This study was an analysis of social work practice in a medical setting: analyzing the work of a medical social worker in an outpatient clinic located in a metropolitan area. The primary purpose of this descriptive study was to evaluate the performance of a medical social worker in a Kaiser-Permanente outpatient clinic and to determine if there were possible associations between social work intervention and patient utilization of existing services offered by the Kaiser Health Care system, also referred to herein as Kaiser. Specifically, the study attempted to determine if there were quantitative changes in patient contacts, and utilization of certain services such as clinic visits, telephone contacts, prescriptions, emergency room visits, hospitalizations, and physicians seen before and after social worker intervention. If there were changes, what were the direction and quantity? Did changes vary according to type of service? Did patient utilization of medical care vary according to the number of social work contacts?

No description available.

Renny Varghese Impact of an Electronic Medical Record Implementation on Drug Allergy Overrides in a Large Southeastern HMO Setting (Under the direction of Russell Toal, Associate Professor) Electronic medical records (EMRs) have become recognized as an important tool for improving patient safety and quality of care. Decision support tools such as alerting functions for patient medication allergies are a key part of reducing the frequency of serious medication problems. Kaiser Permanente Georgia (KPGA) implemented its EMR system in the primary care departments at Kaiser's twelve facilities in the greater metro Atlanta area over a six month period beginning in June 2005 and ending December 2005. The aim of this study is to analyze the impact of the EMR implementation on the number of drug allergy overrides within this large HMO outpatient setting. Research was conducted by comparing the rate of drug allergy overrides during pre and post EMR implementation. The timeline will be six months pre and post implementation. Observing the impact of the incidence rate of drug allergy alerts after the implementation provided insight into the effectiveness of EMRs in reducing contraindicated drug allergies. Results show that the incidence rate of drug allergy overrides per 1,000 filled prescriptions rose by a statistically significant 5.9% (ñ > 0.0002; 95% CI [-1.531, -0.767]) following the implementation. Although results were unexpected, several factors are discussed as to the reason for the increase. Further research is recommended to explore trends in provider behavior, KPGA specific facilities and departments, and in other KP regions and non-KP healthcare settings. INDEX WORDS: electronic medical records, drug allergy overrides, patient safety, medication errors, decision support tools, outpatient setting, primary care, computerized provider order entry

The Social/HMO Demonstration evaluates the feasibility of expanding Medicare Supplemental Insurance benefits to cover a limited amount of ICF and community based long-term care (LTC) services provided under a comprehensive HMO benefit package for capitated Medicare beneficiaries. The policy research question addressed by this study is whether adding an Expanded Care Benefit (ECB) to the capitated HMO benefit package offered by Kaiser Permanente (KP) changes utilization patterns and costs of ICF services, and the probability of becoming Medicaid eligible. This study provides descriptive information regarding this policy research question. The research goal of this study is to measure the extent to which collective ICF use rates and expenditure patterns for S/HMO members are consistently the same, greater or less than baseline data of Risk HMO Medicare members who do not have the S/HMO ECB. The purpose of such measurement is to determine if an empirical basis exists for postulating an ICF utilization and expenditures outcome effect which is influenced by the S/HMO ECB. Utilization and financial data are collected from all SNF and ICF level nursing homes in Multnomah County for all Medicare beneficiaries enrolled in KP between June 1, 1986 and July 31, 1988. Eligibility data are assembled on all Medicare beneficiaries enrolled in KP during the same time period who were residents of Multnomah County. Nursing home use rates and rates for related expenditures are determined for all nursing home residents (1, 331) by their eligibility status in KP during the time of each nursing home stay. Days in an ICF are censored by transfers between Cost, Risk and S/HMO enrollment status. Rates are standardized by the age and gender distribution of research population members (19, 261) to adjust use rates for differences in age cohort distribution of Risk members and S/HMO members. Risk rates and S/HMO rates are compared and differences in utilization and expenditures are evaluated. Conclusions about such patterns are used to formulate hypotheses for testing and confirming descriptive observations. Findings show that overall S/HMO member rates are less than Risk member rates for five of the six Research Questions addressed in this study. Specifically, the probability of admission to an ICF is substantially greater for S/HMO members than for Risk members. However, S/HMO members remained in ICFs fewer days than Risk members, over the two year study period, as measured by age adjusted rates for ICF days per member year of eligibility during the study period. Difference in the mean length of ICF stay is statistically significant between Risk and S/HMO. The rate of total payments received by nursing homes for S/HMO ICF residents per 1000 S/HMO members was substantially less than that for Risk members. The rate of spend-down to welfare status was substantially lower for S/HMO members than for Risk members who became ICF residents. Higher proportions of S/HMO members were discharged from ICFs to home than were Risk members, which is consistent with S/HMO Expanded Care Benefit objectives.

The purpose of this community needs assessment was to explore the unmet health needs in some of the communities of Riverside County, to discover which populations are most adversely affected by these unmet needs, and to determine what barriers hinder individuals from getting their needs met. United Way of the Inland Valleys, in cooperation with Kaiser Permanente of Riverside conducted this study as part of their community based needs assessment.