Martin A. Shearn

A Comparison of the Treatment of Rheumatoid Arthritis in Health Maintenance Organizations and Fee-for-Service Practices

This study compares the use of health care services (hospital and ambulatory) by patients with rheumatoid arthritis who were under the care of rheumatologists in prepaid and fee-for-service arrangements. Participating physicians from a random sample of half the rheumatologists in northern California maintained a log of all their patients with well-established diagnoses of rheumatoid arthritis. We interviewed 822 of their patients, using a structured, validated phone survey to obtain information about health care use. Patients in prepaid plans had about the same number and type of hospitalizations and the same rate of surgery as those receiving fee-for-service care. However, fee-for-service patients made more ambulatory visits. We conclude that the use of expensive services (hospital admissions and surgery) for the care of patients with rheumatoid arthritis is not different in fee-for-service and prepaid settings.

Interstitial nephritis in Sjögren's syndrome.

Abstract Renal histologic changes were studied by biopsy in eight patients with Sjogrens syndrome and at autopsy in one. Renal lesions consistent with interstitial nephritis were present in six of...

Acute Diffuse Glomerulonephritis in Acute Staphylococcal Endocarditis

Abstract Acute diffuse glomerulonephritis developed in two patients with acute bacterial endocarditis due to coagulase-positive staphylococci. Light and electron microscopic findings on renal biops...

Health Outcomes for a Chronic Disease in Prepaid Group Practice and Fee for Service Settings: The Case of Rheumatoid Arthritis

The authors compare health care use and outcomes of a panel of persons with rheumatoid arthritis receiving health care in prepaid group practice and feefor- service settings. In 1982, they randomly sampled one half of all 114 boardcertified or eligible rheumatologists in Northern California. Those who participated provided the names of all patients with rheumatoid arthritis presenting during a 1-month period; 812 of these patients (97% of those listed) were interviewed. In 1984,745 of them (92% of the baseline cohort) were interviewed; 569 receive care in fee-for-service settings and 176 in prepaid group practice. As in the baseline survey year, the prepaid patients received similar amounts and kinds of health care as their fee-for-service counterparts. The prepaid and feefor- service patients achieved similar outcomes, as measured by symptoms of illness, functional status, and work disability. The fee-for-service patients reported poorer overall health status. The authors conclude, after 2 years of followup study, that patients in prepaid group practice receive similar medical care inputs and achieve outcomes at least as good as those in fee-for-service.

Systemic Lupus Erythematosus and Latent Renal Tubular Dysfunction

Excerpt Renal tubular acidosis (1), an impairment of renal acid excretion out of proportion to reduction of glomerular filtration rate, has been described in a variety of clinical settings. Its cha...

ANTIBODY RESPONSE TO BRUCELLA ANTIGEN IN PATIENTS WITH RHEUMATOID ARTHRITIS.

Summary No relationship was found between the antibody response to Brucella antigen and the F II hemagglutination titer in a series of patients with rheumatoid arthritis and osteoarthritis. Those with rheumatoid arthritis showed no greater antibody response to inoculation with Brucella antigen than did those with osteoarthritis. These observations do not confirm the report of antibody hyperreactivity in rheumatoid arthritis.

Recent Advances in the Rheumatic Diseases

Excerpt A review of American and English literature on rheumatism and arthritis was last published in this journal in 1964. An excellent sequel to that review has appeared elsewhere (2). It is not ...

Immunosuppressive Drugs in Lupus Nephritis

Excerpt To the editor: Two papers (1, 2) and an editorial (3) in the November 1975 issue leave an impression that immunosuppressive drugs offer little more than prednisone in the management of the ...