Survey of health maintenance organization instructions to members concerning emergency department and 911 use.
National Association of EMS Physicians Summer Scientific Meeting. Lake Tahoe, NV, USA, 1997/07.
Anecdotal concerns suggest that health management organization (HMO) membership instructions may deter members from calling 911 or going to an emergency department for a perceived emergency.
This study examines such instructions, specifically in regard to their definition of an emergency condition and associated instructions.
Member instructions were requested from 28 HMOs in 3 large West Coast cities with HMO penetration exceeding 30%. Fifteen (54%) provided membership materials.
Features examined included the definition of an emergency, instructions for calling 911, specific instructions regarding chest pain and stroke, and mention of costs associated with emergency care.
Instructions and definitions varied widely.
Six HMOs (40%) included chest pain in their definition of an emergency ; 2 (13%) included symptoms of stroke.
Ten (67%) made mention of calling 911 or going to the ED somewhere within their instructions ; 4 (27%) provided no options for calling 911 or seeking ED care.
Three (20%) cited higher costs associated with ED care.
Eleven (73%) indicated that claims would be denied for visits determined on retrospective review to be nonemergencies.
Instructions varied considerably.
Most did not include chest pain or symptoms of stroke in their definition of an emergency.
Most did include directions to call 911 or go to an ED.
Other instructions may lead members to call the HMO first during an emergency.
Mots-clés Pascal : Service urgence, SAMU, Instruction, Equipe travail, Conduite à tenir, Organisation santé, Soin intégré, Accident cérébrovasculaire, Infarctus, Myocarde, Etats Unis, Amérique du Nord, Amérique, Evaluation système, Homme, Système nerveux pathologie, Système nerveux central pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Cardiopathie coronaire, Myocarde pathologie
Mots-clés Pascal anglais : Emergency department, Emergency medical care unit, Instruction, Work team, Clinical management, Public health organization, Managed care, Stroke, Infarct, Myocardium, United States, North America, America, System evaluation, Human, Nervous system diseases, Central nervous system disease, Cerebral disorder, Cerebrovascular disease, Cardiovascular disease, Vascular disease, Coronary heart disease, Myocardial disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0380511
Code Inist : 002B30A01C. Création : 22/03/2000.