摘要:

Several methods of providing personal health services to a community are presented. Various aspects and issues involved in the implementation of today’s two emerging patterns for the provision of medical care—categorical disease programs and comprehensive health care programs–are discussed. We believe that no basic conflict exists between these two patterns of care and that the preferred medical care model would combine the two into a pattern that is categorically oriented within a comprehensive care context. Such a pattern of medical care seems feasible and could solve some of the problems associated with the increased complexity of medicine faced in America today. The role of the university medical centers in assuming leadership in setting up such health care programs is stressed.

ISSN:0025-7079    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

We report here a project designed to provide the home care and extended care facility services presently available under Medicare to a population of more than 100,000 people under 65 years of age in a comprehensive, prepaid group practice program. Data are presented on the impact of these services on the use of hospital care by the population. Costs and utilization data are presented, and the total cost of home care, extended care facility, and hospital service is compared to the previous cost of acute hospital alone. The project demonstrated that these services can be readily integrated into a prepaid group practice program. The demonstration successfully implemented the much discussed concept of progressive patient care.

ISSN:0025-7079    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

Primary care physicians in private practice were surveyed in depth to enable evaluation of various structural and sociologic variables as predictors of differential prescribing practices. “Appropriateness” or quality of prescribing behavior was determined by expert judges. While it is often suggested that longer professional experience leads to provision of higher quality medical care, this investigation found more appropriate prescribers to be younger, more recent graduates who have taken additional courses and postgraduate training, but who have had fewer years of experience in practice, maintain larger, hurried practices with more ancillary assistants, and spend less time with each patient. Better prescribes are also found to be more cosmopolitan, modern, and concerned with both psychosocial and quality dimensions of medical care. They frequently consult with (and refer more of their patients to) other physicians and rely most heavily upon journal articles for drug information. Good prescribers are more satisfied with their prior training in therapeutics and more concerned about the current general level of prescribing quality; they seek data on contraindications and are more dissatisfied with existing sources of prescribing information. Finally, the better prcscriber is critical of the pharmaceutical industry and supports an expanded role for the Federal Government in regulating drug quality and costs.

ISSN:0025-7079    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

A study of judgments of the quality of clinical care, made after retrospective analyses of hospital charts, in three clinical disciplines (obstetrics, surgery, pediatrics), revealed discrepancies, in intra-disciplinary judgments of the quality of clinical care, that cast doubt on the validity and the reliability ofuncontrolledpeer judgments of this quality. It was demonstrated that the degree of agreement between repeat judgments on the same cases by the same reviewers did not materially differ from the agreement seen in a different study involving serial judgments of the same kind made by different reviewers. It was shown: (1) that individual judges consistently differed, in the degree of harshness or permissiveness of their respective judgments; 2. that judges depended upon different aspects of clinical care to make final judgments of the quality of that care, and 3. that the number of independent (but professionally equally qualified) judges required to reach a stable judgment of care quality exceeded the number logistically available to meet the probable future demands of third-party payors. It was suggested that judgments of the quality of clinical care, derived from retrospective analyses of hospital charts, should be related to the compliance (or noncompliance) of the recorded care with pre-established sets of standards for that care.

ISSN:0025-7079    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

The factors of age, sex, specialty or primary interest, specialty board status, neighborhood of practice, and medical school are examined in relation to whether or not physicians in private practice in the Southern New York Region have appointments to a hospital medical staff. Evidence is adduced to suggest that the existence of the isolated practitioner is probably a function of several variables. While it appears that the medical staff of many hospitals utilize quite selective criteria pertaining to the admission of new members, it seems likely from the data that the individual physician’s perception of the relevance of a hospital appointment is quite varied, being greatly affected by his personal and professional interests, and that as a consequence his motivation to achieve membership is also varied. The implications of such findings are that community, institutional, and individual responsibility should be exercised toward assuring opportunities for institutional affiliation to all licensed physicians and for motivating physicians to seek such opportunities.

ISSN:0025-7079    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

The tendency to enter the sick role is examined in a situation in which economic barriers to medical care have been removed, clinic facilities are accessible, and complete coverage is assured in a system of comprehensive medical insurance. Such a setting serves to highlight the role of norms and cultural values of class and ethnic groups as well as the potential secondary gains to be obtained through illness. The research is based on a sample of 2,013 adult residents drawn systematically from the population register of Israel’s three major urban centers. Since close to 90 per cent of the population is covered by some form of comprehensive medical insurance, virtually all respondents had such medical care available to them. The tendency to enter the sick role was defined by reported behavior in response to a set of ambiguous, mild, familiar symptoms. The data indicate that a high tendency to enter the sick role is concentrated among older, lower class, less acculturated people. Illness may serve a functional role in a society characterized by a large proportion of immigrants by contributing to their integration in the social system. There is a suggestion that medical care institutions may be playing an acculturative role.

ISSN:0025-7079    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

In over a dozen years during which considerable research on emergency units has accumulated, only a few studies have seriously looked beyond the immediate visit to the emergency unit. None has systematically represented the patients’ full methods of getting medical care. The present study was designed to do this by documenting for each emergency unit patient hisoverallpattern of medical care fromallsources. The resulting analysis reflects not only a variety of medical care patterns within an emergency unit’s patient population, but also distinctive differences between two differently situated hospitals—one in an inner-city setting with a substantial lower-class population, the other in a suburban middle-class milieu. The data reported become a vehicle for conveying an overriding principle, important both for medical practice and for research in health services organization and delivery: that comprehension of the patients’ overall patterns of obtaining medical care is needed in order to understand, and properly to exercise, the role of the hospital emergency unit.

ISSN:0025-7079    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

A computer model of a hypothetical group practice was developed to test its economic feasibility and the potential impact of using a nurse to assist in primary care. The program was written to simulate the fiscal and administrative operations of a small rural group composed of internists and pediatricians. Input variables include the demographic profile of the population served, fees, collection rate, work load, and overhead. Output variables include number of ambulatory and hospital visits, staffing requirements, expenses, and net income per physician. Using data from a nearby rural community and the fee schedule in use locally, the results demonstrate the feasibility of a small group practice. Secondary runs using a Primary Care Nurse to render care to a certain proportion of patients indicate that her presence under most conditions of patient demand enhances both the economic viability and financial attractiveness of the practice.

ISSN:0025-7079    

出版商:OVID    

年代:1972

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

A questionnaire study was done on the sources of referral of new patients into the private practices of physicians on the staff of a large, urban, acute, voluntary hospital. The interpretation was limited to those respondent groups who were representative of the active staff of the hospital. After consideration of this limitation, it appears that the internists function as primary physicians and in turn initiate a referral chain among the institutional staff.

ISSN:0025-7079    

出版商:OVID    

年代:1972

数据来源: OVID