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PURPOSE: Cataract surgery is one of the most successful procedures in medicine, and outcome is typically measured by a single factor - improvement in visual acuity. Health-related functional outcome testing, which quantifies the patient's self-reported perception of impairment, can be integrated with objective clinical findings. Based on the patient's self-assessed lifestyle impairment, the physician and patient together can make an informed decision on the treatment that is most likely to benefit the patient. METHOD: A functional outcome test (the Houston Vision Assessment Test - HVAT, copyrighted 1990, 1992) was evaluated in a cataract population of 149 patients from seven study centers. Test results were correlated with objective ophthalmic endpoints. The HVAT divides an estimated total impairment into subcomponents of Visual Impairment (correctable by cataract surgery) and non-visual Physical Impairments (co-morbidities not affected by cataract surgery). RESULTS: In this prospective study, the average Visual Impairment score improved by 19 points (65%) following cataract extraction (the mean HVAT Visual Impairment score was 29 points before surgery and 10 points at 5 months post-surgery, a change of 65%). Physical Impairment remained unchanged by surgery. Visual acuity was a poor predictor of Visual Impairment. CONCLUSIONS: The HVAT has 11 simple questions. It may be self-administered and is available on the Internet: http://www.DHAC.com. The physician may err if his decision in favor of cataract surgery is based only on visual acuity. The HVAT has the potential to guide the decision-making process between patient and physician.

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This research applied the life table technique to nursing personnel data in two types of hospitals to illustrate how administrators can examine patterns of continued employment. Although a large proportion of nurses were short-stay employees, the teaching hospital was found to have a higher retention rate than the community hospital corporation. The retention patterns are examined by personal and professional characteristics, as well as by reason for termination. Implications of our findings are discussed with respect to policy concerns related to hiring, retention, productivity, and staff development.

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This study reports the results of a 1986 national survey of mental health, alcohol, and substance abuse services within health maintenance organizations in the United States. Ninety-seven percent of responding health maintenance organizations (HMOs) offered mental health service coverage and two-thirds of responding HMOs offered alcohol and substance abuse service coverage. Annual mean mental health hospitalization was 36.90 days per 1,000 members and annual mean ambulatory mental health utilization was 0.29 physician encounters per member.

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Medical Technology Assessment begins with carefully posing the appropriate questions to be examined. Specification of the critical assessment provides the framework for the design to provide the answers. This paper addresses the Technology Assessment process as a sequence of the above steps. The practical requisites of the diversity of questions, the economic, and study design considerations generated are addressed in a systems analysis model of input-process-outcome. Applications and the relative merits of such design consideration are discussed and illustrated. The questions related to medical technologies may come from different groups of people directly or indirectly interested, and having active or passive relationship to a given technology. There are 4 basic issues from which the detailed questions derive. These are the issues of need, effectiveness, safety and cost. The timing of asking questions in the life-cycle of a technology and the adequacy of the answers determines the choice of methods, the extent of an evaluation and the quality of the responses. The reliability, external validity, generalizability, and the clarity of conclusions are the characteristics of a practical and valuable assessment.

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Technology Assessment (T.A.) is viewed as a dynamic process. The paper emphasizes the basic aims of T.A. as an assessment and synthesis process. Specific areas of system analysis and the tracking of technology are presented with respect to T.A. priorities, stage of development, and the collateral use of the basic techniques of quantitative analysis in the context of community health. An information system, in conjunction with the role of new approaches to T.A. such as Meta-Analysis are discussed. Several examples from the literature are presented by way of illustration.

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A study of the distribution and prevalence of bone demineralization in the US population is reported. Based on the HANES I Survey data that incorporated bone density examination of V-2 by the Goldsmith and Vose techniques in a national sample of 6030 adults, it was observed that (1) age-adjusted bone density differences between sexes were consistently found when controlling for race (the prevalence of low bone density was greater among females than males) and (2) whites of both sexes had higher prevalence of low density than blacks in most age-sex categories.

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This 1982 national survey of all operational health maintenance organizations (HMOs) provides information on the current status of mental health services, benefits, costs, and utilization within HMOs, updating and augmenting a 1978 study. Approximately 94 per cent of the responding HMOs offered mental health service coverage; over one-half (54 per cent) offered alcohol and drug abuse service coverage. The present coverage benefits and utilization of mental health services within HMOs continue to reflect greater variability vis-a-vis other health services within HMOs. Over one-half (57 per cent) of the HMOs provided for 30 days of inpatient mental health coverage (per member per year). Three out of four (77 per cent) of the health plans provided for 20 ambulatory visits (per member per year). The mean mental health hospital utilization rate was 32 days (per 1,000 members per year). The mean mental health ambulatory utilization rate was 0.33 encounters (per member per year). Further studies should investigate the combined influence of organization characteristics, mental health service organization characteristics, and service benefits on the costs and utilization of HMO mental health services.

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The degree to which mental health services and coverage have been integrated into prepaid health plans (PHPs) on a national level is unknown. Using two self-administered mail questionnaires, the authors obtained descriptive data on the organization and delivery of mental health services within 205 PHPs throughout the United States and Guam. After discussing the growth of PHPs in the United States and the development of prepaid mental health services, the authors analyze the survey data using the PHP as the unit of analysis. Although 94 percent of the PHPs in the survey offered mental health benefits as part of their basic health plan, the authors found that the varied organizational characteristics of both the PHPs and their mental health components may have affected the specific mental health services provided as well as their costs, utilization, and referral patterns. The authors believe that further analysis of the various PHP organizational models is necessary to understand the utilization and costs of prepaid mental health services.

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The catastrophic health insurance bills introduced during the 96th U.S. Congress failed to consider the current role that Health Maintenance Organizations (HMO's) play in providing catastrophic protection and the potential negative impact such legislation may have on their competitive position. This article demonstrates that HMO's are providing this coverage by using the simulated health care expenditures for families in one HMO. The estimated proportion of families that incur catastrophic expenditures varies from 0.3 to 14.4% depending on the definition used for catastrophic. The paper closes with a discussion of the potential adverse impact that the legislation would have had on HMO's.

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This 1978 national survey of all operating Health Maintenance Organizations (HMOs) provided information on the current status of mental health services utilization and service coverage within HMOs. It achieved a 68 per cent response rate. Approximately 90 per cent (108) of the HMOs offered mental health services through basic or supplemental coverage plans; HMO organization characteristics reflected relative heterogeneity; the mean monthly costs for basic health plan coverage (physical and mental health services) were $33.85 (for individuals) and $95.15 (for families); HMOs reported lower physical and mental health hospital utilization and higher ambulatory utilization when compared to more traditional forms of health insurance coverage. The present coverage and uitlization of mental health services within HMOs reflect greater variability of benefits and utilization within HMOs. There is need for further studies of mental health utilization in relation to organizational structure and delivery pattern relationships within HMOs.

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This study investigates whether there is a built-up demand for health services that surfaces when people enroll through a group plan in a Health Maintenance Organization. The study population consists of newly enrolled subscriber units of the Kaiser Foundation Health Plan (Oregon Region). The utilization variables examined include the number of inpatient and outpatient contacts with the Plan, the number and type of specific services performed, and the type of outpatient contact. The enrollees were followed over 12 quarters (three years). The analysis showed that the first quarter stood out in three respects: its average number of inpatient and outpatient contacts were the lowest of any quarter; the mean numbers of radiology services and laboratory tests per outpatient contact were the highest during this quarter; and the highest proportion of regularly scheduled contacts and the lowest rate of patient cancellation of visits occurred during the first quarter. Hence, these data are not supportive of the idea of a built-up demand. Rather they suggest that the enrollee requires some time to learn how to deal with the system; and, once a new member contacts the system, the system may perform a number of tests to obtain baseline data about the enrolee. Additional analysis did not suggest the presence of any time trends in the utilization data.

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The retention patterns of the Kaiser Foundation Health Plan (Oregon Region) were studied over a six-year period using a life table analysis. A 5% random sample, consisting of subscriber units that were enrolled at the initiation of the study of subsequently joined during the six-year period, were followed with respect to enrollment retention. The analysis presented here focuses on the 2,112 subscribers enrolled during the 1967-1970 period. These subscribers were characterized by the year they joined the plan and by their age and sex. The analyses showed that age of the subscriber and length of time on the plan consistently affected the probability of continued enrollment. The sex of the subscriber and the initial year of enrollment showed only a slight differential affect. A general pattern of high attrition in the first year, but rapid slackening thereafter, existed in all subgroup specific analyses. The utility of the analyses and the impact of the effect of differential membership retention on the plan are discussed.

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1) Training experience is closely related to whether or not handicapped children are treated. If practitioners attended a postgraduate pedodontic training program, or received classroom education or clinical training in the treatment of handicapped children, they are much more likely to treat such patients. (Worth noting is the fact that one fourth of the pedodontists treating handicapped children had not received postgraduate pedodontic training and 20-30 percent reported no training on the treatment of such patients at all.) 2) Slightly less than half of the general practitioners and 96 percent of the pedodontists surveyed report that they currently treat the dental problems of handicapped children. 3) Practitioners currently treating handicapped children report treating more such patients during their dental training and are more likely to feel that they received sufficient exposure to these patients during their training. (Twenty percent of the general practitioners and 53 percent of the pedodontists felt they had sufficient exposure.) 4) Dentists treating handicapped children were more likely to report both classroom education and clinical training about the use of multidisciplinary health manpower in the treatment of their patients, and to report using such personnel as consultants in their dental practice.

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