Search PubMed⌕ Search

Biomedical subjects

B Starfield

Publications and source records attributed to B Starfield.

At least 145 records · Page 8Linked to original sources
PubMed1979

Concordance between medical records and observations regarding information on coordination of care.

This study was designed to determine the extent to which the medical record contained evidence of coordination of care. Coordination of care was defined as the recognition of information (problems, therapies, intervening visits and tests) about patients from one visit to a follow-up visit. Overall, there was concordance between the medical record and independent observation of the physician-patient interaction in 70-85 per cent of instances. When there was clear indication that the practitioner recognized the information, the chart contained evidence of this recognition 68-85 per cent of the time, depending on the type of information. However, if the information was highly salient, the record contained evidence of recognition in a much greater percentage of intances: 95 per cent for distinctly identified problems, 83 per cent for problems which were contained within the text of progress notes, 96 per cent for major drugs, and 94 per cent for abnormal tests. The data from this study support the less direct evidence of others that the medical record adequately reflects extent of recognition of important information about patients by practitioners.

Adult↗
PubMed1979

Presence of observers at patient-practitioner interactions: impact on coordination of care and methodologic implications.

In this study in an urban practice, the presence of a neutral observer at follow-up visits enhanced the extent to which practitioners recognized problems which patients had in a previous visit. This improvement was limited to those problems which initially had been mentioned by patients as requiring follow-up. Follow-up of problems initially mentioned by practitioners as needing follow-up was not improved by the observer unless the problem was also mentioned by the patient. Investigators whose information about practitioner-patient interaction depends upon the presence of an observer should be aware of this and possibly other effects. Although routine involvement of a neutral observer in patient-practitioner interactions is probably undesirable, selected deployment of observers or similar alternatives may be useful in situations where practitioner-patient communication is inadequate.

Adult↗
PubMed1979

Variations in utilization of health services by children.

In this longitudinal study in two prepaid group practices, many more children stayed at the same level of use of services over a six- to ten-year period than would be expected if use of services had distributed randomly. Overall, about 13% remained consistently in the highest third of the distribution of use, and another 13% remained consistently in the middle or lowest third. If use of services had distributed randomly, 4% and 7%, respectively, would have been in these groups. Conversely, many fewer children (25%) showed fluctuating patterns of use over time than would be expected by chance alone (37%). Although the reasons for this phenomenon are unknown (and may be multiple), the findings have implications both for clinical care and for development of policy regarding the organization and financing of health services for children.

Adolescent↗
PubMed1978

Routine administration of iron and vitamins during pregnancy: review of controlled clinical trials.

The purpose of this review was to determine whether routine administration of iron and vitamins during pregnancy had beneficial effects on birth weight, length of gestation, infant morbidity and mortality, and maternal morbidity and mortality. We searched for controlled clinical trials done in developed Western countries and reported in English, German, Finnish, and Scandinavian languages. Seventeen trials were found. In one trial, women who received vitamin B6 developed less dental caries. In another trial women receiving several different minerals and vitamins ahd fewer deliveries before the 40th week and less pre-eclampsia. In a third study, women receiving polyvitamin concentrate had less pre-eclampsia. None of the studies reported and benefit for other outcomes.

Birth Weight↗
PubMed1978

Prevention and treatment of premature labour by drugs: review of controlled clinical trials.

This review sought evidence from 18 controlled clinical trials about the benefits of drugs (hormones, ethanol or beta-sympathomimetic agents) used to prevent premature birth. Of the 16 trials comparing drug with placebo, 13 were judged to be methodologically adequate. In eight trials, drugs were given prophylactically and in five they were given therapeutically. Two of the therapeutic trials found the drug more effective than placebo in postponing delivery. However, only one therapeutic trial and one prophylactic trial found the drug to affect favourably the outcome for the infant. The side effects of the drugs were not systematically studied. Additional clinical trials are needed to justify the use of drugs to inhibit labour.

Adrenergic beta-Agonists↗
PubMed1978

Prevention of low birth weight and pre-term birth: literature review and suggestions for research policy.

Mortality during the first week of life has greatly decreased in developed countries, but the gains have been unevenly distributed across socioeconomic groups and geographic areas. Among many explanations for these differences, low birth weight is shown to be significant in the United States, Sweden, and Finland. An imbalance between potential benefits to be gained and the paucity of experiments reporting on this is noted.

Birth Rate↗
PubMed1977

Coordination of care and its relationship to continuity and medical records.

Introduction of a computerized printout ("mini record") containing problems and therapies, and listing visits between regularly scheduled ones to a primary care facility, resulted in improved recognition of problems and therapies. Recognition both of the occurrence of the visits which had been made elsewhere and the content of those visits was not improved, even though the mini record listed the dates and place of visit. Recognition was improved more in situations where the practitioners in the primary care clinic changed than when the practitioner remained the same individual who had seen the patient at the previous visit to the primary care clinic. Coordination of care is an essential ingredient of primary care. Recognition of all information generated by patients in a series of visits is evidence of coordination. Continuity (whether achieved by continuity of practitioner or by medical records) is one means of attaining better coordination. In a previous study we showed that continuity of practitioner improves coordination. This study shows that a technologic innovation consisting of an alteration in medical records facilitates coordination, but only with regard to certain aspects of care. Explanations for this finding are postulated.

Adult↗
PubMed1975

A comparison of effectiveness of screening for phenylketonuria in the United States, United Kingdom and Ireland.

A study of the effectiveness of screening for phenylketonuria in the United Kingdom, Ireland, and the United States indicated that the diagnosis is more likely to be missed in the latter two countries because of the earlier age at which infants are screened. Furthermore, in the United States, diagnosis and treatment are delayed as compared with Ireland and the United Kingdom. Because test most commonly used to detect phenylketonuria is identical in all three countries, the differences in effectiveness are attributable to the way in which it is applied. In the United Kingdom, personnel and facilities have clearly defined roles and responsibilities. There is co-ordination between in-hospital and extra-hospital health care, and follow-up care of young infants in the community is assured. Greater effectiveness of screening in the United States will require a more rational organization of health services.

Age Factors↗
PubMed1975

Validating the content of pediatric outpatient medical records by means of tape-recording doctor-patient encounters.

Information in 51 tape-recorded physician-patient encounters was compared with information written in the patients' medical records. Diagnoses, chief complaints, scheduled appointments, non-drug therapy, and diagnostic studies were uniformly well-recorded. Medication names were well-recorded but dosages were not. Characteristics of care such as levels of function, probable cause of illness, reason for follow-up, and compliance were recorded poorly. Patients were more likely to known about and understand their diagnosis, and names, dosage, and intended function of their medications when this information was written in the record than when it was not. These findings indicate a relationship between the quality of medical records and the effectiveness of care.

Child↗