Effects of compensation method on physician behaviors.
(1/30)
OBJECTIVE: To examine physician and leader perceptions of the relationship between physician compensation and the productivity of physicians practicing in medical groups. STUDY DESIGN: Key informant interviews identified subjects' perceptions of factors influencing physician productivity and the behavioral effects of individual financial incentives. Interview transcripts were analyzed by a team of physicians, economists, and other researchers. STUDY POPULATION: Physicians, medical leaders, and group practice administrators (n = 114) representing 46 medical group practices in California, Oregon, Washington, and Wisconsin were interviewed. RESULTS: Five major themes emerged: (1) Most physicians reported that financial incentives did not substantially affect their own behavior, except for productivity. However, they suggested that specific compensation models do lead to certain seemingly undesirable physician behaviors. (2) By contrast, medical group leaders reported that financial incentives do affect a variety of physician behaviors. (3) Four productivity drivers emerged: financial incentives, demand-side factors, systems and infrastructure, and other individual or group attributes. (4) Physician compensation systems are evolving toward a blend of production-based and production-neutral incentives, plus new metrics aligned with the demands of managed care. (5) Culture, size, and specialty mix are significant determinants of group physician compensation systems. CONCLUSIONS: Compensation method is perceived to be a significant influence on physician productivity, particularly among group practice leaders. The changing context of medical practice represents another powerful "macro" lever on physician behavior. (+info)
Hospital preparedness for victims of chemical or biological terrorism.
(2/30)
OBJECTIVES: This study examined hospital preparedness for incidents involving chemical or biological weapons. METHODS: By using a questionnaire survey of 224 hospital emergency departments in 4 northwestern states, we examined administrative plans, training, physical resources, and representative medication inventories. RESULTS: Responses were received from 186 emergency departments (83%). Fewer than 20% of respondent hospitals had plans for biological or chemical weapons incidents. About half (45%) had an indoor or outdoor decontamination unit with isolated ventilation, shower, and water containment systems, but only 12% had 1 or more self-contained breathing apparatuses or supplied air-line respirators. Only 6% had the minimum recommended physical resources for a hypothetical sarin incident. Of the hospitals providing quantitative answers about medication inventories, 64% reported sufficient ciprofloxacin or doxycycline for 50 hypothetical anthrax victims, and only 29% reported sufficient atropine for 50 hypothetical sarin victims (none had enough pralidoxime). CONCLUSIONS: Hospital emergency departments generally are not prepared in an organized fashion to treat victims of chemical or biological terrorism. The planned federal efforts to improve domestic preparedness will require substantial additional resources at the local level to be truly effective. (+info)
Evaluation of indicated suicide risk prevention approaches for potential high school dropouts.
(3/30)
OBJECTIVES: This study evaluated the efficacy of 2 indicated preventive interventions, postintervention and at 9-month follow-up. METHODS: Drawn from a pool of potential high school dropouts, 460 youths were identified as being at risk for suicide and participated in 1 of 3 conditions randomly assigned by school: (1) Counselors CARE (C-CARE) (n = 150), a brief one-to-one assessment and crisis intervention; (2) Coping and Support Training (CAST) (n = 155), a small-group skills-building and social support intervention delivered with C-CARE; and (3) usual-care control (n = 155). Survey instruments were administered pre-intervention, following C-CARE (4 weeks), following CAST (10 weeks), and at a 9-month follow-up. RESULTS: Growth curve analyses showed significant rates of decline in attitude toward suicide and suicidal ideation associated with the experimental interventions. C-CARE and CAST, compared with usual care, also were effective in reducing depression and hopelessness. Among females, reductions in anxiety and anger were greater in response to the experimental programs. CAST was most effective in enhancing and sustaining personal control and problem-solving coping for males and females. CONCLUSIONS: School-based, indicated prevention approaches are feasible and effective for reducing suicidal behaviors and related emotional distress and for enhancing protective factors. (+info)
Use of antiretroviral therapies among HIV-infected men who have sex with men: a household-based sample of 4 major American cities.
(4/30)
OBJECTIVES: This study sought to determine the prevalence and determinants of use of recommended antiretroviral regimens among urban seropositive men who have sex with men (MSM). METHODS: A probability telephone sample of MSM was taken within regions of Chicago, Los Angeles, New York, and San Francisco. Analysis focused on use of antiretroviral therapies. RESULTS: Although the majority of seropositive MSM with CD4 counts below 500 per microliter were using recommended antiretroviral regimens, 26% of seropositive MSM were not receiving such care. Men who were younger, who reported a sexual orientation other than homosexual, who had a more recent interview date, who were at middle levels of affiliation with the gay community, and who reported higher levels of perceived exclusivity on the part of the gay community were less likely to be using recommended antiretroviral regimens. CONCLUSIONS: Although current efforts to make antiretroviral therapies available to HIV-seropositive MSM are reasonably effective, additional efforts are needed for MSM characterized by relative youth and lower social support. (+info)
Climate change and latitudinal patterns of intertidal thermal stress.
(5/30)
The interaction of climate and the timing of low tides along the West Coast of the United States creates a complex mosaic of thermal environments, in which northern sites can be more thermally stressful than southern sites. Thus, climate change may not lead to a poleward shift in the distribution of intertidal organisms, as has been proposed, but instead will likely cause localized extinctions at a series of "hot spots." Patterns of exposure to extreme climatic conditions are temporally variable, and tidal predictions suggest that in the next 3 to 5 years "hot spots" are likely to appear at several northern sites. (+info)
Impacts of marine-derived nutrients on stream ecosystem functioning.
(6/30)
Energy and nutrient subsidies transported across ecosystem boundaries are increasingly appreciated as key drivers of consumer-resource dynamics. As purveyors of pulsed marine-derived nutrients (MDN), spawning salmon are one such cross-ecosystem subsidy to freshwaters connected to the north Pacific. We examined how salmon carcasses influenced detrital processing in an oligotrophic stream. Experimental manipulations of MDN inputs revealed that salmon carcasses indirectly reduced detrital processing in streams through temporarily decoupling the detrital resource-consumer relationship, in which detrital consumers shifted their diet to the high-nutrient resource, i.e. salmon carcasses. The average decomposition rate of alder leaves with salmon carcass addition was significantly lower than that without the carcass, which was associated with lower abundance and biomass of detritivorous Trichoptera on the carcass-treated leaves. There were generally larger in size Trichopteran detritivores on the carcasses than on leaves. These results imply that cross-boundary MDN subsidies indirectly retard the ecosystem processing of leaf litter within the short term, but may enhance those food-limited detritivorous consumers. Because unproductive freshwaters in the Pacific northwest are highly dependent upon the organic matter inputs from surrounding forests, this novel finding has implications for determining conservation and management strategies of salmon-related aquatic ecosystems, in terms of salmon habitat protection and fisheries exploitation. (+info)
Methodological challenges associated with patient responses to follow-up longitudinal surveys regarding quality of care.
(7/30)
OBJECTIVE: To illustrate, using empirical data, methodological challenges associated with patient responses to longitudinal surveys regarding the quality of process of care and health status, including overall response rate, differential response rate, and stability of responses with time. DATA SOURCES/STUDY SETTING: Primary patient self-report data were collected from 30,308 patients in 1996 and 13,438 patients in 1998 as part of a two-year longitudinal study of quality of care and health status of patients receiving care delivered by 63 physician organizations (physician groups) across three West Coast states. STUDY DESIGN: We analyzed longitudinal, observational data collected by Pacific Business Group on Health (PBGH) from patients aged 18-70 using a four-page survey in 1996 and a similar survey in 1998 to assess health status, satisfaction, use of services, and self-reported process of care. A subset of patients with self-reported chronic disease in the 1996 study received an enriched survey in 1998 to more fully detail processes of care for patients with chronic disease. DATA COLLECTION/EXTRACTION METHODS: We measured response rate overall and separately for patients with chronic disease. Logistic regression was used to assess the impact of 1996 predictors on response to the follow-up 1998 survey. We compared process of care scores without and with nonresponse weights. Additionally, we measured stability of patient responses over time using percent agreement and kappa statistics, and examined rates of gender inconsistencies reported across the 1996 and 1998 surveys. PRINCIPAL FINDINGS: In 1998, response rates were 54 percent overall and 63 percent for patients with chronic disease. Patient demographics, health status, use of services, and satisfaction with care in 1996 were all significant predictors of response in 1998, highlighting the importance of analytic strategies (i.e., application of nonresponse weights) to minimize bias in estimates of care and outcomes associated with longitudinal quality of care and health outcome analyses. Process of care scores weighted for nonresponse differed from unweighted scores (p<.001). Stability of responses across time was moderate, but varied by survey item from fair to excellent. CONCLUSIONS: Longitudinal analyses involving the collection of data from the same patients at two points in time provide opportunities for analysis of relationships between process and outcomes of care that cannot occur with cross-sectional data. We present empirical results documenting the scope of the problems and discuss options for responding to these challenges. With increasing emphasis in the United States on quality reporting and use of financial incentives for quality in the health care market, it is important to identify and address methodological challenges that potentially threaten the validity of quality-of-care assessments. (+info)
Concept and progress of a regional effort to improve blood lead reporting to six Western States by incorporating electronic laboratory reporting.
(8/30)
While electronic laboratory reporting (ELR) has the potential to be both more timely and complete than non-electronic data transmission and direct electronic data transfer can also reduce data input errors, these benefits are often underutilized. A survey of states in HHS Regions IX and X (Alaska, Arizona, California, Hawaii, Oregon, Washington) led to collaborative efforts to maximize ELR benefits on a regional scale. Collaboration outcomes included the ratification of a regional blood lead HL7 message format and the formation of a multi-state committee to address reporting discrepancies by the large regional labs to multiple states in the regions. (+info)