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March/April 1999
ORIGINAL ARTICLES
Diffusion of Laparoscopic Cholecystectomy in the Veterans Affairs Health Care System, 1991-1995
M. Rosario Ferreira, Russell L. Bennett, Stuart C. Gilman, Sheila Mathewson, and Charles L. Bennett
Introduction of laparoscopic cholecystectomy did not increase the overall rate of cholecystectomy in Veterans Affairs (VA) hospitals to the same extent as in fee-for-service, Medicare, and HMO systems. Because the laparoscopic procedure is safer and because the overall rate increased only slightly, the total number of cholecystectomy-related deaths has fallen in the VA hospitals.
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How Well Does a Single Question about Health Predict the Financial Health of Medicare Managed Care Plans?
Arlene S. Bierman, Thomas A. Bubolz, Elliott S. Fisher, and John H. Wasson
A single question strongly predicts subsequent health care utilization. The Medicare capitation formula does not account for health status; thus, health plans can maximize profits by selectively enrolling persons who judge their health to be good.
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Thriving in a Busy Practice: Physician-Patient Communication Training
Terry S. Stein and Julie Kwan
Efforts to enhance the quality of communication between practicing clinicians and their patients have been limited. This study shows that a 1-day educational intervention can improve the clinician's medical interviewing skills and reduce frustrating visits.
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PATTERNS OF PRACTICE
Variation in the Use of Echocardiography
F. Leslie Lucas, David E. Wennberg, and David J. Malenka
Where patients live seems to play a major role in whether they undergo echocardiography—Medicare patients from Miami are four times more likely than those from Seattle to receive the procedure.
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BACK OF THE ENVELOPE
Changing Disease Definitions: Implications for Disease Prevalence. Analysis of the Third National Health and Nutrition Examination Survey, 1988-1994
Lisa M. Schwartz and Steven Woloshin
Modest changes in disease definition can greatly increase the number of people considered to be diseased. New definitions for diabetes, hypertension, hypercholesterolemia, and for being overweight would ultimately label 75% of the U.S. adult population as diseased.
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UNANSWERED QUESTIONS: RESEARCH UNDER CONSTRUCTION
Should This Patient Be Screened for Cancer?
William C. Black
Advances in imaging technology have provided numerous opportunities for cancer screening but have also raised numerous questions. This article explores where randomized trials can—and cannot—be expected to help answer who should be screened and how.
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EDITORIALS
Finding and Redefining Disease
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Primer on Lead-Time, Length, and Overdiagnosis Biases
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Current Screening Recommendations
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