摘要:

This study compared the use of medical resources by recently trained family physicians and general internists. Analyses are based on records of 3,737 adult office encounters with 132 family physicians and 2,250 adult office encounters with 102 general internists. General internists are twice as likely as family physicians to order blood tests, blood counts, chest x-rays, and electrocardiograms for their adult patients. Internists also spend more time with patients, and refer and hospitalize them at slightly higher rates. The different practice styles of general internists and family physicians were evident for adult patients of all ages and for patients with essential benign hypertension. The average per visit charge for diagnostic tests ordered during follow-up visits with hypertensive patients was estimated to be $11.97 for patients seen by general internists and $5.67 for patients seen by family physicians. These findings persisted after controlling for a variety of patient, practice, and physician characteristics.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A measure of global health status, the McMaster Health Index Questionnaire (MHIQ), was assessed to determine two important measurement properties related to its reliability and validity—sensitivity to change and the effect of mode of administration. Ninety-six patients in a physiotherapy clinic were randomly assigned to three mode-of-administration study groups, administered the MHIQ at four points in time including at admission and discharge from the clinic, and assessed for change by their physiotherapist. MHIQ physical function, social function, and emotional function retest scores obtained by self-completion within a 1-week interval were most stable. Physical function scores by any of self-completion, telephone interview, or personal interview were sensitive to change, that is, they improved dramatically by the time of discharge from the clinic. Mode of administration did not affect the size of the change scores. Changes reflected by the physical function scores correlated with changes in physical function reported by a patient's physiotherapist. No systematic changes occurred with social and emotional function scores; this is not surprising in a group of patients with predominantly physical function problems.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Existing methods for estimating additional days of hospital stay due to nosocomial infections (NI) have a number of documented limitations. An alternative method described in this paper uses the Appropriateness Evaluation Protocol (AEP) to determine whether each day of acute inpatient care is appropriate based on the need for care of the NI, original cause of hospitalization (GC), or combined NI-OC requirements. Using this method to identify specific days of hospitalization due toStaphylococcus aureusnosocomial infection, we find: 1) length of stay is increased for only a minority of patients (38%); 2) an average of 20 additional days of stay occurred for patients with 1 or more days attributed to NI; and 3) an average of 52% of length of stay of patients with 1 or more days attributed to NI can be attributed to the NI. Application of the AEP-based method is a useful alternative for identifying additional days of stay due to NI.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A growing body of evidence indicates that certain surgical procedures exhibit a “volume-outcome” relationship in which a higher volume of patients undergoing a particular procedure at a hospital is associated with better outcomes for those patients. The proportion of a hospital's patients operated on by low-volume or less experienced surgeons also may be associated with poor patient outcomes and thus contribute to the hospital “volume-outcome” relationship. This paper analyzes the influence of hospital volume and the proportion of a hospital's patients operated on by low-volume surgeons on patient outcome for 10 procedures, controlling for other selected factors that may influence outcomes. The analysis is based on 503,662 patient abstracts from 757 hospitals. Results indicate that both hospital volume and the proportion of patients operated on by low-volume surgeons are related to quality of care as measured by patient outcomes. Higher hospital volume is positively related to better patient outcomes. These findings are consistent with earlier hospital “volume-outcome” research and add an additional set of procedures using more recent data to the evidence. Unlike previous research on surgeon volume, a positive relationship was found between higher percentage of patients operated on by low-volume surgeons and poorer hospital quality.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This paper describes the reliability and validity of 10 easily administered and scored self-report measures of physicians' humanistic attitudes, values, and behaviors. This research also provides evidence that evaluations of physicians' humanistic behavior made by their outpatients, and non-physician staff with whom they worked, and the faculty physicians supervising them on inpatient ward rotations were positively and significantly correlated with one another. The potential usefulness of a multi-modal approach in evaluating humanistic physician attributes in which self-report measures are combined with direct feedback from all of those who interact with physicians is discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A prospective study was undertaken to characterize 2,000 patients attending a chiropractic teaching clinic and the effectiveness of the care they received. Fifty-two percent of the patients were between 21 and 34 years old; 41% categorized their occupation as professional and 14% as skilled blue collar; 79% presented with musculoskeletal complaints; 44% had low back pain; 41% had complaints less than 1 month; 83% had no work time loss. Eighty-one percent of musculoskeletal diagnoses were reported as strain, with less than 1% intervertebral disc syndrome. The primary treatment approach was manipulation in 90% of cases. As a group, both patients and interns had similar expectations about the likelihood of improvement following treatment and similar assessments of the degree of improvement actually attained. Eighty-two percent of patients improved during their course of treatment. An average 4.4 patient visits were encountered per episode of care, with an average total charge of $66.00.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The results suggest that Prospective Payment System (PPS) prompted a reduction in the proportion of Medicare patients that were discharged, for whom the hospital considered the episode of care to be completed. The results also show a reduction in the proportion of patients discharged dead. When controlling for patient type, the results support the findings, but the magnitude of the change that might be attributed to PPS is somewhat smaller. Proportional changes in the input measures for all patients were next considered. The results indicate that fewer diagnostic tests, fewer laboratory tests, and fewer x-rays were used in 1984. Laboratory tests showed the most dramatic decrease. LOS decreased, but the drug input remained fairly constant. A productivity index that reflects the change in the input measure while controlling for patient type was developed. The results provide strong evidence of a productivity increase in all products for Medicare patients. The drug input did not contribute to the productivity increase. The 50 most frequent DRGs for Medicare patients were examined separately for productivity changes by product. The results further support the findings of an increase in productivity.

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Despite the importance of daily symptoms for people's quality of living, they are seldom studied (thus, the “iceberg of morbidity”). We begin by reviewing United States and British studies that have information on daily symptoms experienced by adults. The most common ones are respiratory (largely from colds) and musculoskeletal (largely from arthritis, injury, overexertion). Using health diaries kept for 6 weeks by a population-based sample of adults, we report the frequency of respiratory and musculoskeletal symptoms, their specific types and causes, and what factors urge people to take therapeutic actions for them. The most popular action for both is prescription or nonprescription drugs, followed by lay consultation, then restricted activity, and lastly seeking medical care. On Respiratory Days, how miserable a person feels is the main stimulus to action; other morbidity aspects of the day also rank high. Sociodemographic groups scarcely differ in their responses to respiratory symptoms. The situation is similar for Musculoskeletal Nondisease Days (injury/overexertion). But for Musculoskeletal Disease Days (arthritis), sociodemographic characteristics figure more strongly in care, and the day's degree of morbidity less. These results signal basic differences in how people approach chronic and acute health problems: For chronic ones, they devise strategies of care (determined partly by their roles, attitudes, and resources) over months and years, and apply them during flare-ups. For acute problems, decisions about care are made in the short run and hinge mostly on symptoms. Our analysis also considers how actions complement or substitute for each other: Self-care actions (nonprescription drug use and restricted activity) tend to co-occur, and so do actions based on medical care (prescription drug use and medical contact). The two domains substitute in one way (nonprescription drug use greatly reduces chances of prescription drug use) and join in another (restricted activity increases chances of medical contact).

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1987

数据来源: OVID