be possible and has specified brand names that fall within the class.

  1. Ratio of hospital beds to benchmark rates.

    The American Hospital Association compiles this information.

  2. Ratio of medical specialists to benchmark rates.

    The local medical community and the AMA can provide these data.

  3. Ratio of primary care physicians to benchmark rates.

    Again, the local medical community or the AMA is a source of data.

The proposed indicator set includes measures of individual behavior (advance directives and smoking), physical environment (low-volume CABG and obstetrical hospitals, avoidable ACS hospitalizations), and health care (missed opportunities, waste, and excess capacity). Most of the measures are tied to hospital data, reflecting its availability and reliability. One measure of public health efficiency (indicator 8) is included. Communities may also want to look for ways in which to incorporate measures of process efficiency and outcome efficiency. For example, communities may want to conduct surveys to learn about such process measures as whether purchasers of health care services are organized and whether consumers have adequate information.

REFERENCES

Baker, E.L., Melton, R.J., Stange, P.V., et al. 1994. Health Reform and the Health of the Public: Forging Community Health Partnerships. Journal of the American Medical Association 272:1276–1282.

Bunker, J.P, Frazier, H.S., and Mosteller, F. 1995. The Role of Medical Care in Determining Health: Creating an Inventory of Benefits. In Society and Health. B.C. Amick, S. Levine, A.R. Tarlov, and D.C. Walsh, eds. New York: Oxford University Press.


Emanuel, E.F. 1996. Cost Savings at the End of Life. What Do the Data Show? Journal of the American Medical Association 275:1907–1914.


Fisher, E.S., Welch, H.G., and Wennberg, J.E. 1992. Prioritizing Oregon's Hospital Resources: An Example Based on Variations in Discretionary Medical Utilization. Journal of the American Medical Association 267:1925–1931.


Guadagnoli, E., Hauptman, P.J., Ayanian, J.Z., Pashos, C.L., McNeil, B.J., and Cleary, P.D. 1995. Variation in the Use of Cardiac Procedures after Acute Myocardial Infarction. New England Journal of Medicine 333:573–578.



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