This article has been withdrawn as it was published elsewhere and accidentally duplicated. The original article can be seen here: 10.1108/14664100010351297. When citing the…
Abstract
This article has been withdrawn as it was published elsewhere and accidentally duplicated. The original article can be seen here: 10.1108/14664100010351297. When citing the article, please cite: Wally R. Smith, J. James Cotter, Donna K. McClish, Viktor E. Bovbjerg, Louis F. Rossiter, (2000), “Access, satisfaction, and utilization in two forms of Medicaid managed care”, British Journal of Clinical Governance, Vol. 5 Iss 3 pp. 150 - 157.
The concept of evidence‐based medicine, or medical practice based on up‐to‐date research about the best available diagnoses and treatments, has been well accepted into mainstream…
Abstract
The concept of evidence‐based medicine, or medical practice based on up‐to‐date research about the best available diagnoses and treatments, has been well accepted into mainstream medicine. In contrast, evidence‐based quality improvement, culminating in evidence‐based dissemination or implementation of the latest research, is far from a reality. One of the many reasons for this failure is that all responsible for dissemination and implementation do not understand or apply relevant theories from the social and educational sciences. Rather, many popular approaches to quality improvement have been chosen empirically, unguided by theory. Sometimes these choices have resulted in failure and/or unintended consequences. The purpose of this review is to categorize and explain various theories relevant to quality improvement interventions. Each reviewed theory is connected with approaches the theory suggests would be successful. The review discusses how knowledge of improvement theory can drive not only the choice of techniques to employ but also the choice of contexts for employment. The review offers a critique of some theories and their associated approaches.
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This paper aims to compare and contrast quality improvement in the domain of health care disparities with quality improvement in other domains.
Abstract
Purpose
This paper aims to compare and contrast quality improvement in the domain of health care disparities with quality improvement in other domains.
Design/methodology/approach
The author provides a descriptive essay and review to put forward the findings of their research.
Findings
In the USA, health care quality improvement systems have largely been accepted and institutionalized. Most if not all hospital and health care systems now have quality monitoring and improvement teams. In contrast, despite a plethora of stark reports in the literature showing that the US health care system has failed to deliver health care with equity when the care of Whites is compared with that of racial and ethnic minorities, there is not a parallel health care disparities improvement system in most health care settings.
Practical implications
Paralleling many steps that have been taken to improve quality in general, health care workers and health systems must take steps to improve structures and processes of care to reduce health care disparities.
Originality/value
Pinpoints some important distinctions between improving structures and processes of care related to health care disparities, and those related to other aspects of quality improvement. Doing so will save lives, and in the process improve overall quality.
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The purpose of this paper is to define, describe, and understand how to combat pseudoevidence‐based medicine (PBM).
Abstract
Purpose
The purpose of this paper is to define, describe, and understand how to combat pseudoevidence‐based medicine (PBM).
Design/methodology/approach
Descriptive essay and review.
Findings
PBM can be defined as the practice of medicine based on falsehoods that are disseminated as true evidence, then adopted by unwitting and well‐intentioned practitioners of evidence‐based medicine (EBM). PBM borders on being not only unethical, but also criminal. It may well result not only in inappropriate quality standards and processes of care, but also in harms to patients. Is there a motive to commit the crime of PBM? Is there an opportunity to commit the crime? And is there evidence of the crime beyond reasonable doubt? This article answers those questions.
Originality/value
PBM should be opposed. This article recommends individual and corporate ways to oppose it, including heightened individual skepticism when evaluating evidence, and improved professionalism in relationships with patients and scientific endeavor.
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Wally R. Smith, J. James Cotter, Donna K. McClish, Viktor E. Bovbjerg and Louis F. Rossiter
We determined access and satisfaction of 2,598 recipients of Virginia’s Medicaid program, comparing its health maintenance organizations (HMOs) to its primary care case management…
Abstract
We determined access and satisfaction of 2,598 recipients of Virginia’s Medicaid program, comparing its health maintenance organizations (HMOs) to its primary care case management (PCCM) program. Positive responses were summed as sub‐domains either of access, satisfaction, or of utilization, and adjusted odds ratios were calculated for HMO (vs. PCCM) sub‐domain scores. The response rate was 47 per cent. We found few significant differences in perceived access, satisfaction, and utilization. Both HMO adults and children more often perceived good geographic access (adults, OR, [CI] = 1.50, [1.04‐2.16]; children, OR, [CI] = 1.773 [1.158, 2.716]). But HMO patients less often reported good after‐hours access (adults, OR, [CI] = 0.527 [0.335, 0.830]; children, OR, [CI] = 0.583 [0.380, 0.894]). Among all patients reporting poorer function, HMO patients more often reported good general and preventive care (OR, [CI] = 2.735 [1.138, 6.575]). We found some differences between Medicaid HMO versus PCCM recipients’ reported access, satisfaction, and utilization, but were unable to validate concerns about access and quality under more restrictive forms of Medicaid managed care.
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Saji S. Varghese, Diane B. Wilson, Lynne T. Penberthy and Wally R. Smith
Purpose – The purpose of the paper is to examine the evidence behind breast self examination recommendations. Design/methodology/approach – In this paper the recommendations of…
Abstract
Purpose – The purpose of the paper is to examine the evidence behind breast self examination recommendations. Design/methodology/approach – In this paper the recommendations of various professional and specialty organizations are reviewed along with an analysis of the randomized controlled trials that provided data for these recommendations. Methodological issues regarding these trials and the conclusions that can be drawn are evaluated and presented here. Findings – The paper finds that the current evidence is not sufficient to make recommendations to western women for or against breast self‐examination. Practical implications – The paper implies that breast cancer is a leading cause of morbidity and mortality in women in the USA. Originality/value – The paper shows that, while mammography and clinical breast examination remain the standard of care in screening for breast cancer, much controversy has surrounded recommendations for breast self‐examination in breast cancer screening.
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J. James Cotter, Wally R. Smith and Peter A. Boling
This review and discussion outline domains and a research agenda leading to improvements in the quality of transitions of care between health‐care settings. Over the past two…
Abstract
This review and discussion outline domains and a research agenda leading to improvements in the quality of transitions of care between health‐care settings. Over the past two decades changes in health care financing have restructured the organization and delivery of health care. Health‐care plans and insurers have shifted to provision of health care in less expensive settings and growing concerns about the quality of health care have arisen – continuity may be lost, errors may occur, and patients may end up deeply dissatisfied. To improve the quality across the continuum of care, providers will need to reconceptualize from an intra‐organizational to an inter‐organizational viewpoint and will have to focus on transitions of care across settings. Services, such as case management, must effectively bridge gaps in the continuity of care. Improved measurement of outcomes, such as satisfaction with the transition, will be necessary.
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Wally R. Smith, Mindy E. Wyttenbach, Warren Austin and Shantaram Rangappa
The use of hospitalists in the care of in‐patients is a relatively new phenomenon in the USA – hospitalists are delivering medical care to patients in private practice, public…
Abstract
The use of hospitalists in the care of in‐patients is a relatively new phenomenon in the USA – hospitalists are delivering medical care to patients in private practice, public hospitals, and academic medical centers. Several obstacles hinder understanding of the characteristics of academic medical center‐based hospitalists. These include differences in definitions and nomenclature, differences in job descriptions, roles and administration across hospitalist programs, and in qualifications and credentialing of hospitalists versus other physicians. These differences derive from the heterogeneity of AMCs by bed size, level of local and regional competition, and cultural, utilization and referral patterns. The field needs an agreed definition of the term “hospitalist”. Assuming a good definition, one could take advantage of already good descriptive data on AMCs to quantify hospitalists within AMCs and to study how hospitalist programs vary by AMC characteristics.
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The aim of this chapter is to argue that charisma is a collective representation, and that charismatic authority is a social status that derives more from the “recognition” of the…
Abstract
Purpose
The aim of this chapter is to argue that charisma is a collective representation, and that charismatic authority is a social status that derives more from the “recognition” of the followers than from the “magnetism” of the leaders. I contend further that a close reading of Max Weber shows that he, too, saw charisma in this light.
Approach
I develop my argument by a close reading of many of the most relevant texts on the subject. This includes not only the renowned texts on this subject by Max Weber, but also many books and articles that interpret or criticize Weber’s views.
Findings
I pay exceptionally close attention to key arguments and texts, several of which have been overlooked in the past.
Implications
Writers for whom charisma is personal magnetism tend to assume that charismatic rule is natural and that the full realization of democratic norms is unlikely. Authority, in this view, emanates from rulers unbound by popular constraint. I argue that, in fact, authority draws both its mandate and its energy from the public, and that rulers depend on the loyalty of their subjects, which is never assured. So charismatic claimants are dependent on popular choice, not vice versa.
Originality
I advocate a “culturalist” interpretation of Weber, which runs counter to the dominant “personalist” account. Conventional interpreters, under the sway of theology or mass psychology, misread Weber as a romantic, for whom charisma is primal and undemocratic rule is destiny. This essay offers a counter-reading.