Gerald Charles

Physician's Assistants and Clinical Algorithms in Health Care Delivery: A Case Study

Abstract During a 3-month program in a large teaching hospital physicians assistants were trained to use clinical algorithms in seeing patients in a drop-in clinic. Evaluative studies revealed tha...

Cost Containment Confronts Physicians

Excerpt Physicians balance two potentially conflicting professional responsibilities: providing optimal care to patients and conserving societys resources. This conflict has been intensified by re...

The use of negative indexes of health to evaluate quality of care in a primary-care group practice.

A quality assessment method using negative indexes of health as a measure of the quality of medical care was applied in a hospital-based primary-care group practice. During a 5-year period, records of 1,147 patients were analyzed. The study led to several observations regarding the use of this method in this setting: 1) The negative indexes of health method encourages physicians to include both primary and secondary preventive measures in their practice of medicine and to see their role as a broad one, from providing good care to individual patients to influencing public policy. 2) Most medical records do not now contain all the data required for use of this method. 3) In cases where this method identifies only a few instances of possibly preventable disease or untimely death, it is impossible to know whether the care is good and the method of evaluation is sensitive, or whether the care is poor and the method is insensitive to deficiencies in care.

Classification of ambulatory care using patient-based, time-oriented indexes.

This paper presents a new approach to the classification of ambulatory care into isoresource consumption groups. In contrast to classification schemes based on visits, this case-mix approach creates an index based on resources used by diagnostic categories by a patient during a year. An application of this method to a primary care, group practice data base produced resource consumption groups with coefficients of variation in an acceptable range compared with the coefficients of variation of the diagnosis-related groups used to classify inpatient care.

The Physician, Rationing, and Medical Care in the Veterans Administration

Excerpt As the debate about ways to influence the ever-increasing costs for health care continues, consideration is being given to limiting that portion of the federal budget related to health care...

Use of Ambulatory Care Resources by Medicare‐Age Patients in a Primary Care Group Practice

The increase in the number of persons age 65 and over—the Medicare‐age group—and the increasing cost of providing medical care to patients in this group have focused attention on enrollment of these persons in capitated plans as a means of containing costs. Although much is known about resources used for inpatient care for Medicare‐age patients, detailed information organized on a per‐patient, per‐year basis about ambulatory care of these patients is lacking. In order to address this problem and to investigate possible differences in resource use by age groups within the Medicare‐age population, a study was made of a primary care group practice in which 523 patients, including 174 patients in the Medicare‐age group, were followed for one year to determine their use of ambulatory care resources. A comparison of annual resource use by patients age 75 and over with patients age 65 through 74 showed that patients age 75 and over made more visits for primary care (8.15 vs. 6.46), made more visits to specialty and subspecialty clinics (3.41 vs. 2.33) and had higher total charges for ambulatory care (

Do Patients Want to Participate in Medical Decision Making

749 vs.

How Strictly Do Dialysis Patients Want Their Advance Directives Followed

623). The pattern of use of specialty and subspecialty clinics suggests that the primary care physicians functioned effectively as gatekeepers because most medical problems were handled without referrals to medical subspecialty clinics. The pattern also suggests that the projected rapid increase between now and the year 2000 in the number of persons age 75 and over may result in a greater than anticipated demand for services provided by ophthalmologists, podiatrists, and otolaryngologists.