PHYSICIAN-PATIENT RELATIONSHIPS--OUTCOMES FOR THE ELDERL

卫生保健提供系统正在进行重组， 控制成本的直接目标。 因此， 竞争系统通常等同于它们实现 这个目标 但从长远来看，组织的变化和 老年人护理的资金筹措必须在以下方面取得平衡： 控制成本和保持医疗保健的特点 这是产生良好结果的关键。 这种情况 对老年人尤其重要， 参加健康维护组织， 医疗计划，以控制医疗保险计划下不断上涨的成本。 为了在不损害健康的情况下控制成本，决策者必须 更好地了解控制费用的影响， 医疗护理的实践方式和对患者的影响 结果。 我们建议分析来自医疗结果研究的数据 (MOS)正在进行的调查提供了一个独特的机会， 来解决这些问题。 MOS是一项为期6年的重大研究， 患有流行性和可治疗的慢性疾病的患者 （高血压、糖尿病、心脏病和抑郁症）抽样， 代表个人和团体的做法，并预付和收费- 波士顿、芝加哥和洛杉矶的服务安排。 的 MOS数据库的特点是：成果的广度和深度 措施和病例组合变量，重复测量超过一个 2-年期间，和大横截面（N-22，785）和 纵向（N-2，546）样本。 在纵向样本中，37% 65岁及以上。 拟议的研究将扩展MOS分析， 额外的数据收集，以确定 医生式保健服务系统 中老年患者，老年人的特点 病人和他们的医生， 实践风格，以及对患者结果的影响。 实践风格是根据人际交往的质量来定义的 医患关系的各个方面，病人的程度 参与决策和信息交流，以及 心理健康问题咨询的存在， 个人健康实践。 三种健康结果（临床状态， 日常活动中的功能，以及总体福祉）， 将研究患者满意度。

The health care delivery system is being restructured with the immediate goal of containing costs. Thus, the success of competing systems is typically equated with how well they achieve this goal. But in the long run, changes in the organization and financing of care for the elderly must strike a balance between containing costs and preserving the features of medical care process essential to producing good outcomes. This situation is particularly crucial for the elderly, who are being encouraged to enroll in health maintenance organizations and competitive medical plans to control rising costs under the Medicare program. To control costs without harm to health, policymakers must be better informed about the effects of cost containment of the style of medical care practiced and the implications for patient outcomes. We propose to analyze data from the Medical Outcomes Study (MOS), an ongoing investigation that provides a unique opportunity to address these issues. The MOS is a major 6-year study of patients with prevalent and treatable chronic conditions (hypertension, diabetes, heart disease and depression) sampled to represent solo and group practices and both prepaid and fee-for- service arrangements in Boston, Chicago, and Los Angeles. The MOS database is characterized by: breadth and depth of outcome measures and case-mix variables, repeated measurements over a 2-year period, and large cross-sectional (N-22,785) and longitudinal (N-2,546) samples. Of the longitudinal sample, 37% are 65 and older. The proposed research would extend MOS analyses, without additional data collection, to determine differences between health care delivery systems in physician style of caring for elderly and middle-aged patients, the characteristics of elderly patients and their physicians that account for variations in practice styles, and the implications for patient outcomes. Practice style is defined in terms of the quality of interpersonal aspects of the doctor-patient relationship, the extent of patient involvement in decision-making and information exchange, and the presence of counseling for mental health problems and personal health practices. Three health outcomes (clinical status, functioning in everyday activities, and general well-being) and patient satisfaction will be studied.