Primary Prevention and Rubella Immunity: Overlooked Issues in the Outpatient Obstetric Setting

1997 ◽  
Vol 18 (09) ◽  
pp. 633-636
Author(s):  
Deborah D. Schoenhoff ◽  
Timothy W. Lane ◽  
Charles J. Hansen
Keyword(s):  
Immune Status ◽  
Multiple Logistic Regression Analysis ◽  
Health Maintenance Organization ◽  
Hospital Setting ◽  
The United States ◽  
Public Institution ◽  
Practice Setting ◽  
Rubella Vaccine ◽  
Health Maintenance ◽  
Office Setting

AbstractObjective:To determine the knowledge of rubella immune status among practicing obstetrician-gynecologists in the United States and of rubella immunity policies covering healthcare workers in the obstetric-care office setting.Design:Mailed survey questionnaire, August through December 1994.Setting:Physicians from multiple-practice sites including private office, public institution, university or teaching hospital, and closed panel health maintenance organization settings.Participants:3,302 practicing obstetrician-gynecologists, chosen by a systematic random sample from the AMA national physician database.Main Outcome Measures:Participants were defined as rubella immune if they reported knowledge of prior rubella vaccination or positive antibody titer. Knowledge of a policy for documenting rubella immunity among employees in the office-based practice setting also was assessed.Results:Questionnaires were returned from 50% (1,666) of the 3,302 surveyed, and 96% (1,599) were evaluable. Approximately 20% (304/1,599) of the responding obstetrician-gynecologists did not have knowledge of documented rubella immunity, and the majority of office-based practices did not require documentation of rubella immunity in the following groups: physicians, 66% (723/1,094); office nurses, 62% (666/1,070); and other office staff, 69% (728/1,063). Sixty-two percent (993/1,599) of responding physicians had individual rubella serologies performed, with 916 known to be positive, 53 reported negative, and 24 reported unknown. Fifty-seven percent (918/1,599) reported receiving monovalent rubella vaccine or trivalent measles-mumps-rubella vaccine. Multiple logistic regression analysis revealed the following to be independent predictors of positive immune status among respondents: female gender (odds ratio [OR], 2.4; 95% confidence interval [CI95], 1.8-3.1), medical school graduation since 1980 (OR, 2.6; CI95, 2.0-3.3), providing obstetric or fertility services (OR, 1.5; CI95, 1.2-1.9), and group practice setting ≥5 physicians; OR, 1.2; CI95, 1.1-14).Conclusions:Nationally, nearly one of every five practicing obstetricians may not have documented rubella immunity, and the majority of office-based practices have no system for assuring such immunity. Rubella immunity should extend beyond the hospital setting, with consideration for requiring rubella immunity as a condition for employment. Methods for effective implementation and documentation of current guidelines need to be addressed, particularly in the office setting.

scholarly journals A Comparison of Work-Exacerbated Asthma Cases from Clinical and Epidemiological Settings

2013 ◽  
Vol 20 (3) ◽  
pp. 159-164 ◽  
Author(s):  
Paul K Henneberger ◽  
Xiaoming Liang ◽  
Catherine Lemière
Keyword(s):  
Health Maintenance Organization ◽  
The United States ◽  
Epidemiological Studies ◽  
Case Definitions ◽  
Health Maintenance ◽  
Work Related ◽  
Screening And Surveillance ◽  
Asthma Patients ◽  
Surveillance Programs ◽  
Doctor's Office

BACKGROUND: Clinical and epidemiological studies commonly use different case definitions in different settings when investigating work-exacerbated asthma (WEA). These differences are likely to impact characteristics of the resulting WEA cases.OBJECTIVES: To investigate this issue by comparing two groups of WEA cases, one identified using an intensive clinical evaluation and another that fulfilled epidemiological criteria.METHODS: A total of 53 clinical WEA cases had been referred for suspected work-related asthma to two tertiary clinics in Canada, where patients completed tests that confirmed asthma and ruled out asthma caused by work. Forty-seven epidemiological WEA cases were employed asthma patients treated at a health maintenance organization in the United States who completed a questionnaire and spirometry, and fulfilled criteria for WEA based on self-reported, work-related worsening of asthma and relevant workplace exposures as judged by an expert panel.RESULTS: Using different case criteria in different settings resulted in case groups that had a mix of similarities and differences. The clinical WEA cases were more likely to have visited a doctor’s office ≥3 times for asthma in the past year (75% versus 11%; P<0.0001), but did not seek more asthma-related emergency or in-patient care, or have lower spirometry values. The two groups differed substantially according to the industries and occupations where the cases worked.CONCLUSIONS: Findings from both types of studies should be considered when measuring the contribution of work to asthma exacerbations, identifying putative agents, and selecting industries and occupations in which to implement screening and surveillance programs.

Kaiser-Permanente: A Model American Health Maintenance Organization

1974 ◽  
Vol 4 (4) ◽  
pp. 599-615 ◽  
Author(s):  
Judith Carnoy ◽  
Linda Koo
Keyword(s):  
Cost Reduction ◽  
Health Maintenance Organization ◽  
Care Program ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Kaiser Permanente ◽  
Health Maintenance ◽  
For Profit ◽  
Use Of Services ◽  
Private Corporations

The Kaiser-Permanente medical care program, a prepaid group practice that has been operating in California for over 30 years, is one of the most successful Health Maintenance Organizations (HMOs) in the United States. Kaiser's membership in California, Portland, Hawaii, Denver, and Cleveland exceeds 2.5 million. The main success that HMOs can claim is cost reduction. Kaiser can provide a package of services at lower cost than identical services would cost in “mainstream” medicine. The way in which an HMO reduces cost is by lowering the use of services by its members. Kaiser members spend half as many days in the hospital as a similar population of Blue Cross/Blue Shield subscribers. But Kaiser also tends to lower the availability of services that are not presently performed in excess. Ambulatory care is not easily accessible-large numbers of patients complain of waiting several weeks for appointments, of receiving rushed impersonal treatment, and of being unable to find and keep a personal physician. Thus Kaiser cost reduction goes hand-in-hand with a general inaccessibility of services. The reason for this is the working of the profit motive. Whether for-profit or technically “nonprofit,” private corporations have always committed themselves to maximizing their income, reducing their expenditures, and using the surplus for expansion. The profit incentive leads private HMOs to limit services by hiring an inadequate number of physicians and other personnel so that patients will be discouraged from seeking care. In this way, expenses go down and surplus goes up. This is a revision of an article, “Kaiser Plan,” that appeared in the Health-PAC Bulletin, No. 55, pp. 1-18, November 1973.

Appeals Court Rejects Federal Jurisdiction over Chiropractors Challenge to Medicare Coverage – Am. Chiropractic Ass'n, Inc. v. Leavitt

2006 ◽  
Vol 34 (2) ◽  
pp. 472-474 ◽  
Author(s):  
Carmen E. Lewis
Keyword(s):  
Health Maintenance Organization ◽  
The United States ◽  
Disabled Persons ◽  
District Court ◽  
Medicare Beneficiaries ◽  
Health Maintenance ◽  
Court Of Appeals ◽  
Medicare Program ◽  
Federal Jurisdiction ◽  
Appeals Court

The United States Court of Appeals for the District of Columbia Circuit (“Appeals Court”) held that the district court did not have jurisdiction over the American Chiropractor's Association's (“ACA”) federal question claims brought under the Medicare Act, despite affirming the ACA's prudential standing to pursue its claims. The Appeals Court reversed the lower court's decision allowing a doctor of medicine or osteopathy to perform manual manipulations of the spine on Medicare beneficiaries to correct a subluxation.The Medicare program “subsidizes medical insurance for elderly and disabled persons.” An enrollee selects a physician or obtains medical services through a managed-care provider, such as a health maintenance organization (“HMO”).

Career Plans of New Pediatricians: Results from a Survey of Residency Program Directors

PEDIATRICS ◽  
1991 ◽  
Vol 88 (4) ◽  
pp. 861-866
Author(s):  
Sarah E. Brotherton
Keyword(s):  
United States ◽  
Academic Staff ◽  
Health Maintenance Organization ◽  
Program Directors ◽  
The United States ◽  
Subspecialty Training ◽  
Pediatric Practice ◽  
Health Maintenance ◽  
Pediatric Residency ◽  
Residency Program Directors

Directors of pediatric residency programs in the United States, Puerto Rico, and Canada were surveyed regarding plans of graduating residents to determine whether new pediatricians experienced problems finding employment in light of a decreasing growth rate in the child population. Nearly 90% of directors responded, providing information on 1915 residents. Of the 1782 nonmilitary residents in the United States, 815 were entering general pediatric practice and one third (596) were entering subspecialty training. Nearly one half (379) of residents entering general pediatric practice were joining a small group practice, almost one fourth (184) were joining a larger group, 6% (48) were becoming solo practitioners, 7% (57) were joining a health maintenance organization, and nearly 8% (62) were joining a hospital or academic staff. Most residents in the United States experienced no difficulty finding a position and received multiple offers for jobs. Canadian residents were similar to residents in the United States, whereas the postresidency situations of graduates of military and Puerto Rican programs were very different. Despite manpower predictions to the contrary, comments by program directors indicated a demand for general pediatricians. This paper presents only the viewpoint of program directors; whether this perceived need illustrates an avid market for young general pediatricians merits further study.

A Model to Determine Workforce Needs for Endocrinologists in the United States Until 20201

2003 ◽  
Vol 88 (5) ◽  
pp. 1979-1987 ◽  
Author(s):  
Robert A. Rizza ◽  
Robert A. Vigersky ◽  
Helena W. Rodbard ◽  
Paul W. Ladenson ◽  
William F. Young Jr. ◽  
...  
Keyword(s):  
United States ◽  
Supply And Demand ◽  
Health Maintenance Organization ◽  
The United States ◽  
Endocrine Disorders ◽  
Office Visits ◽  
Health Maintenance ◽  
Age Related ◽  
Wide Range ◽  
Workforce Needs

The objective of this study was to define the workforce needs for the specialty of endocrinology, diabetes, and metabolism in the United States between 1999 and 2020. An interactive model of factors likely to influence the balance between the supply and demand of endocrinologists during the next 20 yr was constructed. The model used data from a wide range of sources and was developed under the guidance of a panel of experts derived from sponsoring organizations of endocrinologists. We determined current and projected numbers and demographics of endocrinologists in the United States workforce and the anticipated balance between supply and demand from 1999 to 2020. There were 3,623 adult endocrinologists in the workforce in 1999, of which 2,389 (66%) were in office-based practice. Their median age was 49 yr. Both total office visits and services performed by endocrinologists (particularly for diabetes) increased substantially during the 1990s. Waiting time for an initial appointment is presently longer for endocrinologists than for other physicians. Compared with a balanced, largely closed-staff health maintenance organization, the current national supply of endocrinologists is estimated to be 12% lower than demand. The number of endocrinologists entering the market has continuously fallen over the previous 5 yr, from 200 in 1995 to 171 in 1999. Even if this downward trend were abruptly stopped, the model predicts that demand will exceed supply from now until 2020. Whereas this gap narrows from 2000 to 2008 due to projected growth of managed care, it widens thereafter due to the aging of both the population and the endocrine workforce. Inclusion of other factors such as projected real income growth and increased prevalence of age-related endocrine disorders (e.g. diabetes and osteoporosis) further accentuates the deficit. If the number of endocrinologists entering the workforce remains at 1999 levels, demand will continue to exceed supply from now through 2020 for adult endocrinologists, and the gap will widen progressively from 2010 onward. The present analysis indicates that the number of endocrinologists entering the workforce will not be sufficient to meet future demand. These data suggest that steps should be taken to stop the ongoing decline in the number of endocrinologists in training and consideration should be given to actions designed to increase the number of endocrinologists in practice in the years ahead.

Primary Medical Care in the United States: Present Status and Future Prospects

1972 ◽  
Vol 2 (2) ◽  
pp. 195-206 ◽  
Author(s):  
R. R. Huntley
Keyword(s):  
United States ◽  
Medical Care ◽  
Minority Group ◽  
Health Maintenance Organization ◽  
The United States ◽  
Future Prospects ◽  
Rural People ◽  
Health Maintenance ◽  
Primary Medical Care ◽  
Primary Physicians

The steady decline in primary physicians in the United States is documented. The increasingly severe maldistribution of physicians is examined in relation to the effect this has on primary care. The effect on the poor, rural people, and minority group people is particularly serious. Four approaches to the solution of this problem are identified and discussed in some detail: an increase in the output of physicians, an increase in the supply and use of ancillary support personnel, reform in the organization of medical care, and the creation of a new specialty of family practice. Special attention is devoted to the likely contribution of the Neighborhood Health Center and Health Maintenance Organization movements to solution of current problems in primary medical care.

A Comparison of Ambulatory Care and Selected Procedure Rates in the Health Care Systems of the Province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States

1997 ◽  
Vol 10 (4) ◽  
pp. 26-34 ◽  
Author(s):  
Carolyn A. DeCoster ◽  
Marvin Smoller ◽  
Noralou P. Roos ◽  
Edward Thomas
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Care ◽  
Health Care Systems ◽  
Health Maintenance Organization ◽  
The United States ◽  
Kaiser Permanente ◽  
Financial Barriers ◽  
Health Maintenance ◽  
Care Systems

To determine if there are differences in physician services in different health care systems, we compared ambulatory visit rates and procedure rates for three surgical procedures in the province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States. The KP system, with its single payer and low financial barriers, is not unlike the Canadian system. But, for most of the United States, the primary payment mechanism is fee-for-service, with the patient paying a significant amount, thereby militating against preventive and early primary care. Manitoba and KP data were extracted from computerized administrative records. U.S. data were obtained from publicly available reports, Manitoba provides 1.8 times and KP 1.2 times (1.4 when allied health visits are included) as many primary care physician visits as the United States. For the surgical procedures studied, U.S. rates were higher than those in either the KP HMO or in Manitoba. We conclude that (1) the U.S. system leads to more surgical intervention, and (2) removal of financial barriers leads to higher use of primary care services where more preventive and ameliorative care can occur.

Athletic Injuries

1989 ◽  
Vol 10 (10) ◽  
pp. 291-299
Author(s):  
Paul G. Dyment
Keyword(s):  
Sports Medicine ◽  
Primary Care Physicians ◽  
Health Maintenance Organization ◽  
Soft Tissue Injuries ◽  
The United States ◽  
Athletic Injuries ◽  
Athletic Injury ◽  
Health Maintenance ◽  
Interscholastic Sports ◽  
Number Of Children

Sports medicine was for many years considered to be the preserve of the orthopedic surgeon, and it consisted primarily of the management of musculoskeletal injuries. With the recognition that primary care physicians can adequately care for more than 80% of athletic soft tissue injuries, there has been a corresponding increase in the number of pediatricians incorporating sports medicine into their practices, and many are actively pursuing further training in this field by attending continuing medical education courses. Many pediatric residencies offer at least an elective experience in sports medicine. The number of children and adolescents taking part in sports programs in the United States is enormous: 30 million in nonschool-organized athletics and more than 3 million in interscholastic sports. Therefore, it is not surprising that athletic injuries occur frequently in our patients. One study at a health maintenance organization indicated that more than 2% of all visits to that pediatric clinic were for recreational injuries.1 Another study of school-aged children found that each year 6% sustained an athletic injury requiring at least first aid.2 Pediatricians, because of their interest in preventive and behavioral medicine, can not only care for most injuries but, more important, can play a role in the prevention of injuries by becoming team physicians.

Health Care Utilization and Cost among Adults with Chronic Rhinosinusitis Enrolled in a Health Maintenance Organization

2002 ◽  
Vol 127 (5) ◽  
pp. 367-376 ◽  
Author(s):  
Michael p. Murphy ◽  
Paul Fishman ◽  
Steven O. Short ◽  
Sean D. Sullivan ◽  
Bevan Yueh ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Rhinosinusitis ◽  
Health Maintenance Organization ◽  
The United States ◽  
Care Utilization ◽  
Health Maintenance ◽  
Outpatient Visits ◽  
Marginal Total ◽  
Hospital Days ◽  
The Impact

OBJECTIVE: Our goal was to measure the impact of chronic rhinosinusitis (CRS) on the use and cost of health care by adults in a health maintenance organization (HMO). SETTING AND SUBJECTS: In the setting of the Group Health Cooperative, an HMO in Washington State, we conducted a study of all 218,587 adults (≥18 years) who used services during 1994. Using automated data, 20,175 adults were identified with one or more CRS diagnoses during 1994. OUTCOME MEASURES: We identified nonurgent outpatient visits, pharmacy fills, urgent visits, hospital days, and their associated costs (per adult per year). RESULTS: The marginal utilization associated with a diagnosis of CRS was 2.0 nonurgent outpatient visits, 5.1 pharmacy fills, 0.01 urgent visit, and −0.07 hospital day. The marginal total cost of CRS was $206. CONCLUSIONS: Adults with CRS had higher costs primarily because of increased nonurgent outpatient visit and pharmacy fill utilization. The overall direct cost of CRS in the United States in 1994 is estimated to have been $4.3 billion.

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