Health-related quality-of-life assessment and planning for the pharmaceutical industry.

Health-related quality of life (HRQL) represents a patient-centered approach to assessing functional status and well-being that integrates the impact of both medical treatment and disease. The pharmaceutical industry is increasingly incorporating HRQL measures into the drug development process as part of a comprehensive outcomes evaluation. HRQL measures can be used to distinguish the effects of competing treatments, demonstrate trade-offs between survival and functional status and well-being, and provide comprehensive information on the effects of treatment on patient outcomes. Two main approaches have been used to measure HRQL: psychometric-based instruments and preference-based instruments. Each approach has advantages and disadvantages for the evaluation of pharmaceuticals, and no one approach can be recommended for all studies. The selection of HRQL measures for clinical trials requires attention to the appropriateness, psychometric characteristics, and practicality of the available instruments. The comprehensive evaluation of pharmaceutical treatments requires measures of HRQL as well as safety and clinical efficacy.

A comparison of the content of army family practice with nonfederal family practice.

BACKGROUND: To assist with planning for education and practice, family physicians should know the practice content of their practices. The present study compared the content of nonfederal family practice with Army family practice to explore their differences. METHODS: This was a secondary analysis that compared the similar variables within two national data sets: The National Ambulatory Medical Care Survey and the Army's Ambulatory Care Data Base. RESULTS: Army patients were younger and more likely to be female than were nonfederal patients. Army family physicians spent more time with patients in all groups than did nonfederal family physicians. While 12 of the top 20 diagnosis clusters of each sector were the same, there were differences found in the percentages of total visits contained within the top 20 clusters. CONCLUSIONS: Both nonfederal and Army family practice have a wide variation in patients and diagnoses. The two sectors are different in patient age and the frequency of different diagnoses. Knowledge of these differences can assist with planning.

The development and evaluation of hospital performance measures for policy analysis.

The purpose of this study was to develop and evaluate hospital performance measures to include aspects of hospital behavior beyond the traditional use of hospital profit margins for policy analysis. A number of measures have been used in the literature that are purported to reflect a variety of hospital behaviors. The reliability and validity of these and new measures were assessed using descriptive statistics and factor analysis on a sample of hospitals for a 3-year period. The sample consisted of all hospitals for which there were Medicare Cost Report and balance sheet data during the federal fiscal years 1987 through 1989. Using a subset of three hospital groups, 33 measures were evaluated, from which five were selected to represent the critical aspects of hospital performance important for policy analysis. The measures are: TEM, a new technical efficiency measure using data envelopment analysis techniques; the current ratio, depicting short-term financial performance; the ratio of longterm debt-to-net fixed assets, representing long-term viability; total margin, portraying profitability; and Medicare margin, characterizing Medicare's contribution to hospital financial position. Each represents different aspects of hospital efficiency and financially viability.

Adult day health care organizational and program characteristics.

A survey of 31 adult day health care (ADHC) programs assessed the extent to which the programs were implemented as intended by the VA. The study described and compared the host communities, ADHC organizational characteristics, program characteristics, and patient use of services. Four of the centers were operated by the Department of Veterans Affairs in VA Medical Center facilities. The remaining 27 centers were community providers serving veterans on contract through four additional VA Medical Centers. Veterans Administration programs were located in larger facilities, with lower client/staff ratios and fewer hours of operation than community contract programs. Patients on the average made 45 visits to the VA-ADHC programs and 58 visits to the contract ADHC programs. The VA and contract programs were generally found to have been implemented as planned, i.e., they followed VA guidelines for staffing, space, and equipment.

A description of the content of army family practice.

BACKGROUND: For decisions about residency curricula and downsizing the US Army medical corps, decision makers must know the practice content of the various specialties. Little is known about the content of Army family practice. The purpose of our study was to describe the content of Army family practice. METHODS: We analyzed a random sample of 28,849 family practice encounters from the US Army Ambulatory Care Data Base Study. Variables included patient demographics, diagnoses, visit duration, procedures, and medical facility. Patient age and visit duration were compared using analysis of variance; facility profiles were compared by age category and sex of patients, family member position, and procedure frequency using chi-square analysis. Diagnostic content of the facilities was compared by both chi-square and Kendall's tau B tests. RESULTS: The typical patient was a 26-year-old woman. The 25 most frequent diagnoses accounted for three-fourths of all encounters, with variation by patient age. The majority of visits did not include a procedure, but procedure frequency varied by patient age and diagnostic certainty. Mean visit duration was 16.4 minutes and varied by age. There were differences among the sites for all variables. CONCLUSIONS: Army family physicians see patients of all ages, of whom more are the family members of soldiers than the soldiers themselves; they frequently do procedures and are usually certain of their diagnoses, which include a broad spectrum of illnesses. Army family physicians are flexible, adapt to local patient and environmental needs, and are uniquely qualified to form the basis of Army medicine.

Financial management of posthospital care programs.

In this article the model estimates differences in utilization and subsequent costs of inpatient acute care, nursing home, and clinic visits as a result of patients using a posthospital care program. These estimates are compared to actual costs showing the model's robustness. The model is developed to aid in both the evaluation and the management of hospital-based postdischarge programs.

Methods of determining the cost of health care in the Department of Veterans Affairs medical centers and other non-priced settings.

Cost is increasingly important in the evaluation of health care. Though charges are often used as a proxy for cost, some health care systems such as the Veterans Administration do little or no billing. This article describes, presents examples of, and evaluates four options for determining the cost of care within the Department of Veterans Affairs: measuring input costs, the Department's cost accounting system, the reimbursement system, and use of charges from a surrogate health care facility. Each approach is evaluated for accuracy, ability to compare the costs of different treatments, and effort required to estimate cost.

A model for reducing the cost of care in VA medical centers that offer adult day health care.

One approach to providing cost-effective adult day health care (ADHC) services is to guide both the inputs to ADHC services and the provision of other services so that substitution for institutional services can realistically take place. This approach has been used in a randomized clinical trial to evaluate the medical efficacy and cost of ADHC in the Department of Veterans Affairs (DVA). This article describes the strategies that were used to improve the cost effectiveness of ADHC during the evaluation. Cost and use estimates were developed based on the best data available from the DVA and previous research on the cost for patients' use of ADHC, nursing home, hospital, and ambulatory care. A cost workshop was attended by the ADHC managers to develop plans for controlling costs. Plans were identified that increase the likelihood that ADHC can be shown to be less costly than customary care.