Showing papers on "Health care published in 1971"

American Medicine and the Public Interest

Abstract: The reissue of Rosemary Stevens's groundbreaking book on the growth of medical specialties offers a new opportunity to consider the state of the American health care system. Updated with an extensive new introduction and a new bibliography, Stevens's book chronicles the development of the medical profession and shows how increasing emphasis on specialization has influenced medical education and public policy. She details specialization's effects on health care costs and on health care providers, and her concerns are especially timely: the implications of technology and the resulting ethical dilemmas, the issues of insurance, many people's limited access to care. As a long-time observer of American medicine, Stevens makes a valuable contribution to the current debate on how best to provide--and pay for--a high level of medical care in this country.

Evaluating Quality of Patient Care: A Strategy Relating Outcome and Process Assessment

Abstract: One of the most important questions to be asked of any health care system is the following:Whoneeds to learnwhatto most improve health status of the population receiving care? Previous studies have demonstrated (1) that there is an important relationship between patient care assessment and education that might provide a framework for answering this question1and (2) that systematic application of this approach requires a priority list of health problems to be studied.2 The first study dealt with physician response to apparently unexpected abnormalities in three routine screening tests in which it was found that physicians made no apparent response of any kind to approximately two thirds of the test abnormalities. In solving this problem, it was learned that systematic investigation is needed to identify education objectives that specify the individual who needs to learn, as well as the goals to be achieved in the

Health care and the family: a three-generational analysis.

Abstract: While a great deal is known about the health and health care of the population as a whole, little is known about the family as a basic unit of health. Fallowing the work of Reuben Hill & Associates, a three-generational exploratory study of the health and health care of a select group of families living in the Minneapolis-St. Paul metropolitan area was undertaken in 1967-68. Some 210 nuclear families (70 three-generation linkages), all residingwithin a 75 mile radius of the Twin Cities area, were interviewed intensively, five times over the course of a year. Data of both a cross-sectional as well as longitudinal nature were obtained. Although only in its formative stage of analysis, our study has seemed to demonstrate not only the feasibility and value of intergenerational-family analysis to the field of health care but highlight the relatively precarious position of the younger generation vis-a-vis the financial demands of illness and the ill preparedness of their grandparents to cope with their health care problems as well. Finally, our findings tend to lend at least partial support to Parson and Fox's rather pessimistic view of the role of the family in health care, suggesting somewhat greater universality than originally proposed.

Factors associated with delay in the initiation of physicians' care among late adulthood persons.

Abstract: THE shift in the dominant pattern of Tillness from sudden-dramatic acute forms to gradual-insidious chronic forms has led to a modification of the concept of preventive medicine to include the early diagnosis and treatment of illness, as well as activities aimed at avoiding the onset of illness.' In its study of chronic illness in the United States, the Commission on Chronic Illness estimated that in nearly 40 per cent of all cases of chronic illness, unnecessary suffering and disability result because of avoidable delays in diagnosis and treatment.2 In the case of cancer of the breast alone, the American Cancer Society has stated that 82 per cent of all deaths could be prevented through early detection and treatment, in contrast to 37 per cent when treatment is delayed.3 Though there are exceptions, entrance into the health-care system is largely a matter of individual volition. The decision by the individual to initiate or refrain from initiating a physician's visit is an important element in the effective application of medical knowledge and technology.4 Generally speaking, the successful application of medical know-how calls for early diagnosis and treatment. Early diagnosis and treatment in turn requires the cooperation of the individual in the frequent and prompt initiation of health care. While there may be some question about the practicality of getting individuals to initiate care for illness in the preclinical stage (because of the difficulty of convincing individuals to see a physician when they are feeling well, problems associated with the accuracy and efficiency of mass screening and diagnostic technology, and resistance to change from traditions of private medical practice and the doctor-patient relationship), there appears to be little question among health professionals that

The physician referral process: a theoretical perspective.

Abstract: The behavior of physicians in referring patients to other physicians is considered from the standpoint of social costs and rewards to the interacting physicians, and the implications of referral for quality of care and cost to the patient are discussed. Exchange theory is offered as a framework allowing conceptualization and analysis of the various aspects of the referral interaction. Relevant variables for investigation are identified, and suggestions are made for future research into this aspect of the health care delivery system.

Toward an Integrated Methodology for the Analysis of Health-Care Systems

Abstract: This paper introduces patient state and physician state of information as two unifying concepts for the analysis of health-care systems. The concepts are presented in the context of four specific problem areas. As a demonstration of the utility of these concepts, a technique for evaluating alternative facility macroplans is described and some results from an actual application are presented and reviewed.

Medical care in western Sydney. A report on the utilization of health services by a defined population.

Abstract: A household survey of a representative sample of the population of five local government areas in western Sydney revealed a high rate of utilization of hospital and medical services. The very old and the very young place the greatest demands on these services, and utilization rates are higher for women than for men. General practitioners form the major source of primary medical, antenatal and obstetric care and undertake a quarter of all surgical operations.

The school nurse practitioner program. A new and expanded role for the school nurse.

Abstract: The school nurse practitioner program is a new educational and training program in pediatric health care for professional nurses which prepares school nurses to assume an expanded role in providing improved health care to school-aged children. School nurses will be prepared to offer comprehensive well-child care and to identify and assess the factors that may operate to produce learning disorders, psychoeducational problems, perceptive-cognitive difficulties, and behavior problems as well as those causing physical disease. The school will serve as a principal setting for comprehensive primary and continuing health care and services since it is the one place where children between the ages of 5 and 18 years are regularly and readily accessible. Effective utilization of nurses in a school setting could result in a major modification of the present health-care system.

Modeling Patterns of Death and Disease in Chicago

Abstract: The purpose of this paper is to develop methods of relating notifiable diseases1 and other key measures reported by small subareas within cities to the socioeconomic characteristics of the people residing in those areas. It is believed that such a study will provide a valuable input for future analyses of illnesses in relation to social groups, and lead towards much needed improvement in urban medical geography. Predictions of future need for health care based on

Measuring the Quality of Health Care

Abstract: IT is no news that the quality of health care in the United States is often called "inadequate," with the descriptors ranging (±2 S.D.) from "catastrophic" to "spotty." Although a host of distressf...

Acceptability of an expanded nurse role to nurses and physicians.

Abstract: THE EXPANSION of the nurse's role in medical care has been offered as a solution to the medical manpower shortage. Admittedly, a large part of the physician's daily activity does not actually require his highly specialized training. The technical feasibility of further training and greater professionalization of the nurse is acknowledged, so an expansion of the professional role of the nurse seems to be one obvious solution. Nurse role expansion is already taking place in coronary care units and primary pediatric care. Success of these innovative health care measures depends upon the degree to which they are accepted; the new role of the nurse must be recognized by other professionals, para-professionals, health care legislators, and consumers. This study addresses itself only to the problem of the acceptability of an expanded nurse role to nurses and physicians. Measures were devised to obtain comparable scores of acceptability for doctors and nurses. Levels of acceptance were compared, and an attempt was made to identify determining factors which were significant.

Use of allied health professionals in internists' offices. Current practices and physicians' attitudes.

Abstract: A survey of 3,425 members of the American Society of Internal Medicine (ASIM) in 1,800 offices shows an average of 2.22 allied health workers employed per internist. The smaller the office, the less likely are the personnel to have formal training in health care. There is an inverse correlation between physician-population ratio and both the number of health workers employed and the degree to which the physician delegates aspects of his practice to assistants in the various regions of the United States. There is a considerable gap between what the internist believes he could and should entrust to allied health personnel and what he actually does. A substantial number of internists believe that either a registered nurse (RN) or a physician's assistant can, under supervision, perform aspects of patient care traditionally restricted to the physician.

Casual attendances at an accident department and a health centre.

Abstract: In six months patients from a defined population of 11,417 provided 826 casual attendances for minor conditions at a hospital accident department and 1,430 similar attendances at a health centre treatment room. Attendances at the accident department reached a peak during the early evening, and included relatively more males, more adults, more patients with injuries than with symptoms, and more residents from the area immediately adjoining the hospital. Care of most of the casual attenders with minor conditions at the health centre treatment room would require additional nursing staff and some reorganization of primary care to enable a doctor to be available at most times. Attendances at night and at week-ends were insufficient to justify a 24-hour service at the health centre.

Variations in Visits to Hospital Emergency Care Facilities: Ritualistic and Meteorological Factors Affecting Supply and Demand

Abstract: Analysis of Boston Police Department ambulance runs, emergency unit visits to three Boston hospitals located within a six-block radius of one another, and weather conditions during 1968 allows both a micro- and a macroview of the influence of ritualistic and meteorological factors on hospital emergency unit utilization. On a theoretical plane, differences in the temporal distribution of injuries vs. diseases and emergent vs. nonurgent conditions are reduced to variation in levels of risk attributable to meteorological influences and the pursuit by various segments of the population of activities prescribed by occupational and/or social ritual. Empirical findings and their implications have relevance for health care planners and administrators trying to reach decisions about appropriate staffing patterns in hospital emergency care facilities as presently utilized. Assessment of the relative inflexibility of expectations based upon occupational and/or social ritual as it effects supply suggests ways of reorganizing the system for treating the range of nonurgent to urgent conditions arising in the community in the course of the year.

Health care organizations and innovation.

Abstract: A 4-year case study of organizational change is presented. The Community Nurse Agency (CNA) initiated a Neighborhood Center Project in a large midwestern city (population over 1.5 million and almost 50% black). According to the experience organizational innovation is best understood as a political problem involving power relations among organizations seeking scarce resources. Some ways for dealing with the political problem are suggested through this case. Innovation may require the formation of new constituencies which transcend the boundaries of race sex community position and size. Such alliances may well be formed to acquire resources from new federal programs. New strategic techniques were needed in the innovation. A major area of difficulty in CNAs innovation was the operation of public bureaucratic structures. A second area of difficulty was the appeal to quality and standards by the health professionals based on an effort to protect and control professional domain. The control of the citys health organizations by whites was pointed out. Isolation of organizations by race impedes alliances that could foster innovation.

Muddling through: planning for health care in England.

Abstract: Some of the limits of rationality in health planning are illustrated in contemporary England. The English penchant for "muddling through," often considered to be the antithesis of rational planning, may in fact suggest that in certain stable political environments a model of comprehensive rationality in decision-making not only is not, but also cannot and should not, be followed. Development of policies in regard to physician manpower, hospital beds, and health centers reflects a complex mixture of advocacy and evidence in the decision process. Although the English style of health planning illustrates the limits of a rational model, the National Health Service appears to have provided extraordinary value for money over the past two decades.

Home health services.

Abstract: The Health Services and Development Agency (HSDA) may consider the following standards and criteria for applications seeking to provide home health services. Rationale statements for each standard are provided following the standard. Existing providers of home health services are not affected by these standards and criteria unless they take an action that requires a new certificate of need (CON) for such services.