Abdominal pain and appendicitis: is there a difference in referrals between HMO pediatricians and private pediatricians?
The results are very similar in both groups, with a similar percentage of abdominal pain not being appendicitis (60% v 54%). HMO patients did not pay for consultations, and the HMO was not charged for any consultations. However, it does not appear that they overused the consultations for abdominal pain that were not appendicitis. Their accuracy for correct diagnosis of appendicitis was similar to the private group (46% v 40%), and the incidence of perforated appendicitis for both groups was 28% to 30%. The authors cannot draw any conclusions from their experience that HMOs in general do refer patients to surgeons in a timely fashion, and do not delay the referrals to avoid the cost of consultation, because the authors had a capitated agreement with their HMO, and consultations were free. Both groups of pediatricians, the HMO and the private pediatricians, did not realize financial gain or loss by sending children to the pediatric surgeon and were not penalized by sending patients with abdominal pain to the surgeon. On the contrary, their referral habits and judgments were similar and did not appear to change by being part of an HMO.
Transiently blocking NF-κB activity after the onset of CLP-induced sepsis can effectively reduce acute lung injury in mice without compromising bacterial host defense or survival after CLP.