Utilization patterns of cohorts of elderly clients: a structural equation model.

OBJECTIVE: To identify a model that takes into account the interrelationship of health services utilization variables, and that allows examination of the utilization patterns of health services for a cohort of elderly clients. DATA SOURCES AND STUDY SETTING: The data of each client in the study were taken from three computer databases maintained for administrative purposes by the Ministry of Health in British Columbia. Time frame for the utilization variables is one year before and one year after admission to the long-term care program in BC which occurred in 1981-1982. STUDY DESIGN: A basic model was fitted to the utilization data for the year before admission and patterns of utilization were assessed for each gender-age group for the year before admission and for the two periods, using LISREL: Fifteen utilization variables were included: number of GP and specialist visits in different settings (office, home, etc.) and number of other services such as lab tests, hospital stay, etc. DATA COLLECTION: The three files were linked to produce one record per client. PRINCIPAL FINDINGS: A model was identified that fits the data well. The total effect of GP emergency room visits on hospital stay is 0.30 compared to 0.19 direct effect. The additional impact is produced via the effect of specialist consultations on hospital stay. This and similar findings by age, gender, and period are consistent with the joint dependency of utilization variables. CONCLUSIONS: The analysis shows that males and females have different utilization patterns, while age has no effect on utilization of health services by male clients and only a small effect on utilization patterns by female clients. Admission to LTC causes more specialist contacts resulting from contact with a GP and generally a more intensive use of diagnostic and surgical procedures. However, there is significantly less acute care hospital services utilization.

Health care managers in British Columbia, Part I: Who manages our system?

Part I of this article provides, for the first time, the supply side overview of middle- and high-level managers in the B.C. health care system. It presents findings from two province-wide surveys and describes the sociodemographic characteristics and the employment experiences of the population of interest. Part II presents a detailed analysis of management tasks and management roles, and of competency requirements for future managerial roles.

The effect of admission to long-term care program on utilization of health services by the elderly in British Columbia.

Utilization patterns of elderly clients admitted to the British Columbia Long Term Care (LTC) program were recorded and analysed. Patients were either located at home or in facilities and were classified into one of five levels of care. Data on GP and specialist contacts, acute care hospital admissions and hospital length of stay were analysed for each client (N = 7251) for two consecutive years, one before and one after admission to the program. There was only a slight decline or no change in utilization of ambulatory health services following admission to the program but a more pronounced reduction in utilization of hospital related services particularly by clients located in facilities (60-70%). When utilization rates were controlled for peak levels in the period around admission, more moderate trends evolved. Yet, clients located in facilities showed a 20% decrease in hospital admission rates and a 40% decrease in GP hospital visits in the period following admission. The data suggests that admission to LTC may reduce acute hospital utilization and consequent physician utilization among clients who are cared for in an institution.

A profile of academic physicians in British Columbia.

To determine the extent of involvement of British Columbia's physician community in the operation of the province's only medical school, the authors sent questionnaires to all physicians who had any affiliation with the University of British Columbia (UBC). About 20 percent of the province's physicians were involved in some capacity with the UBC Faculty of Medicine, which accepts about 120 students into the first year annually. Most faculty held "clinical" appointments, meaning that they pursued largely non-academic careers. Full-time academic appointees worked more than 20 percent more hours annually than did their "clinical" counterparts, and average hours for men exceeded those for women. As many as two-thirds of the full-time faculty were also engaged in sufficient clinical practice activity to be classified as full-time practicing physicians by a definition adopted by a provincial Joint Medical Manpower Committee.