CONSISTENTLY HIGH AND LOW ELDERLY USERS OF MEDICAL CARE

人口的重大转变和老龄化，以及 医疗费用的上升使我们必须了解 老年人随时间的使用模式、接受服务的成本、 以及一贯高低不齐的特点和医学问题 用户。提供适当的护理，以及具有成本效益 干预依赖于这样的知识。因此，目标是 这项研究的主要内容包括： -确定门诊护理利用模式的一致性 在连续登记的老年成员中的较长时间内 大型预付费团体实行HMO。 -确定医疗保健服务和程序的数量和类型 始终由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) 以及始终由高和低的老年用户使用的程序。 -识别和比较高、低用户寻求护理的原因 (即症状、疾病和特定的医疗条件)。 -就服务地点比较高用户和低用户 看到的提供程序类型。 -确定下列社会、经济和健康特征 区分始终如一的高、低老年用户。 这项拟议的研究克服了以往研究的主要困难： 利用数据来源于访谈、跨部门研究设计、 不具代表性的小样本和短时间框架。 这项研究采用纵向设计，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.