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Biomedical subjects

D J Shulkin

Publications and source records attributed to D J Shulkin.

At least 37 records · Page 2Linked to original sources
PubMed1993

Patterns of authorship among chairmen of departments of medicine.

BACKGROUND: This study examines changes in the authorship patterns of chairmen of medicine departments from 1979 through 1990, a time when criteria for authorship were widely debated among medical journal editors. Chairmen were selected to be studied because, due to their leadership position and stature, they are likely to "set the example" for many scholars in the academic medicine community. METHOD: Computerized literature searches were conducted for all 233 persons who were chairmen during at least one year of the 12-year study period (1979-1990) to determine the average number of publications per chairman per year, the average number of coauthors per article published, the location of the chairman on the published list of authors, and other pertinent data required for a thorough analysis of authorship practices. Statistical methods included repeated-measure analysis, sensitivity analyses, and the use of linear models to analyze trends over time. RESULTS: Among all the chairmen, there was no statistically significant decrease in the average number of articles per year for which the chairmen were last authors, and there was a significant increase in the average number of coauthors per year on published articles. However, factors such as length of chairmanship, frequency of publication, and academic position (i.e., chair, pre-chair, or post-chair) were found to influence patterns of authorship; for example, the 61 individuals who were chairmen for ten years or more had a significant decrease in the number of last-author articles, whereas the 172 individuals who were chairmen for fewer than ten years had a significant increase. CONCLUSION: Changes in the definition of authorship by medical journal editors did not seem to be important influences on the authorship patterns of the chairmen, since the chairmen did not significantly decrease the number of articles for which they were the last authors, and they significantly increased the number of coauthors of their articles.

Authorship↗
PubMed1993

The walk-through patient-focus assessment: preliminary results in augmenting patient satisfaction data.

This article describes a new tool, the Walk-through Patient-focus Assessment Tool (WTPFAT), which is intended to supplement traditional methods of collecting patient satisfaction data. The WTPFAT is an instrument that has been developed for use by health care workers, managers, and professionals to examine their environment from a patient-focus point of view.

Health Facility Environment↗
PubMed1993

Promoting cost-effective physician behavior.

The current demand for cost containment, improved quality of care, and increased efficiency requires the cooperation of hospital administrators and physicians. Too often, however, administrators are frustrated in their attempts to gain the cooperation of physicians in working toward improving a hospital's financial position. In many instances administration efforts are perceived by physicians as promoting economic efficiency at the expense of quality of care. This article offers specific suggestions, from the physician's perspective, regarding how hospitals can develop a successful program to promote cost-effective physician behavior.

Cost Control↗
PubMed1993

Establishing criteria for evaluating health system reform proposals.

Effective proposals for health system reform will need to address the many complex issues facing medicine. Piecemeal approaches to health system reform are not likely to succeed. The Health System Reform Index may be a useful instrument for evaluating the scope and potential success of proposals that address critical issues in health care.

Delivery of Health Care↗
PubMed1992

A privately financed fellowship model for management training of physicians.

This paper describes the ongoing need for physician executives and reviews current opportunities for training physicians in management. The authors discuss existing sources of funding and highlight one management training program that uses various mechanisms of a new funding model that can increase the number and diversity of learning opportunities, not only in management but also in all disciplines where training traditionally has been underfunded. The basic mechanism of this new model is as follows: a privately funded program uses a locum tenens arrangement whereby a physician fellow works in a community-based private practice in order to produce both compensation for work done and funding for training at an academic institution. Finally, the authors suggest that academic institutions and managed care organizations might consider such a model as one means of using clinical income to expand management training within the contexts of their existing academic missions and patient care commitments.

Fellowships and Scholarships↗
PubMed1992

Learning generics.

The growing use of generic drug substitution may have important implications on quality of care. This study was conducted to determine resident physicians' knowledge of restrictive prescribing policies at the hospitals where they primarily practice.

Chemistry, Pharmaceutical↗
PubMed1991

Impact of the Medicare fee schedule on an academic department of medicine.

OBJECTIVE: To examine the effect of the Medicare Fee Schedule (MFS) on Medicare revenues in the department of medicine at an urban academic medical center after the MFS is fully implemented. METHODS: Department revenues from Medicare were compared with projected revenues using the MFS proposed by the Health Care Financing Administration on June 5, 1991. National Medicare claims data were used to determine differences in service mix between community and academic internists and the impact of the geographic component of the MFS on department revenues. RESULTS: Department revenues from Medicare in 1996 are projected to be 25.5% lower under the MFS than if the current system had continued. Subspecialty sections that perform large numbers of procedures and special tests had the largest decrease in revenues (eg, gastroenterology, -29.8%); however, this did not differ greatly from decreases in sections that mainly provide visits and consultations (eg, general internal medicine, -24.7%). CONCLUSION: The proposed MFS is projected to lead to substantial reductions in department revenues from Medicare. While relative values for services and geographic location will play a role in how individual departments fare under the MFS, the value of the conversion factor used in the final MFS will be the factor of greatest importance.

Academic Medical Centers↗
PubMed1991

The cost of monitoring medical care in Pennsylvania.

We estimated the cost of the Health Care Cost Containment Act in Pennsylvania to be over $19 million; the yearly direct cost of KePRO activities to be over $14 million; and compliance costs for peer review to possibly be as large as $27 million, based on our high estimate. We also found that medical records, utilization review and administrative departments in Pennsylvania hospitals have collective annual budgetary expenditures of close to $2.4 billion. In addition, we estimated Pennsylvania physicians to spend from $14 million to $17 million each year on administrative and fiscal activities related to reimbursement. Our cost estimates for non-clinical expenditures were based on the best data available at the time, though in many cases this data was crude. However, we believe that this data is a useful starting place for a dialogue about the cost and effectiveness of these programs. In reporting the cost of these activities it was not our intent to judge the value of any individual program. Instead we hope that we have taken a first step in the process of collecting cost data so that actual costs for non-clinical activities can be appropriately evaluated. Future studies of non-clinical expenditures should not only include direct program expenditures but also the economic impact on providers in complying with the mandates. Finally, efforts to reduce duplicate and unproductive regulatory programs will be necessary in working toward a cost-efficient system. Legislative efforts, such as the Physician Regulatory Relief and Improvement Act (H.R. 4475 and S.B 2051), aimed at the so called "hassle factor" will be helpful.

Cost Control↗