RESUMEN
The use of individual resource utilization scores to compare primary care physicians (PCPs) has become more commonplace as managed care organizations (MCOs) increase their penetration into the US healthcare market. This study looks at the validity and usage of these scores among a group of PCPs within a multispecialty clinic that is part of an integrated managed care network. Personal interviews were conducted with PCPs; and reviews were done of the practice site paper charts, the computerized visit record system of the clinic and affiliated hospital, and the MCO-supplied resource utilization data on the 25 patients of each PCP on whom the most healthcare dollars were spent in 1995. As of October 1996, few PCPs had done more than a cursory review of their resource utilization data. None had identified the patients who use the most resources or developed any methods to proactively manage those patients with a history of high utilization. The clinic's communication systems alerted the PCPs less than 50% of the time when patients for whom they were responsible had high utilization of services. Patients appeared to be assigned to the incorrect PCP more than 20% of the time. All players in this managed care network--PCPs, clinic administration, and the MCO--must work together to improve the current system before resource utilization data are considered valid and are incorporated more fully into clinical practice.
Asunto(s)
Recursos en Salud/estadística & datos numéricos , Programas Controlados de Atención en Salud/estadística & datos numéricos , Médicos de Familia/estadística & datos numéricos , Revisión de Utilización de Recursos , Eficiencia Organizacional , Humanos , Entrevistas como Asunto , Louisiana , Programas Controlados de Atención en Salud/economía , Auditoría Médica , Sistemas de Registros Médicos Computarizados , Aceptación de la Atención de Salud/estadística & datos numéricos , Médicos de Familia/normasRESUMEN
A retrospective study of 767 HIV positive patients from a large urban public hospital, 238 of whom were co-infected with syphilis, was performed to determine the prevalence of neurosyphilis. A prevalence of 3% of neurosyphilis in the co-infected cohort was demonstrated. The 7 cases of neurosyphilis ascertained were of the early stage variety, with cranial nerve involvement the predominant focal deficit. Of the 5 cases presenting after initial diagnosis and treatment of syphilis, 4 were felt to be inadequately treated. An overall prevalence of 1% (7/767) was determined for the entire HIV(+) cohort. The majority of the cases of syphilis (90%) were characterized as latent syphilis. Based on these findings, the authors recommend routine CSF examination in all patients who are HIV positive and who present with latent syphilis. Treatment regimens should be maximized in an effort to reduce the prevalence of neurosyphilis in such a co-infected cohort.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infecciones por VIH/complicaciones , Neurosífilis/epidemiología , Adulto , Análisis de Varianza , Cardiolipinas/líquido cefalorraquídeo , Colesterol/líquido cefalorraquídeo , Estudios de Cohortes , Femenino , Humanos , Masculino , Neurosífilis/líquido cefalorraquídeo , Neurosífilis/complicaciones , Fosfatidilcolinas/líquido cefalorraquídeo , Prevalencia , Estudios Retrospectivos , Serodiagnóstico de la SífilisRESUMEN
Previously defined "risk factors" in homosexuals with Kaposi's sarcoma may not be causative of AIDS (acquired immune deficiency syndrome) but are an important tool in identifying segments of the homosexual population who are at increased risk for the development of AIDS and who may benefit from health education and surveillance efforts. The epidemiologic characteristics of such a group of homosexuals from a low incidence area (Pittsburgh, PA) are examined and several factors which may account for differences in incidence are briefly discussed.