摘要:

The purposes of the paper are to describe changes in the technologic methods used in Finnish obstetric practice and to relate them to some measures of infant and mother health. Antenatal care in Finland still largely retains its original low-technology character, but changes toward more technology-oriented care can be seen. The management of labor and deliveries changed dramatically in the latter half of the 1960s and in the 1970s. More and more births occurred in large, specialized hospitals instead of in small, local hospitals. Electronic fetal monitoring, drug treatment of labor (oxytocin and analgesia), deliveries with instruments, and cesarean sections became common. Comparisons of perinatal mortality by county and by hospital suggest that the correlations between the technologic methods studied, especially cesarean sections, and decreasing perinatal mortality probably do not reflect direct causal relationships.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Residency programs in general internal medicine must ensure that skills relevant to the care of both ambulatory and hospitalized patients are taught effectively. The authors evaluated both a general and a traditional internal medicine training program at the same institution. They employed a medical records audit technique based on educational objectives that assessed the approach of residents in each program in dealing with five inpatient and five outpatient problems. Inpatient performance also was assessed by subjective faculty evaluations. Resident physicians in the general program more closely reflected the educational objectives in two of five outpatient audits. There were no differences between the programs for inpatient audits or subjective evaluations. These findings support the argument that the emphasis on teaching ambulatory medicine need not jeopardize inpatient training, and they demonstrate the feasibility of a medical records audit based on educational objectives for program evaluation.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Although high annual disenrollments from prepaid group practices (PGPs) present significant problems to the manager, studies on this subject generally have been limited to simple descriptions of the phenomenon, The authors’ approach utilizes multivariate techniques—discriminant analysis and logistic regression—to overcome the simplicity of these bivariate studies. It allows an examination of the significant correlates of disenrollment in a stepwise manner that adjusts for the effects of all variables included in the models. Two surveys conducted by the Medical Care Group of St. Louis (MCGSL) provide data for this research. After classifying the sample of 2,402 families as continuous enrollees, voluntary disenrollees, and mandatory disenrollees, the analyses show that these groups represent significantly different member populations. The variables that significantly and independently discriminate among them include sociodemographic characteristics (subscriber age, race, education and occupation, and family size and income), satisfaction level with the plan, and presence of alternatives to the PGP (nonplan family members and coverage by alternative health insurance). These findings suggest that voluntary and mandatory disenrollment behavior may be more complex than previously considered. Moreover, the PGP manager is faced with perplexing problems in attempting to control this troublesome phenomenon.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Foreign-bom physicians graduated from foreign medical schools who were unlicensed in California are described by nationality, age, sex, location, visa status, employment, English fluency, and specialty. Over 1,210 unlicensed foreign medical graduates (FMGs) were located in California and 736 were interviewed, approximately 40% of the estimated 3,000 FMGs residing in the state. Most of the FMGs who passed the ECFMG and FLEX were young, had specialty training, had studied for the examination, had participated in review courses, and were unemployed. GMENAC projections for the number of FMGs entering the residency pool to the year 1990 may be far too low, because many unlicensed FMGs are already in the country. Two thirds of the FMGs studied came to the United States after immigration of FMGs was restricted in 1977. Many were refugees or were from countries in political upheaval. Policy issues raised are the role of FMGs in improving primary care to the underserved, medical standards, humanitarian issues related to the resettlement of refugees and immigrants, and the projected oversupply of physicians.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Highly specialized housestaff programs often call for training in another specialty area, especially internal medicine. Because of differences in training background and experience with internal medicine, laboratory utilization patterns might differ. Hence, laboratory test comparisons between medical (“onservice”) and nonmedical (“off-service”) housestaff were carried out on the general medicine service. On-service and off-service housestaff were found to have similarly ill patients and similar workloads. Off-service housestaff generally used less laboratory services than on-service housestaff, although both groups used large numbers of tests. Despite differences in experience and training, off-service housestaff appeared to deliver less costly and apparently equal quality medical care, compared with on-service housestaff.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Burn care treatment is among the costliest yet least studied forms of care. This paper presents estimates of the magnitude and components of burn care costs. It analyzes the extent to which burn care cost is determined by severity of burns or by characteristics of the institution in which the patient is treated, based on patient-specific data from eight hospitals representing different levels of technical sophistication in the delivery of burn care. Costs of care are higher in specialized facilities. Many patients with small burns are treated in specialized facilities, at much higher costs than patients treated in general care facilities. Among specialized facilities, patient severity accounts for a portion of the variance in costs, but significant cost differences remain after adjusting for severity. These results suggest that cost-control efforts should concentrate on specifying criteria for admission to specialized bum facilities, regional coordination of facilities and institutions, and improved facilities design and management.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

It is often assumed that family physicians are able to provide a higher quality of medical care because of the greater degree of continuity inherent in their practices. The authors attempted to measure the association between continuity and quality of medical care using pregnancy as a tracer condition. Using a retrospective cohort study design, two groups of pregnant women were identified—those cared for in the family practice (FP) centers and those cared for in the obstetric (OB) clinics. Process and outcome of medical care were measured along with patient satisfaction. Provider continuity, as measured by the SECON value, was much higher in the FP group, and was highly correlated with the presence of an “attitudinal contract” between patient and physician. Although not statistically significant, four times as many newborns from the OB group were admitted to the neonatal intensive care unit. FP group newborn weight averaged 220 grams more than the OB group (P<0.05). This difference remained after control for covariates. While not reaching statistical significance, patient satisfaction scores tended to be higher for the FP group in two of three categories measured. The results suggest that continuity of care was associated with better patient outcome and satisfaction. Directions for causal interpretation and future research are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The length of stay (LOS) pattern of nursing home admissions has not been directly measured because the long duration of stay of some patients (e.g., 25% of persons admitted reside in homes for longer than 1 year) makes it impractical to follow specific admission cohorts until the members have been discharged. By applying life-table methods to data on current and discharged residents from the 1977 National Nursing Home Survey, the authors were able to generate estimates of this distribution. They estimated that the typical nursing home admission initially has an expected LOS of 456 days, but, more interesting, the remaining LOS is expected to increase, in the intermediate term, with the amount of time spent in the facility. They also examined LOS distributions of subsets of the national nursing home population, and illustrated potential applications for this new information for policy formulation.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In light of recent evidence suggesting the importance of communication in the health care setting, an instrument to measure communication style preferences was developed. This reliable and content-valid paper-and-pencil measure consisted of six scenarios depicting physician-patient interactions, each followed by four potential verbal responses from the physician. The four responses, representing four communications styles—humor, hostility, reassurance, and neutrality—were ranked by respondents according to their preferences. Among both physicians and consumers, reassuring responses were the most preferred, followed by neutral, humorous, and hostile responses. The intercorrelations of the four preferences and their relationships to standardized tests of both facilitating verbal response preferences and nonverbal expressiveness are presented. Potential uses of the instrument are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

This study documents changes in surgical treatment of breast cancer using data from the National Hospital Discharge Survey. All discharge records for women aged 25 years and older who received a mastectomy and had a diagnosis of breast cancer were selected for analysis. The proportion of such women discharged who received a radical mastectomy declined precipitously from 49% in 1972-1974 to 14% in 1978-1980. The proportion of women discharged who received modified radical mastectomies increased concomitantly from 29% in 1972-1974 to 64% in 1979-1980. Further, these changes in surgical practice were observed in all regions of the United States and for both small and large hospitals. The average length of hospital stay for discharged women treated surgically for breast cancer declined from 11.8 to 10.3 days between 1972-1974 and 1978-1980. About one third of this decline can be attributed to the shift toward less extensive operations.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID