ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Data compiled by The National Center for Health Statistics show that surgical utilization has increased dramatically, particularly during 1971-1977 (+34 per cent). Increases were greater among females than males, primarily because of an increase in gynecologic surgery. The 15-years-and-younger cohort was the only age group that did not show an increase, while surgical patients per 1,000 increased consistently with advancing age. Many factors probably have contributed to the increase in surgical utilization, yet the one factor which as been suggested more frequently than any other is surgical manpower (there may be too many doctors performing surgery for the needs of the population and this situation may lead to excessive surgery). This issue of how many physicians there should be in surgical training is widely disputed and politically volatile, however. The problems inherent in estimating future manpower requirements are many, making it hard to derive “optimal” distribution patterns.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

This article reports the results of a survey of a nationwide sample of more than 900 surgeons and post-surgical nurses, who were asked to rate the relative complexity and uncertainty of 71 surgical procedures frequently performed in hospitals. Average scores assigned to each surgical procedure by both types of raters are reported and the extent of agreement is assessed across indicator questions and types of raters. A surprisingly high level of agreement was observed. Explanations for the extent of agreement are discussed and uses for these scores are described

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Previous studies of the work loads and time utilization of general surgeons in two different practice settings suggested that paraprofessional surgical assistants (SAs) could reduce surgeon assisting time and perhaps increase productivity. In order to further assess the potential advantage of using SAs as surgical assistants, the present study examines assisting patterns in a prepaid group practice where SAs are used and in a community hospital where only physicians are available to assist. In the prepaid group practice, 87 per cent of general surgical procedures were performed with an assistant; in the community hospital, 67 per cent of general surgical procedures were performed with an assistant. General practitioners also were found to assist in the community hospital; family practice residents, medical students and “others” also assisted in prepaid group. In both settings, the propensity to use an assistant was positively correlated with operative complexity. On operations of greatest complexity, surgeons were most likely to act as first assistants. The use of SAs was not usually associated with operative sessions longer than when surgeons assisted, except on operations of high complexity. In the prepaid group, SAs also frequently assisted on orthopedic surgery, neurosurgery and obstetricsgynecology, only occasionally on otolaryngology and plastic surgery, and never on ophthalmology. It appears that in organizations such as a prepaid group practice, where mechanisms for sharing resources exist and incentives are provided to minimize the total cost of surgery, the utilization of SAs might be associated with cost savings. At present, organizational and financial barriers exist to the introduction of paraprofessionals as surgical assistants. It is difficult to advocate the modification of these barriers to facilitate the training and large-scale introduction of this new group of paraprofessionals in the current surgical market where there may already be an excess supply of surgeons.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The influence of surgery upon the natural history of congenital heart disease is great. Children with many types of congential heart lesions are now living to adult life. Most of these children will, however, require continuing medical care, care which traditionally has been given by the pediatrician. We have developed a method by which incidence figures and a knowledge of the natural history may be used to obtain prevalence estimates of congential heart disease. We estimate that in the United States in 1995 there will be nearly 300,000 children under 21 years old with congenital heart disease; 38 per cent of these will have had one or more surgical procedures. In the last two decades the majority of care for children with congential heart disease was aimed at the correction of the original lesion; however, we predict that in the next two decades an increasing fraction of medical resources will be directed toward the residua and sequelae of cardiac surgical procedures. This alteration in character of congenital heart disease will affect the patient mix seen by the cardiologist with adult patients as well as that of the pediatrician. For ventricular septal defect, pulmonary stenosis, a trial septal defect, persistent ductus arteriosus, coarctation of the aorta and tetralogy of Fallot, we have estimated the nationwide prevalence and the surgical requirements for 1995. Used with more specific local data on population and birth rate, this model can provide important input into planning the delivery of cardiovascular services.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A previous study of 12 procedures of varying complexity in 1,498 hospitals identified a strong negative curvilinear relationship between the volume of a particular operation and postoperative mortality. The current study uses multiple regression techniques to explore the role of other potentially important variables and alternative interpretations of the volume-mortality relationship. The dependent variable is the difference between the hospital's actual death rate and its expected death rate based upon the riskiness of its case mix. The inclusion of other variables, such as size of hospital, teaching status, geographic location and cost, improves the fit of the regression, but does not diminish the importance of volume. There is no evidence that volume accumulated over 2 years is a better measure than volume in 1 year. Experience and volume of related operations are important in some cases but not others. Several likely alternative explanations for the observed relationship were not supported: larger hospitals and those with more house staff had outcomes that were worse than expected. Large geographic differences in mortality rates remain unexplained. A simultaneous-equation model is used to test whether higher volume leads to better outcomes or better outcomes lead to higher volumes. Both causal paths are supported, but their relative importance varies with the procedure in ways that are consistent with anticipated referral patterns.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The health care left—a traditional source of critique and reform—has become intellectually less competent and politically less effective in carrying out its historic role in the continuing great debate over health policies and programs. Its credibility has diminished in recent years as it has come to operate on a series of undocumented assumptions: 1) that malevolence and greed are at the roots of adverse decision-making in health-care policies and programs; 2) that budgetary constraints are little more than convenient alibis to account for programmatic inadequacies; 3) that treachery, lack of social commitment and careerism are the major explanations for the behavior of public health professionals; and 4) that substantive progress in social legislation and service delivery has not occurred. A self-respecting health care left that wishes to be taken seriously once more will revive its former allegiance to objective empirical data, will abandon simplistic explanations and will eschew inflated rhetoric and habitual invective.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID