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Biomedical subjects

D B Nash

Publications and source records attributed to D B Nash.

At least 91 records · Page 5Linked to original sources
PubMed1985

Academic health centers: their future in a changing economic environment.

In order to survive, academic health centers will have to learn new ways of coping with the changing health environment. Explored here are the trends affecting academic health centers and speculation on how to meet the challenges presented. The author outlines a new dimension to the classical tripod of teaching, research, and patient care.

Academic Medical Centers↗
PubMed1982

A study of HMO physicians' receptivity to special programs for sociomedical and behavioral problems.

The purpose of this study was to determine HMO physicians' receptivity to special organized programs dealing with sociomedical and behavioral problems. The study population consisted of full-time physicians in a large prepaid group practice HMO, and the data were obtained in 1977 by means of a self-administered structured questionnaire. Most physicians favored special organized services for alcoholism, drug abuse, obesity, disturbances in sexual relations, and the like. Except for alcohol and drug abuse, favoring organized services for one problem did not correlate highly across problem areas. Specialty, AMA membership, and political orientation were the main characteristics that differentiated physicians on their receptivity to organized programs for sociomedical problems. Social background and professional training and experience may be more important than the practice setting in influencing physicians' receptivity to these types of services.

Attitude of Health Personnel↗
PubMedDate not supplied

Certificate of need and the quality of cardiac surgery.

Historically, states have used Certificate of Need (CON) programs to review proposals for new construction and expanded services in an effort to control costs and to improve the quality of and promote access to health care services. Congressional funding for CON ended in 1987. However, today, 26 states use CON to regulate cardiac surgery. There has been little evidence of the impact of CON on the quality of services. Pennsylvania is in a unique position to study the impact of CON on the quality and outcomes of care because the state terminated CON in 1996 and has publicly reported quality and outcomes data on coronary bypass graft (CABG) surgeries since 1992. Using a statewide inpatient data-reporting system, the volumes and outcomes of CABG surgeries at all Pennsylvania hospitals were examined in the 3 years prior to and the 3 years after the termination of CON. In the 3 years following the elimination of CON, the number of open-heart surgery programs increased 25%, yet there was no significant increase in the number of CABG surgeries performed. Quality, as measured by mortality rate, was not impacted by the real-location of the relatively stable CABG volume in the short term; this may be due, in part, to itinerant surgeons and statewide public performance monitoring. The long-term implications of deregulation are unclear and deserve future study.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Quality and outcome determination in health care and orthopaedics: evolution and current structure.

Quality health care has many definitions. Among those definitions is "care that consistently contributes to the improvement or maintenance of the quality and/or duration of life." The current evolution in health care has been fueled by three necessities frequently demanded by payers and employers: improvement in access, lowering of cost, and definition and quantification of the quality of care. This evolution has been facilitated by the so-called industrialization of medicine. This concept includes the adoption of industrial economic principles and techniques that facilitate the measurement of processes and outcomes. Quality health care is currently recognized as health care that is characterized by three elements: the use of practice guidelines or standards, the implementation of continuous quality improvement techniques, and the use of outcome determination and management. Practice guidelines demand the adoption of evidence-based principles in evaluation and care, as well as minimization of variations in evaluation and care. Continuous quality improvement seeks to determine why variations in processes of care occur and then to minimize those variations. Outcomes may be measured in terms of both very objective and very subjective variables and also on the basis of cost-efficiency. Most tools currently used to quantify outcomes, especially in orthopaedics, involve measurements of general health and of specific body part or organ system function. This evolution in health care is producing significant alterations in methods of traditional health-care delivery. The accumulating evidence indicates that these changes, although frequently unpopular, are improving the quality of health care.

Female↗
PubMedDate not supplied

Putting a price tag on training new doctors.

The nation's teaching hospitals depend heavily on $5.2 billion in annual federal payments for graduate medical education, but few of them know what portion pays for patient care and what portion supports teaching activities. Because hospitals and medical schools will continue to confront funding cutbacks under health reform, they must learn how to quantify the revenue and expenses associated with each activity to receive adequate compensation.

Costs and Cost Analysis↗
PubMedDate not supplied

The AHCPR guidelines on heart failure: comparison of a family medicine and an internal medicine practice with the guidelines and an educational intervention to modify behavior.

OBJECTIVES: The objectives of this study were to apply the Agency for Health Care Policy and Research (AHCPR) guideline for heart failure to the measurement of quality of care in the ambulatory setting, to compare the results for two large practices and to design an educational intervention for the two practices being studied. METHODS: A retrospective chart review was conducted on a random sample of 50 patients with heart failure selected from each of two outpatient practices: the general internal medicine practice and the family medicine practice at a large academic medical center. Five medical review criteria were developed from the AHCPR guideline for heart failure to compare the two practices with each other and the guidelines. An educational intervention was developed to modify physician behavior in regard to compliance with guidelines. RESULTS: Assessment of left ventricular function occurred in 79% of all cases. Of eligible patients, 68% were treated with angiotensin-converting enzyme inhibitors (ACE-Is). Of those patients treated with enalapril and captopril, 30% and 12%, respectively, were receiving the target dose as defined in the AHCPR guidelines. Of patients not eligible for treatment with ACE-Is, none were treated with hydralazine and nitrates. When the ejection fraction was less than or equal to 40%, 81% of eligible patients were treated with ACE-Is, whereas 59% were treated with ACE-Is when the ejection fraction was greater than 40%. Calcium channel blockers were used in the treatment of 42% of patients. A statistical difference (P = .05) was found between the two practices for documentation of left ventricular function, the use of ACE-Is for patients with ejection fraction less than or equal to 40%, and the use of calcium channel blockers and beta blockers. CONCLUSIONS: In the practices studied, there is underutilization of the documentation of left ventricular function, ACE-Is in eligible patients, target doses of ACE-Is, and the use of hydralazine and nitrates for ineligible patients. A higher proportion of patients receive ACE-I therapy when the ejection fraction is less than or equal to 40%. There may be inappropriate use of calcium channel blockers in some patients. There is unexplained clinical variation between the two practices studied.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Physician executives report high job satisfaction. Summary of findings from a survey of senior physician executives.

The role of the senior physician executive is well established in American hospitals and health systems. There is little research, however, on overall physician executive job satisfaction, their perceptions of their organizational role and job performance, or their views of the medical staffs with which they work. A recent survey of physician executives examined these and other areas. It found physician executives to be quite satisfied with their jobs. What follows is a summary of the findings. An article based on the survey will be featured in a future issue of The Physician Executive.

Data Collection↗