摘要:

In the United States, activities related to assessment of the quality of care have completed a cycle, first concerned with end-results or outcomes, then structural attributes (qualifications of institutions and providers), and processes of care. Over a half-century later, the importance of assessing outcomes of care is being re-examined. A review of existing approaches suggests that the results of surveillance are dependent upon the methods used. Process criteria should reflect the decision-making activities of providers, not a consensus of ignorance. Those outcomes of care that are dependent upon patients behaviors (change in habits, use of medication, etc) should be studied as a function of the types of provider-consumer interactions employed. Perhaps only individual consumer involvement/control in the processes of care will result in improved outcomes.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Criteria were developed by the Joint Committee on Quality Assurance for evaluation of ambulatory child health care through chart audit. These covered history, physical examination, laboratory tests, and management in the areas of health supervision, tonsillopharyngitis, bronchial asthma, and urinary infection. Following testing for self-audit of patient records by practitioners, the criteria were rated for relevance to outcome and suitability for use in peer review by 390 “experts,” half academicians and half practitioners. The experts showed marked concordance, substantially agreeing as to relevance in 203 of 211 criteria and in 199 regarding use in peer review. Only three quarters of the criteria were, however, considered relevant to outcome by 85 per cent of the experts.The study suggests that academicians and practitioners will agree well in judging criteria for peer review; however, small groups unaccustomed to the task should not be charged with developing criteria of such importance.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

The influence that selected factors may have on referral of hospitalized patients to a Visiting Nurse Association (VNA) home care program was assessed. Length of participation in the program was examined by comparing two newly participating small “sister” hospitals with a larger hospital which had been participating in the home care program for a number of years. A questionnaire which covered knowledge about services available through home care, attitudes toward home care, and perception about the influence of specific factors upon home care referral was used. The respondents were nurses and social workers in the three hospitals, physicians in the three hospitals whose specialties were such that their patients might need after-care, and VNA staff who were affiliated with the home care program. Comparative findings are presented in terms of agencies, i.e., the three hospitals and the VNA. Favorable attitudes toward home care were found despite the fact that the respondents lacked considerable knowledge about the program. Length of hospital participation in the program did not present a reliable trend. Five factors were identified as important sources of dissatisfaction; these are discussed in terms of suggestions for improvement of the home care referral program.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Medical technology is having major effects on health care decision making at the patient-physician interaction, community-health care institution, and society-national government levels. This impact is characterized by three processes—diffusion of decision making through the increase of possible alternatives, the relinquishing of part of the role of decision maker to others in the health care system, and the shift of some of the decision making process onto the object (patient or community) of that decision. These processes are having their most pronounced effect at the national government level where decisions regarding the allocation of limited societal resources are often made without sufficient weight being given to the intended or negative consequences of specific technologies or to their external and opportunity costs, since these may not be the concern of powerfully organized special interest groups. We recommend that if national decision making is to represent societal choices, mechanisms such as technological review panels and public notification forms, must be established for ferreting out relevant social, economic and ethical considerations early in the development of a technology and disclosing these to the public.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

It was hypothesized that the distribution of programs in the United States designed to improve effective, comprehensive use of primary health care (home health, family planning, rehabilitation, mental health, medical social work, and chronic disease screening programs) are more related to the environmental resources of a particular community than the needs of that population. Hospitals in poor communities were significantly less likely to provide any of these services than those in more wealthy areas. The discrepancies between the services provided in poor as opposed to more wealthy areas by health departments were less. Health departments were significantly more likely to provide chronic disease screening and family planning services in poor areas. In general, medical social work, rehabilitation, and mental health services tended to be more emphasized in more wealthy areas while chronic disease screening and family planning services seemed to get more emphasis in poor areas. The implications of these findings for understanding the political economic dynamics within the health sector and the formulation of change strategies are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Access to information is the ultimate purpose of data storage systems. The medical record is a data storage and retrieval system. Its organization, however, has confounded the purpose of providing accessible data to the physician who must make the clinical decision. Traditional and proposed formats for manual medical information storage are surveyed for features which improve or impede the access-time to clinical data. Time studies demonstrating the effect of different formats upon the task of retrieving standard information from the medical record are presented. With a traditional record in his hand, the physician requires an average of 30 to 40 seconds to answer very simple clinical questions. A medical record with fixed-format, flow sheet organization permits access to certain data in approximately one-fourth the time of other formats, together with a significant improvement in the accuracy of retrieved information. Long access time to clinical data probably results in infrequent use of the traditional record for data retrieval. With more accessible data, information in the record may play a more active part in the clinical decision process.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Shortages in health care personnel have caused the expansion of nurses* duties. Physician acceptance of this augmented role for the nurse will depend in fact on appropriate studies. Extending the responsibilities of the nurse practitioner to active patient treatment is the basis of this report. Twenty-three female patients with maturity-onset diabetes mellitus were selected for this study, which lasted six months. Twelve patients comprised the experimental group. Their medical management was supervised by a nurse practitioner trained in the management of diabetes mellitus. The remaining eleven patients with diabetes mellitus were managed in the traditional fashion by a clinic physician. Standard measurements of the course of the disease were followed during the six-month interval, and comparisons were made.No difference existed in patient morbidity or mortality and only minor differences in specific measurements of the course of diabetes mellitus between the two groups. However, a significant improvement in the patients' understanding of diabetes mellitus occurred with the nurse practitioner group.This study adds to the viewpoint that the role of the nurse practitioner may be extended to encompass more comprehensive treatment programs in patients with chronic disease. Demonstrations of efficacy of the nurse practitioner, utilizing properly planned studies, will help the medical community to gain greater acceptance of the nurse practitioner as an active member of the personal care health team.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID