CONSISTENTLY HIGH AND LOW ELDERLY USERS OF MEDICAL CARE

主要的人口变化和人口老龄化，以及 医疗保健费用的上涨使我们有必要了解 老年人长期使用服务的模式，所接受服务的成本， 以及持续高和低的特征和医学问题， 用户. 提供适当的护理，以及成本效益 干预措施取决于这种知识。 因此，目标 本研究的主要内容是： - 确定门诊护理使用模式的一致性 长期以来，在连续登记的老年成员中， 大型预付费医疗组织 - 确定医疗服务和程序的数量和类型 由一贯高和低的老年用户使用。 - 确定服务的相对价值和美元价值（成本） 以及由一贯高和低的老年用户使用的程序。 - 确定和比较高和低使用者寻求护理的原因 (i.e.,症状、发病率和特定的医学状况）。 - 比较服务地点的高用户和低用户， 看到的供应商 - 确定社会、经济和健康特征， 区分一贯高和低的老年用户。 这项研究克服了过去研究的主要困难： 利用数据来自访谈，横截面研究设计， 小的非代表性样本和短的时间框架。 本研究采用纵向设计，得出利用数据 从实际的医疗记录和独立预测变量， 精心设计的调查。

The major demographic shifts and aging of the population, as well as the rise in the costs of medical care make it imperative to understand the elderly's utilization patterns over time, the costs of services received, and the characteristics and medical problems of consistently high and low users. The provision of appropriate care, as well as cost effective interventions are dependent on such knowledge. Accordingly, the objectives of this study are: -To determine the consistency in patterns of ambulatory care utilization over an extended time among continuously enrolled elderly members of a large prepaid group practice HMO. -To determine the amount and types of medical care services and procedures utilized by consistently high and low elderly users. -To determine the relative values and dollar values (costs) of the services and procedures utilized by consistently high and low elderly users. -To identify and compare the high and low users' reasons for seeking care (i.e., symptoms, morbidities, and specific medical conditions). -To compare the high and low users with respect to the place of service and type of providers seen. -To identify the social, economic, and health characteristics which differentiate the consistently high and low elderly users. The proposed research overcomes the major difficulties of past research: utilization data derived from interviews, cross--ectional study designs, small non-representative samples, and short time frames. This study uses a longitudinal design which derives the utilization data from actual medical records and the independent predictor variables from carefully designed surveys.