Curtis P. McLaughlin

The Outcomes and Costs of Care for Acute Low Back Pain among Patients Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons

BACKGROUND Patients with back pain receive quite different care from different types of health care practitioners. We performed a prospective observational study to determine whether the outcomes of and charges for care differ among primary care practitioners, chiropractors, and orthopedic surgeons. METHODS Two hundred eight practitioners in North Carolina were randomly selected from six strata: urban primary care physicians (n = 39), rural primary care physicians (n = 48), urban chiropractors (n = 32), rural chiropractors (n = 32), orthopedic surgeons (n = 29), and primary care providers at a group-model health maintenance organization (HMO) (n = 28). The practitioners enrolled consecutive patients with acute low back pain. The patients were contacted by telephone periodically for up to 24 weeks to assess functional status, work status, use of health care services, and satisfaction with the care received. RESULTS The status at six months was ascertained for 1555 of the 1633 patients enrolled in the study (95 percent). The times to functional recovery, return to work, and complete recovery from low back pain were similar among patients seen by all six groups of practitioners, but there were marked differences in the use of health care services. The mean total estimated outpatient charges were highest for the patients seen by orthopedic surgeons and chiropractors and were lowest for the patients seen by HMO and primary care providers. Satisfaction was greatest among the patients who went to the chiropractors. CONCLUSIONS Among patients with acute low back pain, the outcomes are similar whether they receive care from primary care practitioners, chiropractors, or orthopedic surgeons. Primary care practitioners provide the least expensive care for acute low back pain.

Care-seeking Among Individuals With Chronic Low Back Pain

Study Design. This was a stratified, random telephone survey of adults in North Carolina. Objective To determine the prevalance of chronic low back pain and the extent to which treatment is sought for this condition. Summary of Background Data Chronic low back pain is a major problem. Previous studies often have comb ined acute and chronic back pain. Methods Telephone interviews regarding back pain were conducted with 4437 North Caroliona adults during 1992. Results Chronic back pain affects 3.9% of the North Carolina population. Thirty-four percent considered themselves permanently disabled and 52% assessed their overall health as fair or poor. The median number of bed-disability days per year was three. Seventy-three percent saw a health care provider Of those who sought care, 91% saw a medical doctore, 29% saw a physical therapist, and 25% saw a chiropractor, Use of technology was extensive: 37% received a computed tomography scan, 25% received a magnetic resonance imaging scan, and 10.4% underwent surgery. Conclusions Chronic back pain is common, and the level of care-seeking and costs of care among those afflicted are extremely high.

Measuring Productivity in Services

The wide variety of productivity measurement methods available for use in services is reviewed. The diversity of the service industries has meant that each field has developed its own productivity measures which have often not been widely disseminated due to the lack of a common professional literature. The available measurement approaches are outlined, including those from the health sector where there has been a sizeable effort at productivity research. A classification scheme is presented to assist in the description and selection of available service productivity measures. The classification scheme is based on (1) complexity of inputs and outputs, (2) degree of customisation, and (3) level of aggregation. The measures of services productivity reviewed are presented in terms of this classification. An approach is suggested for the manager to follow in selecting productivity measures according to this classification and other considerations. While some attributes of services make productivity measuremen...

Total quality management in health: making it work.

Many health organizations are trying total quality management (TQM). This approach represents a total paradigm shift in health care management and presents a series of potential conflict areas in the way health organizations are managed. These areas include TQMs participatory approach versus professional and managerial authority, collective versus individual responsibility, quality assurance and standards versus continuous improvement, and flexible versus rigid objectives and plans. This article reviews the areas of conflict and suggests a number of action guidelines for the successful implementation of TQM.

Strategies for globalizing service operations

International trade in services is growing rapidly despite many barriers to trade. Consumer services are being established world wide and increasingly business services are becoming globalized in much the same way that manufacturing is outsourcing overseas. The manager of a service organization can no longer ignore international competition in services, especially the globalization of back‐room operations. Service managers need a framework in which to develop a global service strategy. Addresses two questions which managers face when developing a global service strategy: what are the factors that we can use to classify services in terms of their potential for moving globally; and how do these factors translate into strategies for the globalization of specific services? The most common dimensions for classifying service operations include consumer involvement and customization, complexity of inputs and outputs, and labour intensity. Examines five generic strategies: multi‐country expansion; importing customers; following your customers; service unbundling; and beating the clock.

Why variation reduction is not everything: a new paradigm for service operations

Highlights that one service industry in the USA ‐ health care ‐ has accepted high inherent rates of variation into its process designs. Notes that, increasingly, health care industry leaders recognize that elimination of unnecessary variation is a necessary, but not a sufficient, condition for producing quality professional services at reasonable costs. Using the innovation model of Boynton et al. (1993), identifies continuous improvement, rather than mass production, as the key step in the rationalization of what has been a craft industry and the ultimate objective of delivering health care in a mass customization mode. Claims, however, that it is not sufficient, because high levels of inherent variation will continue to exist and must be managed, even in the best of all possible worlds. Reviews the health care experience (in the context of that model) to suggest how service operations managers and researchers should conceptualize variation, and then discusses what that conceptualization of variation implies about how operations management should treat variation in its modelling and decision making.

Building Client Centered Systems of Care: Choosing a Process Direction for the Next Century

Forecasting the future of health care is difficult. However, we argue that this future will include the movement of health care through process improvement (enhancement) toward the objective of mass customization. This article discusses how mass customization might apply to specific portions of client-centered health care.

The Different Operations Strategy Planning Process for Service Operations

The manager who moves from manufacturing to services or the professor who wishes to research and teach service operations must recognise the key differences for developing an appropriate operations management strategy in a service business. For this process to be successful, the operations manager must participate assertively in the strategy debate. In manufacturing it is important that the functional strategy supports the corporate strategy in the marketplace and is co‐ordinated with other functional strategies. There is sufficient buffering between the manufacturing system and the customer that functional strategies can be developed within corporate strategies and then be co‐ordinated. In services, however, there are many issues where co‐ordination is not an adequate response. Virtually all strategic issues involving customer contact and front‐office operations must be the result of joint decision making involving marketing, operations, finance, and human resources. What little buffering there is occurs...

Managed care and public health

Current themes in public health public health and managed care - an introduction managed health care and its relationship to public health applications of managed care and privatization in the public sector case studies in public health and managed care.

Linking strategy formulation in marketing and operations: Empirical research

The scope of this special issue embraces two of the important facets of research within manufacturing strategy-subject matter and methodology. The early recognition by Skinner’ of the significant and critical contribution of manufacturing in strategic corporate debate was followed by a number of years in which the contributions, though high in quality, were low in number. During the last few years, however, the area of manufacturing strategy has attracted increasing attention in both the business and academic communities. This has been stimulated in part by need and also in part by a better understanding of how and what to do. The opportunity, therefore, to add to this gathering pace of activity through a special edition seemed both opportune and timely. This special issue was designed to highlight this growing need and display the scope of some of the current work in the field of manufacturing strategy, while also underscoring the interdisciplinary and empirical characteristics essential to this applied field. It was anticipated that the special issue would provide an invaluable forum for related research. In this way, it would not only contribute to the knowledge base, but also update the boundaries of the field, encourage a higher level of cross-fertilization between the functional areas within a firm and help fill the gap between empirical research and the conceptual developments necessary to reinforce its legitimacy and usefulness. The special issue was expected to contribute to two important areas. First, it would identify applied research methods involving small samples, surveys, in-plant studies, and the use of secondary data both in the firm and industries. Second, it would fill in the gap between theorems and cases; thereby supporting this as a legitimate research area, increasing the cross-fertilization of research between the functional areas, and providing a forum for discussion in manufacturing that already exists in services.