Biomedical subjects
G T Perkoff
Publications and source records attributed to G T Perkoff.
The virtue of unconventional research.
This address develops an historical approach to unconventional research in medicine. Such research is predominantly but not exclusively non-biological in character. Earlier examples of unconventional research are given, and these then are related to examples chosen from recent work dealing with patient function as an outcome of medical and nursing care. The major argument made is that it is important for unconventional research to continue.
Should there be a merger to a single primary care specialty for the 21st century? An affirmative view.
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Graduate medical education confronted.
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Sounding boards. General internal medicine, family practice or something better?
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The cost of a primary care teaching program in a prepaid group practice.
Costs were determined for a teaching program in general pediatrics and general internal medicine for advanced residents in a prepaid group practice, the Medical Care Group of Washington University. A time and motion study was conducted to measure the productivity of faculty physicians before and after the establishment of the teaching program. There was a statistically significant loss in productivity for internists and an apparent loss, though not significant, for pediatricians as a result of their teaching effort, but the productivity of the residents more than compensated for the loss. The residual positive value of a full time equivalent (FTE) pediatric resident after reimbursement of all possible lost productivity by faculty pediatricians represented 43.9 per cent of a FTE pediatrician. For a FTE resident in internal medicine the residual positive value was 49.7 per cent of a FTE internist.
An effect of organization of medical care upon health: manpower distribution.
Data are presented from the Medical Care Group of Washington University and from several other organized medical care settings responsible for prepaid enrollees. As few as 8 per cent of visit may be made to specialists under systems which are organized to emphazide primary care. Further, the proportions of primary care and specialty visits vary inversely weith the "strictness" of this organization. Those groups which employ family physicians have a higher proportion of primary care physicians than do those which employ general intermists and pediatricans, or than exist in the medical care system at large. The data suggest strongly that the organization of medical care, as well as the training of personnel employed has a major influence upon the types of health manpower needed. Future research in this area is urgent, but even the currently available data have important implications for health manpower policy.
Gastroenterologists: too many or too few?
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Comparability of two methods of time and motion study used in a clinical setting: work sampling and continuous observation.
Two methods of time and motion study, continuous observation and work sampling, were used to measure physician behavior in a prepaid group practice. Results of the two methods were compared to determine whether differences occurred because of method. No significant differences appeared in time/unit of patient service for 82 per cent of physicians studied, nor did the presence of the continuous observed affect the number of units of patient service/half day of observation. Nonpatient activities showed a slightly larger number of differences although 74 per cent of comparisons of mean activity times still showed none. Suggested causes for noted discrepancies may be circumstantial dissimilarities in the two study periods or observed proximity. Nonetheless, overall the two methods show a high degree of similarity. Unless there is particular interest in the exact content of the physician-patient encounter, when continuous observation is required, work sampling is preferred because of time, cost, and possible observed influence on nonpatient activities.
The effects of an experimental prepaid group practice on medical care utilization and cost.
Rates of utilization and costs of medical care by a study group in a prepaid group practice, the Medical Care Group of Washington University (MCG), were compared prospectively over a three-year period with those of a demonstrably similar control group cared for by fee-for-service private physicians. MCG enrollees used twice the ambulatory services control enrollees did (p=less than 0.01), but used 23 per cent fewer hospital days (p=less than 0.01). Cost per diagnostic and therapeutic visit was similar for both groups; MCG preventive visits cost more. Increased numbers of MCG services provided led to increased ambulatory care costs for MCG over controls. Hospital utilization savings did not compensate for these increased costs. Thus prepayment in an organized setting did change hospital and ambulatory care utilization but did not reduce medical care costs. Other changes in medical care besides those which result from a different organization of medical care are discussed which might make control of medical care costs more likely.
Letter: Toxic potential of aldehyde in man.
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Lack of effect of an experimental prepaid group practice on utilization of surgical care.
The utilization of surgical care in an experimental period group practice for a 3 year period is reported. In contrast to what was expected, prepaid enrollees used the same or more surgical care than did control enrollees. The same proportion of emergency, urgent, and nonurgent admissions, occurred in both groups. Likewise there was no difference in the proportion of various procedures often thought to be overutilized in the traditional medical care system. High quality of surgical care in the area where the study was conducted was considered the most likely explanation for failure to show differences in the prepaid growth practice. Few, if any, unnecessary operations were performed in either group studied. Thus, under the conditions of this study, no significant measurable effect on surgical utilization by a change in the method of medical care organization and payment could be demonstrated.
Cost of medical care in an experimental study of prepaid group and fee for service practice.
Enrollees in an experimental prepaid group practice did use fewer hospital days and more ambulatory services than did control enrollees. In spite of this, however, savings generated from this reduction in hospital utilization were not enough to pay for the increased ambulatory services provided. Mechanisms for cost control must be sought in areas in addition to hospital savings. Two such areas are preventive services of unproved value, and physicians' services costs.
The case for a biological component in family practice behavioral science research.
This paper presents some of the reasoning behind the author's belief that it is important for academic family physicians to do research. The research process is compared to the process of clinical care, and significant analogies are pointed out. The argument then is presented to support the author's contention that it is time for family physicians to develop a research capability in selected aspects of the biological sciences in addition to the growing research activity in the social, behavioral, and clinical sciences which characterizes family medicine today. Reasons are given for considering the neurosciences the proper field in which such work should begin.