摘要:

Group medical practice has grown slowly but steadily in the United States, as measured by the proportion of physicians in such units; these proportions, however, differ markedly among the 50 states. Relationships were explored between ten socioenvironmental factors and seven medical resource factors associated with the strength of group practice in each state, using both simple correlations and multivariate techniques. The findings point to greatest group practice growth in newly settled regions of relatively low population density, suggesting the favorability of a nontraditional medical atmosphere and a rural environment for this type of professional innovation. Comparatively fewer hospital-based physicians and a lower overall doctor-population ratio are also involved. If group practice is to be promoted, the task will be to overcome the apparent handicaps of traditionalism and urbanization.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

The descriptive literature on primary health care reveals an abundance of articles, without documentation, extolling or disparaging different forms of primary care. Experimental studies have measured the effects of making a clinic setting more comprehensive. Making a clinic more comprehensive decreases hospitalization after about one year. Differences in utilization of preventive vs. illness-related visits may explain the failure to decrease outpatient utilization with increasing comprehensiveness of care. Unconfirmed studies found decreased emergency room visits, fewer multiple hospitalizations, fewer broken appointments, and increased return to referring physician. End result studies are sparse and inconclusive. Present data is insufficient to show superior quality for any one kind of primary care. Age, sex, race, martial status, family size, education, socioeconomic status, symptomatology, tendency to use services, university clinic setting vs. solo private practice, and sick vs. general population samples are variables which affect utilization and have not been controlled for adequately in past studies. Future studies should have more adequate control groups and more objective variables.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

The purpose of this study was to compare the health care of two groups of ambulatory patients–those treated primarily by a nurse-clinician under physician supervision, with those treated by attending physicians–in the general medical clinic of a large university teaching hospital.One hundred and sixty-nine new patients were randomly assigned to the Health Maintenance Service (HMS) staffed by the urse-clinician and to the Control Group, staffed by attending physicians. The data based upon patients medical charts and questionnaires revealed that among the HMS patients, there were fewer recorded lapses in care, proportionally fewer whose health conditions were rated as unstable one year after their initial visit, and none whose health condition was judged as deteriorated. The nurse-clinician was able to provide coordinated and continuous medical care for ambulatory patients and the quality of this care appeared to be at least equal to that provided by the physicians.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

To determine if an undifferentiated entry mix impedes the effective and efficient delivery of health care services, the relative impact of nonsick patients on a health care system is empirically examined. The distribution of new presenting morbidities in a 5 per cent sample of Kaiser Health Plan members seen by all physicians in the ambulatory care system for 1970 and the distribution of all presenting morbidities in the sample seen by primary physicians in the department of internal medicine for the same year are assessed. The nonemergent contacts made by patients without a regular doctor are isolated on the assumption that this group contains the “worried-well” visits. The number of visits in this special group accounts for only 18.8 per cent of total presenting visits to the department of internal medicine. The large number of new morbidities revealed by physical examinations necessitates reclassifying the patients who made visits for this purpose from the well to the asymptomatic sick. It can be concluded that the relative impact of the group of patients described as the “worried-well” is much smaller than has been previously postulated.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

The development and design of a computer simulation model of a health maintenance organization (HMO) is described. Simulation models permit experimenting with policy changes without the risk of actually making major alterations. The data for this model came from applying it to the issues facing a Children and Youth Project considering conversion to an HMO. To illustrate the model's usefulness, simulations arc presented, showing the impact of different marketing approaches, benefit packages, and fitness programs.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

The following article describes and analyzes a unique type of a physicians' strike in Israel's largest Health Care organization–The Labour Federation Sick-Fund (Kupat Holim). This strike occurred as a result of the physicians' demand that the newly vacated office of Chief Executive be entrusted to a physician and not to a political administrator, and management refusal to succumb to such a dictate. The strikers' arguments as well as the management's position are analyzed and conclusions are drawn by the authors.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

This paper reports the results of a study which set out to determine whether a young dental practitioner who employs the concepts of four-handed dentistry using one chairside dental assistant could sufficiently increase his productivity by employing an expanded duties dental assistant (EDDA) and one additional chairside assistant to make the resulting increase in overhead economically feasible.Productivity data were collected as 20 senior dental students treated patients in a control setting which consisted of two identical operatories and a staff of one chairside dental assistant, and an experimental situation consisting of two identical operatories equipped the some as the control operatories and a staff of one EDDA and two chairside assistants.Analysis of the data indicated that, on the average, the students performed sufficiently more services using the larger staff to have generated more than enough additional revenue to pay the added salaries. Although each patient was required to remain in the chair somewhat longer to receive treatment in the experimental situation, the students working with a team of auxiliaries performed substantially more services for more patients within the available time.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

A previous study at this institution demonstrated extreme variation in use laboratory tests among similarly trained internists caring for similar groups of ambulatory patients. This report examines whether these variations can be related to differences in the quality of physician performance. The physician group studied consisted of 21 medical interns at the George Washington University Hospital. In order to insure that differences in laboratory use among the physicians were not attributable to clinical differences in their patient populations, measurement of laboratory use was restricted to a standardized subset of patients admitted to the coronary care unit with acute myocardial infarction or chest pain. Mean laboratory costs for the first three hospital days varied from $48 to $113 per patient among the interns. The relative clinical competence of the interns was independently assessed by five active faculty members. Concordance among the faculty raters was high and statistically significant (p < .01). Rank order correlation between an intern's cost behavior and his assessed clinical competence was negligible (rs= — .13). Strong correlation existed between the number of redundant (unnecessary) tests ordered per intern and his overall cost rank (p < .01), but not between frequency of redundant tests and clinical competence. At least in this setting, a physician's laboratory utilization profile is not a good index of quality of care.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Within eight diagnostic categories on an individual case level of analysis, separate indices of recorded physician conformance to predetermined criteria for optimal care were derived. One index for each diagnosis was composed of measures that depended upon a physician's medical record recording and another was composed of measures recorded independently of the physician. Correlation coefficients between indices averaged +0.23 with a range from −0.03 to +0.53. The magnitudes of the correlations were related to the estimated reliabilities of the subindices. These data, congruent with previous research, indicate that measures of good medical recording performance and good medical care performance are related, that the overall relationship is not at all perfect, and that the reliabilities of the measures may attenuate the degrees of obtained relationships.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID