Managed care and patient ratings of the quality of specialty care among patients with pain or depressive symptoms

BACKGROUND: Managed care efforts to regulate access to specialists and reduce costs may lower quality of care. Few studies have examined whether managed care is associated with patient perceptions of the quality of care provided by physician and non-physician specialists. Aim is to determine whether associations exist between managed care controls and patient ratings of the quality of specialty care among primary care patients with pain and depressive symptoms who received specialty care for those conditions. METHODS: A prospective cohort study design was conducted in the offices of 261 primary physicians in private practice in Seattle in 1997. Patients (N = 17,187) were screened in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms. Patients (n = 1,995) completed a 6-month follow-up survey. Of these, 691 patients received specialty care for pain, and 356 patients saw mental health specialists. For each patient, managed care was measured by the intensity of managed care controls in the patient's health plan and primary care office. Quality of specialty care at follow-up was measured by patient rating of care provided by the specialists. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days. RESULTS: The intensity of managed care controls in health plans and primary care offices was generally not associated with patient ratings of the quality of specialty care. However, pain patients in more-managed primary care offices had lower ratings of the quality of specialty care from physician specialists and ancillary providers. CONCLUSION: For primary care patients with pain or depressive symptoms and who see specialists, managed care controls may influence ratings of specialty care for patients with pain but not patients with depressive symptoms

Reducing Oral Health Disparities: A Focus on Social and Cultural Determinants

Oral health is essential to the general health and well-being of individuals and the population. Yet significant oral health disparities persist in the U.S. population because of a web of influences that include complex cultural and social processes that affect both oral health and access to effective dental health care

Randomized pilot study to disseminate caries-control services in dentist offices

BACKGROUND: To determine whether education and financial incentives increased dentists' delivery of fluoride varnish and sealants to at risk children covered by capitation dental insurance in Washington state (U.S.). METHODS: In 1999, 53 dental offices in Washington Dental Service's capitation dental plan were invited to participate in the study, and consenting offices were randomized to intervention (n = 9) and control (n = 10) groups. Offices recruited 689 capitation children aged 6–14 and at risk for caries, who were followed for 2 years. Intervention offices received provider education and fee-for-service reimbursement for delivering fluoride varnish and sealants. Insurance records were used to calculate office service rates for fluoride, sealants, and restorations. Parents completed mail surveys after follow-up to measure their children's dental utilization, dental satisfaction, dental fear and oral health status. Regression models estimated differences in service rates between intervention and control offices, and compared survey measures between groups. RESULTS: Nineteen offices (34%) consented to participate in the study. Fluoride and sealant rates were greater in the intervention offices than the control offices, but the differences were not statistically significant. Restoration rates were lower in the intervention offices than the control offices. Parents in the intervention group reported their children had less dental fear than control group parents. CONCLUSION: Due to low dentist participation the study lacked power to detect an intervention effect on dentists' delivery of caries-control services. The intervention may have reduced children's dental fear

The Practrice of Health Program Evaluation

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Who governs?: who plans? : in King County's farmland retention decisionmaking process

Thesis (Ph. D.)--University of Washington, 1982In the United States where the political process dominates planning, the rational application of the planning process and alternative planning approaches have been generally ineffective in resolving urban problems. New planning theory is needed that defines how planners may perform effectively in American urban political systems. However, because planners know very little about how planning occurs in these systems, empirical studies of planning processes are needed to develop effective planning theory. This study examines the effectiveness of a successful planning process through two interrelated questions, "Who governs, how and to what effect?" and "Who plans with what means and ends for which interest groups?"The planning process chosen is King County, Washington's (USA) voter-approved purchase of development rights (PDR) farmland retention policy and program development process that occurred between 1969 and 1979. Multiple data gathering techniques and sources of information were used. Major sources include interviews with participants, local newspapers, government records and secondary publications.The major findings of the study are that a relatively small number of interest groups holding a narrow range of views govern, each influencing decisionmaking, each prevailing at different times in the case study, and each contributing toward the study's ultimate outcome (voter approval of the PDR program). Moreover, the interest groups supporting farmland retention dominated and used the planning process to promote their own views. Groups holding opposing views were often excluded, and when they were included, their challenges to the program were suppressed through cooptation by pro-PDR interest groups.The findings indicate that while politics is inseparable from planning, the political process per se is not a constraint on the development of effective planning procedures. The effectiveness of local government planning may be improved by institutionalizing procedures which regularly include unrepresented and/or underrepresented interest groups in the planning process. By centralizing planning resources in a separate branch of local government and allocating planning resources among these groups, local government planning may become more effective than under planning procedures present in most local governments