What effect does physician "profiling" have on inpatient physician satisfaction and hospital length of stay?

Background: 2002 marked the first time that the rate of hospital spending in the United States out-paced the overall health care spending rate of growth since 1991. As hospital spending continues to grow and as reimbursement for hospital expenses has moved towards the prospective payment system, there is still increasing pressure to reduce costs. Hospitals have a major incentive to decrease resource utilization, including hospital length of stay.

When there is too much to do: how practicing physicians prioritize among recommended interventions.

Background: Recent evidence suggests that patients are receiving only 50% of recommended processes of care. It is important to understand physician priorities among recommended interventions and how these priorities are influenced both intentionally as well as unintentionally.

Methods: A survey was mailed to all primary care physicians (PCPs) from two VA hospital networks (N= 289), one of which had participated in a broad, evidence-based guideline development effort 8 to 12 months earlier, and all endocrinologists nationwide in the VA (N= 213); response rate, 63% (n= 315).

What effect does increasing inpatient time have on outpatient-oriented internist satisfaction?

Objective: Because career satisfaction among general internists is relatively low, we sought to understand the impact on satisfaction of general internists managing patients both in and outside of the hospital. Using data from a national survey, we asked, "Among outpatient-oriented general internists (i.e.

Four-year prospective evaluation of community-acquired bacteremia: epidemiology, microbiology, and patient outcome.

The objectives of this study were to (1) describe the epidemiology and microbiology of community-acquired bacteremia; (2) determine the crude mortality associated with such infections; and (3) identify independent predictors of mortality. All patients with clinically significant community-acquired bacteremia admitted to a university-affiliated Veterans Affairs medical center from January 1994 through December 1997 were evaluated. During the study period, 387 bacteremic episodes occurred in 334 patients.

Correlates of surgical treatment type for women with noninvasive and invasive breast cancer.

There is concern that breast-conserving surgery is underused in some breast cancer patient subpopulations, including women with ductal carcinoma in situ (DCIS), an early-stage form of the disease. We conducted a population-based study to identify correlates of surgical treatment type and patient satisfaction, comparing women with DCIS and those with invasive disease. We used telephone interview and mailed survey of 183 women recently diagnosed with breast cancer (oversampling for women with DCIS), identified from the Metropolitan Detroit Cancer Surveillance System (response rate 71.

Four year prospective evaluation of nosocomial bacteremia: epidemiology, microbiology, and patient outcome.

A prospective study of all patients with clinically significant nosocomial bacteremia at one institution from 1994 to 1997 was performed to: (1) describe the epidemiology and microbiology of nosocomial bacteremias; (2) determine the crude mortality associated with such infections; and (3) identify independent predictors of mortality. Four hundred four episodes of bacteremia occurred in 322 patients; the crude in-hospital mortality was 31%. Coagulase-negative staphylococci, Staphylococcus aureus, and enterococci were the leading pathogens, and intravascular catheters were the most frequently identified source.

Are physicians aware of which of their patients have indwelling urinary catheters?

Purpose: Although infections associated with indwelling urinary catheters are common, costly, and morbid, the use of these catheters is unnecessary in more than one-third of patients. We sought to assess whether attending physicians, medical residents, and medical students are aware if their hospitalized patients have an indwelling urinary catheter, and whether physician awareness is associated with appropriate use of these catheters.

Methods: The physicians and medical students responsible for patients admitted to the medical services at four university-affiliated hospitals were given a list of the patients on their service.

Breast cancer screening in the United States and Canada, 1994: socioeconomic gradients persist.

Objectives: This study compared rates of annual mammography screening across socioeconomic status between the United States and Canada in 1994.

Methods: Population-based cross-sectional surveys were used to compare the rates.

Results: Screening rates were higher in the United States than in Canada for women aged 50 to 69 years (47.

Associations between primary care physician satisfaction and self-reported aspects of utilization management.

Objective: To evaluate the association between physician-reported utilization management (UM) techniques in capitated physician groups and physician satisfaction with capitated care.

Study Setting: 1,138 primary care physicians from 89 California capitated physician groups in 1995.

Study Design: Eighty percent of physicians (N = 910) responded to a mail survey regarding the UM policies in their groups and their satisfaction with the care they deliver.

Patients' desires and expectations for medical care: a challenge to improving patient satisfaction.

Patients' desires and expectations for medical care warrant scrutiny because of their potential influence on health care use and patient satisfaction and their effects on patients' perceptions of quality of care. To determine if desires and expectations for selected elements of medical care and specialty referral differ between VA outpatients and non-VA outpatients, we conducted a cross-sectional survey of patients at a VA medical center site and 2 primary care sites of its university affiliate. Of 390 eligible patients at the VA medical center site, 270 (69%) consented to participate and returned completed self-administered questionnaires.

Patients' desires and expectations for medical care in primary care clinics.

To explore whether patients' desires for and expectations of medical care differ between the United States and Canada, we surveyed 652 patients and 105 physicians at primary care sites in Michigan and Ontario. Patient desires were similar at both sites, but expectations were higher in Michigan. Michigan physicians gave higher estimates of patient desire than physicians in Ontario.

Motherhood for women with serious mental illness: pregnancy, childbirth, and the postpartum period.

Although women with serious mental illness have normal fertility rates, the literature points to multiple risk factors and a paucity of emotional and economic support during the initial phases of parenthood. Since most research has focused on child outcomes, the extent and nature of parenting problems experienced by these mothers are not adequately understood. An emphasis on the context of parenting and the meaning of pregnancy and childbearing to these mothers is called for and implications for research and clinical practice are discussed.

Resources and supports for mothers with severe mental illness.

Over the past 20 years, community mental health services have enabled individuals with severe mental illness (SMI) to spend more time in the community and to have greater opportunities to face normal developmental life tasks. Currently, women with SMI appear to be as likely to have children as women in the general population. Although these mothers tend to be single parents, often live in inadequate housing, have small social networks, and lack social and emotional supports, they have received little treatment attention.