Health Maintenance Organization Setting Research Articles

The Impact of Fever Health Education on Clinic Utilization

We evaluated the ability of an office health education program to (1) increase parental knowledge about fever in children, (2) improve parental satisfaction with services, and (3) affect the number of fever-associated clinic visits. Randomly selected experimental and control groups differed only in that the former group viewed a slide-tape presentation. Testing of population samples before and after the presentation disclosed a highly significant improvement in knowledge about fever in the experimental population that persisted for almost 6 months. Monitoring of subsequent clinic visits revealed a 30% to 35% decrease in visits for fever and a 20% to 25% decrease in all visits for acute problems. These findings suggest that an audiovisual health education intervention can significantly improve patient confidence in managing fever as reflected by decreased clinic visits. This program is potentially useful in both the office and clinic in a health maintenance organization setting.

Triaging the "Somaticizer" Out of the Medical System into a Psychological System

An effective system for triaging somaticizing patients out of the medical system and into a psychological system is proposed. The system is based on over 25 years of research performed in a Health Maintenance Organization setting. It is suggested that by involving "somaticizers" in a psychologica f system, therapeutic relief of pain, anxiety, and depression can be accomplished, as well as the reailzation of significant decreases in inappropriate medical utilization and reduction of psychiatric costs.

Teaching psychiatry in the health maintenance organization.

Psychiatric residents training in a health maintenance organization (HMO) rapidly encounter the conflict between high demand for services and limited supply of time. In one HMO setting, the Harvard Community Health Plan, supervisors assist trainees in managing their practices to recognize their avoidances and conflicts and to respond therapeutically in keeping with the setting.

The organization of medical practice and primary care physician income.

This study investigates the effect of the organization of medical practice, e.g., solo, fee-for-service group, or health maintenance organization (HMO) settings, on primary care physicians' net incomes. Using pooled data on 2,372 primary care physicians, multivariate regression analysis is used to adjust physicians' 1979 net incomes for differences in medical specialty, workload, sex, and experience before estimating the effects of the organization of medical practice. Among HMO physicians, only those in staff model HMOs were found to have significantly lower net incomes than their fee-for-service group practice counterparts. Accordingly, there is little evidence to support the popular belief that physicians practicing in HMOs consistently earn less than their fee-for-service counterparts. (Am J Public Health 1983; 73:379-383.)

Prepaid Comprehensive Mental Health Services for Children

A comprehensive mental health program for children in a Health Maintenance Organization setting is described, focusing on the synergistic relationship between a consultative (indirect service) role and specialized (direct service) treatment programs. About half the patients diagnosed by pediatricians as having a psychosocial problem are referred to mental health, over 97% of thsoe referred are seen 10 sessions or fewer, and under 2% require continuous (long-term) psychotherapy when a full range of alternatives exists. Cost and utilization data are presented, and case examples demonstrate the adaptation of traditional techniques to the setting. Such adaptation, and careful treatment planning, underlie cost containment.

Quality assessment study of brief psychotherapy at a University HMO setting.

Abstract This paper describes the results of a short-term psychotherapy (four to fifteen sessions) quality assessment study conducted at the University of Massachusetts Mental Health Service. The outcome measures devised and the process of their administration are described. The positive outcome results of this study are encouraging and supportive of the impression that high quality brief psychotherapy can be provided at university counseling services. Student and health maintenance organization (HMO) member consumer evaluation opinions were positive and their utilization of services was found to be psychologically sophisticated and appropriate. A frequency table lists the most common presenting problems of this population. Practical modifications are suggested for future quality assessment research of brief psychotherapy.

Outcome in short-term group psychotherapy

This study examines the effectiveness of planned dynamic short-term group psychotherapy in a health maintenance organization setting. The groups, conducted by experienced short-term psychodynamically trained therapists, focused on common life-stage issues. A pretest/posttest design was employed; group participants completed a battery of self-report measures before, after, and 4–6 months after treatment. Group participants made statistically (and clinically) significant positive changes on the majority of change measures. They saw themselves as improved on target problems, became far less symptomatic, and reported considerable growth in interpersonal functioning.

An optimization model for planning community health services

This article reports results of a project to develop methods of planning health care delivery for a community with emphasis on ambulatory services in a health maintenance organization setting. Some of the special difficulties of the problem are discussed and a linear optimization model is presented that addresses the problem of planning the ambulatory service mix for a specified population. The model accounts for population characteristics, financial data, and system dynamics (including referral patterns). An application is shown for the case of a “model cities” population in Buffalo, New York, and some implications for further research are presented.