Arnold V. Hurtado

Determinants of medical care utilization. Failure to keep appointments.

This study is an analysis of patient and physician characteristics that are related to failure of patients to keep an appointment in a prepaid, multispecialty group practice. There was a high relationship between the frequency of appointments and the frequency of appointment failures, leading to the conclusion that the probability of failures is relatively equal across appointments. High medical care utilizers, therefore, were most likely to have failures. Demographic and psychosocial patient characteristics, as well as physician characteristics, were of much less significance in determining patient failures to keep appointments. The medically indigent have a significantly higher rate of appointment failures which suggests that studies of appointment failures, when dealing with medically indigent populations, may have limited pertinence to other population groups.

Ambulatory surgery in an HMO. A study of costs, quality of care and satisfaction.

This study is a retrospective examination of data from a prepaid group practice that introduced a change in surgical services so that about 35 per cent of patients having surgery in the operating room were not admitted to the hospital. The study population is the membership of the Oregon Region of the Kaiser Foundation Health Plan for the period 1966 through 1974. The data come from 100 per cent of the hospital admissions and 100 per cent of the ambulatory (nonadmit) surgical procedures. This study examines the costs, quality of care, and satisfaction of providers and patients with ambulatory surgery. Cost savings for the ambulatory procedures averaged

The Utilization and Cost of Home Care and Extended Care Facility Services in a Comprehensive, Prepaid Group Practice Program

192.19 per procedure (based on 1977 costs). National savings for 1977 were projected at

Unscheduled use of ambulatory care services.

773,947,208. In addition, ambulatory surgery absorbed an increasing demand for surgical procedures without requiring additional hospital beds. No differences in quality of care were found for inpatients and ambulatory patients (both used the same operating rooms and staff), and both providers and patients were found to be very satisfied with ambulatory surgery services.

Determinants of medical care utilization.

We report here a project designed to provide the home care and extended care facility services presently available under Medicare to a population of more than 100,000 people under 65 years of age in a comprehensive, prepaid group practice program. Data are presented on the impact of these services on the use of hospital care by the population. Costs and utilization data are presented, and the total cost of home care, extended care facility, and hospital service is compared to the previous cost of acute hospital alone. The project demonstrated that these services can be readily integrated into a prepaid group practice program. The demonstration successfully implemented the much discussed concept of progressive patient care.

The sensitivity and specificity of forecasting high-cost users of medical care

The objectives of this study were to describe changes over time in unscheduled use of ambulatory care services and to identify factors related to unscheduled use. The study setting was a prepaid group practice designed to provide services primarily by appointment. The data were obtained from Health Plan and Hospital Operating Statistics, an ongoing utilization study and a household interview survey. A major increase in unscheduled use of outpatient services occurred over the time period studied, particularly in the major departments of medicine, surgery and pediatrics. Unscheduled clinic visits rather than emergency department visits accounted for most of the increase in unscheduled use. The second phase of the study analyzed factors related to unscheduled use. Age, sex, and family size were associated with unscheduled use. Occupation and employment status were related to unscheduled use but only in certain age/sex groups. Satisfaction, health status, and morbidity were also important factors. Unscheduled use was highly related to scheduled use. Possible reasons are suggested for the rise in unscheduled use and its impact on the system is discussed. Recommendations are included for future research and for changes in the appointment system.