Health-related quality of life, functional impairment, and healthcare utilization by veterans: veterans' quality of life study.

Objectives: To describe the health status of veterans receiving care in a veterans integrated service network (VISN).

Design: Cross-sectional survey with prospective follow-up.

Setting: Former Upper Midwest VISN 13 (now a part of VISN 23), a regional Veterans Affairs (VA) network comprising five inpatient facilities and associated outpatient clinics.

Characteristics of veterans using Veterans Affairs community-based outpatient clinics.

In the late 1990s, the Department of Veterans Affairs (VA) initiated a system of community-based outpatient clinics to enhance access to care. The purpose of this study was to explore factors that may be related to veterans' desire to transfer care from VA-based to community clinics. Among 1,452 veterans who were currently receiving VA clinic care and were eligible for care in two community-based clinics in rural Minnesota, 85 percent responded to a survey.

VA community-based outpatient clinics: performance measures based on patient perceptions of care.

Background: The Department of Veterans Affairs (VA) recently initiated a system of Community- Based Outpatient Clinics (CBOCs) to enhance delivery of primary care to veterans.

Objective: The objective of this study was to determine the effect of CBOCs on patients' perceptions of care.

Research Design: The study design is a cross-sectional survey.

VA community-based outpatient clinics: quality of care performance measures.

Background: The Veterans Health Administration (VHA) recently initiated a system of Community-Based Outpatient Clinics (CBOCs) to enhance delivery of primary care to veterans.

Objective: The objective of this study was to compare quality of care provided to veterans at CBOCs and at traditional hospital-based VA Medical Center (VAMC) clinics.

Research Design: Quality of care was assessed using medical record data abstracted at CBOCs and VAMCs.

VA community-based outpatient clinics: access and utilization performance measures.

Objectives: The purpose of this study was to compare access and utilization performance measures between Community-Based Outpatient Clinics (CBOC) and primary care clinics at parent VA Medical Centers (VAMC) and between VA-staff CBOCs and contract CBOCs.

Methods: The study design was cross-sectional and retrospective. Performance measures were based on data routinely collected for administrative and research purposes by the VA.

Evaluation of the Department of Veterans Affairs community-based outpatient clinics.

Objective: This paper describes the history of the Department of Veterans Affairs (VA) Community-Based Outpatient Clinics (CBOCs), CBOC Performance Evaluation Project, and characteristics of CBOCs within the VA, and summarizes the findings and implications of the CBOC Performance Evaluation Project.

Subjects: There were 139 CBOCs in operation at the end of fiscal year 1998. Ninety-eight percent of CBOCs offered primary health care, and 28% offered primary health care and primary mental health care.

Effect of written and computerized decision support aids for the U.S. Agency for Health Care Policy and Research depression guidelines on the evaluation of hypothetical clinical scenarios.

Objective: The objective of this study was to compare the effects of written and computerized decision support aids (DSAs) based on U.S. Agency for Health Care Policy and Research depression guidelines.

Measuring the physician perspective on quality of care in health plans.

Physicians provide one source of information about the quality of care in health plans, but concerns exist that physicians cannot distinguish quality from financial considerations or other underlying attitudes. We examined whether physicians can (a) distinguish different domains of health plan quality and (b) distinguish health plan quality from their underlying attitudes. We analyzed data on 419 generalist physicians from four health plans.

Who is at risk of nondetection of mental health problems in primary care?

Objective: To determine patient and provider characteristics associated with increased risk of nondetection of mental health problems by primary care physicians.

Design: Cross-sectional patient and physician surveys conducted as part of the Medical Outcomes Study.

Participants: We studied 19,309 patients and 349 internists and family physicians.

An evaluation of radical prostatectomy at Veterans Affairs Medical Centers: time trends and geographic variation in utilization and outcomes.

Objective: To examine temporal trends and geographic variation in utilization of radical prostatectomy (RP) as well as 30-day mortality and complication rates.

Design: Administrative data-base study of radical prostatectomy (RP) using the Department of Veterans Affairs Patient Treatment File and Outpatient Clinic File between 1986 to 1996. Logistic regression was used to estimate temporal and geographic effects on the use of RP.

Dual use of VA and non-VA primary care.

Objective: To determine how frequently veterans use non-Department of Veterans Affairs (VA) sources of care in addition to primary care provided by the VA and to assess the association of this pattern of "dual use" to patient characteristics and satisfaction with VA care.

Design: Cross-sectional telephone survey of randomly selected patients from four VA medical centers.

Participants: Of 1,240 eligible veterans, 830 (67%) participated in the survey.

Internal medical residents' ability to diagnose and characterize major depression.

The purpose of this study was to assess medical residents' knowledge of symptom criteria and subtypes of major depressive episode and their accuracy in diagnosing major depressive disorders and classifying episode severity and subtype according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Thirty-five third-year internal medicine residents completed a self-administered, written instrument containing 2 open-ended questions and 21 hypothetical scenarios. The sensitivity for recognizing major depressive disorder was 64%, and the specificity was 69%.

Referrals by general internists and internal medicine trainees in an academic medicine practice.

Patient referral from generalists to specialists is a critical clinic care process that has received relatively little scrutiny, especially in academic settings. This study describes the frequency with which patients enrolled in a prepaid health plan were referred to specialists by general internal medicine faculty members, general internal medicine track residents, and other internal medicine residents; the types of clinicians they were referred to; and the types of diagnoses with which they presented to their primary care physicians. Requested referrals for all 2,113 enrolled prepaid health plan patients during a 1-year period (1992-1993) were identified by computer search of the practice's administrative database.

Are all health plans created equal? The physician's view.

Context: The health care market is demanding increasing amounts of information regarding quality of care in health plans. Physicians are a potentially important but infrequently used source of such information.

Objective: To assess physicians' views on health plan practices that promote or impede delivery of high-quality care in health plans and to compare ratings between plans.

Under use of coronary angiography: application of a clinical method.

Objective: To estimate the extent of under use of coronary angiography and to determine whether women, ethnic minorities and poor and uninsured patients are less likely than their counterparts to receive necessary coronary angiography.

Design: Retrospective cohort study employing chart review and patient interviews.

Setting: Four teaching hospitals: three government owned (public) and one private university medical center in Los Angeles, California.

Effect of physician specialty on use of necessary coronary angiography.

Objectives: This study sought to determine whether having a cardiologist as a regular source of care influences likelihood of undergoing necessary coronary angiography.

Background: An important element of the current health policy debate is the respective roles of primary care and specialist physicians. However, there are few data on interspecialty differences in quality of care for patients with ischemic heart disease.

Elevation of serum angiotensin-converting enzyme level. Occurrence in alcoholic liver disease.

Serum angiotensin-converting enzyme (ACE) levels were measured in 151 patients with chronic alcoholism and alcoholic liver disease. The mean serum ACE level was elevated to 30.8 +/- 13 units/mL compared with 22.

Measurement of somatomedin-related peptides in fetal, neonatal, and maternal rat serum by insulin-like growth factor (IGF) I radioimmunoassay, IGF-II radioreceptor assay (RRA), and multiplication-stimulating activity RRA after acid-ethanol extraction.

Previous measurements of somatomedins (Sms) and insulin-like growth factors (IGFs) in maternal and fetal serum have yielded contradictory results. We have, therefore, measured maternal, fetal, and neonatal rat serum with two highly specific assays: 1) IGF-I/Sm-C RiA and 2) a highly specific IGF-II/rat placental membrane radioreceptor assay (RRA). In addition, we have made measurements with a less specific multiplication-stimulating activity (MSA)-rat placental membrane RRA.

Continued heavy drinking and survival in alcoholic cirrhotics.

Survival of 64 male chronic alcoholic cirrhotics with first-onset ascites discharged from a gastrointestinal convalescent service was examined over a 32-mo period of study. Of 54 patients discharged as improved, 23 (43%) remained abstinent for a mean time of 14.0 mo and 15 (28%) resumed heavy drinking (greater than 2 g/kg/day).