摘要:

Utilizing a tracer method in the assessment of care was investigated in a large pediatric clinic. A set of tracers were selected and agreement was obtained concerning the relevance of care criteria by at least 80 per cent of the facility physicians. One tracer, iron-deficiency anemia, was studied using two nonphysician abstractors to review a sample of 100 patient records with hemoglobins of 11.0 gm/100 ml or less. Results were compared with an implicit review by a panel of physicians. In 52 patients, the low hemoglobin level was not recognized. Only 25 patients proceeded through the care levels of evaluation, diagnosis, treatment, and follow-up. Poor compliance was found with the approved criteria. Weighted scores of the explicit tracer method were closely related to ratings by the implicit reviewers. Utilizing tracer assessment with nonphysician abstractors demonstrated remediable deficiencies in health care services.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The paper describes a method to evaluate patient care. The technique is based on the staging concept. Its basic premise is that the seriousness of a patient's condition at some point in the treatment process is a good indicator of the outcome of the previous parts of the process.Data were collected for 5,000 patients who had been admitted to a sample of hospitals in two California cities with a primary diagnosis matching one of the diseases for which staging criteria had been developed. The results indicate that the staging technique can be used to distinguish between the outcomes of ambulatory care received by different population groups.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

This paper reports the opinions of a representative sample of 1,329 physicians providing primary care regarding criteria developed by the Joint Committee on Quality Assurance for evaluation of ambulatory child health care. Areas of care were health supervision (in four age ranges), tonsillopharyngitis, bronchial asthma, and urinary infection. The criteria had been previously appraised by 452 “experts”— academicians and practitioners.Physicians rated criteria for relevance to health outcome, and desirability for use in peer review. They also stated whether they usually performed and recorded each item and gave reasons for not recording.Agreement between the pediatricians and other physicians of the sample and the “experts” was close regarding relevance to health outcome, but many fewer criteria were recommended for peer review by the sample. A significant number of respondents said they performed but did not record many of the criteria. Documentation of only abnormal findings was the main reason given for not recording. Criteria dealing with developmental or behavioral assessment or with counseling were rated lower in all categories than more easily measured items.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

A technique is described which circumvents the difficulty in obtaining reliable judgments by clinicians on cases of inappropriate use of hospital beds. By application of the Delphi method of measuring group expert opinion, convergence was achieved in the estimate, by four physicians, of the total number of bed days wasted on a medical ward during a period of two weeks. Cases of possible misutilization were identified by the author and a second study was designed to measure the effect on the physicians' behavior of her presence on the ward (Hawthorne effect). It is suggested that review of cases of misutilization by the Delphi method could be used in the continuing education of physicians.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Recent federal legislation has contained the stipulation that participating health maintenance organizations (HMOs) include a quality assurance program which stresses health outcomes. This provision was ostensibly directed at correcting alleged abuses in HMOs serving the urban poor. One version of the outcome method was employed for an 18-month period at an urban HMO caring for 2,000 Medicaid subscribers. The program involved comparing diagnostic accuracy and therapeutic outcomes for clinical conditions relevant to the study population with ideal standards established by the HMO. Three conditions were selected: contraception, depression, and hypertension. The results revealed widespread underdiagnosis (44—74%) in each condition and unacceptable therapeutic outcomes in two. Data collection was hampered by shifts in geography and financial eligibility among the denominator population and low response rates (38-63%) to telephone and mail surveys. Applying the general project guidelines to specific conditions proved considerably more difficult than anticipated. Further refinement of this approach to quality assessment must occur before its widespread use is feasible. Its effectiveness in improving quality remains to be seen. This experience raises doubts regarding the wisdom of legislating a specific outcome approach to quality assessment before feasibility and effectiveness have been demonstrated in organized health settings.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The Sickness Impact Profile (SIP), a measure of health status, is being developed as an outcome measure of health care. A preliminary study of the validity of the SIP was conducted on a sample of 278 subjects who were grouped into four subsamples differing in land and severity of sickness. Selfassessment of health status, clinician assessment of health status, and other measures of dysfunction were used as criteria. SIP scores discriminated among subsamples, and correlations between criterion measures and SIP scores provided evidence for the validity of the SIP. Differences among the correlations obtained for each criterion measure with SIP score are discussed in terms of the need for the development of criterion measures that can be expected to differentially relate to the constructs inherent in the SIP.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The medical record should be viewed as an instrument to facilitate and demonstrate the achievement of explicit health care goals. Current systems do not accomplish this. Our examination of the traditional record suggests that modifications of the record should be based on the principles of information system design theory. Necessary modifications include changes which prompt the monitoring of the outcome parameters of a patient's illness, encourage the analysis of the patient's outcome, and facilitate adaptive (corrective) actions. We have termed those data elements which describe the achievement of patientspecific, problem-specific objectives as the “minimum care assurance data set.” To designers of computerized medical information systems, this approach provides a rationale for selecting which data to place in computer storage from the myriad of detail in the traditional paper record.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The problem-oriented system can be used to encourage the involvement of the patient in bis health care. A Health Care Plan is described, the purposes of which include facilitation of provider-patient communication, and emphasis on the shared responsibility of provider and patient in problem solving and health maintenance. The Health Care Flan is not designed to supplant other parts of the system such as the problem list or audit.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The Certified Hospital Admission Program (CHAP), which was originated by the Medical Care Foundation of Sacramento, California, is regarded as a prototype of admission certification programs and the concurrent monitoring of inpatient care. These peer review functions have now been made key elements of provider utilization review requirements and of Professional Standards Review Organizations' program operations for Medicare and Medicaid. The present article questions, on methodological and interpretive grounds, earlier published findings and conclusions about CHAP's effectiveness. Significant deficiencies in evaluating its impact may mean that the success of CHAP has not yet been demonstrated and, hence, that an adequate basis for formulating certain national peer review policies may not exist.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID