摘要:

Many current quality assurance programs aim at maximizing the quality of health services instead of optimizing it, because they rest on the erroneous “best to all” approach, which overemphasizes the scientific and technical aspects of quality. The result is prohibitively expensive “Cadillac care.” It is suggested that the optimal qualitative level can be identified by answering a chain of hierarchical questions beginning with the relevance of medical care to the solution of the problem at hand and ending with such detailed questions as what diagnostic procedures should be performed by whom, and with what technique. Using the functional definition of quality applied in industrial quality control, a mathematical model is developed to illustrate the relative nature of the concept of quality and its implications for quality assurance programs. Special attention is paid to logical quality, i.e., the efficacy with which information is used in arriving at decisions.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

An indirect measure of adherence to drug regimens was developed from pharmacy records of prescription refills. This measure was validated by demonstrations of significant relationships between compliance with hydrochlorothiazide and propranolol and expected physiologic effects of these drugs (decreased blood pressures and decreased pulse rates, respectively). The measure was used to survey compliance with 20 common drugs prescribed to 419 outpatients for long-term administration on regular schedules. Eight of the study drugs showed very low levels of compliance, suggesting “take-as-needed” (PRN) use, in spite of medical record, pharmacy record, and label instructions for regular administration. For the whole survey population, 12 truly “non-PRN” drugs showed a considerable gradient in mean compliance rates, ranging from digoxin (76.6 per cent) to hydralazine (50.4 per cent). Within-patient differences in mean compliance with different drugs were shown (e.g., hydrochlorothiazide 61.2 per cent versus potassium chloride 41.2 per cent mean compliance, p < 0.001). Correlations between compliance rates with different drugs in a single regimen were sometimes strikingly low. We conclude that 1) chart and prescription directions for regular administration are not sufficient to identify “non-PRN” drugs in compliance studies; 2) when compliance is an outcome measure in health care trials, drug mix is an important confounding variable; 3) in outpatient clinical settings, it may be appropriate to be inherently more suspicious of noncompliance with some drugs than others; and 4) patients may comply at different rates with individual drug components of a single regimen.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The Medical Audit Committee chairmen in each of the 70 general hospitals in central and southern Illinois were interviewed. Each chairman was specifically asked questions related to 1) the purpose of their hospital's medical audit; 2) how audit topics are determined; and 3) their committee's competence at developing, conducting and following up on the results of their audit. Questions were also designed to investigate the usefulness of these audit results in planning formal continuing medical education (CME) activities. A total of 75 interviews were conducted with the following individuals: 32 chairmen from small hospitals, 18 from medium hospitals, 12 from large hospitals and 13 from hospitals that had department audit committees. Seventy-nine per cent of the chairmen believe that the Joint Commission on Accreditation of Hospitals' (JCAH) requirements are at least partially responsible for their hospitals conducting audits. More than half of the chairmen from small hospitals and one quarter of the other chairmen believed they would suspend conducting audits if the JCAH requirements were lifted. While 81 per cent of the chairmen believed audit was a good method of planning continuing medical education, only 23 per cent of the chairmen could identify a CME program that had been developed from audit. Even though it appears theoretically sound to base formal continuing medical education programs on needs identified through medical audit, those most directly involved in audit at the local hospital level in central and southern Illinois do not perceive this to be a workable model.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Using Brook and Stevenson's “trajectory” method of assessment of quality, both the process and outcome of medical care for 72 patients in a primary care clinic was evaluated. In terms of technical quality, evidence was found of failure to order required tests or examinations and inadequate diagnostic work-ups. The most positive findings were in the high number of x-ray examinations of adequate quality and the high proportion of adequate treatment received by patients within four diagnostic categories for which criteria had been established. Overall, more than 50 per cent of the patients were deemed to have received effective medical care. Interview data revealed some indication of patient dissatisfaction with the medical care received, as well as communication problems between physicians and patients.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

This study reports on some factors related to scores on a recently developed pencil-and paper measure of communication style among physicians in training. High scores on this measure (the Facilitating Response Index) indicate a greater preference by the respondent to explore or clarify the thoughts or feelings of the patient in a nondirective, open-ended fashion. Higher scores were attained by physicians who had been exposed to interpersonal skills training, who were evaluated by their teachers as being more clinically competent, who planned to enter private practice sometime to the future and whose patients were less likely to fail to show up for follow-up appointments without first calling to cancel.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

During the July 1975-June 1976 academic year, nonphysician abstractors collected data on 15,101 ambulatory patient visits managed by 175 residents in five pediatric training programs. The visits included in this study were those on which a general data base should be collected and visits for health maintenance, head trauma, impetigo, otitis media, tonsillopharyngitis and urinary tract infection. These data provided an opportunity to investigate the number of medical record audits required to obtain a stable estimate of resident performance for a given medical condition and the relationship of performance across a number of medical conditions. The standard errors of the mean for 844 distributions of per cent compliance scores for individual residents were calculated. The standard error was less than five in 97 per cent of the instances where ten or more records had been abstracted for a given resident. Although there was some variability of resident performance from case to case, these data indicate that ten records may be a lower bound on the number of abstracts required to provide a stable estimate of performance. The correlations across conditions showed a moderate amount of homogeneity of performance and a clustering of performance for the acute care conditions included in the study. The correlations across acute care conditions were all statistically significant and ranged in magnitude from .52 to .77. Although the relationships between general data base and health maintenance and the acute conditions were statistically significant in some instances, they were all of lower magnitude and ranged from -.20 to .36. Thus, a modest number of abstracts for only a few conditions may provide a reliable estimate of resident day-to-day performance in ambulatory care clinics.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

This article presents a methodology for utilization review which aids the local Professional Standards Review Organization (PSRO) in selecting optimal timing of Concurrent Stay certification by diagnosis. This procedure is accomplished by modeling patients' admissions, inpatients stays and discharges for each diagnosis as a stochastic process which is audited under the PSRO by three utilization review techniques: preadmission, concurrent and retrospective review. The timing of concurrent stay certification is determined so that the maximum benefits are derived for the utilization review cost expended. The methodology presented here is a tool to aid local PSRO management in determining the most cost-beneficial utilization review process to be utilized in their jurisdiction. It is not an attempt to demonstrate the effectiveness of our utilization review policy over another in general. On the contrary, while the model is generalizable to every PSRO, the utilization review policies resulting from any application are situation-specific. The major contributions of this article are new insight into modeling the utilization review process and the provision of a methodology for which computer programs exist and are readily available to any PSRO that should desire to determine its utilization review procedure in this cost-benefit framework. In order to apply the model it is necessary that certain parameters specific to the application site be estimated or assumed. Exact procedures to aid the PSRO in parameter estimation is the subject of current investigation.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Many believe that improvement in laboratory automation has been responsible for the considerable growth in the volume of tests that has occurred in recent years. Results are presented from an 8-year national survey of hospital laboratory utilization that show no definitive correlation between technological change and growth in volume of well-established clinical laboratory tests. These results leave room for hypothesizing other major contributory factors to volume increases such as a behavioral change on the part of practitioners who order tests and place increased diagnositc importance on laboratory results in addition to medical histories and physical examinations. If the findings prove correct, successful regulatory strategies for the containment of laboratory costs might be as likely to come from those that directly address practitioners' behavior as from those that limit capacity by requiring prior approval for acquisition of new laboratory equipment.

ISSN:0025-7079    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

From the empirical studies that generalize the individual's job satisfaction to his life satisfaction, a meta-level hypothesis was developed to suggest a positive association between the physician's assistant's satisfaction with his current job and his satisfaction with his broader occupational or career choice. A questionnaire was mailed to 280 graduates of two Physician's Assistant Programs. Data analysis is based on 170 returns. Job satisfaction is measured with an amended version of the Job Description Inventory that includes a patient satisfaction component. Job satisfaction is found to relate positively to a global measure of career satisfaction, with the work satisfaction component explaining most of the variance in career satisfaction.

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