摘要:

A unique medical audit procedure has been employed to combine the scope of population data with the detail of case histories. All tonsillectomy and adenoidectomy (T&As) in Manitoba for one year were studied. A group of individuals treated for respiratory illness but not having T&As were also identified. Individual histories were reconstructed from medical insurance claims. These cases were reviewed to test conformity between practice and authoritative standards for surgical intervention.The quality of the data on which this procedure depends withstood a battery of challenges. The analysis indicates that most cases selected for surgery lack evidence of meeting authoritative standards. However, a sizeable group of individuals not selected for surgery perhaps should have been, if the same standards are applied. Also, those physicians performing the most operations had the highest criteria for patient selection.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Through conceptual discussion and consideration of a case study, this paper examines how physicians respond to the availability of an innovative treatment of a serious illness. It is argued that the unusual economic environment of the delivery of catastrophic illness care works with the “social contract” in medicine to encourage the use of innovative therapies, even before their efficacy has been demonstrated and often irrespective of their costs, in striking contrast with the conventional innovation adoption process. The primary constraint on catastrophic illness treatment may well be the technology or the state of knowledge. In the case of the management of leukemias in Connecticut, decisions to use drug therapies appear to have been based on a treatment trend rather than on the inherent merits of the therapies. The trend seems to have spread from the treatment of one leukemia, which responded significantly, to the management of three other leukemias. The influence on treatment decisions of a few individual variables differed across the leukemias. For example, treatment decisions in the acute leukemias were unrelated to the patient's economic status, whereas receipt of chemotherapy for one of the chronic leukemias was significantly positively correlated with economic status.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The care-seeking behavior of 262 patients who experienced acute episodes of coronary heart disease (CHD) was analyzed to determine: the incidence and duration of physician consultation; the proportion of total time from acute symptom onset to hospital arrival consumed by medical evaluation; and the impact of medical evaluation on mode and duration of travel to the hospital and the duration of medical evaluation and administrative procedures in the hospital emergency room. The results of this analysis suggest that physicians and ancillary medical personnel and the patient and lay others are about equally responsible for “delay” in obtaining definitive medical care. Extended medical evaluation was likely to occur when a patient's physician was an internist-cardiologist and the patient was young or without CHD, and a patient had numerous pre-existent chronic diseases. If effective techniques to bring patients under definitive medical care during the first critical hour of acute coronary episodes are to be developed, both lay and medical behavior should receive research attention.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The purpose of this study is to determine the influence of medical school, teaching hospital, and specialization on physicians' use of clinical and technical resources. The universe of the study consists of 34 internists practicing in the prepaid group practice setting of Kaiser in Portland, Oregon. The data reported here show that physicians trained in medical schools and hospitals with a scientific medical orientation generally use fewer such resources than other physicians. However, under conditions of uncertainty, that is, when diagnosis is unknown, they tend to use more services. In other words, these physicians are conservative in their use of resources when ambiguity is low, and liberal when ambiguity increases. Graduates of the more scientifically oriented institutions seem therefore more flexible in adjusting to the demands of the disease situation.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Physicians at Stanford University Medical Center were surveyed to evaluate their responses to a computerized drug interaction warning system one year after its installation. While one-fourth of the 862 respondents had personally received at least one warning report, the educational benefits of the system had diffused to many physicians in the hospital. Reports were found to be useful for patient management and 44 per cent of the phyysicians who had received reports indicated they had changed their behavior in response to the information. The system was particularly beneficial for interns and medical students, and appears to have potential as an educational tool for training in therapeutics. While several problems with the system were noted, the overall attitude of the respondents toward it was favorable. The drug interaction warning system appears to have a promising future for reducing the problem of drug interactions among hospitalized patients.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A health care technology evaluation framework is presented along with its application to the Missouri Automated Radiology System (MARS) project. The framework is made up of the following components: evaluation objectives, evaluation design, system documentation, analysis model, evaluation measures, and data collection. The results of applying the framework indicate that MARS incerases the cost of diagnostic radiology 2.3 per cent, significantly decreases report response time, and successfully performs the film management function.

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1977

数据来源: OVID