Kurt W. Deuschle

Strategies for prevention using allied health professionals.

Abstract Preventive services which are directed at groups and individuals who are at high risk of some unfavorable outcome should be incorporated into the fabric of medical care practice. Allied health professionals have the required skills to provide preventive services with a greater sense of job satisfaction than do physicians. Experiences to date attest to the usefulness of allied health professionals in meeting the gaps in health care which are largely preventive in nature.

HMO development in an academic medical center: The rise and fall of a prepaid health program in New York City

Through a documented case study the authors identify the critical factors that impede the introduction of prepaid medical care as part of education and practice within a prestigious and well established academic medical center. The inherent conflicts between individual fee-for-service practice and population-based prepaid practice and the resistance to innovations in medical care organization as they surfaced in that center, are presented. The need for a clear understanding of the complexities of HMO development and of an appreciation for the importance of a planning process in which all interested parties are involved, is emphasized. A clear commitment by policy makers, administrators and providers is highlighted as fundamental for the implementation of a system where practitioners are motivated to assume responsibility for the comprehensive care of a defined population that prepays for their services. The rewards as well as the difficulties for institutionalizing commitment to this form of health care delivery and impacting on medical education are discussed.

Development of faculty consultants in a problem-based third year community medicine clerkship

This paper describes the development of consultancy groups in behavioral science, epidemiology and biostatistics, and information science in a required community medicine rotation with a twenty year history. The addition of consultants to individual student tutors and field preceptors has led to a structure which promotes student-project flexibility, development of critical assessment skills and independent learning while maximizing faculty expertise and effectiveness.