PHYSICIAN-PATIENT RELATIONSHIPS--OUTCOMES FOR THE ELDERL

医患关系——老年人的结果

• 批准号: 3120001
• 负责人: JOHN E WARE
• 金额: $ 24.09万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 1988
• 资助国家: 美国
• 起止时间: 1988-09-01 至 1990-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3120001
• 关键词: Medicare /Medicaid; health care professional practice; health care service evaluation; health economics; managed care; physicians; satisfaction; Medicare /Medicaid; health care professional practice; health care service evaluation; health economics; managed care; physicians; satisfaction

The health care delivery system is being restructured with the immediate goal of containing costs. Thus, the success of competing systems is typically equated with how well they achieve this goal. But in the long run, changes in the organization and financing of care for the elderly must strike a balance between containing costs and preserving the features of medical care process essential to producing good outcomes. This situation is particularly crucial for the elderly, who are being encouraged to enroll in health maintenance organizations and competitive medical plans to control rising costs under the Medicare program. To control costs without harm to health, policymakers must be better informed about the effects of cost containment of the style of medical care practiced and the implications for patient outcomes. We propose to analyze data from the Medical Outcomes Study (MOS), an ongoing investigation that provides a unique opportunity to address these issues. The MOS is a major 6-year study of patients with prevalent and treatable chronic conditions (hypertension, diabetes, heart disease and depression) sampled to represent solo and group practices and both prepaid and fee-for- service arrangements in Boston, Chicago, and Los Angeles. The MOS database is characterized by: breadth and depth of outcome measures and case-mix variables, repeated measurements over a 2-year period, and large cross-sectional (N-22,785) and longitudinal (N-2,546) samples. Of the longitudinal sample, 37% are 65 and older. The proposed research would extend MOS analyses, without additional data collection, to determine differences between health care delivery systems in physician style of caring for elderly and middle-aged patients, the characteristics of elderly patients and their physicians that account for variations in practice styles, and the implications for patient outcomes. Practice style is defined in terms of the quality of interpersonal aspects of the doctor-patient relationship, the extent of patient involvement in decision-making and information exchange, and the presence of counseling for mental health problems and personal health practices. Three health outcomes (clinical status, functioning in everyday activities, and general well-being) and patient satisfaction will be studied.

医疗保健提供系统正在与 纳入成本的直接目标。 因此，成功的成功 竞争系统通常等同于他们的实现程度 这个目标。 但是从长远来看，组织的变化和 老年人的护理融资必须在 包含费用并保留医疗的功能 过程对于产生良好结果至关重要。 这种情况是 对老年人特别至关重要，他们被鼓励 参加健康维护组织和竞争性 根据Medicare计划控制上升成本的医疗计划。 为了控制成本而不会损害健康，决策者必须是 更好地了解了成本控制的影响 实践的医疗风格及其对患者的影响 结果。 我们建议分析医疗结果研究的数据 （MOS），正在进行的调查，提供了独特的机会 解决这些问题。 MOS是一项为期6年的重大研究 患有流行且可治疗的慢性病患者 （高血压，糖尿病，心脏病和抑郁） 代表独奏和团体练习，并预付款和收费 波士顿，芝加哥和洛杉矶的服务安排。 这 MOS数据库的特征是：结果的广度和深度 测量和案例混合变量，对 2年和大横截面（N-22,785）和 纵向（N-2,546）样品。 在纵向样本中，37％ 年龄较高65岁。 拟议的研究将扩展MOS分析，而无需 其他数据收集，以确定 医师风格的护理风格的医疗保健提供系统 老年人和中年患者，老年人的特征 病人及其医生，解释了变化的 练习样式以及对患者预后的影响。 练习样式是根据人际关系的质量来定义的 医生关系的各个方面，患者的程度 参与决策和信息交流，以及 存在有关心理健康问题的咨询和 个人健康实践。 三个健康结果（临床状况， 在日常活动以及一般福祉中运作）和 将研究患者满意度。