摘要:

Based on detailed studies of the content of family medical practice in a setting where there is universal-coverage medical care insurance, the authors focus on three areas: social structure, health and manpower planning, and financing and organization of family doctor services, where major changes will need to occur in the decades ahead, if a new family doctor is to emerge as a cornerstone of a team-oriented approach to primary health care services.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The association between distance traveled by a patient to an inner-city clinic and his utilization of its services is investigated. Clinics are divided into two types—large-bureaucratic and small-neighborhood—to determine the extent to which clinic size and administrative structure affect this relationship. “Source of patient referral” is related to distance traveled to ascertain whether it plays any part in the association between distance and type of clinic. The relationship between frequency of attendance, which is an alternative to the distance-interval method of measuring utilization, and distance traveled to a clinic is also investigated. The study concludes by exploring the extent to which “patient satisfaction” is associated with frequency of attendance and with type of clinic.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The issue of physician employment stability in OEO neighborhood health centers is discussed. To study the stability of this work force, life-table analysis was used. The “cumulative expectation of survivorship” was translated into a cumulative probability of remaining in employment. Age, sex, race, employment status, specialty status, board certification, and AMA-membership-specific cumulative expectations were calculated. At the level of theorganization(the specific neighborhood health center), data were developed which link organizational type, i.e., some administrative characteristics of the centers themselves independent of the physicians working in them—with the stability of the physician population. The 2-year indicator of population stability was developed for each center, centers classified according to this indicator and contrasted according to the associations between survivorship and other identifiable organizational characteristics.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Geographic maldistribution of dentists is an important aspect of the current and projected dental manpower shortage. In an effort to understand some of the factors associated with dentists' choice of practice location, approximately 2,400 dentists who graduated from selected dental schools during 1950, 1955, and 1960 through 1965, were surveyed and the relationship between their current practice location, their place of residence at the time of admission to dental school, and the location of the school they attended was investigated. It was found that most of the dentists who were New York State residents at the time of admission to the three New York dental schools, or five selected out-of-state schools, located their practices in New York State. Similarly, most of the non-resident graduates of the New York dental schools returned to their home states to practice. Furthermore, the large majority of New York State residents who graduated from New York dental schools established their practices in the same geographic region within the state as their original residence, or in a region which was similar to their original residence with respect to urbanization and population density. The implications of these findings for dental manpower planning are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Physician offices are commonly assumed to be comparatively scarce in low income and black urban areas. To test this assumption, the number of physician offices in each census tract in the city of Pittsburgh was cross tabulated against median income levels. This cursory analysis indicated that, in contradiction to the conventional wisdom, income level and office frequency were negatively correlated. Multiple regression techniques were then employed to test a model of physician distribution within Pittsburgh that allowed the contribution of several determinants to be tested simultaneously. The results indicated that proximity to short term hospitals and the presence of large amounts of commercial zoning were the principal factors affecting physician office location. After controlling for these factors, the effect of median income of an area was found to be neutral, exerting no influence one way or the other, although there was a slight tendency for physicians to be scarce near concentrations of blacks.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

A management control system was adapted from its applications in the business world to a neighborhood health center. The system was planned, then implemented in the health center, and management control data were collected and used for a study period of 1 year. The system proved acceptable to the professionals in the health center and was associated with motivational changes in the health center staff and subsequent modifications of the production characteristics of the health center. Such a system, even with the limitations resulting from a first effort, seems adaptable to the medical care setting and may be useful in modifying some of the inefficiencies that exist within the health system.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

As a step toward understanding and improving clinical judgment, this study clarifies the bases or physicians' prognostic judgments and evaluates accuracy of prognosis against an outcome criterion. Prognoses of improve, remain the same, and deteriorate or die were made for 477 mostly elderly patients being placed from a VA Hospital into 40 community nursing homes. It was found that prognosis was importantly influenced by a diagnosis of internal cancer, far more importantly, in fact, than was warranted by its relationship to outcome. Physical impairment was also a significant determinant of prognosis, but to a lesser degree than might have been anticipated considering its importance in diagnosis and treatment. Prognostic accuracy was found to be quite poor, a finding which supports the relevance of further inquiry into the problem of prognostic judgments.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Planning the reorganization of a large medical clinic has been greatly facilitated through the use of systems analysis and model simulation techniques. This study describes a monitoring system utilizing the separate techniques of time-motion and work sampling which provides the input data for the models thus allowing an accurate simulation of actual clinic operations. Time-motion data is obtained by utilizing permanently installed automatic printing time clocks that record various times on a work sheet accompanying the patient's chart. Physician activity is determined by work sampling, a technique characterized by random observation sampling. An observation describes the type of physician activity concerned at an instant of time. Activity categories are charting, with patient, consulting and miscellaneous. In a typical week, 471 patients spent an average of 149 minutes in the clinic which included 80 minutes waiting, 8 minutes in exam room prior to physician beginning, 31 minutes physician time and 31 minutes of processing prior to leaving the clinic. The 2,587 observations of the physician group (103 physicians) obtained by work sampling, determined that they spend 37.8 per cent of their time charting, 5.3 per cent consulting, 55.2 per cent with the patient and 1.7 per cent in miscellaneous activities. Reproducibility of the data over months of obsrvaion suggest that it interferes minimally with clinic activity and is a reliable source of data for model simulation and evaluating operational changes.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID