Disaggregating the effects of race on breast cancer survival.

Background And Objectives: This study examines differences in breast cancer survival between African-American and white women to determine whether there is a racial difference in survival after accounting for established influences on outcome, such as stage of cancer, health status, health behavior, utilization patterns, access to care, quality of care, and the doctor-patient relationship.

Methods: This study is a retrospective review of clinical records. The sample consists of 246 patients of three staff model HMOs who had mastectomies at stage II or above.

Vision testing and the elderly driver: is there a problem meriting policy change?

Background: The number of elderly drivers is increasing. The primary purpose of public policy requiring vision screening for driver's license renewal is to identify, and, when necessary, restrict drivers with functional vision impairments. Because of age-related ocular conditions, elderly drivers, as a group, have a higher incidence and prevalence of functionally impaired vision.

Initiation of medical malpractice suits: a conceptualization and test.

Despite the concern with medical malpractice suits and research about them, little is known about why some perceived injuries lead to claims of malpractice while other similar injuries do not. This paper presents a conceptualization and hypotheses regarding the determinants of an injury or perceived injury leading to suit. The conceptualization and hypotheses are tested using information collected from 113 medical malpractice plaintiffs' attorneys in three states.

Targeting ambulatory care cases for risk management and quality management.

Means are needed to identify "highly productive" areas for quality review and risk management in ambulatory care; untargeted medical record reviews have too low a yield and too high a cost to be useful. Highly productive areas are those with important medical and economic consequences, large numbers of cases, and a reasonable potential that problems exist. This paper describes untoward event screens to identify highly productive areas for review based on hospital discharge diagnosis, procedure codes, and parameters such as length of stay and cancer staging.

Ensuring excellence: reconceptualizing quality assurance, risk management, and utilization review.

A new conceptualization of the related activities QA, RM, and UR may allow an organization to ensure appropriate, proficient, and satisfactory care and to ameliorate the consequences of bad outcomes. Three processes incorporated into the conceptualization are essential to ensuring excellence, as are specific attributes of the care process. The difference in initiation of activities (reactive versus proactive) is part of the model; relationships among the essential activities and processes and between reactive and proactive activities are suggested; and viewing data sources or collection as separate from the processes and activities is suggested.