Biomedical subjects
Publications and source records attributed to J A Gleiner.
There are clearly many differences between fee-for-service and capitation. Making the transition to capitation poses some special problems and areas of risk that are not apparent from looking at either reimbursement method in isolation. The boundary and transition issues require special attention during the next several years as capitation is implemented in new markets.
Is cookbook medicine a major threat to patients and physicians alike? Should this management tool be condemned as yet another disdainful and questionable aspect of managed care? Presented here are arguments for and against cookbook medicine--with some surprising conclusions. Could it be that cookbook medicine actually fosters creativity, discipline, and freedom?
Information systems have yet to make a significant inroad at the interface between clinicians and patients. The obstacles to implementing information systems at the clinical level are formidable. As these systems have begun to mature and marketplace pressures have created changing needs for clinicians and the integrated delivery systems they are working in, the need for these systems has increased. Understanding the pressures that managed care brings to bear on clinical processes will facilitate clinicians' acceptance of these technologies.
Sixty-seven previously healthy patients with acute bronchitis were randomized and treated with either a fixed dose of trimethoprim and sulfamethoxazole or placebo for seven days. All outcomes examined showed a trend favoring the use of antibiotic, with statistically significant differences for cough, night cough, mean temperature, and use of antihistamines or decongestants. Night cough occurred on 84 percent of nights in the control group vs 56 percent in the antibiotic group (P = .003). Cough occurred on 99 percent of days for patients in the control group vs 93 percent of days for patients in the antibiotic group (P = .05). Mean temperature over the seven nights was 37.3 degrees C in the control group vs 36.9 degrees C in the antibiotic group (P = .004). The use of antihistamines and decongestants was reduced from 32 percent of days in the control group to 6 percent of days in the antibiotic group (P = .005). Patients in the antibiotic group worked 73 percent of days vs 55 percent of days for patients in the control group, which was significant when patients were stratified by the appearance of their sputum on Gram stain (P = .006). Smoking history was not found to help predict the response to antibiotic therapy.
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This article explores the reasons why electronic medical records have not become widely deployed in the health care industry. Y2K moved to center stage and fears of computer meltdowns became the single greatest obstacle to overcome before considering new technology possibilities. Almost every other information technology initiative in health care was delayed or suspended, while the issues of compatibility with four-digit dates were examined. Finding systems and devices that weren't Y2K compliant and replacing or working around their deficiencies left precious few resources available for other tasks. Another issue is standardization. The potential and promise of electronic records can only be realized if a standard way to describe clinical information can be agreed upon and implemented in practice situations. Clients have been reluctant to purchase electronic records while vendors are offering nonstandard solutions. Obstacles and benefits to implementing EMR systems are outlined. Despite some of the barriers to implementing EMRs, the future is bright for their widespread deployment.