Medical group adoption of Internet services.

Physician leaders and office-based practicing physicians in medium and large practice organizations were surveyed regarding their use of administrative and clinical systems enabled by the Internet. More than 85% of medical groups reported using one or more Internet-enabled services and 35 reported use of more than five Internet-enabled services, including both business and clinical applications. Physician leaders and practicing physicians identified six Internet-enabled services as "essential" for the future success of their practice and indicated that reduced administrative costs, faster payments, and improved quality of care are the most important benefits derived from Internet-enabled applications. Ninety-six percent of survey respondents estimated that Internet-enabled technologies will have a significant, positive impact on the practice of medicine in general and will improve the quality of care before 2003. The lack of industrywide standards for health information and the inability of current computer systems to exchange information across health care delivery networks were cited as the most important barriers to the adoption of Internet-enabled applications by physicians. Respondents believed that action by the Health Care Financing Administration (HCFA) or major health plans to require participating physicians to use the Internet for administrative services will be needed to bring about rapid migration to Internet-enabled services.

Taking account of quality. Discussion.

Another report from the Institute of Medicine in March 2001 has joined a large body of literature documenting serious quality and safety problems. Eight health care leaders discuss ways in which organizations can reduce medical errors and improve patient outcomes.

No Toyotas in health care: why medical care has not evolved to meet patients' needs.

The incentives and structure of health care in the United States produce exactly what we should expect in the quality of care for chronic disease: highly variable patterns of care and widespread failure to implement evidence-based best practices. The persistent inability of providers to improve patterns of practice is due in part to the lack of a "business case for quality." Providers cannot anticipate that quality improvements will result in higher prices, increased volume, or decreased costs. However, signs of a business case for quality are emerging, fueled by cost pressures, the increased availability of data, informed consumers, and public- and private-sector purchaser initiatives.

Financing and payment reform for primary health care and substance abuse treatment.

One of the most controversial areas for health care reform concerns the treatment of alcohol and other drug problems, which account for some of the most rapidly rising costs in the health care sector. There is arguably no other set of conditions that show such variation in accessibility to treatment on the basis of insurance status, present the same degree of difficulty in providing comprehensive care, or challenge as many public and professional assumptions about behavioral, social and economic determinants. The purpose of this article is to discuss some of the financing and coverage barriers to comprehensive treatment for alcohol and other drug abuse; to discuss some innovative mechanisms for providing and financing comprehensive services; and to suggest some directions for public policy to support the development of new practice models that emphasize cost-effectiveness and efficiency of care.

A study of the relationship between severity of illness and hospital cost in New Jersey hospitals.

In response to concerns over the equity of diagnosis-related group (DRG)-based prospective payment, the New Jersey Department of Health conducted a Severity of Illness evaluation study in which severity of illness, DRG, and uniform cost information were collected for 76,798 patients in 25 hospitals. Severity of illness was measured using the Computerized Severity Index (CSI) and was found to be a significant determinant of hospital cost in 76 DRGs that accounted for 41.4 percent of the total direct hospital patient care costs and 27 percent of the patients. The addition of CSI severity levels to the 76 DRGs reduced the coefficient of variation of cost in these DRGs by 17.4 percent and improved the overall reduction in variance of cost within the 76 DRGs by 38.2 percent. The change in total hospital payments due to the addition of severity for the 76 DRGs varied from a positive 5.71 percent to a negative 5.48 percent. These results demonstrate that a severity adjustment to this subset of DRGs would result in a more equitable DRG-based prospective payment system.

State of the state's health care.

California leaders tell us what's right and what's wrong with our health care system. While consensus on health care reform is far from being reached, all agree that universal access, cost control and preventive services must be part of any health reform plan.

Pediatric acquired immunodeficiency syndrome hospitalizations in New Jersey.

This study examines all acquired immunodeficiency syndrome (AIDS) hospitalizations during 1987 for children younger than 13 years of age in New Jersey, with the AIDS diagnosis confirmed through a match with the state AIDS Registry. Days of hospitalization and cost for 318 admissions and annual utilization measures for the 74 children in the sample were analyzed by sex, age, race/ethnicity, hospital, discharge status, payer, and a severity-of-illness proxy. These measures were also compared with those for 3152 admissions of 1623 New Jersey adolescents and adults with AIDS hospitalized during 1987. Children with AIDS averaged 14.09 days and $8636 per admission, 4.35 admissions per year, and 60.96 days of hospitalization per year at an average cost of $37,110. The severity-of-illness proxy was the best predictor of hospital utilization and mortality. Hospitals varied widely in their proportions of very short and very long stays that signal possibly inappropriate utilization. Medicaid patients had relatively high utilization measures, and Hispanic children, relatively low measures. Per-admission utilization of children was similar to that of adults, but annual hospital utilization was significantly higher for children. Reimbursable outpatient and home care services appear to reduce inappropriate utilization.

Birthweight of infants born to Hispanic women employed in agriculture.

A prospective study examined the effects of maternal occupation on the birthweight of infants of Hispanic women. The study population consisted of 1,040 pregnant women enrolled for prenatal care in two rural health care centers in California between 1982 and 1984. Birthweights of infants were examined after classifying these women into three groups: (1) 255 mothers who did agricultural work, (2) 134 mothers who worked in nonagricultural jobs, and (3) 651 mothers who did not work during pregnancy. Prenatal interviews and medical records revealed medical, social, and occupational histories of the mothers. Stepwise linear regression analyses, using the backward elimination method, were conducted for some exposure models to determine whether work category influenced birthweight after controlling for confounders. The incidence of low birthweight and mean birthweights did not vary significantly with work status.