy. (1984, February). Does practice make perfect? Part II: The relation between volume and outcomes and other hospital characteristics. Medical Care 22(2), pp. 115—124. (NCHSR Contract PH—42—63—65). Hospital variables related to both volume and outcome (such as size, amount of expenditures, and teaching status) were studied to determine whether the high volume/better outcome relationship was masked when other variables were introduced. Strong and consistent evidence that greater volume produces better outcome was found for both surgical and medical patients. 0 Fryback, D. (1981). Studies on Improving Efficacy of Clinical Decisions (NCHSR Grant H502112). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P882-157074), 72 pp. Results are reported from two clinical simulation studies that sought to improve physicians' clinical decisionmaking by use of decision analysis techniques. 0 Gall, J. (1980). A Patient Care Quality Assurance System (NCHSR Grant H502027). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P881—207490), 412 pp. This report describes the planned implementation of four extensions to an existing hospital—wide medical information system to derive quality of care benefits at marginal cost. The actual operations of the completed nurse care planning subsystem and the patient care audit subsystem are detailed; two other subsystems, partially completed, are also introduced. 0 Gehlbach, S. and others. (1984, March). Improving drug prescribing in a primary care practice. Medical Care 22(3), PP. 193-201. (NCHSR Grant HSO3896). A model for improving physician 118 prescribing that used computerized feedback was studied in a family medicine practice. An experimental group received monthly printouts over a 9—month period identifying drugs they had prescribed by brand name along with an estimate of cost savings that might have been realized by prescribing generic drugs; a control group received no feedback. After a period of prescription monitoring, the increase in generic prescribing by the experimental physicians was found to be significantly greater than that of the control physicians. o Grundy, B. (1983). Telehealth in Anesthesia: Model for a Network (NCHSR Grant HSOJIOS). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PB84—221571, 18 pp.; Final Report, NTIS Order Nos. P384—221589 (volume 1) and PBB4—221597 (volume 2), 824 pp.; complete set, NTIS Order No. PBB4—221563). Results are reported from a comprehensive survey of certified registered nurse anesthetists in four States to determine current practices and quality of care in anesthesia and to assess receptivity to the telehealth consultation concept. The author develops a receptivity model for hospitals, including an optimal configuration for the telehealth system. 0 Hadley, J. (1982). More Medical Care, Better Health? An Economic Analysis of Mortality Rates (NCHSR Grant HSOZ790). Washington, DC: The Urban Institute. This volume reports the results of a detailed statistical analysis of the relationship between mortality rates and medical care use. It demonstrates that more medical care use appears to lower mortality rates. The analysis was done as part of a program by The Urban Institute’s Health Policy Center to explore issues in health policy and health care financing. 0 Barrel, F. and others. (1982, May). Evaluating the yield of medical tests. Journal of the American Medical Association 247(18), pp. 2543—2§36. (NCHSR Grant 3803834). A method is presented for evaluating the amount of information provided by a medical test. The authors maintain that the yield of a test is best interpreted by analyzing the prognostic information it gives. 0 Hulka, B. (1980). Quality of Ambulatory Care: An Exploration of the Discrepancy Between Explicit Process Criteria and Performance (NCHSR Contract 230—7 —0186). Rockville, MD: Public Health Service. (Research Summary, DHHS Publication No. (PHS) 80-3244, NTIS Order No. P380—178569), 17 pp. This report summarizes some of the issues demonstrated by a number of studies that have shown lack of compliance with quality of ambulatory care process criteria. The relationships between process scores and outcomes are also examined. 0 Johnson, 5., J. Rose, and D. Gustafson. (1983). Severity and Quality of Care Indices: Psychiatric Emergencies (NCHSR Grant HSO4673). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P885—112589), 63 pp. Development 119 and validation of one index for severity and two for quality of care are outlined. 0 Kane, R. L. and others. (1983). Predicting the outcomes of nursing home patients. The Gerontologist 23(2), pp. 200—206. (NCHSR Grant HSO3275). A system of nursing home reimbursement based on attaining achievable outcomes is proposed. Patient functioning in physiologic, activity, cognitive, social, and satisfaction areas was predicted by using three waves of data collected at 3—month intervals for 250 patients. o Knapp, D. (1983). Drug Prescribing Quality and Length of Hospital Stay (NCHSR Grant HSO3698). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884—166354), 91 pp. Three types of explicit prescribing criteria were employed in a retrospective review of patient charts to judge the appropriateness of drug prescribing behavior for pyelonephritis and pneumococcal pneumonia. Results showed that prescribing errors usually involved underutilization of antimicrobial therapy and were associated with more days of morbidity for pyelonephritis cases and with more days of inefficient care for both types of cases. o Knaus, W. and others. (1982). Evaluating outcome from intensive care: A preliminary multihospital comparison. Critical Care Medicine 10(8), pp. 491-496. (NCHSR Grant HSO4857). Mortality rates for groups of intensive care unit (ICU) patients in different hospitals were contrasted. Most of the variation in death rates between the hospitals could be accounted for by the differences in severity of illness, as determined by a general severity of illness classification system. In all ICUs, projected death rates were very similar to observed deaths. 0 Komaroff, A. (1984, February 9). Acute dysuria in women. The New England Journal of Medicine 310(6). Pp. 368—375. (NCHSR Grants H802063 and HSO4066). A new scheme for categorizing women with acute dysuria is proposed that considers-—in order-—vaginitis, subclinical pyelonephritis, chlamydial and gonococcal urethritis, and finally bacterial infection of the lower urinary tract. o Komaroff, A. (1984). Streptococcal pharyngitis. In R. Rakel (Ed.). Conn's Current Therapy (pp. 123—125). Philadelphia, PA: W. B. Saunders. (NCHSR Grants H802063 and HSO4066). The author presents a strategy and treatment regimen for group A streptococcal pharyngitis including both benefits and risks from diagnosis and treatment. Diagnostic clues that might suggest other types of pharyngitis are also summarized. o Komaroff, A. and others. (1983, November 25). Serologic evidence of chlamydial and mycoplasmal pharyngitis in adults. Science 222(4626), pp. 927—929. (NCHSR Grants H502063 and HSO4066). Data from a study of 763 adult patients with sore throats showed that infection was caused in a larger percentage of 120 cases by the nonstreptococcal agents Chlamydia trachomatis and Mycoplasma pneumoniae than by group A streptococcus. o Komaroff, A. and M. Aronson. (1983). Pharyngitis. In E. Kass and R. Platt (Eds.). Current Therapy in Infectious Disease, 1983-1984 (pp. 69—71). Philadelphia, PA: B. C. Decker. (NCHSR Grants H802063 and HSO4066). The authors present strategies for treatment of streptococcal pharyngitis, mycoplasma pharyngitis, and infectious mononucleosis. They also point out that no specific therapy exists for virus—caused pharyngitis. o Maloney, S. (1981). An Analysis of Federal, State and Private A roaches to the Promotion of Qualit in the Deliver of Health NCHSR Contract 233—79—3 09 . Roc vi1 9, MD: Public Hea t Service. (Executive Summary and Final Report, NTIS Order No. PB84—112358), 446 pp. This report discusses the development by Aspen Systems of a searchable data base composed of 53,000 Federal and State statutes and regulations relating to quality assurance in health care. Indepth information on quality assurance regulations and experiences of nine States is given in the study’s final report. o Maternity care center found safe for women and babies. [Editorial]. (1984, May). The Journal of Nursing Administration, p. 8. (NCHSR Grant HSO3762). Results and availability of an NCHSR—supported study entitled An Evaluation Study of an Alternative Birthing Center are announced. A maternity center and a teaching hospital were compared by Johns Hopkins University investigators who found evidence of more active intervention in the delivery process at the hospital than at the maternity center. o McDonald, C. (1981). A Controlled Trial of a Quality Assurance Mechanism (NCHSR Grant 8502485). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P382—265539), 228 pp. Results are reported from a study that determined the long-term effects of how computer—generated reminders to physicians influenced their responses. Subject matter for the reminder logic covered all major subspecialties, but the computer reminders had the largest effect on preventive care. It was found that physicians' responsiveness to computer reminders was significantly associated with positive attitudes about the computer system in general. o Mushlin, A. and F. Appel. (1980). Developing a Quality Assurance Strategy for Primary Care (DHHS Publication No. (PHS) 80-3266, NCHSR Grant HSOl310). Research Summary Series, National Center for Health Services Research. Rockville, MD: Public Health Service. This project developed a quality assurance program for the Columbia Medical Plan health maintenance organization based on measurements of health care accessibility and effectiveness. Effectiveness—of—care standards were set for 17 problems in three specialty areas. Sampling was done at discrete intervals rather than continuously. Results showed that accessibility to care was 121 improved and a positive relationship between outcome and access was demonstrated. 0 Palmer, R. (1984). Ambulatory Care Medical Audit Demonstration Project (NCHSR Grant H803087). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P885—160570/AS, 11 pp.; Final Report, NTIS Order No. P385—160588/AS, 362 PP-). A randomized controlled trial tested the feasibility, cost, and effectiveness of health care evaluation cycles that met quality assurance requirements in four hospitals and six health centers. For three of the eight tasks for which performance was measured, clinically and statistically significant improvements in care resulted from the quality assurance interventions. o Palmer, R. and others. (1983). Evaluation of operational failures in clinical decision making. Medical Decision Making 3(3), pp. 299-310. (NCHSR Grant HSO3087). An evaluation of operational failures in followup of positive urine cultures in pediatric patients is reported. Rates of failure at individual decision nodes varied from 2 percent to 48 percent, thereby suggesting that decision analyses that do not take operational failures into consideration may inaccurately predict the actual yield of health benefits. o Palmer, R. and others. (1984, July). Quality assurance in eight adult medicine group practices. Medical Care 22(7), pp. 632—643. (NCHSR Grant HSO3087). FOur evaluations of ambulatory medical tasks using medical record data and explicit branching-logic criteria were developed. They were implemented in eight general medicine provider groups at two teaching hospitals and six related health centers. Provider agreement with the criteria ranged greatly, from 57 percent to 100 percent. 0 Peddecord, K. and R. Taylor. (1984). Evaluation of Laboratory Quality Assurance Activities (NCHSR Grant HSO4767). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884-205913), 135 pp. Correlations between proficiency test performance and independent variables from six specialty areas were analyzed in a homogeneous laboratory sample. Previous history of adverse regulatory actions, time in a laboratory improvement program, and deficiencies documented on inspection were found to be unrelated to proficiency. o Pozen, M. and others. (1982). Differential effects of experience on house officer's admission diagnoses for patients with possible myocardial infarction. Medical Decision Making 2(1), pp. 13-21. (NCHSR Grant H802068). Results are summarized from a study of the effects of different levels of experience on the ability of house medical officers to accurately diagnose patients with possible heart attacks. For patients with high probabilities of heart disease, sensitivity rates were similar for both junior residents and interns; but for patients with low probabilities, junior residents correctly admitted a significantly 122 higher proportion of patients with confirmed heart disease than did interns. o Pozen, H. and others. (1984, May). A predictive instrument to improve coronary care unit admission practices in acute ischemic heart disease. The New England Journal of Medicine 310(20), pp. 1273—1278. (NCHSR Grant HSOZOGB). A predictive diagnostic instrument was developed for use in a hand—held programmable calculator; the calculator could compute a patient’s probability of having acute cardiac ischemia in only 20 seconds. In a prospective trial that included 2,320 patients treated in six emergency rooms, physicians' specificity for diagnosing acute ischemia increased when the probability value determined by the instrument was made available to them. Rates of false—positive diagnosis decreased without any increase in rates of false-negative diagnosis. 0 Pryor, D. and others. (1983, October). Early discharge after acute myocardial infarction. Annals of Internal Medicine 99(4), pp. 528-538. (NCHSR Grant HSO3834). The article specifies what constitutes an uncomplicated course for patients hospitalized with acute myocardial infarction and points out that early and rapidly progressive rehabilitation programs permit safe discharge of such patients after 7 days. 0 Ray, W. (1980). Claims File Research: Pediatric Health Care Quality (NCHSR Grant HSO3222). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PB81—211542, 7 pp.; Final Report, NITS Order No. PBBl-211559, 90 pp.). A descriptive epidemiology of psychotropic and narcotic drug use by children is presented along with results of an analysis of physician prescribing patterns for these drugs. Analysis of 5 years of Tennessee Medicaid data showed that use of narcotic drugs by children increased disproportionately, especially use of codeine and other opioid derivatives, and that the increase was greater for girls than for boys. 0 Rogers, J. and O. Haring. (1981). Automated Record Summaries: Analysis of an Experiment (NCHSR Grant H802649). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P882—157058), 291 pp. This report examines the impact of the Northwestern University Medical Record Summary System on the process and outcome of care in the university’s cardiac, pulmonary, and renal clinics. The ability of the system to identify omissions in the recording of both observations and recommended treatment is evaluated. o Roghmann, K., T. Zastowny, and A. Hengst. (1983, March). Satisfaction with medical care: Replications and theoretic reevaluation. Medical Care 21(3), pp. 294—322. (NCHSR Grant HSOO467). This article reports on several surveys that measured satisfaction with medical care in a community pediatrics research program. Several multivariate approaches were also applied to study the relation between satisfaction and utilization of care. 123 o Rosati, R. and others. (1980). Expansion, Extension, and Evaluation of a Clinical Databank for Coronar Arter Disease (NCHSR Contract 235—73—6366. RockviIIe, HD: Public Health Service. (Final Report: Volume 1, NTIS Order No. P381—134850, 150 pp., and Volume 2——Appendixes, NTIS Order No. P381—134868, 365 pp.). Results are reported on a project that extended and modified a clinical data bank for coronary artery disease and tested its transferability to another institution. Ways in which the data bank affected provider productivity, efficacy of treatment, and patient outcomes are also evaluated. 0 Rutow, I. (1982). Surgical Decision Making and Operative Rates (NCHSR Grant HSO4054). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB3—141929), 311 pp. Three facets of surgical decisionmaking were studied. The results indicated that technical judgment on the need for surgery varied greatly from one case to another. No correlation was found between such judgment and (1) operative rates, (2) financial and organizational arrangements, or (3) various educational characteristics of surgeons. o Scheffler, R. and others. (1982, May). Severity of illness and the relationship between intensive care and survival. American Journal of Public Health 72(5), pp. 449—454. (NCHSR Grant H504857). A new acute physiology scoring system was used to control for severity of illness in a reevaluation of the relationship between intensive patient care and patient survival. The statistical relationship between the use of intensive care and the probability of survival was found to be nonlinear (taking the form of a U—shaped curve) and significant. o Sherman, H. (1984, January). Surveillance effects on community physician test ordering. Medical Care 22(1), pp. 80—83. (NCHSR Grant HSO3314). After it was announced in a community hospital that orders for long-term electrocardiograms were the subject of study, the physician test ordering rate decreased 30 percent from the corresponding quarter of the previous year. 0 Soboroff, S., E. Pappius, and A. Komaroff. (1984). Benefits, risks and costs of alternative approaches to the evaluation and treatment of severe ankle sprain. Clinical Orthopedics and Related Research 183, pp. 160—168. (NCHSR Grants H802063 and HSO4066). A cost-effectiveness analysis was used to compare five methods for managing severe ankle sprain: (1) wrapping it immediately, (2) casting it immediately, (3) obtaining stress films and treating appropriately, (4) obtaining arthrograms and treating appropriately, and (5) obtaining stress films, followed by arthrograms in patients with positive stress films, and treating appropriately. Cost-effectiveness and risk/benefit ratios indicated that (1) and (3) were the most cost—effective strategies. 124 0 Thompson, J. (1984). Drug Prescribing and Evaluations in a Skilled Nursing Facility (NCHSR Grant HSO3898). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P885—188928/AS), 12 pp. Clinical pharmacists under the supervision of a family practice physician assumed responsibility for drug management of geriatric nursing home patients. Results showed that, compared with a control group that received traditional care, the prescribing clinical pharmacists’ group had a significantly lower number of deaths, a significantly higher number of patients discharged to lower levels of care, and a significantly lower average number of drugs used per patient. 0 Thompson, J. and others. (1984, February). Clinical pharmacists prescribing drug therapy in a geriatric setting: Outcome of a trial. Journal of the American Geriatrics Society 32(2), pp. 154—159. (NCHSR Grant HSO3898). This article reports the results of a quasi—experiment that measured nursing home outcome criteria (see previous citation) in which clinical pharmacists managed patients’ drug therapy under physician supervision. 0 Thompson, n. and others. (1984, November). Resource requirements for evaluating ambulatory health care. American Journal of Public Health 74(11), pp. 1244—1248. (NCHSR Grant HSO3087). To investigate the quality assurance activity of 16 ambulatory care providers, the authors abstracted information from patients’ medical records and communicated findings to the providers. After accepting the evaluation criteria, site providers agreed that there were deficiencies in care and effected improvements for some medical tasks. o Tugwell, P. (1983). Quality of Care in Acute Myocardial Infarction (NCHSR Grant HSO3239). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB4—159201), 365 pp. This report develops strategies, methods, and instruments to be used in validating a medical care process against both clinical and functional outcomes for patients with severe heart attacks. o Wagner, D. and others. (1984, Fall). Initial international use of APACHE: An acute severity of disease measure. Medical Decision Making 4(3), pp. 297-313. (NCHSR Grant HSO4857). The predictive accuracy of the acute physiology and chronic health evaluation (APACHE) measure of disease severity is demonstrated with hospital data from four countries. 0 Wagner, D. and others. (1983, April). Identification of low—risk monitor patients within a medical-surgical intensive care unit. Medical Care 21(4), pp. 425—434. (NCHSR Grant HSO4857). Multivariate logistic regression analysis that included a new scale measuring severity of illness was used to analyze which monitored admissions to an intensive care unit were suitable for early transfer. The severity measure was found to be the most 125 important variable in identifying low-risk monitor patients and performed well in both estimation and validation data sets. 0 Wagner, D. and E. Draper. (1984, November; Annual Supplement). Acute physiology and chronic health evaluation (APACHE II) and Medicare reimbursement. Health Care Financing Review, pp. 91—105. (NCHSR Grant HSO4857). The article describes the potential of APACHE II's acute physiology score to be used as a disease severity adjustment to diagnosis related groups and other diagnostic classifications. o Wennberg, J. (1984, Summer). Dealing with medical practice variations: A proposal for action. Health Affairs 3(2), pp. 6—32. (NCHSR Grants HSO4932 and H505563). This article proposes that unambiguous information on outcomes of care is needed to improve the opportunities for informed evaluation of specific medical services. 0 Willemain, T. (1983). Designing Quality Incentive Systems for Nursing Homes (NCHSR Grant HSO4672). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P885—113629, 5 pp.; Final Report, NTIS Order No. P385—113637, 139 pp.). Issues and problems in designing incentive reimbursement systems for nursing homes are analyzed. Central to the analysis is a model that relates true quality differences to assessed quality rankings. o Willemain, T. (1983, March). Survey—based indices for nursing home quality incentive reimbursement. Health Care Financing Review 4(3), pp. 83—89. (NCHSR Grant HSO4672). This article reviews the rationale for incentive reimbursements to nursing homes and proposes an index of nursing home quality. A procedure for creating a survey-based index is also outlined. o Wood—Dauphinee, S. and others. (1984, October). A randomized trial of team care following stroke. Stroke 15(5), pp. 864—872. (NCHSR Grant HSO4072). Results are reported from a randomized controlled trial that examined the effects of interdisciplinary team care on hospitalized stroke patients. In terms of functional abilities, male survivors who had team care performed better than men who had the traditional methods of treatment, but women showed no group differences in functional abilities. o Wood-Dauphinee, S. and S. Shapiro. (1982). A Trial of Team Care in the Treatment of Acute Stroke (NCHSR Grant H504072). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PBB4—186451), 270 pp. The study determined if care of acute stroke patients by a coordinated, multidisciplinary team produced better patient outcomes than traditional care. The findings indicate that both the team— and the traditional~care patients fared similarly in survival and motor performance, but the team patients achieved better functional outcomes. o Wortman, P. and W. YeatOn. (1983). Synthesis of results in controlled trials of coronary artery bypass graft surgery. In R. 126 Light (Ed.). Evaluation Studies Review Annual 8 (pp. 536—551). Beverly Hills, CA: Sage. (NCHSR Grant HSO4849). Published data from 25 studies are synthesized to compare the effectiveness of coronary artery bypass graft surgery (CABGS) with nonsurgical interventions for coronary artery disease. The authors point out that the results of their examination of 9 randomized clinical trials and 16 quasi—experiments showed that the quasi-experiments overestimated the effect of CABGS relative to nonsurgical treatment. 0 Wyszewianski, L. (1980). Determinants and Effects of Organizational Strategies of Control Directed at Quality of Care in Organized Ambulatory Care Settings (NCHSR Grant HSOZ315). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P381-133613), 351 pp. This report investigates the extent to which performance (or nonperformance) of clinical tasks is influenced by the clinic staff’s attitudes toward organizational control. It was found that if a task was thought routine, performance tended to be high if bureaucratic strategies of control were directed to it. But equally high performance levels were observed for some routine tasks for which no strategies were present, suggesting that other mechanisms may also lead to high performance for routine tasks. 12. Research Methods and Models Topics covered in this section include the following: health survey research methods; statistical validation of disease staging as a severity-of-illness measure; evaluation issues in medical research synthesis; utility of predictive instruments in hospital admissions; cost-of—illness methodologies; variance estimation for complex survey data; statistical record linkage problems; weighting and imputation strategies; and various methodological issues in the National Medical Care Expenditure Survey (NMCES). o Berk, M. and A. Bernstein. (1984, August). Interviewer characteristics and performance on a complex health survey. In American Statistical Association——Survey Research Methods Section. Proceedings (pp. 808—812). Washington, DC: American Statistical Association. The authors studied the association between various interviewer characteristics and responses to questions on the National Medical Care Expenditure Survey. Findings indicated that neither education nor experience of the interviewer was associated with lower rates of item nonresponse for health expenditure data. Older interviewers, however, appeared to be more successful in obtaining complete expenditure information. o Berk, M., S. Cohen, and S. Meyers. (1981, August). The usefulness of proxy reporting in an economic survey of physicians. In American Statistical Association——Survey Research Methods Section. Proceedings (pp. 671—673). Washington, DC: American statistical Association. The authors discuss the quality of data obtained from physicians' proxy respondents in the physicians’ practice survey component of the National Medical Care Expenditure Survey. 0 Berk, M., G. Wilensky, and S. Cohen. (1984, June). Methodological issues in health surveys——An evaluation of procedures used in the National Medical Care Expenditure Survey. Evaluation Review 8(3). (NTIS Order No. PB84—239615). The report summarizes some findings from NMCES methodological studies previously conducted to evaluate response bias and response rates, organizational effects, usefulness of medical provider and health insurer surveys, and other issues of survey design. o Bonham, G. and L. Corder. (1981). NMCES household interview instruments. National Health Care Expenditures Study Instruments and Procedures 1, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 81—3280, NTIS Order No. PB82—250796), 180 pp. Questionnaires used in the household interview component of the National Medical Care Expenditure Survey are described. The report includes an overview of the household instrument, discusses the structure of the interview, and summarizes the types of data collected. 127 128 o Burt, V. and S. Cohen. (1984). A comparison of methods to approximate standard errors for complex survey data. Review of Public Data Use 12, pp. 159-168. The authors report on a method of approximating standard errors in complex survey designs by using average relative standard error as a basis. Its accuracy is compared with that of the relative variance curve and the average design effect model. 0 Burt, V. and S. Cohen. (1984, November 11—15). Levels of item nonresponse in the National Medical Care Expenditure Survey. Paper presented at the annual meeting of the American Public Health Association, Anaheim, CA. (NTIS Order No. PBBS—180248/AS), 38 pp. Types of nonresponse encountered in the complex NMCES survey are discussed, including a description of questionnaire items characterized by high levels of nonresponse. In addition characteristics of individuals with a relatively greater likelihood of item nonresponse are also identified. 0 Cannell, C. and R. Groves (Eds.). (1984, September). Health Survey Research Methods (Proceedings of the Fourth Conference on Health Survey Research Methods, NCHSR Grant HSO4569). Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3346; NTIS Order No. PB85—114015/AS). Six topics are covered in this conference report: (1) measures and correlates of response errors; (2) telephone survey methodology; (3) survey measurement techniques; (4) use of records in health survey research; (5) hiring, training, and monitoring of interviewers; (6) and survey methods for rare populations. 0 Champion, H. (1981). Quantification of Critical Illness and Injury (NCHSR Grant H802559). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P382—180720), 171 pp. Data on 3,500 trauma patients were collected over 4 years and a number of indexes were developed to characterize the trauma patient throughout the acute and subacute phases of injury. o Clopton, T. (1984). An Analysis of Methodologies for the Delineation of Hospital Service Planning Areas (NCHSR Grant HSO4444). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PBBS—176238/AS), 263 pp. This dissertation grant examined different methodologies for the delineation of hospital service planning areas. Included are models for administration, travel time minimization, gravity, and market penetration. 0 Cohen, M. and J. Hershey. (1980). An Analysis of Regional Health Planning Methodologies (NCHSR Grant HSO3543). Rockville, MD: Public Health Service. (Revised Executive Summary, NTIS Order No. P881—212656, 8 pp.; Final Report, NTIS Order No. PBBl—212649, 154 pP.). Available health planning methodologies are reviewed in the context of an overall planning framework. A new methodology for capacity planning in progressive patient care hospital facilities is also presented. 129 0 Cohen, S. (1982). An analysis of alternative imputation strategies for individuals with partial data in the National Medical Care Expenditure Survey. Review of Public Data Use 10, pp. 153—165. A controlled experiment was conducted to test which of three imputation strategies would be used for respondents with incomplete data in the National Medical Care Expenditure Survey. The strategies tested were a weighted adjustment to the partial data, substituting data from participants with complete information for incomplete data if relevant demographic characteristics were the same for both groups, and using data from participants with complete information exclusively. Results revealed the substitution method was the most reliable but the weighting strategy produced acceptable results at lower cost. 0 Cohen, S. (1980, August). A comparative study of synthetic estimation strategies with application to data from the National Health Care Expenditures Study. In American Statistical Association——Survey Research Methods Section. Proceedings (pp. 595—600). Washington, DC: American Statistical Association. The author uses data from the National Medical Care Expenditure Survey to examine the most widely used procedures for small area estimation. The procedures discussed use national data, local population statistics, and other auxiliary variables to synthetically produce the desired small area estimates. 0 Cohen, S. (1982, November 14—18). Comparison of design effect and relative variance curve strategy for variance estimation from complex survey data. Paper presented at the annual meeting of the American Public Health Association, Montreal, PQ. The author discusses a variance estimation procedure that predicts design effects as a function of the relevant parameter estimates and related demographic factors. The reliability of the method is also examined. 0 Cohen, S. (1983, August). Design effect variation in the National Medical Care Expenditure Survey. In American Statistical Association——Survey Research Methods Section. Proceedings (pp. 748—753). Washington, DC: American Statistical Association. Design effects of the National Medical Care Expenditure Survey are determined for a representative set of survey statistics that estimate medical care utilization, expenditures, health insurance coverage, and demographic characteristics of the U.S. population. The design effect variation is examined, controlling for criterion, variable type, range, class of statistic, and sample Size. 0 Cohen, S. (1982). Estimated data collection organization effect in the National Medical Care Expenditure Survey. American Statistician 36, pp. 337—341. The author estimates the data collection organization effect in the National Medical Care Expenditure Survey and tests it within a multivariate analysis framework. The findings showed a statistically nonsignificant 130 effect when testing for differences in domain estimates of the relevant health measures. 0 Cohen, S. (1982, August). Family unit analysis in the National Medical Care Expenditure Survey. In American Statistical Association——Survey Research Methods Section. Proceedings (pp. 561—566). Washington, DC: American Statistical Association. A framework for family unit analysis is presented that allows for deriving national estimates of family health characteristics. Particular attention is given to the weighting strategy adopted and the resulting estimates of relevant health care measures. 0 Cohen, S., V. Burt, and G. Jones. (1984). Efficiencies in Variance Estimation for Complex Survey Data. Rockville, MD: Public Health Service. (NTIS Order No. P385—17SS94/AS), 30 pp. Data from the National Medical Care Expenditure Survey were used as the basis for a comparison of four variance estimation programs. The comparisons were concentrated in the areas of computational efficiency, programming capability, and facility for the user. 0 Cohen, S. and P. Farley. (1984). Estimation and sampling procedures in the NMCES insurance surveys. National Health Care Expenditures Study Instruments and Procedures 3, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3369, NTIS Order No. PB84—219484), 55 pp. Sampling procedures and weights that were developed for the health insurance/employer survey component of the National Medical Care Expenditure Survey are described. Health insurance information from two substudies, the uninsured validation survey and the health insurance options survey, is also included. 0 Cohen, S. and G. Gridley. (1981, November 1-5). Effects of alternative weighting strategies on households as sampling units in the National Medical Care Expenditure Survey. Paper presented at the annual meeting of the American Public Health Association, Los Angeles, CA. The authors discuss the various alternative sample weighting strategies employed in the National Medical Care Expenditure Survey and how they affect family analyses, estimation of health expenditures and utilization characteristics, and related sampling variances. 0 Cohen, S. and W. Kalsbeek. (1981). NMCES estimation and sampling variances in the household survey. National Health Care Expenditures Study Instruments and Procedures 2, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 81—3281, NTIS Order No. P882—250804), 85 pp. The sampling design for the household survey component of the National Medical Care Expenditure Survey is described. Statistical issues surrounding data collection and analysis are also detailed. 0 Cox, B. and G. Gridley. (1981, November 1—5). The relationship between household— and provider—reported diagnoses for medical 131 care visits. Paper presented to the annual meeting of the American Public Health Association, Los Angeles, CA. The authors used data from the medical provider survey component of the National Medical Care Expenditure Survey to compare the correspondence between household and provider diagnostic reports. After the condition codes were recoded to produce fewer categories, the level of agreement between households and providers was found to be relatively low. But when collapsed versions of the diagnostic recodes were used, the level of agreement increased substantially. o Feinstein, A. (1980). The Development of Clinimetrics (NCHSR Grant HSOZ764). Rockville, MD: Public Health Service. (Executive Summary with final progress report, NTIS Order No. P882—178906), 56 pp. A system for classifying and quantifying clinical information was developed. The report discusses improvements in the ability to arrange, enumerate, and analyze symptoms and other descriptive clinical information. o Fitch, D. (1984, August 29-31). Deriving uncorrelated variables for use in small area estimation. Paper presented to the Data Use Conference on Small Area statistics sponsored by the National Center for Health Statistics, Hyattsville, MD. Two—factor score estimation methods previously reported by the author (see next citation) are used to make State utilization and expenditure estimates. The accuracy of the State estimates was found to be significantly better with the two—factor score methods than with the more standard regression approach. 0 Fitch, D. (1983, August). Estimating from factor scores derived from criterion-weighted matrices. In American Statistical Association--Social Statistics Section. Proceedings (pp. 503-505). Washington, DC: American Statistical Association. The author points out the usefulness of deriving a small set of uncorrelated variables if there are several variables and relatively few observations for estimating some criterion. Two methods that give more weight to those variables that correlate more highly with the criterion to be estimated are presented and applied to a small area estimation problem using data from the National Medical Care Expenditure Survey. 0 Fleishman, E. and M. Berk. (1981). Survey of interviewer attitudes toward selected methodological issues in the National Medical Care Expenditure Survey. In S. Sudman (Ed.). Health Survey Research Methods (Research Proceedings of the Third Biennial Conference, pp. 249—256). Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 81—3268, NTIS Order No. P581—242984). Interviewers for the National Medical Care Expenditure Survey were themselves surveyed for their reactions and those of their interviewees to certain field procedures. Particular emphasis was placed on determining how survey procedures affected quality of data from poor and elderly respondents. o Freeman, H. and others. (1983). Data Collection: The Achilles Reel of Evaluation Research (NCHSR Grant HSO4676). Rockville, MD: 132 Public Health Service. (Final Report, NTIS Order No. P884—121714), 23 pp. In an examination of published and working documents from nine major program evaluations, the authors discovered a lack of explicit information on data collection procedures. 0 Gonnella, J., M. Hornbrook, and D. Louis. (1984, February 3). Staging of disease——A case—mix measurement. Journal of the American Medical Association 251(5), pp. 637—644. (NCHSR Contract 233—78—3001; NTIS Order No. PBB4—215235). Staging is defined as a method for measuring severity of specific diseases by defining discrete, clinically detectable points. The uses of staging in epidemiologic, casemix, and utilization analyses are illustrated for diabetes mellitus. o Hanley, J. and B. McNeil. (1983, September). A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148(3), pp. 839—843. (NCHSR Grant HSO3645). Receiver operating characteristic (ROC) curves are used to describe and compare the performance of diagnostic algorithms. This paper refines the statistical comparison of the areas under two ROC curves derived from the same set of patients by taking into account the correlation between the areas induced by the paired nature of the data. 0 Hodgson, T. and M. Meiners. (1982, Summer). Cost—of—illness methodology: A guide to current practices and procedures. Milbank Memorial Fund Quarterly/Health and Society 60(3), pp. 429—462. The authors summarize state—of—the—art methodology for estimating costs of illness and disease, discussing in detail the human capital approach and the willingness—to-pay approach. Several procedural recommendations for future cost-of—illness studies are presented. 0 Hu, T. and F. Sandifer. (1981). Synthesis of Cost of Illness Methodology (NCHSR Contract 233—79—3010). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P882—125055), 123 pp. Methodological studies on cost of illness were surveyed to assess variations and limitations in the methodologies employed. Estimation of cost of illness and recommendations for improving estimates in this area are included in the report. o Kasper, J. (1984). Comparisons of three data sources from the National Medical Care Expenditure Survey: Household questionnaire, household summary, and medical provider survey. In C. Cannell and R. Groves (Eds). Health Survey Research Methods (Proceedings of the Fourth Conference on Health Survey Research Methods, pp. 252—263). Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3346, NTIS Order No. PB85—114015/AS). This paper examines the relationships between three components of the National Medical Care Expenditure Survey and discusses the effects of multiple data sources on the quality of the expenditure data. The author also makes comparisons of reported data on charges and source of payment between the household questionnaire and summary, and between the household summary and medical provider survey. 133 o Lindberg, D. (1981). Health Services Research Center/Health Care Technology Center (NCHSR Grant HS02569). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB82—224403), 83 pp. The health services research agenda of a multidisciplinary research center at the University of Missouri—Columbia is profiled. 0 Louis, D. and others. (1983). Disease Staging: A Clinically Based Approach to Measurement of Disease Severity. Volume 1 —— Executive Summary (NCHSR Contract 233—78—3001). Rockville, MD: Public Health Service. (NTIS Order No. PBB3—254656), 25 pp. An overview of computerized disease staging is presented. Included are a discussion of the conceptual foundations of staging, methods used for developing medical and coded criteria, practical applications of staging, and an introduction to the staging software. 0 Louis, D. and others. (1983). Disease Staging: A Clinically Based Approach to Measurement of Disease Severity. Volume 2 —— Medical Staging Criteria (NCHSR Contract 233—78—3001). Rockville, MD: Public Health Service. (NTIS Order No. P883—254631), 619 pp. The medical staging criteria for 408 diseases are described. 0 Louis, D. and others. (1983). Disease Staging: A Clinically Based Approach to Measurement of Disease Severity. Volume 3 —- Coded Staging Criteria (NCHSR Contract 233—78—3001). Rockville, MD: Public Health Service. (NTIS Order No. PB83—254623, 15 pp.; Appendix A (ICDA-8 translation), NTIS Order No. P883—254615, 487 pp.; Appendix B (H—ICDA—Z translation), NTIS Order No. PBB3—254607, 487 pp.; Appendix C (ICD—9-CM translation), NTIS Order No. PBB3—254599, 487 pp.). Volume 3 is a guide to the development and generic interpretation of the coded staging criteria which translate sets of medical criteria into sets of coded criteria. Separate translations into ICDA—8, H-ICDA—Z, and ICD—9-CM codes are provided in appendixes A, B, and C, respectively. 0 Louis, D. and others. (1983). Disease Staging: A Clinically Based Approach to Measurement of Disease Severity. Volume 4 —- Staging Software User's Manual (NCHSR Contract 233—78—3001). Rockville, MD: Public Health Service. (NTIS Order No. P883-254581), 55 pp. This report describes the operation of the disease staging software. (The actual computer algorithm for assigning severity of illness for each patient from computerized discharge abstract data is given in Volume 6 -— Staging Software Magnetic Tape, NTIS Order No. P883-254649.) 0 Louis, D. and others. (1985). Disease Staging: A Clinically Based Approach to Measurement of Disease Severity. Volume 5 —— Reabstracting Study (NCHSR Contract 233-78—3001). Rockville, MD: Public Health Service. (NTIS Order No. P885—204691/AS), 65 pp. The results of an analysis of 2,500 hospital discharges are described. The study provides a measure of the extent of 134 information loss in the discharge abstracting process. Results of applying disease staging using medical records are compared with results obtained by using automated discharge abstract data. 0 Ludke, R. (1980). Prospective Evaluation Models for Physician Referral (NCHSR Grant H802351). Rockville, MD: Public Health Service. (Dissertation Final Report, NTIS Order No. P881—153306), 519 pp. Two decisionmaking models-—a multiattribute utility model and a Bayesian probability mode1—-are evaluated in terms of their ability to predict the probability of patients being referred to physicians in a breast cancer referral program. Factors related to the quality and technical aspects of care appeared to be more important than patient or physician factors in predicting and explaining the referral decisions. 0 McDonald, C., S. Mazzuca, and G. McCabe. (1983, February). How much of the placebo "effect" is really statistical regression? Statistics in Medicine 2, pp. 417—427. (NCHSR Grants HSOZ485 and 8504080). Because statistical regression to the mean predicts that patients selected for abnormalcy will on average tend to improve, the authors argue that most improvements attributed to the placebo effect are actually instances of statistical regression. o Newacheck, P., P. Budetti, and P. McManus. (1984, March). Trends in childhood disability. American Journal of Public Health 74(3), pp. 232—236. (NCHSR Grant HSO4399). Several possible explanations for the upward trend in prevalence of childhood disability since 1960 are examined. Among the explanations discussed are changes in survey design and procedures, changes in awareness of chronic illness, and changes in the institutionalized population of disabled children. 0 Odoroff, C. (1980). Application of Log—Linear Models to Statistical Record Linkage (NCHSR Grant H500685). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P882—143017), 172 pp. Recent developments in the analysis of multidimensional contingency tables are applied to the construction of automated record linkage systems in order to investigate how to match——with minimum possible error——the records of an individual in one data file with the records in another. Applications of such linkage to other areas of health research are also noted. o Payne, B. (1982). Burn Care Facility Study (NCHSR Grant HSO3261). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB4—240688), 360 pp. This feasibility study was designed to develop methods to determine the cost effectiveness of special care facilities for burn patients. The study developed research instruments and collected data for seven specialized burn facilities and three general care facilities. The study measures were found to satisfactorily quantify the burn care facilities for the limited sample. 135 o Poe, G. and D. Walden. (1984). A comparison of estimates of out—of—pocket expenditures for health services obtained from the National Health Interview Survey Family Medical Expense Supplement and the National Medical Care Expenditure Survey. In C. Cannell and R. Groves (Eds.). Health Survey Research Methods (Proceedings of the Fourth Conference on Health Survey Research Methods, pp. 77—97). Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3346, NTIS Order No. PBBS—114015/AS). Comparisons are made between estimates for health services expenditures from two national surveys. Detailed information on how the data were obtained and updated is included. o Pozen, M. and Others. (1980). The usefulness of a predictive instrument to reduce inappropriate admissions to the coronary care unit. Annals of Internal Medicine 92(2; Part 1), pp. 238—242. (NCHSR Grant H502068). This article describes the empirical derivation of a mathematical instrument used to supplement the diagnostic information available to emergency room physicians. o Rossiter, L. and S. Cohen. (1981, November 30—December 11). Alternative measures of expenditures for the analysis of health services. In International Statistical Institute. Contributed Papers of the 43rd Session 1, pp. 297—300. The authors use three sources of household data from the National Medical Care Expenditure Survey to estimate U.S. health care expenditures. Estimates of both annual expenditures and sources of payment were found to be different depending on which data source was used. o Sechrest, L., P. Mabe, and K. Howland. (1983). Using observer methods in EMS research. Emergency Health Services Quarterly 1(4), pp. 51—60. (NCHSR Grant HSOZ702). Methodological issues in implementing an observer study of emergency medical care are examined. Included are selection and training of observers, deployment, monitoring, and data recording. Validity and reliability issues and ethical/legal questions are also discussed. o Slesinger, D. (1982). Migrant Agricultural Workers in Wisconsin (NCHSR Grant HSO4368). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB3—172726), 125 pp. This report builds on previously collected data on Hispanic migrant farmworkers who reside in Wisconsin for part of the year. Two of the four papers inclued are methodological: one critiques methodologies employed in previous studies of migrant workers; the other analyzes the multiplicity sampling procedure used to obtain a subsample of childbearing women in migrant families. o Sudman, S. (Ed.). (1981, May). Health Survey Research Methods. (Research Proceedings of the Third Biennial Conference, NCHSR Grant HSO3271). Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 81—3268, NTIS Order No. P881—242984), 305 pp. Recent advances in health survey methods, user concerns, and areas in need of further methodological research are explored. 136 o Sudman, S. and L. Lannom. (1982). Cost-Effective Methods for Collecting Health Data (NCHSR Grant HSU3843). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBB3—254169), 234 pp. Various procedures for collecting high—quality health data were evaluated. It was found that the method for collecting the most accurate information for policy purposes consisted of an initial face—to—face interview, followed by the administration of monthly diaries which were reviewed by the interviewer at the end of the month. o Wagner, D., W. Knaus, and E. Draper. (1983). Statistical validation of a severity of illness measure. American Journal of Public Health 73(8), pp. 878-884. (NCHSR Grant H804857). This article provides statistical detail on the predictive power of the Acute Physiology and Chronic Health Evaluation (APACHE) severity-of—illness scale. It is suggested that APACHE is promising as a prognostic scale in randomized clinical trials or in retrospective case control studies. o Walden, D., C. Horgan, and G. Cafferata. (1984). Consumer knowledge of health insurance coverage. In C. Cannell and R. Groves (Eds.). Health Survey Research Methods (Proceedings of the Fourth Conference on Health Survey Research Methods, pp. 219—232). Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 84—3345, NTIS Order No. PB85—114015/AS). Three aspects of consumer knowledge about health insurance are examined: (1) fact of coverage; (2) amount of premium, source of payment, and proportion from various sources; and (3) coverage for specific services. Findings are discussed with reference to policy considerations but the major focus is methodological. The authors use two data sources from the National Medical Care Expenditure Survey——the household survey and a survey of insurers and/or employers of household members. o Weinstein, M. (1981). Economic assessments of medical practices and technologies. Medical Decision Making 1(4), pp. 309—330. The article points out that in cost-effectiveness analyses, it is necessary to include sensitivity analyses in which preference weights and parameters are varied over the plausible range. Such analyses are, according to the author, less useful if the measure of effectiveness is expressed in units unique to the intervention or class of interventions under study than if the measure is comparable across interventions. o Wilensky, G. (1981). Some methodological issues raised by the National Medical Care Expenditure Survey. In S. Sudman (Ed.). Health Survey Research Methods (Research Proceedings of the Third Biennial Conference, pp. 260—264). Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 81—3268, NTIS Order No. PBBl—242984). This preliminary discussion of key methodological issues raised by the National Medical Care Expenditure Survey includes an examination of proposed studies on using comparative data collection procedures, cost effectiveness of efforts to 137 increase response rates, and the reporting of specific data items such as occupation, expenditures, and insurance coverage. 0 Wilensky, G. and others. (1982, August). A methodological overview of the National Medical Care Expenditure Survey. In American Statistical Association——Socia1 Statistics Section. Proceedings (pp. 46—55). Washington, DC: American Statistical Association. The authors summarize the results of investigating several methodological issues in the National Medical Care Expenditure Survey. The iSSues addressed in the paper include response bias, organizational effects, effect of improved response rates, respondent attrition, and relationship between provider and household data. 0 Wilensky, G. and L. Rossiter. (1983, Spring). The relative importance of physician—induced demand in the demand for medical care. nilbank Memorial Fund Quarterly/Health and Society 61(2), pp. 252-277. (NTIS Order No. PBB4—160472). This article analyzes the validity of studies on demand inducement and discusses some of their methodological problems. Findings from demand inducement studies that employed data from the National Medical Care Expenditure Survey are also reviewed. 0 Yeaton, W. and P. Wortman. (1984, December). Evaluation issues in medical research synthesis. In New Directions for Program Evaluation No. 24, pp. 43—56. (NCHSR Grant 8804849). Three problems in synthesizing medical research studies are described: (1) assessment within the context'of change, (2) aggregation of medical dependent variables, and (3) aggregation of studies with consistent flaws. A research synthesis previously conducted by the authors relating to coronary artery bypass graft surgery is used to illustrate some of the suggested methodological solutions to these problems. Implications of the methodologies for other technologies are also addressed. 13. Service Delivery, Access, and Utilization Topics covered in this section include the following: use of health care services by specific groups; alternative delivery systems; issues in the rationing of medical care; clinical versus commercial influences on medical and drug-prescribing practices; patient— and physician—induced demand for care; validity of specific access—to—care indicators; effect on service delivery of changes in health insurance coverage; sociodemographic differences in regular source of health care; Medicaid’s role in access to care for specific groups; price and nonprice competition among providers; and various delivery and access issues in the National Medical Care Expenditure Survey (NMCES). 0 Aaron, H. and W. Schwartz. (1984). The Painful Prescription: Rationing Hospital Care (NCHSR Grant HSO3878). Washington, DC: The Brookings Institution. This report from the Brookings Studies in Social Economics series describes the British experience with curtailing medical expenditures by rationing various health care services. U.S. and British uses of technology in certain diagnostic, surgical, and chronic care treatment procedures are contrasted. The authors examine medical efficiency and quality of care relative to resources allocation in Britain and discuss how lessons learned from the British system may be applied to U.S. efforts to reduce medical care budgets. 0 Andersen, R. and others. (1983, Spring). Exploring dimensions of access to medical care. Health Services Research 18(1), pp. 49—74. (NCHSR Grant HSO4106). The dimensions of access are examined with particular attention paid to the potential for development of more "parsimonious" social indicators of access. The authors maintain that such indicators are needed to better monitor the need for and effect of innovative programs in health care delivery. 0 Avorn, J. (1982). De—Harketing and Administrative Strategies in Prescription Drug Use (NCHSR Grant HSO3880). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P384—182781), 53 pp. Physicians were randomized into three groups for a study of their drug prescribing behavior. One experimental group received written information about the drugs and two personal visits by pharmacists; another group received only the printed information; and a control group received neither. Study results indicated that the face-to—face educational intervention was an effective way to modify physician prescribing behavior. o Avorn, J. (1983, Fall). Drug policy in the aging society. Health Affairs 2(3), pp. 23—32. (NCHSR Grants HSO3880 and HSO4933). The relationship between drug information and medical practice is discussed. The author also maintains that the 139 140 disparity among physicians in knowledge of drug properties is a serious flaw in the medical care delivery system. 0 Avorn, J. (1984, March). Drug revolution places prescribing practices in question. Business and Health 1(4), pp. 35—39. (NCHSR Grant HSO3880). The article addresses the author’s contention that physicians' capacity to make better drug—prescribing decisions has not kept pace with pharmacological developments. Results are reported from the Drug Information Program——an NCHSR—sponsored project at Harvard Medical School——in which pharmacology and primary-care experts taught optimal prescribing strategies to physicians using sophisticated visual techniques and person—to—person communication. Inappropriate prescribing was significantly reduced among those physicians who received both printed informational materials and personal visits. o Avorn, J., M. Chen, and R. Hartley. (1982, July). Scientific versus commercial sources of influence on the prescribing behavior of physicians. The American Journal of Medicine 73, pp. 4—8. (NCHSR Grant HSO3880). Commercial and noncommercial sources of information on two drugs advertised as effective were used to study how information sources affect physicians’ drug prescribing behavior. o Avorn, J. and S. Soumerai. (1983, June). Improving drug—therapy decisions through educational outreach: A randomized controlled trial of academically based "detailing." The New England Journal of Medicine 308(24), pp. 1457—1463. (NCHSR Grant HSO3880). The article reports on an office—based physician education program to reduce excessive prescribing of three drug groups. Physicians who were offered personal educational visits by clinical pharmacists along with a series of mailed print materials were found to reduce their prescribing of the target drugs by 14 percent. o Bailit, H., J. Balzer, and J. Clive. (1983, May). Evaluation of a focused dental utilization review system. Medical Care 21(5), pp. 473—485. (NCHSR Grant H503599). Results of a study of a prospective dental utilization review system indicated that pretreatment service claims submitted by dentists with high utilization rates were no more likely to be denied than those with moderate rates. The study suggests that further development of focused review systems requires a better understanding of the association between utilization rates and overutilization and new methods for improving reviewer reliability. 0 Berk,.M. and A. Bernstein. (1982). Regular source of care and the minority aged. Journal of the American Geriatrics Society 30(4), pp. 251—254. The access of elderly minorities to a regular source of care is examined with data from the National Medical Care Expenditure Survey. When compared to the aged whites, aged minority individuals were found to be more likely to have a regular source of care that provided housecalls or emergency services. 141 o Berk, M., A. Bernstein, and A. Taylor. (1983, Winter). The use and availability of medical care in health manpower shortage areas. Inguiry 20(4), pp. 369—380. This article examines access to care and utilization of health services in federally designated health manpower shortage areas. The authors analyzed data from the National Medical Care Expenditure Survey and found that shortage area designation had little relationship to indicators of access and use. 0 Berk, M. and G. Wilensky. (1984). Health care of the poor elderly: Supplementing Medicare. Rockville, MD: Public Health Service. (NTIS Order No. P885-109114), 16 pp. The potential role of private and public insurance in supplementing the health care coverage of the elderly poor is analyzed. 0 Berk, M. and G. Wilensky (1984, November 11—15). Health care of the working poor. Paper presented at the annual meeting of the American Public Health Association, Anaheim, CA. (NTIS Order No. P885—169696/AS), 23 pp. The health insurance coverage of the working poor, their patterns of use, and expenditures for care are analyzed. The relationship between employment and access to medical care is also discussed. 0 Bernstein, A. and M. Berk. (1981, November 1—5). Perceived health status and selected indicators of access to care among the minority aged. Paper presented at the annual meeting of the American Public Health Association, Los Angeles, CA. This paper presents findings from the National Medical Care Expenditure Survey on access to care as measured by waiting time at site of care, usual source of care, and site of usual source of care. Findings showed that elderly minorities had longer waiting times than elderly whites and received their regular medical care in a hospital outpatient department or emergency room in higher proportions than whites. o Bernstein, A. and M. Berk. (1983, November 13-16). Utilization of services for health care among the black and white elderly. Paper presented at the annual meeting of the American Public Health Association, Dallas, Tx. Medical use patterns of aged blacks and whites are discussed in relation to need. It was found that financial barriers to care played a relatively minor role in the use of physician services by the black elderly. 0 Blazer, D. and others. (1983, January). The risk of anticholinergic toxicity in the elderly: A study of prescribing practices in two populations. Journal of Cardiology 38(1), pp. 31—35. (NCHSR Grant H503899). An examination of nursing home patients concurrently receiving the most frequently prescribed antipsychotic and tricyclic antidepressant drugs revealed that physicians did not prescribe drugs selectively within the two classes to minimize the potential for anticholinergic toxicity. 142 o Boyd, E., T. Konrad, and C. Seipp. (1982, December). In and out of the mainstream: The miners' medical program, 1946—78. Journal of Public Health Policy 3(4), pp. 432—444. (NCHSR Grant HSO4313). The authors examine how changes in the health benefit program of the United Mine Workers of America affected clinics in four States, focusing on cutbacks in staffing, use of services by miners and others, clinic management, and scope of service delivery. They found that, despite some decline in usage, the scope of services was generally consistent. 0 Brand, D. (1982). A Computer Audit To Improve ER Drug Prescribing (NCHSR Grant 3803953). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P882—253188), 104 pp. The effectiveness of a computer—assisted surveillance system in improving drug prescribing is detailed. It was found that the clinical algorithm——called OPCARE——used in conjunction with daily computer feedback was capable of identifying drug prescribing problems and modifying physicians' clinical practices. o Cafferata, G. (1984, August). Marital status, household structure, and the elderly’s use of health services. Paper presented at the annual meeting of the American Sociological Association, San Antonio, TX. The author used data from the National Medical Care Expenditure Survey to investigate the relationship between aged persons' utilization of health care services and their living arrangements. Widowed, divorced, and separated persons were found to use more ambulatory physician services than married persons, but household structure and marital status did not affect likelihood of hospitalization or length of hospital stay. 0 Cafferata, G., J. Kasper, and A. Bernstein. (1983, June). Family roles, structure, and stressors in relation to sex differences in obtaining psychotropic drugs. Journal of Health and Social Behavior 24, pp. 132—143. (NTIS Order No. PB85—109205). Sex differences in the likelihood of obtaining prescribed psychotropic drugs are examined from three theoretical perspectives: stress, sex roles, and social support. o Cafferata, G. and G. Wilensky. (1983). Women and the use of health services. American Economic Association Papers and Proceedings 73(2), pp. 128—133. The authors estimate the effects of employment status and other sociodemographic and health factors on the use of physician services. Multivariate analysis shows that sex differences in the use of physician services disappear among the full—time working population; among all adults, however, sex, age, perceived health status, education, race, and money price are important in explaining utilization. o Coffey, R. (1983, Summer). The effect of time price on the demand for medical care services. The Journal of Human Resources 18(3), pp. 409—424. (NTIS Order No. P884—160480). The effect of time price on demand for medical care is analyzed. A 143 comprehensive three—equation model shows that, when testing for a negative time price effect of obtaining medical care, demand equations should control for the type of provider chosen and the opportunity cost of time for alternative activities. 0 Conrad, D. (1983, Summer). Dental care demands: Age—specific estimates for the population 65 years of age and over. Health Care Financing Review 4(4), pp. 47-57. (NCHSR Grant H803772). Estimates for the demand for dental care among the population over age 65 are derived. The paper suggests that price elasticity of demand varies among various dental procedures. 0 Crossland, C. (1982). Public Schools, Health Care and the Handicapped Child (NCHSR Grant HSO3812). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P885—107225), 54 pp. This report analyzes the extent to which the medical care system and the educational system interact to identify, treat, and academically place children with learning-related handicapping conditions. o Dempkowski, A. (1981). Literature, Issues, and Results Regarding the Assessment of Health Services Utilization Throughout the U.S.—Mexico Border. Rockville, MD: Public Health Service. (NTIS Order No. P382—203282), 80 pp. Issues relating to the access, utilization and delivery of health services in the U.S.—Mexico border region are addressed in a comprehensive literature survey. o DeVito, C. (1981). Structural Characteristics Associated With Innovative Behavior of Pharmacies (NCHSR Grant HSO4011, formerly HSO3671). Rockville, MD: Public Health Service. (NTIS Order No. P881—206161), 327 pp. This dissertation examines various issues raised by the apparent failure of State drug product selection laws that allow pharmacists to sometimes substitute "generic" brands for more costly drugs. Possible barriers to substitution posed by "company loyalty" and prescriber "cues" to the pharmacy are also noted. o Durmaskin, B. and others. (1982). The Impact and Consequences of Changes in Health Care Coverage Provided by the United Mine Workers of America Health and Retirement Funds in West Virginia Primary Care and Multi—Specialty Clinics Having Extensive Miner Caseloads (NCHSR Grant H804317). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884—100239), 191 pp. The authors examined how changes in the United Mine Workers of America health program affected clinics in West Virginia in the late 19705 and found that the scope and mix of services were essentially maintained despite cutbacks in staffing. o Eichhorn, R., C. Haurana, and L. Lonnquist. (1981). The Use of Health Services: Indices and Correlates—-A Research Bibliography, 1981 (NCHSR Grant H503995). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order 144 No. P882—255522), 336 pp. This report updates a bibliography on the same topic prepared in 1972. Trends in the use of health services through 1981 are summarized. 0 Eve, S. (1981). Health Care Services Utilization Among Older Adults (NCHSR Grant HSO3824). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PB82—130477), 182 pp. The socioeconomic and health—related factors that may predict the elderly’s use of various health care services are discussed. It was found that older adults who belonged to health maintenance organizations used more physicians’ services than nonmembers but did not differ in their use of hospital services. 0 Federspiel, C. (1980). Health Care Among Tennessee Medicaid Recipients (NCHSR Grant HSOl703). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P382—265109), 81 pp. Data from the Tennessee Medicaid program were used to analyze physicians' prescribing patterns and to evaluate certain mechanisms for professional activities review. 0 Feldman, R. and others. (1981, September). Physician choice of patient load and mode of treatment. Atlantic Economic Journal 9, pp. 69-78. (NTIS Order No. PB84—239482). The physician’s choice of practice size and modes of treatment and how they affect the supply of and demand for medical services are analyzed. o Gehlbach, S. (1982). Improving Drug Prescribing in Family Practice (NCHSR Grant HSO3896). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P883—221671), 32 pp. A computer—assisted model for improving physician drug prescribing was studied in a family medicine setting. Physicians in an experimental group received monthly printouts identifying drugs they had prescribed by brand names with estimates of the cost savings that might have been realized by generic prescribing; a control group received no feedback. It was found that the increase in generic prescribing by physicians in the experimental group was significantly greater than that for control group physicians. o Gravenstein, J. and B. Grundy. (1980). Multidisciplinary Telemedicine in Health Care Delivery: Laser Mediated Telemedicine in Anesthesia (NCHSR Grant H801390). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PBBl—129116), 243 pp. This report evaluates the effectiveness of a telemedicine system that linked a consulting station of a university hospital with an operating-room in a veterans’ hospital and an operating room, an intensive care unit, and a newborn nursery in a small inner city hospital. The system was found to be helpful in all settings, and a significant improvement in outcome was observed in the newborn nursery after the introduction of telemedicine. o Haug, M. and B. Lavin. (1980). Challenging M.D. Authority and Utilization Behavior (NCHSR Grant HSOZ968). Rockville, MD: Public 145 Health Service. (Executive Summary and Final Report, PBBl—207433), 113 pp. The concept of consumerism in medicine is assessed both as a factor in the questioning of physician authority and its effect on rates of utilization of physician services. 0 Havighurst, C. (1983). Decentralizing decision making: Private contract versus professional norms. In J. Meyer (Ed.). Market Reforms in Health Care (pp. 22—45). Washington, DC: American Enterprise Institute. (NCHSR Grant HSO4089). The author argues that consumers can be encouraged to choose health plans and providers whose practices depart from conventional norms. The private contract between patients and providers is presented as a vehicle for introducing new standards in health care delivery. o Hibbard, J. (1982). Gender Roles, Illness Orientation, and the Use of Health Services (NCHSR Grant HSO4412). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. PBB3—186601), 167 pp. Illness behavior was studied as a factor which may account for sex differences in medical care utilization. An index of illness behavior was constructed on four dimensions: attentiveness to pain and symptoms, extent to which help was sought, changes made in life regimen, and claims made on others. Findings showed a sex difference in the perception of symptoms with women reporting more symptoms than men, but tendency to adopt the "sick role" did not show differences by sex. o Hibbard, J. and C. Pope. (1983). Gender roles, illness orientation and use of medical services. Social Science and Medicine 17(3), pp. 129—137. (NCHSR Grant HSO4412). This article was developed from the final report of a grant by the same title (see previous citation) that investigated gender difference in illness orientation as a factor in medical care utilization. o Horgan, C., A. Bernstein, and M. Berk. (1982, November 14-18). Elderly veterans' use of health care services. Paper presented at the annual meeting of the American Public Health Association, Montreal, PQ. This paper examines patterns of use for ambulatory physician visits, inpatient hospital services, and prescribed medicines by several groups according to age and veteran status. Questions addressed relate to utilization of the veterans’ health care system, out—of—pocket expenditures, and sources of payment. 0 Horgan, C., A. Taylor, and G. Wilensky. (1983, Fall). Aging veterans: Will they overwhelm the VA medical care system? Health Affairs 2(3), pp. 77—86. (NTIS Order No. P884—160506). This paper explores veterans’ health care utilization patterns in 1977 by age and type of insurance. Future implications for the Veterans' Administration medical system are also discussed. 0 Imershein, A. and others. (1983). The integration of health and human services in State human resource agencies (NCHSR Grant H804275). [Unpublished final report]. Unstructured interviews and observations were employed in an effort to describe how the 146 reorganization of the Florida Department of Health and Rehabilitative Services affected service delivery. 0 Jaramillo, P. (1981). Hispanic Health Services Research——A Preliminary Bibliography. Rockville, MD: Public Health Service. (NCHSR Research Report, DHHS Publication No. (PHS) 81—3300, NTIS Order No. PBBl—224149), 16 pp. The bibliography includes research (primarily unpublished) on the financing, delivery, and organization of health services fOr Hispanics. o Johnston, M. (1983). The Costs and Effectiveness of Stroke Rehabilitation: Measurement and Prediction (NCHSR Grant HSO3693). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB4—244979), 15 pp. The cost effectiveness of a stroke rehabilitation program, including the family's ability to care for the patient without payment, is summarized. o Kasper, J. and G. Barrish. (1982). Usual sources of medical care and their characteristics. National Health Care Expenditures Study Data Preview 12, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 82—3324, NTIS Order No. P883—173724), 20 pp. Indicators of access to a regular source of medical care are described with data from the National Medical Care Expenditure Survey. Estimates of extent of medical services available outside office hours from the regular source of care are included. 0 Kasper, J. and M. Berk. (1980, August). Comparisons by age, sex, race, and insurance coverage on some indicators of access to care. Paper presented at the annual meeting of the American Sociological Association, New York, NY. The authors examine differences among various demographic groups in access to and source of regular health care and in satisfaction with delivery of care in terms of time spent waiting to see a doctor. Findings showed that Medicaid patients were about as likely as privately insured patients to report a regular source of care but more likely to report that source as a hospital outpatient department or emergency room. 0 Kasper, J. and M. Berk. (1981). Waiting times in different medical settings: Appointment waits and office waits. National Health Care Expenditures Study Data Preview 6, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 81—3296, P882—257031), 12 pp. Waiting times for appointments in various medical care settings are analyzed as possible sources of dissatisfaction with health services delivery. The study found that dissatisfaction with the delay between making an appointment and seeing a physician was generally low when waiting time was 2 to 7 days; but when longer waits were involved, dissatisfaction was higher for visits not associated with preventive services. o Kasper, J. and R. Wilson. (1983). Use of prescribed medicines: A proxy indicator of access and health status. International 147 Journal of Health Services 13(3), pp. 433—442. This article summarizes data on the likelihood and volume of use of prescribed medicines by selected demographic characteristics. Findings indicated that children from poor and less educated families had a lower likelihood of receiving a prescription than those in better off families, a difference that appeared to correspond to different levels of physician use. 0 Knaus, W. and others. (1982, September 18). A comparison of intensive care in the U.S.A. and France. The Lancet, pp. 642—646. (NCHSR Grant HSO4857). Intensive care unit admissions in the United States and France were compared. It was found that although actual death rates, severity of illness, and amount of treatment were similar, invasive monitoring was employed less for French than for American patients. 0 Konrad, T. (1984). Eight Coalfield Clinics: Their Development and Responses to the Cutbacks in the UHWA Funds Health Program (NCHSR Grant HS 313). Roc ville, MD: Pub ic Hea th Service. (Executive Summary and Final Report, PBB4—181270), 200 pp. This report examines how eight clinic systems in four States were ,affected by changes in the United Mine Workers of America health benefit program. 0 Kviz, F. (1984, April). Attitudes toward physician advertising among rural consumers. Medical Care 22(4), pp. 300—309. (NCHSR Grant H502778). Findings are reported from a survey of Illinois residents which showed general indifference toward physician advertising. 0 Kviz, F. and J. Flaskerud. (1980). An Evaluation of the Index of Medical Underservice: Results From a Consumer Survey (NCHSR Grant HSOZ778). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P381—244345), 222 pp. The validity of the Index of Medical Underservice was assessed and found to be a weak discriminator of the health care delivery experiences of persons surveyed. o Langwell, K. (1982). Research on Competition in the Financing and Delivery of Health Services: Future Research Needs (NCHSR Contract 233—81-3031). Rockville, MD: Public Health Service. (NCHSR Research Proceedings, DHHS Publication No. (PHS) 83—3328—2, NTIS Order No. P883—131938), 83 pp. The proceedings of a 1982 conference sponsored by the National Center for Health Services Research are summarized. Topics covered include competition issues and the effect of tax changes on health care delivery. 0 Langwell, K. (1982). Research on Competition in the Financing and Delivery of Health Services: A Summary of Policy Issues (NCHSR Contract 233—81—3031). Rockville, MD: Public Health Service. (NCHSR Research (Executive) Summary, DHHS Publication No. (PHS) 83-3328—1, NTIS Order No. PB83—131912), 23 pp. The evidence on competition and performance in the health services market is 148 reviewed and several proposals to increase competition are discussed. 0 Langwell, K. and others. (1982). An Annotated Bibliography of Research on Competition in the Financing and Delivery of Health Services (NCHSR Contract 233—81—3031). Rockville, MD: Public Health Service. (NCHSR Research Report, DHHS Publication No. (PHS) 83—3326, NTIS Order No. P883—131920), 100 pp. This report lists 1,000 research items (200 annotated) on the nature and extent of competition in the health care delivery market. o Langwell, K. and S. Moore. (1982). A Synthesis of Research on Competition in the Financing and Delivery of Health Services (NCHSR Contract 233—81—3031). Rockville, MD: Public Health Service. (NCHSR Research (Final) Report, DHHS Publication No. (PHS) 83—3327, NTIS Order No. PBB3—131946), 85 pp. Research on the nature and extent of competition in the financing and delivery of health services is synthesized. Barriers to competition that affect the performance of the market are emphasized. o Latting, J. (1980). Consumer Representation: Attaining Influence (NCHSR Grant H802864). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P881—215311), 294 pp. Predictors of consumer influence in neighborhood health centers are identified. o Luft, H. and J. Trauner. (1981). Operations and Performance of Health Maintenance Or anizations: A S nthesis of Findin s From Health Services Research (NCHSR Contract 233—79—3016). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB4—207760, 10 pp.; Final Report, NTIS Order No. P882-130444, 203 pp.). Existing research on health maintenance organizations is synthesized. Program planning and service delivery issues are included in the literature review. o Manuel, R. and M. Berk. (1983, May—June). A look at similarities and differences in older minority populations. Aging, pp. 21—29. Data from the National Medical Care Expenditure Survey and other sources are used to compare differences in health status, access to health services, and expenditures in various components of the elderly minority population. 0 Meyer, T. (1981). Effect of Education on Drug Utilization (NCHSR Grant HSO3985). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P381—215840), 102 pp. How physicians' drug prescribing patterns were affected by educational intervention is detailed. Few variations from the accepted and acceptable—use criteria were found for the drugs studied, which made cost/benefit calculations impossible. o Meyers, S. and G. Cafferata. (1984, September 28). Differential psychotropic drug use by males and females: A suggested explanation. Paper presented at the annual meeting of the American College of Apothecaries, Orlando, FL. The authors 149 point out that more women than men report illness episodes and report more illnesses for which a physician is contacted; thus the probability is increased that they will have a psychotropic drug prescribed by their physician during some episode of illness. 0 Miners, L. (1981). The Family's Demand for Health: A Rural Investigation (NCHSR Grant HSOZ417). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P382—141011), 177 pp. A household model of the demand for medical care——including the effect of time price——was constructed and tested with data from a rural southern community. o Monheit, A. and others. (1984, Spring). Health insurance for the unemployed: Is Federal legislation needed? Health Affairs 3(1), pp. 101-111. (NTIS Order No. PBB4—207745). This article discusses the question of whether unemployment raises significant barriers to health insurance coverage, thereby requiring remedial public intervention. 0 Mueller, C. and A. Monheit. (1984, December 28—30). Insurance coverage and the demand for dental care. Paper presented at the annual meeting of the American Economic Association, Dallas, Tx. The authors use data from the health insurance/employer survey component of the National Medical Care Expenditure Survey to report estimates for two dimensions of demand: (1) the responsiveness of the probability of some contact with a dentist during the year to changes in net price and (2) the effects of insurance on dental care utilization levels. Separate logistic demand estimates examining access to preventive and treatment services are also reported. 0 Newport, J. (1982). Holistic Health Center Orientations and Characteristics (NCHSR Grant HSO3712). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P384—162254), 546 pp. A typology of holistic health centers is presented and the concept of holistic health as an alternative method of delivering some health care services is explored. o Novack, A., G. Wolf, and N. Breslau. (1980). A Study of Primary Care Health Units (NCHSR Grant H501699). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PB81—238081, 11 pp.; Final Report, NTIS Order No. PB81—238099, 131 pp.). How the division of labor affects service delivery in a primary care health unit is discussed. It was found that physicians performed most of the work for a patient office visit, delegating only 12 percent of the patient care activities and 64 percent of the routine technical tasks. Physicians in large multispecialty practices said they delegated more work but felt that office visits took longer and the quality of care was lower than their counterparts in solo or small group practices. o Pantell, R. and others. (1982, September). Physician communication with children and parents. Pediatrics 70(3), pp. 396—402. (NCHSR Grant HSO4373). The investigators videotaped 150 routine office visits to pediatricians to identify demographic and situational characteristics that influenced the extent of doctor/patient communication. It was found that although most of the information about the problem was obtained from the child (over 45 percent of total communication was between doctor and child), almost all of the feedback was provided to the parent. 0 Penrod, S., D. Linz, and S. Silverhus. (1984). Social Cognition and Patient Physician Communication (NCHSR Grant HSO4338). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. P885—204329/AS, 46 pp.; Final Report, NTIS Order No. P385—204337/AS, 79 pp.). Script theory was used to study the differences in conception of illness between patient and physician and thereby to improve communication and understanding between them. 0 Pescosolido, B. (1982). Yesterday's Choices? Medical Pluralism and the Structure of Decision Making (NCHSR Grant HSO3172). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB3—249409), 11 pp. Factors that influence the type of medical care practitioner chosen by the patient are examined. The notion of "alternative healers" and the effect of availability on medical care choice are also explored. o Politser, P. (1982). The Evaluation and Use of Repeated Medical Tests: Logical and Statistical Considerations (NCHSR Grant HSO4726). Rockville, MD: Public Health Service. (Executive Summary, NTIS Order No. PBB3—173716), 13 pp. Results are summarized from an experiment that tested physician understanding of the effects of particular statistical parameters on the diagnosticity of clinical tests for colon cancer. 0 Reed, W. (1982). Access to Services by the Urban Elderly (NCHSR Grant HSO3125). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. P884—245364), 173 pp. Findings are presented from a household survey of elderly persons to determine if those in need of medical, transportation, or social services received them. 0 Richardson, W. and others. (1980). Comparisons of Prepaid Health Care Plans in a Com etitive Market: The Seattle Pre aid Health Care Project (NCHSR Grant H800694). Rockville, MD: Public Health Service. (Research Summary, DHHS Publication No. (PHS) 80—3199, NTIS Order No. PBBl—l30890), 46 pp. Results are summarized from a final report of the same title in which two Seattle health plans were compared on the basis of various access and service—delivery measures. 0 Rossiter, L. (1980). who initiates visits to a physician? National Health Care Expenditures Study Data Preview 3, National Center for Health Services Research. Rockville, MD: Public Health Service. (DHHS Publication No. (PHS) 80-3278, NTIS Order No. P882—257007), 9 pp. The relative frequency of physician—initiated versus patient—initiated visits to a doctor is shown according to 151 characteristics of both the visit and the patient. The percentage of physician—initiated visits was found to be higher in hospital outpatient departments than in physician’s offices. 0 Rossiter, L. and C. Horgan. (1981, November 1—5). Unequal financial incentives for diagnostic and preventive health care. Paper presented at the annual meeting of the American Public Health Association, Los Angeles, CA. Data are presented to show how financial incentives (or disincentives) to patients and providers influence patterns of medical care use and service delivery. Marked variations in payments for diagnostic and preventive services were found, with the family paying a lower proportion of total charges for physician visits with diagnostic tests and a higher proportion of charges for visits with specific preventive services. 0 Rossiter, L. and G. Wilensky. (1983, Summer). A reexamination of the use of physician services: The role of physician—initiated demand. Inquiry 20(2), pp. 162—172. Variations in the demand for ambulatory care are explained in terms of whether they derive from the patient or the physician. Results show that patient—initiated and physician—initiated demand were influenced by variations in waiting time, health status measures, sex, and racial/ethnic background. 0 Rushing, W. (1980). Effects of Disability on Individuals and Households (NCHSR Grant H302712). Rockville, MD: Public Health Service. (Executive Summary and Final Report, NTIS Order No. PBBl—198301), 375 pp. This report discusses the consequences of physical disability on social, financial, psychological, and other concerns of disabled persons and their families. It is suggested that the nonmedical aspects of disability should be incorporated into the treatment of disabled persons. 0 Schaffner, W. (1980). Effect of Intervention in Physician Prescribing (NCHSR Grant H802535). Rockville, MD: Public Health Service. (Final Report, NTIS Order No. P885—109445), 71 pp. Tetracycline prescribing practices in Tennessee were analyzed according to physician specialty and practice location. It was found that rural location was associated with increased prescribing; in terms of specialty, family practice physicians were the most frequent prescribers. All specialties prescribed less of the drug after receiving a mailed intervention with the greatest reductions occurring among family practitioners and pediatricians and in urban settings. 0 Schaffner, W. and others. (1983, October 7). Improving antibiotic prescribing in office practice: A controlled trial of three educational methods. Journal of the American Medical Association 250(13), pp. 1728-1732. (NCHSR Grants HSO3222 and HSO3899). A mailed brochure, a drug educator visit, and a physician visit were compared in terms of their effectiveness in improving antibiotic drug prescribing. The mailed brochure and drug educator visit had little or no effect on prescribing 152 practices. The physician visits, however, produced strong attributable reductions for contraindicated antibiotics. o Schwartz, W. and H. Aaron. (1984, January 5). Rationing hospital care: Lessons from Britain. The New England Journal of Medicine 310(1), pp. 52—56. (NCHSR Grant HSO3878). Rationales for and methods of rationing scarce medical resources in Great Britain are discussed. The authors point out that acceptance of scarcity in general and "affection" for the country’s National Health Service contribute to the British public’s widespread acceptance of rationing medical treatment. o Siegenthaler, L. (1982—83, Winter). Deinstitutionalization in Switzerland: The incrementalist model. International Journal of Mental Health 11(4), pp. 137—152. The author reviews many factors and agents involved in decisionmaking and service delivery in Switzerland's mental health care system at both the national and cantonal level. The process of incrementalism——the restructuring of services through a series of small steps——is also described. 0 Soumerai, S. and J. Avorn. (1984, Summer). Efficacy and cost containment in hospital pharmacotherapy: State of the art and future directions. Milbank Memorial Fund Quarterly/Health and Society 62(3), pp. 447—474. (NCHSR Grant HSO4933). The authors discuss approaches to improving drug utilization in the hospital and assess evidence for the effectiveness of these procedures in changing physicians' prescribing patterns. Thirty—one studies that employed six methods are examined: (1) dissemination of printed drug information, (2) drug-utilization audit with single notice of results, (3) group education through lectures or rounds, (4) drug—utilization audit with group discussion, (5) one-to—one education initiated by a drug-utilization expert, and (6) required consultation or justification before using specific drugs. 0 Stamps, P. and J. Finkelstein. (1981, November). Statistical analysis of an attitude scale to measure patient satisfaction with medical care. Medical Care 29(11), pp. 1108—1134. (NCHSR Grant HSOO709). Patient satisfaction with medical care was measured through administration of a standardized attitude scale. However, after scalogram, item, and factor analyses, the authors concluded that the three tests for statistical validity did not support usage of the attitude scale as presently constituted. o Stiles, W., S. Putnam, and M. Jacob. (1982). Verbal exchange structure of initial medical interviews. Health Psychology 1(4), pp. 315—336. (NCHSR Grant HSO3040). Speech between physician and patient during a medical interview was measured by a verbal response mode coding system and analyzed in three interview segments—~the medical history, the physical exam, and the conclusion. Four or five verbal exchanges were revealed in each segment and they appeared to correspond to major tasks of the interview. 153 o Waitzkin, H. (1984, November). Doctor—patient communication: Clinical implications of social scientific research. Journal of the American Medical Association 252(17), Pp. 2441—2446. (NCHSR Grant HSOZlOO). The author analyzes social and structural barriers that impede effective physician-patient communication. He maintains that doctors tend both to underestimate patients' desire for information and to incorrectly perceive the process of information giving itself. o Wilensky, G. and M. Berk. (1982, Fall). Health care, the poor, and the role of Medicaid. Health Affairs, pp. 93—100. This article uses data from the National Medical Care Expenditure Survey to examine the health status and medical services utilization of poor persons in 1977. When health status was controlled, the uninsured poor were found to use far fewer medical services than those with Medicaid coverage. 0 Wilensky, G. and L. Rossiter. (1981). The magnitude and determinants of physician—initiated visits in the United States. In J. VanderGaag and M. Perlman (Eds.). Health, Economics, and Health Economics (pp. 215—243). Amsterdam, The Netherlands: North Holland Press. Data from the National Medical Care Expenditure Survey showed that although most visits to physicians were initiated by the patient, 39 percent were physician induced. Decreases in the proportion of the bill paid by the family were associated with increases in the probability that the physician initiated the patient's visit. 0 Wilensky, G. and L. Rossiter. (1983, Summer). A reexamination of differences in the use of health services: The role of physician—initiated demand. Inguiry 20(2), pp. 162—172. The authors discuss variations in the demand for ambulatory care in terms of whether visits to a physician were initiated by the patient or by the physician. Findings from the National Medical Care Expenditure Survey showed that both patient-initiated and physician-initiated visits were influenced by variations in waiting time, various measures of health status, sex, and racial/ethnic background. 0 Wilensky, G. and L. Rossiter. (1981, April). Alternative measurements of physician—induced demand. Paper presented at a meeting of the Eastern Economic Association, Philadelphia, PA. This paper discusses the differential use of health services as a function of both individual characteristics and physician-induced demand. The authors give particular attention to the role of market forces, including the financial characteristics of the physician, in explaining differences in health services utilization. o Wilensky, G., L. Rossiter. and A. Taylor. (1981, December 28—30). The role of money and time in the demand for medical care. Paper presented at the annual meeting of the American Economic Association, Washington, DC. The authors discuss how a patient’s out—of-pocket costs and time spent in traveling to and waiting in 154 the doctor's office affect the frequency of physician visits. Findings are from the National Medical Care Expenditure Survey. 0 Wilensky, G. and D. Walden. (1981, November 1-5). Minorities, poverty, and the uninsured. Paper presented at the annual meeting of the American Public Health Association, Los Angeles, CA. Data from the National Medical Care Expenditure Survey are used to show how absence of health insurance coverage increases an individual’s financial and health risk, especially for minorities and the poor. 0 Wilensky, G., D. Walden, and J. Kasper. (1981, August). The uninsured and their use of health services. In American Statistical Association—~Social Statistics Section. Proceedin 8 (pp. 327—332). Washington, DC: American Statistical Assoc1ation. Information is presented on the number of uninsured persons in the United States at any given time, the likelihood of remaining uninsured for extended periods of time, and the use of medical services by uninsured persons. The relationship between changing insurance status and utilization is also explored. 0 Williams, S. and others. (1982, Winter). Physicians' perceptions about unnecessary diagnostic testing. Inguiry 19(4), pp. 363—370. (NCHSR Grant H502577). The authors surveyed 280 physicians in three groups——senior medical residents, medical attending physicians, and community internists—-to discover reasons for unnecessary diagnostic testing and found that there were some differences in test ordering among the three groups. 0 Wong, R. (1981). Efficient Resource Allocation in Special Care Networks (NCHSR Grant HSO3157). Rockville, MD: Public Health Service. (Dissertation Executive Summary, NTIS Order No. PB82—168667, 11 pp.; Final Report, NTIS Order No. PB82—168675, 222 pp.). This report analyzes how design and control issues affect the planning and operation of special care referral networks in northern California. The effects of capacity expansion, dispatch policies, and patient redistribution were also studied. Aaron, H. 139, 152 Aaroneon, L. 45 Andersen, R. 49, 139 Anderson, M. 24 Appel, F. 114 Aronson, M. 113, 120 Adamache, K. 11 Altman, D. 45 Avorn, J. 11, 139, 140, 152 Anwar, R. 35 Appel, F. 120 Argote, L. 59 Asher, C. 45 Bailit, H. 113, 140 Balzer, J. 140 Barley, S. 35 Barnett, G. 3 Baruffi, G. 113, 114 Barzel, Y. 11 Barrish, G. 146 Bass, P. 99 Batey, M. 89 Beardsley, R. 114 Beazoglou, T. 11 Becker, B. 28 Beery, W. 45 Begley, C. 89 Begun, J. 39, 90 Bennett, M. 35 Bentkover, J. 45, 9O Bergner, L. 82, 101, 104, 105 Bergner, M. 90, Berk, M. 12, 32, 35, 127, 131, 140, 141, 145, 146, 148, 153 Berki, S. 12 Berkman, L. 46 Bernstein, A. 32, 127, 140, 141, 142, 145 Berry, C. 114 Berwick, S. 46 Bice, T. 90 Biener, L. 35 Birkel, R. 67 Blazer, D. 141 Bleich, H. 3 Blum, R. 3, 9 Author Index Bly, J. 12 Bohm, L. 46 Bonham, G. 127 Bovbjerg, R. 90 Boyd, 3. 142 Branch, L. 46, 67, 91 Brand, D. 114, 115, 142 Braun, P. 46, 47 Breed, L. 69 Breslau, N. 115, 149 Brealow, L. 46 Brian, E. 3, 59 Brody, E. 67 Broida, J. 77, 78 Budetti, P. 47, 55, 134 Budner, N. 53 Buechner, J. 33 Bunker, J. 48, 115 Burkett, G. 12 Burt, V. 128, 130 Bush, P. 13 Cafferata, G. 12, 13, 136, 142, 148 Calderone, G. 59, 95 Calift, R. 47 Cannell, C. 128 Caper, P. 31, 91 Carey, S. 36 Carter, E. 77, 78 Carter, R. 36, 40 Carter, w. 55, 101 Cayten, C. 101, 102 Champion, H. 128 Charnes, A. 102 Charney, W. 102 Chen, M. 140 Christianson, J. 60 Chow, R. 78 Churgin, S. 91 Clive, J. 140 Clopton, T. 128 Coate, D. 52 Cobb, L. 102, 103 Coburn, A. 91 Coffey, R. 14, 60, 98, 142 Cohen, M. 128 Cohen, S. 4, 47, 127, 128, 129, 130, 135 155 Colombotoa, J. 36 Conboy, J. 40 Conrad, D. 14, 19, 24, 60, 92, 143 Cook, F. 49 Cook, K. 92 Cooley, P. 4 Copeland, R. 14 Corder, L. 127 Cordray, D. 68 Cotter, D. 78, 79 Cox, B. 4, 130 Cox, C. 47 Cox, J. 4 Crescenzi, C. 56 Cretin, S. 46 Croasland, C. 143 Cumming, R. 79 Cummings, V. 15 Cunningham, F. 92 Curran, B. 15 D'Agostino, R. 103, 111 Daniels, C. 60 Daniels, N. 115 Davis, L. 4 Dean, D. 52 Dean, R. 92 Dempkowski, A. 143 Deprez, R. 15 Devito, C. 15, 143 Dewey, D. 36 Dibner, A. 48 Dikmen, S. 115 Dittman, J. 5 Dolan, A. 60 Donabedian, A. 116 Draper, E. 9, 61, 125, 136 Drazen, B. 15 DuBois, R. 6 Dumas, M. 65, 66 Dunham, A. 93 Durmaskin, B. 143 Dusansky, R. 36 Dutton, D. 116 Eckenrode, J. 48, 50 Eichhorn, R. 143 Eisenberg, M. 55, 82, 103, 156 104, 105, 116 Ellinoy, B. 5 Emerson, M. 92 Emilio, J. 36 Erlichman, M. 79, 80 Ermann, D. 61 Estes, C. 98 Eve, 5. 144 Ewy, w. 117 Farley, D. 61 Farley, P. 16, 19, 29, 32, 98, 130 Faulkner, L. 60 Feder, J. 71, 93 Federspiel, C. 144 Feigenbaum, E. 80, 81 Feldman, R. 37, 89, 90, 144 Feldstein, P. 37 Feinstein, A. 131 Fine, E. 104 Fineberg, H. 81 Finkelsteln, J. 152 Fitch, D. 131 Flaskerud, J. 147 Fleisher, B. 53 Fleishman, E. 131 Fleming, G. 48, 49 Flood, A. 117 Foltz, A. 48 Ford, A. 93 Fortress, E. 5 Fowles, J. 48 Franzese, R. 61 Frech, H. 18 Freeman, H. 131 Freeman, J. 114 Freund, C. 37 Frey, D. 95 Fries, J. 5, 81 Fryback, D. 117 Gabel, J. 16, 61 Gagnon, J. 17 Gall, J. 117 Gallo, F. 49 Gerber, A. 49 Gardner, R. 5 Garnlck, D. 37, 38, 105 Gaumer, G. 39, 93 Gay, C. 17 Gaynor, M. 18 Gehlbach, s. 117, 144 Gelfand, H. 105 Georgopoulos, B. 105 Giachello, A. 49 Gibbons, R. 81 Gilroy, G. 5 Gilson, B. 49 Ginsburg, P. 18 Gittelsohn, A. 6 Gohagen, J. 82 Goldberg, J. 105 Goldberg, T. 18 Goldfarb, M. 14, 18, 61, 62, 63 Goldman, F. 105 Goldman, L. 49, Gollub, J. 23 Gonnella, J. 132 Gore, S. 50 Gortmaker, S. 50 Grambowski, D. 19 Gravenstein, J. 144 Gray, L. 38 Greenberg, J. 93 Gridley, G. 130, 13 Grossman, M. 50, 52, 105 Groth—Juncker, A. 67, 68, 74, 75 Groves, R. 128 Grundy, B. 118, 144 Gustafson, D. 118 Habermacher, J. 94 Hadley, J. 50, 118 Hagan, M. 12, 19 Halliday, H. 63 Hallstrom, A. 82, 102, 104, 105 Halpern, S. 38 Harrel, F. 118 Handelsman, H. 82, 83 Hanley, J. 132 Haring, O. 122 Harkey, P. 68 Harrington, C. 19 Harris, P. 50 Hartley, R. 140 Haug, M. 144 Havighurst, C. 94, 95, 145 Hay, J. 38 Heinemann, G. 69 Hemelt, M. 19 Hendrix, T. 83 Hengst, A. 122 Herdman, B. 62 Hershey, J. 128 Hetherington, R. 95 Hibbard, J. 145 Hielma, F. 68 Higgins, C. 62 Hodge, M. 95 Hodgson, T. 132 Holland, D. 83 Holland, J. 89 Holub, D. 73 Hopkins, J. 106, 110 Horgan, C. 19, 29, 106, 136, 145, 151 Hornbrook, M. 20, 62, 63, 64, 132 Howell, J. 96 Howland, K. 135 Hu, T. 132 Hughes, 5. 68 Hulka, B. 118 Hyde, J. 52 Imershein, A. 145 Jackson, G. 38 Jacob, M. 152 Jacobs, P. 14 Jaffe, R. 24 Jansen, G. 51 Jaramillo, P. 146 Jarvis, M. 68 Jette, A. 46, 67, 91 Johnson, L. 51 Johnson, 5. 118 Johnston, C. 97 Johnston, M. 146 Jonas, S. 96 Jones, E. 69 Jones, D. 20 Jones, G. 130 Jones, P. 63 Jones, R. 12 Jones, 5. 63 Juris, H. 38 Juster, R. 21 Kalsbeek, w. 130 Kane, R. A. 68, 69 Kane, R. L. 25, 68, 69, 119 Kasper, J. 13, 20, 32, 132, 142, 146, 154 Katz, S. 21, 51, 69 Keeler, E. 46 Kelly, J. 24, 63, 64, 96 Kendall, P. 51 Kidder, D. 39 Kingsdale, J. 64 Kirchner, C. 21, 36 Kiyak, A. 14, Kiyak, H. 24 Knapp, D. 119 Knaus, w. 9, 30, 61, 119, 136, 147 Koepsell, T. 6, 8 Kokiko, E. 6 Komaroff, A. 113, 106, 109, 119, 120, 123 Kominski, G. 21 Konrad, T. 142, 147 Kristein, M. 96 Kroger, M. 70 Kronenfeld, J. 106 Kropf, R. 93 Kurowski, B. 69 Kviz, F. 147 Ladimer, I. 96 Lambert, w. 6 Langberg, N. 88 Langwell, K. 147, 148 Lanning, J. 21 Lannom, L. 136 Lattinq, J. 148 Lavin, B. 144 Lawler, E. 39 Lawson, W. 22, 26, 29 Lawton, M. 67 Ledley, R. 107 Lee, H. 64 Lee, L. 37 Lemperle, B. 83, 84, 85 Levy, J. 12, 65 Lewin, L. 39 Lewit, E. 52 Lichtenstein, R. 39 Liebowitz, B. 67 Lindberg, D. 133 Linz, D. 150 Livieratos, B. 74 Long, M. 22 Lonnquist, L. 143 Louis, D. 132, 133 Lovett, J. 22 Lowy, L. 48 Lubeck, D. 52 Ludke, R. 134 Luft, H. 22, 64, 148 Luke, R. 64 Maatsch, J. 39 Mabe, P. 93, 135 Mackenzie, E. 107 Madoff, J. 52 Maerki, S. 38, 64 Mahalak, D. 69 Maloney, S. 120 Manard, B. 39 Manny, E. 86 Manseau, w. 97 Manuel, R. 148 Marks, E. 98 Marks, H. 81 Marshall, R. 40 Martin, J. 97 Marvel, H. 53 Maturi, V. 6 Maurana, C. 143 Mazzuca, S. 134 McCabe, G. 10, 134 McCusker, J. 68, 75 McDonald, C. 7, 10, 107, 120, 134 McManus, P. 134 McNeil, B. 86, 132 McPherson, K. 31 MEDIPHOR 7 Melnick, G. 37 Meiners, M. 13, 23, 69, 132 Mennemeyer, S. 39 Meyer, T. 148 Meyers, S. 35, 127, 148 Meyers, T. 52 Milgrom, P. 14, 24 Miners, L. 149 Monheit, A. 16, 24, 40, 149 Moore, P. 107 Moore, 5. 148 Morlock, L. 40, 65 Morris, J. 48, 71, 72 Morrisey, M. 70, 97 Moscovice, I. 60, 64 Mudgett, C. 107 Mueller, C. 24, 41, 149 Murphy, J. 40 Murt, H. 57 Mushlin, A. 120 Myrick, J. 107 Nagel, E. 108 National Center for Health Services Research 1, 2, 53, 70, 86, 87, 108 National Center for Health 157 Statistics 2 Nathanson, C. 65 Nations, M. 53 Needleman, J. 24, 72 Neumann, B. 24 Newacheck, P. 47, 134 Newhouse, J. 40 Newman, M. 108 Newport, J. 149 Nichols, A. 97 Nikias, M. 53 Novack, A. 149 O'Brien, J. 64 odoroff, C. 134 Okada, Y. 55 Oliver, D. 36, 4O ouslander, J. 25 Palmer, R. 121 Pantell, R. 149 Pappius, E. 109, 123 Papsidero, J. 21, 69, 70 Parsons, D. 53 Pass, T. 7, 106 Payne, B. 134 Peddecord, K. 121 Penrod, S. 150 Peoples, M. 53 Perry, H. 36, 41 Perry, 5. 87 Pescosolido, B. 150 Pierskalla, W. 65 Plaska, M. 97 Podgorny, G. 108 Poe, G. 135 Politser, P. 150 Pope, C. 145 Potter, L. 54 Pozen, M. 103, 109, 111, 121, 122, 135 Predhomme, J. 42 Price, J. 41 Pryor, D. 54, 87, 122 Puskin, D. 97 Putnam, s. 152 Queen, 5. 59 Rabinowitz, M. 65, 66 Rafferty, J. 20, 62 Rappoport, A. 7 Raskin, I. 98 Ray, w. 122 158 Reed, W. 54, 150 Rettig, R. 98 Reverby, S. 41 Rice, D. 98 Rice, T. 25 Richardson, W. 150 Risley, T. 70 Rogers, J. 122 Roghmann, K. 122 Romm, J. 41 Rosati, R. 56, 123 Rose, J. 118 Rosenblatt, R. 64 Ross, C. 54 Rossiter, L. 25, 26, 27, 43, 135, 137, 150, 151, 153 Rothert, M. 70 Ruchlin, H. 71 Ruefli, T. 99 Rupp, A. 27 Russell, L. 54 Rushing, W. 151 Ruth, R. 98 Rutow, I. 123 Saint Louis, P. 55 Salkever, D. 27, 29 Sall, L. 28 Salomon, M. 26 Sandifer, F. 132 Sapolsky, H. 28 Scanlon, W. 71, 93 Schaffner, W. 151 Scheffler, R. 28, 123 Scheib, B. 109 Schlenker, R. 73 Schoeman, M. 89 Schwartz, W. 41, 42, 139, 152 Schweitzer, S. 30 Scott, W. 117 Sechrest, L. 135 Seipp, C. 142 Selden, J. 65 Shachtman, R. 57 Shapiro, S. 125 Sheiner, L. 28 Sheldon, G. 14, 60, 92 Isherman, H. 106, 109, 123 Sherman, M. 98 Sherwood, S. 71, 72 Shoemaker, W. 7, 106, 109, 110 Showstack, J. 55 Shukla, R. 42 Siegel, C. 8 Siegenthaler, L. 152 Silver, G. 98 Silverhus, S. 150 Simborg, D. 8 Slesinger, D. 55, 135 Sloan, F. 11, 18, 28, 99 Smale, J. 59 Smith, D. 72 Soboroff, S. 123 Soumerai, S. 140, 152 Spielberg, L. 55 Spiker, A. 68 Spindler, M. 15 Stamps, P. 152 Stancavage, F. 43, 44 Stead, E. 8 Steel, K. 56 Steiner, P. 72 Steinwachs, D. 27, 29 Stevens, R. 21 Stewart, T. 110 Stiles, G. 56 Stiles, w. 152 Stokes, J. 110 Storbeck, J. 99, 102, 110 Sudman, S. 135, 136 Sussman, E. 116 Swan, J. 19 Swart, J. 42 Sytkowski, P. 29, 103, 111 Taylor, A. 12, 19, 27, 29, 30, 32, 141, 145, 153 Taylor, R. 121 Thompson, J. 124 Thompson, M. 124 Tompkins, R. 8 Trapnell, G. 23, 72 Trauner, J. 148 Traxler, H. 68, 73, 89 Trivedi, V. 42, 99 Trobaugh, G. 102, 103 Trobe, J. 42 Tugwell, P. 124 TYnan, E. 73 Unterharnscheidt, A. 56 Urban, N. 90 Valiante, J. 30 Valinsky, D. 65, 66 Vogt, T. 30, 56 Wagner, D. 9, 30, 61, 124, 125, 136 Wagner, E. 57 Wagner, G. 111 Wagner, J. 30 waitzkin, H. 153 Walden, D. 16, 20, 30, 31, 32, 135, 136, 154 Wallace, A. 56 Walsh, J. 6 Wan, T. 73, 74 ward, M. 42 Warner, K. 57 Waxman, B. 9, 78, 87, 88 Weed, L. 42 Weinberger, M. 57 Weiner, S. 99 Weinstein, M. 136 weisman, C. 43 Weissert, W. 73, 74 Wenchel, H. 88 Whnnberg, J. 31, 125 Werner, J. 102, 103 Whrtheimer, A. 60 Weston, J. 43 Wheeler, J. 31 White, W. 100 Wiederhold, G. 9 Wilensky, G. 16, 19, 20, 27, 30, 31, 32, 43, 127, 136, 137, 141, 142, 145, 151, 153, 154 Willemain, T. 74, 125 Williams, S. 154 Wilson, E. 9 Wilson, G. 10 Wilson, R. 146 Wilson, S. 43, 44 Wineland, T. 30 Wise, L. 43, 44 Wood—Dauphinee, S. 125 Wolf, G. 149 Wong, R. 154 Wortman, P. 88, 125, 137 wyszewianski, L. 126 Yeaton, W. 88, 125, 137 Yesalis, C. 32, 33 Zalkind, D. 57 Zastowny, T. 122 Zimmer, J. 74, 75 Zimmerman, H. 33 Zimmerman, J. 10 Zucker, L. 33 Index of Abbreviated Titles A Access to care indicator comparisons 146 Access to medical care—-dimensions 139 Access to services by the urban elderly 150 Active life expectancy 51 Administrative strategies in prescription drug use 139 Administrative technology impact on acute bed need 97 Admission diagnoses and house officer's 121 Admission practice improvement in acute heart disease 122 Advanced life support costs vs. benefits Alameda County health study 46 Allocative medicine efficiency, disease severity, experience 109 and the payment mechanism 20 Alternative birthing center evaluation study 113 Ambulatory blood pressure monitoring 78 Ambulatory Ambulatory Ambulatory Ambulatory software 10 Ambulatory 106 Ambulatory Ambulatory 107 Ambulatory mental health services from specialty 106 Ankle sprain treatment approaches 123 Antibiotic prescribing in office practice 151 106 124 medical audit demonstration 121 record specification with MESCH care cost—effective strategies care evaluation requirements care care care sources and utilization models EEG monitoring 79 medicine decisions providers Antibiotic resistance costs and control 49 Anticholinergic toxicity risk in the elderly 141 Antigastroesophageal reflux implantation 83 Antismoking campaign and deaths avoided 57 Antismoking policies’ benefits and costs 57 Antitetanus prophylaxis in hospital emergency 115 Antitrust enforcement in medical services industry 94 Antitrust law contributions to procompetitive health policy 94 APACHE severity of disease measure: Initial international use 124 Medicare reimbursement and APACHE II 125 Apheresis for treatment of Goodpasture's syndrome rooms and glomerulonephritis 82 159 Apheresis in chronic relapsing polyneuropathy 82 Apheresis used in preparation for kidney transplant 83 Assimilation effect on Hispanic fertility patterns 55 Attitude scale to measure patient satisfaction with medical care 152 Automated ambulatory medical record systems in the U.S. 9 Automated clinical chemistry analyzers 81 Automated data matching procedure 4 Automated hospital data management system evaluation 59 Automated Automated Automatic home 82 Automatic information system cost method 15 record summaries' experiment 122 defibrillation potential use in the external defibrillator sensitivity 79 Baltimore hospital growth history 64 Behavioral outcome in head injury 115 Behaviorally linked location hierarchies 99 Benefit and cost analysis in geriatric care 11 Birthweight and prenatal care 55 Black and white elderly's health services utilization 141 Black physicians’ location and career practices 38 Board certification's economic advantages 43 Burn care facility study 134 Burn severity and institution effects on cost of care 31 Burn unit outcome bias 114 C Cancer Information Service evaluation 45 Capital acquisition by nonprofit hospitals 96 Capital cost, rate of return, and investment decisions 14 Capital expenditures of hospitals: Committee resource allocation implications 30 Programs to limit 30 Capitation payment for pharmacy services: Cost impact 33 Impact on use and dispensing behavior 32 Carbon dioxide breath test for diagnosing bile 160 acid malabsorption 83 Carbon dioxide breath test for diagnosing fat malabsorption 83 Carbon dioxide lasers in head and neck surgery 83 Cardiac arrest and resuscitation in children 104 Cardiac arrest out of hospital: Basic emergency services failure 103 Improved survival with paramedic services 104 Long—term survival 104 Predicting survival with ACLS score 104 Rapid defibrillation treatment 103 Cardiac arrest survivors’ health status 101 Cardiac care setting's impact on use, outcome, and costs 29 Cardiac procedures study released 59 Cardiac testing decisions using computer—assisted models 5 Cardiokymography 7B Caregiver strain in long—term home care 67 Catastrophic health expense and State options 24 Catastrophic illness and spinal injury 20 Catastrophic illness study in Maine 15 Certificate-of—need and health planning methodology 90 Certificate—of—need regulation impact on health 93 Cesarean patient and hospital characteristics 61 Charges for children's dental care visits 22 Chemotherapy infusion pump implant 78 Child health under Medicaid 48 Child health policy implementation study 91 Childhood disability trends 134 Children's health, access to services, and quality of care 116 Children's health determinants 50 Cholesterol, children, and heart disease 46 Chronic disease and disability risks 47 Chronic disease data bank 5 Clinical and managerial data analysis 3 Clinical decisionmaking operational failures 121 Clinical laboratory cost reduction 28 Clinimetrics development 131 Closed—loop blood glucose control device 77 Cognition and patient—physician communication 150 Collective bargaining impact on hospital cost 27 Communication and clinical implications of social scientific research 153 Communication in a family medicine setting 110 Communication with children and parents 149 Community cardiopulmonary resuscitation 102 Community health center cost effectiveness 97 Community health center economic analysis 105 Community health center information guide 97 Community response to 911 system 104 Competition and insurer—provider relationship changes 16 Competition as means to contain dental costs 14 Competition between nonprofit and for—profit insurers 11 Competition implications of State dental practice acts 92 Competition in health service delivery/financing: Bibliography 148 Future research needs 147 Policy issues 147 Competition's role in health services market 95 Competitive tying arrangements in medical insurance 11 Computer audit to improve drug prescribing 142 Computer—based medical records in ambulatory practice 3 Computer-based monitoring of blood pressure 3 Computer enhanced perimetry 77 Computer medical record randomized trial 7 Computer voice answerback in health care 7 Computerized drug order review 8 Computerized drug profile evaluation 8 Computerized drug profiles (Seattle experiment): Prescribing practices and resource use 6 Provider effects 6 Computerized measurement algorithm in postoperative shock 7 Computerized medical information systems for hospitals 6 Computerized medical record effect on test ordering 10 Computerized protocols in emergency care 5 Consumer knowledge of health insurance 136 Consumer representation——attaining influence 148 Coordination and input uncertainty in emergency units 59 Coronary artery bypass surgery 87 Coronary artery bypass graft surgery trials 125 Coronary artery disease databank evaluation 123 Coronary disease and nonfatal infarction 50 Coronary disease likelihood estimation 54 Coronary disease outcomes of ischemic events 51 Coronary stenosis and prognostic significance 51 Corporate attitudes toward health care costs 28 Cost accounting for pharmaceutical services 17 Cost containment strategies for HSAs 21, 22 Cost containment through sharing multihospital systems and health systems agencies 22 Cost control incentives in an IPA-HMO 12 Cost—effective methods for collecting health data 136 Cost of cigarette smoking 30 Cost of illness methodology guide 132 Cost of illness methodology synthesis 132 Cost of incontinence 21, 25 Cost shifting in hospitals 18 COSTAR guide and system description 6 COSTAR system implementation in California 9 Cough and community—acquired pneumonia 113 CPR complications 108 CPR prescribing survey of physicians 55 CPR Q a A 108 CPR telephone instruction 101 Cranial CT scan use appropriate 86 Cultural context of children's illness 53 D Data base approach to evaluate technology 8 Data collection and evaluation research 131 Data needs of local health departments 6 Day care services effects and costs 74 Decision analysis approach to influenza vaccination 57 Decision analysis with computerized algorithm 9 Dental care demand estimates for over—65 population 143 Dental charges and sources of payment 26 Dental education and prevention compliance 53 Dental radiology overview and primer 86 Dental services expenditures from NMCES 26 Dental services price variation determinants 11 Dental services use, expenditures, and payment sources 25 Dental utilization review system evaluation 140 Deregulating the health care industry 94 Design effect and relative variance curve strategy 129 Design effect variation in NMCES 129 Diabetic children’s parents and medical compliance 51 Diabetic retinopathy risk factors 56 Diathermy as a physical therapy modality 84 Diet regimen compliance 51 Differential attrition effect on technology evaluation 88 Disability effects on individuals and households 151 Discharge after acute myocardial infarction 122 Disease staging—-a casemix measurement 132 Disease staging severity measurement approach: Coded staging criteria 133 Medical staging criteria 133 Reabstracting study 133 Staging software users' manual 133 161 Distribution effect on medical group equilibrium price 18 Divorce effects on women's health care and insurance 12 Doppler ultrasound method of cardiac output monitoring 77 ORG—based payment and hospital cost control 31 D865 and disease staging for reimbursing Medicare patients 14 Drug interaction facts 7 Drug policy in aging society 139 Drug prescribing and evaluations in a skilled nursing facility 124 Drug prescribing by clinical pharmacists 124 Drug prescribing quality and length of hospital stay 119 Drug revolution places prescribing practices in question 140 Drug therapy decision improvement through education 140 Dysuria in women 119 Economic analysis of health legislation 37 Economic assessments of medical practices, technologies 136 Economic considerations of testing donor blood to reduce hepatitis incidence 20 Economic impact of nurse practitioner—patient delegation patterns 37 Economic response to poor health in older men 53 Economics of hospital reimbursement 20 Economics, ownership, and financing of nursing home care 18 Education effect on drug utilization 148 EEG monitoring during open heart surgery 78 Effectiveness of advanced versus basic EMTs 109 Elderly health policy issues 98 Elderly veterans’ use of health services 145 Elderly’s knowledge of their health insurance coverage 13 Electrotherapy for facial nerve paralysis 87 Electroversion therapy for treatment of alcoholism 78 Emergencies treated with/without algorithm 106 Emergency alarm system for elderly: Cost—benefit analysis 71 Factors/effects of acceptance 68, 71 Operational manual 71 Service needs of persons living alone 71 Standardized scales for LTC populations 72 Usage and acceptance by frail elderly 48 Emergency care changes surveyed 105 162 Emergency resuscitation comparison with colloids and crystalloids 109, 110 Emergency medical services research, 1979-81 108 Emergency medical systems management models 110 Emergency medical technician defibrillation 103, 104 Emergency resuscitation algorithm trial 106 Emergency room referral system evaluation 102 Emergency service system effectiveness 105 EMS algorithm system evaluation 108 EMS and health planning research and policy integration 93 EMS system development in rural areas 110 EMS systems goal programming model 102 Employment—related health insurance coverage 16 EMT decision assessment parameters 109 EMT performance assessment with clinical algorithms 101 End—stage renal disease planning 98 Endocardial electrical stimulation 80 Estimate comparison on health services expenditures 135 Estimated data collection organisation effect in NMCES 129 Estimation strategies applied to NMCES data 129 Evaluation in medical research synthesis 137 Evaluation of an HMO formulary and pharmacy 13 Evaluation of strategies to control health care costs 98 Excise taxes’ potential to reduce smoking 52 Expenditures for health care 16 Expenditures out of pocket for personal health services 27 External counterpulsation 84 External infusion pump for heparin 87 External open—loop pump for insulin infusion 80 Extramural research bibliography 1983—84 1 Eyeglass/contact lens purchases, expenditures, and payment sources 30 Fact sheets, program notes, and technical notes (NCHSR) 1 Factor score estimation from criterion—weighted matrices 131 Family psychosocial predictors of child health care use 54 Family unit analysis in NMCES 130 Family's demand for health 149 Financial burden of high cost illness 22 Financial incentives for diagnostic and preventive care 151 Financially distressed hospital characteristics 64 Financing study of low~vision services 21 Foreign medical graduates' demographic characteristics 36 Gender roles, illness orientation, and health services use 145 Generic drug legislation evaluation 18 Generic drug legislation impact in Kentucky 15 Geographic distribution changes of certified physicians 41, 42 Geriatric day care and homemaker services experimental study 74 Geriatric home care study 74 Government and health care financing 32 Grants/contracts (NCHSR) active 1978-84—-year1y reports 1, 2 Harder data for quality assurance 116 Health assistants in long—term care 70 Health behavior in pregnancy 45 Health care of poor elderly——supp1ementing Medicare 141 Health care of working poor 141 Health care services utilization among older adults 144 Health hazard/health risk appraisal assessment 45, 57 Health information system transferability 5 Health maintenance organizations: Factors influencing viability 92 Operations and performance 148 Health professional manpower effectiveness 39 Health promotion bibliography 53 Health services research/technology center 133 Health services use research bibliography 143 Health services utilization assessment at the U.S.—Mexico border 143 Health status consequence of health practices 54 Health status measures research 53 Health survey research methods 128, 135 Health technology assessment reports 1981—84, compiled yearly 86 Health United States, 1980 2 Heart disease mortality rate decline 49 Heart disease prevention benefit—cost analysis 52 High cost illness among hospitalized patients 12 Hip fracture care in nursing homes 68 Hispanic health services bibliograhy 146 Hispanic health services research conference 94 Hispanics' utilization of ambulatory health services 107 Holistic health center characteristics 149 Home care team effects on terminal care 75 Home health care team trial 67 Homemaker services cost effectiveness 74 Hospital ancillary services utilization: Blood banking policies 66 Microscopy laboratory planning 65 Misplaced patient transfer procedure 66 Radiology scheduling 66 Total system model 66 Hospital behavioral model test 63 Hospital capital stock 63 Hospital casemix definition, measurement, use: Conceptual framework 62 Alternative measures 62 Hospital classification’s foundation 64 Hospital competition potential 64 Hospital Cost and Utilization Project 63 Hospital cost containment and county budget crises 33 Hospital emergency services 105 Hospital employees' absenteeism and turnover 41 Hospital employees' wages and labor unions 37 Hospital formulary effects on cost control 60 Hospital information systems workbook 3 Hospital local area communication network 8 Hospital—medical school affiliation analysis 40 Hospital—nursing relationship history 41 Hospital organization empirical research: Codes and abstracts file 59 Synthesis (1960—79) 59 Hospital personnel market 36 Hospital pharmacotherapy efficacy and cost containment 152 Hospital pharmacy practice in the future 5 Hospital productivity research synthesis 92 Hospital response to economic regulation 92 Hospital services coordination case study 62 Hospital/State agency processing of Medicaid claims in Washington 60 Hospital structure, values, and innovation—— comparative study 65 Hospital unionism impact 38 Hospital unionization cost implications 27 Hospital use determinants 62 Hospital volume-outcome relationships: Diagnostic categories 117 other hospital characteristics 117 163 Household— vs. provider-reported medical care diagnoses 130 Household wealth and insurance as protection against medical risks 16 HSA's expenditure data development and use 97 Hyperbaric oxygen for actinomycosis 84 Hyperbaric oxygen for cerebral edema 85 Hyperbaric oxygen for crush injury or peripheral ischemia 84 Hyperbaric oxygen for peripheral vascular insufficiency 84 Hyperbaric oxygen in treatment of severed limbs 85 Hysterectomy benefits, risks, and costs 46 Hysterectomy cost—effectiveness analysis 47 Iatrogenic disease and geriatric medicine conference 56 Iatrogenic disease bibliography 56 Illinois trauma system 105 Illness behavior in midlife women 47 Impact of pharmacokinetic laboratory on physician prescribing 114 Impact of serum level data provision to physicians 114 Implantable pump for chronic heparin therapy 07 Improving drug prescribing: Family practice 144 Primary care 117 Improving efficacy of clinical decisions 117 Imputation strategies for partial NMCBS data 129 Index of Medical Underservice consumer survey evaluation 147 Informal long—term care assistance to elderly 67 Information source ratings and preventive medicine decisions 57 Information sources' influence on medical decisionmaking 47 Informed consent and medical information seeking 48 Initial medical interview's verbal exchange structure 152 Injury severity scales and future research 107 Inpatient services use, expenditures, and payment sources 29 Insurance benefit and premium variations 32 Insurance coverage and dental care demand 149 Insurance coverage of persons with activity limitations 12 Insurance coverage under multiple policies 31 Insurance effects on dental treatment patterns 164 for elderly patients 14 Insurance effects on employer group dental expenditures 19 Insurance for unemployed 149 Insurance impact on physician practice 19 Intensive care in the U.S. and France 147 Intensive care unit charges and resource consumption 30 Intensive care use in university and community hospitals 61 Interstate differences in certificate—of-need decisions 89 Intervention effect in physician prescribing 151 Interviewer attitudes toward NMCES methodological issues 131 Interviewer characteristics and survey performance 127 Intraoperative ventricular mapping 79 Investment behavior in community hospitals 61 Investment criteria for critical care units 98 J, K, L Judicial review of health care planning and capital expenditures review 90 Laboratory quality assurance evaluation 121 Lactose breath test for diagnosis of lactose malabsorption 85 Lactulose breath test for bowel overgrowth or transit time 85 LAMP data management system 7 Lead poisoning screening approach 54 Legal constraints’ effects on dental care prices 92 legal issues in health care 95 Legal issues in hospital planning 99 Liver transplantation 77 Log—linear model application to statistical record linkage 134 Local hyperthermia for superficial or subcutaneous lesions 85 Long—term care and State program design: Bibliography 72 Cost containment issues 72 Expanding efforts in care 72 Long—term care client needs assessment and quality assurance programs 69 Long-term care data archive development 69 Long—term care extramural research supported by NCHSR 70 Long—term care institutionalization study 67 Long—term care insurance: Emerging market 23 Premium estimates for prototype policies 23 Private sector role 23 State of the art 23 Study procedures manual 72 Long—term care studies bibliography 70 Long-term care values 69 Long—term home care program evaluation 66 Low-risk monitor patient identification in intensive care 124 Malpractice arbitration case studies 96 Malpractice law reform by consumer choice 95 Mandatory licensure of nurses 100 Marital/household status and elderly’s health services use 142 Market form comparisons of hospital foods 61 Massachusetts Health Care Panel Study prevalence findings 91 Maternal and child health research review 98 Maternity and infant care project evaluation 53 Maternity care center safe for women, babies 120 Measurement and assessment of the elderly 68 Measures of expenditures for health services analysis 135 Medicaid and children's dental services use 24 Medicaid nursing home reimbursement policies, rates, and expenditures l9 Medicaid population changes 32 Medicaid reimbursement effects on nursing home services 70 Medicaid role, health care, and the poor 153 Medical audit criteria 115 Medical care and geographic variations in mortality rates 50 Medical care and health improvement 50 Medical care satisfaction reevaluation 122 Medical care use in health manpower shortage areas 141 Medical career decision study 44 Medical equipment purchases, expenditures, and payment sources 19 Medical group practice under competition 26 Medical information effects on hospital costs 14 Medical information systems design methodology 4 Medical pluralism and the structure of decisionmaking 150 Medical practice variations: Implications for health policy 91 Proposal for action 125 Medical specialty exams' predictive validity 39 Medical specialty test model 39 Medical technology industry and government policies 88 Medical test yield evaluation 118 Medicare participation decision and physician—induced demand 25 Medicare reimbursement rate impact on induced demand 25 Medigap insurance and reducing Medicare deficits 29 MEDIPHOR system development and evaluation 4 Methodologies for delineating hospital service planning areas 128 Methodologies for regional health planning 128 Methods comparison for complex survey standard errors 128 Migrant agricultural workers in Wisconsin 135 Miners' medical program and the mainstream 142 Minorities, poverty, and the uninsured 154 Minority aged's health status and access to care indicators 141 Minority aged's regular source of care 140 Minority older populations—-similarities and differences 148 Mobile intensive care effectiveness 111 Moral acceptability of rationing by age 115 Morbidity cost estimates and economic determinants 27 Mortality rate differences among hospitals 63 Mortality rate economic analysis 118 Multihospital system issues and empirical findings 61 Multiinstitutional systems' performance evaluation 65 Multiproduct firm behavior of the nonprofit hospital 62 Myocardial infarction prediction in emergency rooms 103 National Health Care Expenditures Study bibliography 28 Navajo ambulatory care utilization 107 Nd:YAG laser for posterior capsulotomies 79 Negative pressure respirators 79 NMCES data source comparisons 132 NMCES estimation and household survey sampling variances 130 NMCES estimation and sampling procedures 130 NMCES household interview instruments 127 NMCES methodological issues 127, 136 NMCES methodological overview 137 Nonresponse levels in NMCES 128 Nurse practitioner prescribing and structural 165 autonomy 89 Nurse practitioners/physician assistants: Bibliography 38 Changes——where and why 43 Distribution implications 43 Evaluation of study findings 41 Role ambiguity 43 Nurse supervisors and role expectation relationships 36 Nurse task delegation measurements 42 Nurse utilization systems model 42 Nursing directors' perceptions of supplemental nurses 42 Nursing home control patterns 72 Nursing home cost determinants 23 NUrsing home costs and policy implications in Florida 73 Nursing home market theory 71 Nursing home meal service 70 Nursing home patient outcome prediction 119 Nursing home payments to encourage appropriate care 69 Nursing home quality incentives: Survey—based index for reimbursement 125 Systems design 125 Nursing home reimbursement research 73 Nursing home residents' nutrient intake 70 0 Observer methods use in EMS research 135 Obstetrical care patterns in hospitals 64 Obstetrical practice and perinatal outcome 6 Occupational choice and earnings 38 Occupational licensure and nursing labor utilisation 40 Ophthalmic technicians' impact on eye care 42 Optimization decisionmaking models 9 Organizational response of hospitals to regulation 92 Organizational strategies and quality of ambulatory care 126 Outcome assessment for nursing home patients 69 Outcome—based reimbursement for nursing home care 69 Outcome evaluation from intensive care 119 Outcome incentives for nursing homes 74 Palpation, thermography, and mammography effectiveness 82 Pancreas transplantion 77 Paramedic services for cardiac arrest 101 166 Parental smoking effects on children's medical care use 56 Parkside quality-of—worklife project failure 39 Patient care quality assurance system 117 Patient statements on doctors and medical care significance 115 Paying several physicians for treating an illness episode 31 Payment method effects on mental health care 27 Payment per case vs. per service in Maryland 29 Payment/subsidies for hospital care 28 Pediatric health care quality 122 Percutaneous transluminal angioplasty 80 Personal health practices and mortality among elderly 46 Pharmacies' structural characteristics associated with innovative behavior 143 Pharyngitis 119, 120 Pharyngitis in adults 119 Photokymography 78 Physician assignment rates by type of service 25 Physician assistant deployment and career trends 41 Physician assistant practice characteristics 40 Physician assistant student characteristics 36 Physician assistant survey results 36 Physician choice of patient load and treatment mode 144 Physician contacts in ambulatory settings 32 Physician effectiveness in preventive care 49 Physician—induced/physician—initiated demand: Alternative measurements 153 Relative importance in medical care demand 137 Role in health services use 153 Role in physician services use 151 Physician job satisfaction and retention in correctional programs 39 Physician job satisfaction measurement in organized settings 39 Physician—nurse practitioner team effectiveness determinants 35 Physician prescribing behavior sources of influence 140 Physician specialty distribution by gender 43 Physician supply and distribution issues for state policymakers 39 Physician visit charges and sources of payment 26 Physician visit determinants and magnitude in the U.S. 153 Physicians' activities in urban hospitals 38 Physicians' career development 40 Physicians' future 42 Physicians’ perceptions about unnecessary diagnostic testing 154 Physicians' practice survey nonresponse 35 Physicians' view of social change 36 Place of death and patient characteristics 68 Placebo effect is statistical regression 134 Plan implementation in health systems agencies 91 Planning and antitrust law implied by 535 Hospital case 95 Planning hospital service criteria with casemix method 93 Planning manual for BSA: 96 Planning model for primary care manpower 99 Planning model for regional hospital inpatient service 98 Planning of cardiac care units 93 Planning review of medical information systems 95 Plasma perfusion of charcoal filters 79 Political action committee contributions to Congress 37 Poor, sick, and uninsured 32 Predicting course of nursing home patients 69 Predictive instrument's usefulness to reduce CCU admissions 135 Pregnancy outcome study 114 Prehospital cardiac resuscitation complications 108 Prescribed medicines: Findings from NMCES 26 Use as proxy indicator of access and health status 146 Use, expenditures, and payment sources 20 Preventive care as health strategy 54 Prevention economics 54 Primary care health services research 108 Primary care health unit study 149 Primary care practice study 52 Primary medical encounter tests’ dollar rank order 109 Private contract vs. professional norms 145 Private health insurance: Cost sharing for insured under 65 16 Employee and family benefits 16 Employer and employee expenditures 29 Medicare population coverage 13 Medicare population’s out—of—pocket expenditures 13 Mental health services coverage 19 Premium expenditures and payment sources 13 Tax effect on expenditures 30 Procedures for evaluating technologies for Medicare 87 Productivity improvement in health care- conference 91 Professional activity study by CHPA 22 Professional organization impact on quality of care 117 Professional regulation in optometry 89, 90 Prognostic implications of ventricular arrhythmias 47 Program notes——NCHSR reports in NTIS 1 Programming model for nursing service budgeting 99 PROMIS (automated medical information system) expansion 4 Prospective capital reimbursement system components 24 Prospective evaluation models for physician referral 134 Prospective reimbursement of hospital capital costs 24 Provider response and dentistry cost for the elderly 24 Proxy reporting usefulness in economic survey of physicians 127 Psychiatric hospital unit systems 65 Psychotropic drug expenditures and payment sources 13 Psychotropic drug use by males and females 148 Public general hospital patients 60 Public schools, health care, and the handicapped child 143 Public service employment in health 40 0 Quality assessment and dental practice profiles 113 Quality assessment and monitoring: Criteria and quality standards 116 Definition and approaches 116 Quality assessment measures in EMS 114 Quality assessment process criteria 116 Quality assurance in group practices 121 Quality assurance mechanism trial 120 Quality assurance strategy for primary care 120 Quality in health care delivery 120 Quality of ambulatory care and discrepancy between criteria and performance 118 Quality of care and problem-oriented assessment design 113 Quality of care assessment criteria 116 Quality of care in acute myocardial infarction 124 Quantification of critical illness/injury 128 167 Radiographic examination of the colon 83 Radionuclide angiography in coronary artery disease diagnosis 81 Radionuclide angiography indicators for coronary prognosis 87 Rate regulation impact analysis 60 Rate regulation strategy for hospital cost control 99 Rate regulation, unionization, and hospital labor demand 37 Rate review effect on hospitals 97 Rationing hospital care 139, 152 Receiver operating characteristic curve method for area comparison 132 Redistributions of revenue in prospective payment systems 21 Rehabilitation day hospital evaluation 15 Regulating bed supply in nursing homes 93 Regulating health professionals 93 Regulating hospital capital investment in Massachusetts 96 Regulation effects on computed tomography diffusion 90 Regulation of investment in long—term care facilities 71 Regulation, reimbursement, and hospital finances 99 Regulatory effects on teenage smoking 52 Research Activities (NCHSR) 1 Research agenda on border health 97 Resource allocation in special care networks 154 Resuscitation with and without an algorithm 110 Rhode Island catastrophic health insurance program 33 RX Project: Discovery, confirmation, incorporation of data base causal relationships 3 Medical knowledge and clinical data banks 9 Rural consumer attitudes toward physician advertising 147 Rural emergency evaluation method 111 Rural emergency medical coordinators 107 Rural emergency medical service development 111 Rural hospital contribution to local economies 60 Rural hospital economic issues 60 Rural hospital viability 64 S Seattle prepaid health care project 150 Screening/treatment's impact on child health care 168 use 55 Segmental professionalization in pediatric medicine 38 Self—care as substitute, supplement, stimulus, for formal medical care 48 Self—care practices in the U.S. 49 Self-regulation by doctors 94 Senile dementia, policy, and adequate care 67 Severity and quality indexes for psychiatric emergencies 118 Severity of illness and intensive care/survival relationship 123 Sex differences related to roles, structure, and stressors in obtaining psychotropic drugs 142 SHARE-A—HOME: Dependent elderly’s residential alternative 68 Economics/logistics of living as "family" 73 Short procedure unit impact 12 Sickness impact profile development 90 Slack, natural slack, and location covering 99 Social ramifications of computer—based imaging in radiology 35 Social science and health services research 90 Social science research utilization in mental health 95 Social support and well—being 46 Social support mobilization constraints 48 Social support networks and elderly health 49 Social support networks and impact on health 45 Social support networks, patient status, and institutionalization 73 Socialization in residency programs 35 Software limitations in survey data analysis 4 Spatial distribution of regional hospital utilization 64 S—T elevation clinical relevance 56 Statistical validation of illness severity measure 136 State agencies' integration of health and human services 145 streptokinase infusion for acute myocardial infarction 80 Stress and Amish community transition 52 stress and utilization of health services 50 Stressor impact on daily mood 48 Stroke rehabilitation cost—effectiveness measurement .146 Sudden cardiac death 102, 103 Summary record system evaluation 8 Surgical decisionmaking and operative rates 123 Surveillance effects on community physician test ordering 123 Switzerland's incrementaliat model for deinstitutionalization 152 T TALENT Project physicians' career development 43 Tax expenditures and health insurance premium limits 32 Team care in stroke treatment 125 Telehealth network model in anesthesia 118 Telemedicine in anesthesia 144 Telemetry's effect on advanced life support care 102 Television consultation evaluation 63 Tennessee Medicaid recipients’ health care 144 Thermography for breast cancer detection 88 Third party quality assurance systems 113 Time and money role in demand for medical care 153 Time price effect on medical care demand 142 Topical oxygen for decubitis ulcers and skin lesions 85 Transcutaneous electrical nerve stimulation for acute pain 81 Transillumination light scanning in breast cancer diagnosis 88 Triage process and decision theory applications 107 uncorrelated variables’ use in small area estimation 131 Unemployment, health insurance, and medical care use 24 Uninsured and their use of health services 154 unionism effects on health insurance benefits 27 United Mine Workers' funds cutback and clinics’ responses 147 United Mine Workers’ health care coverage changes 143 United Mine Workers' health plan cost sharing 28 Use, evaluation, and logic of repeated medical tests 150 Usual sources of medical care and their characteristics 146 Utilization behavior and challenging M.D. authority 144 V Vaccine cost relationship to selected medical events 45 Variance estimation for complex survey data 130 VA medical care system and aging veterans 145 Veterans' health insurance coverage 22 Veterans' medical system-economic research issues 62 Veterans' overlapping insurance coverage 19 W, X, I, 2 Waiting times in different medical settings 146 Weighting strategy effects on household sampling units 130 169 Where doctors have gone 40 Who are the uninsured 20 who initiates physician visits 150 Women's community health care survey: Data processing, coding, editing 17 Instructions for listers and interviewers 17 Overview and design 17 Tape documentation 17 Women’s use of health services 142 X—ray selection protocol for extremity injuries 115 «His. Government Printing Office: lQSB—ZM—ZM/OOOOS tut-.- r A - fidfi zn- ' 1H UBRARV REHMU'DOCUMHHIHON L'finflTNQ 1 thunhu'hwqdmou PAGE NCHSR 88-54 ' ' _g3q 4. Title Ind mm. I. m M November 1988 Annotated Bibliography of NCHSR Publications 1980—84 s 7. MI) I. mm DonnaRae Castillo, Compiler MM".- .. Pom“ Drunk-don Mom. and Adams It hold/funk” Unh Io. DHHS, PHS, OASH, National Center for Health Services Research and Health Care Technology Assessment (NCHSR) "-°~*~dflD-'0~dflhlt Publications and Information Branch, 18-12 Parklawn Building «a N A Rockville, MD 20857 Tel.: 301/443-4100 m) / lenOn-nlutbnflomondm: XLYdeIWW s b In house ame as a ove u ‘Rst — a?" fl.hu*mmuwflmn ‘5SS DHHS Publication No. (PHS) 89-3433 “Sr “223‘ fl-ana(wmca»-ua) g§z§‘3»~ » The National Center for Health Services Research and He Technology Assessment (NCHSR) has supported research on ,iems related to the quality, cost, and delivery of health serv1ces since its inception in 1968. This bibliography, published as a historical reference during NCHSR’s 20th anniversary year, is the first comprehensive compilation of all NCHSR intramural and extramural publications for the years 1980 to 1984. Annotations from nearly 800 reports are included in this document and are arranged alphabetically by principal author in a general reference section and 12 specific subject areas. Examples of topics covered in the subject areas are listed at the beginning of each chapter. The subject areas covered are computer science applications; financing, costs, and expenditures; health care professionals; health promotion and disease preven- tion; hospitals (includes: care, services, and operations); long-term and nursing home care; medical technology assessments; planning, evaluation, and regulation; primary care; quality assurance and quality of care; research methods and models; and service delivery, access, and utilization. The bibliography is indexed both by abbreviated title and by \ principal author and up to two coauthors. r 17. Document mini: 0. Descriptor- NCHSR publication of research findings does not necessarily represent approval or official endorsement by the National Center for Health Services Research and Health Care Technology Assessment or the U.S. Department of Health and Human Services. b. Minna/0W Yam: bibliography, health services research, financing, health services delivery, utilization c. 003A" Hon/0091» ll. Availability Wu: 1’. Item"! Clu- (TNI m 11. Na. d m Releasable to the public. Available from the Unclassified 169 National Technical Information Service acumen-mar...) um Springfield, VA 22161 Tel.: 703/487-4650 Unc13551fjed ($00 ANSt—DQJO) loo lndwcuom on M arm». you 272 (#77) (Fmdy "115-45) MM 0' W DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service National Center for Health Services Research and Health Care Technology Assessment Parklawn Building, Room 18-12 Rockville MD 20857 Official Business Penalty For Private Use $300 OASH DHHS Publication No. (PHS) 89-3433 BULK RATE POSTAGE & FEES PAID PHSINCHSR Permit No. G-282