Raymond Fink

Issues and problems in measuring children's health status in community health research

The measurement of childrens health status in community surveys is hampered by both methodologic and substantive problems. These include relatively low prevalence of medical conditions among children, appropriate selection of sample questionnaire items, and difficulties in measuring health status change. There is potential value in including measures of health risk instead of, or in addition to, health status measures. This may overcome problems of low prevalence, and provide a broader base for testing the effects of program and policy changes.

Changes in family doctors' services for emotional disorders after addition of psychiatric treatment to a prepaid group practice program

The family doctors medical care for emotional problems in a prepaid group practice plan during a period when mental health services were limited to psychiatric consultation is compared with the situation two years later when services included psychiatric treatment at no cost to the patient. During this time the annual rates for psychiatric consultation increased from 7 to 11 per 1000. There was a greater tendency during the later period to prescribe a wider range of drugs, and stronger drugs. Psychiatric referrals for patients with a wide range of emotional problems, including those whose emotional problems interfered with three or more life activities and those whose emotional problems caused no interference, increased. There was an increased tendency in the later period to refer patients whose self-reports described less serious or less acute problems.

Family physician referrals for psychiatric consultation and patient initiative in seeking care

Abstract This report examines in a prepaid medical group practice, the role of doctor and patient initiative in the family physicians referral decision. Patients referred to the psychiatrist are classified according to whether the referral was patient-initiated or doctor-initiated; those not referred were classified according to whether or not they had ever wished a referral. Comparisons are presented among these groups based on patient interview information on demographic characteristics, reports on their emotional problems, previous mental health care and doctor-patient relations. Comparisons are also made among some patient groups on information from family physician interviews.

Referral and Utilization Patterns in the First Year of a Mental Health Center in a Prepaid Group Practice Medical Program

was established in association with the Jamaica Medical Group through grants from the New York Foundation and the United States Public Health Service. The Jamaica Medical Group is the largest of the 31 medical groups of the Health Insurance Plan of Greater New York (HIP). Nearly 700,000 persons in the New York City area are enrolled in HIP. The Jamaica Medical Group serves about 60,000 of these members. The new psychiatric service was designed as a demonstration project to determine the organization, cost and scope of a psychiatric treatment program that could be incorporated into a prepaid group prac-

A program to measure the impact of multiphasic health testing on health differentials between poverty and nonpoverty groups.

Periodic automated multiphasic health testing (AMHT) for poverty and nonpoverty groups enrolled in HIP is being integrated with an action program that utilizes paramedical personnel and the medical care resources within the Plan. The primary question under investigation is whether through AMHT and the activities generated by it, the anticipated gaps in health status and health-related behavior and understanding between the two groups can be narrowed. Control groups have been established to provide the basis for judging whether observed changes are independent of the projects activities. Feasibility, cost, and manpower requirements are also to be determined for a system in which physician referrals are limited to patients who meet specified criteria. Major sources of information for the study groups include a battery of tests differing moderately from those included in other AMHT programs, and a health inventory that covers, in addition to questions usually found in a health history, a broad range of items concerned with patterns of health care, practices, attitudes, disability, and limitations of function. Outcome measures will be of two types— those that might be inferred from information about health behavior and those that reflect a change in health status.