The impact of mandatory continuing medical education.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
J K Stross
Publications and source records attributed to J K Stross.
Educating patients with Osteoarthritis.
An education program was developed for geriatric patients with osteoarthritis utilizing adult learner methods. The format used was slide/tape with accompanying booklets. Sixty-seven patients were tested before, immediately after, and three weeks after viewing the programs. A change in knowledge was noted for all objectives and was statistically significant (P .05) in five of six objectives. Although initial production costs are substantial, duplication costs are minimal. These results suggest that geriatric patients with osteoarthritis are able to learn and the method used is a cost-effective one.
Cost-Benefit Analysis↗
An epidemic of mysterious cardiopulmonary arrests.
Over a six-week period, a striking increase in the incidence of cardiopulmonary arrests occurred at the Ann Arbor Veterans Administration Hospital, Criminal administration of a muscle-paralyzing agent was implicated. An epidemiologic investigation les to a description of the classic features of an epidemic; time, place, person, agent and mode of transmission. Control of the agent and susceptible patients led to cessation of the epidemic. Although the perpetrator was not specifically identified, the concurrent criminal investigation was aided by the data developed in the medical investigation. On the basis of this experience, we propose a surveilliance mechanism for early detection of increased critical incidents, such as cardiopulmonary arrests, and a scheme for systematically examining similar events.
Disease Outbreaks↗
A senior-year experience similar to an internship.
A senior year experience similar to an internship was initiated in community hospitals. It is designed to shorten the overall length of training and to restore a broad-based clinical experience to the period of "intermediate patient care responsibility" in the training of new physicians. The program provides students with an opportunity to observe and practice in a primary care setting and expands the clinical resources of the medical school. Analysis of the performance of students in the class of 1974 indicates that they perform on a level comparable with first-year house officers. This program provides a general clinical experience for those students who have not yet decided on future training plans or who are going into primary care fields.
Clinical Competence↗
Effectiveness of coronary care units in small community hospitals.
A prospective study was undertaken from 1969 to 1974 to evaluate a program establishing coronary care units in small community hospitals. Crude mortality rates from acute myocardial infarction in these small hospitals were 14.5%, slightly higher but not statistically different from concurrently collected data in three larger comparision hospitals (11.5%). Mutivariate discriminate analysis of clinical characteristics was used to calculate a risk score for each patient admitted. Observed deaths exceeded expected deaths (134 versus 119) (P greater than 0.30) in small hospitals but observed deaths were less than expected (55 versus 77)(P less than 0.05) in comparison hospitals. Mortality was significantly greater in those units admitting fewer than 60 patients with infarctions yearly (20.9%) than in those admitting more than 60 (10.7%) (P less than 0.001). These data suggest that coronary care units in small community hospitals can provide adequate coronary care, but their level of performance drops when fewer than 60 patients with infarctions are admitted yearly.
Acute Disease↗
A statewide approach to graduate medical education.
Explore the source record for details and available documents.
Education, Medical, Graduate↗
Diagnostic features of malfunction of disk mitral valve prostheses.
Explore the source record for details and available documents.
Autopsy↗
Information sources and clinical decisions.
This study was undertaken to assess the dissemination of information about the management of chronic airway obstruction (CAO) in small community hospitals. The charts of all patients with CAO discharged from six hospitals were audited at two points in time, 1978 and 1983. In addition, physicians were surveyed to determine what information sources were critical in changing their behavior. Significant changes were seen in the use of diagnostic tests and therapeutic agents. Continuing medical education (CME) played a key role in test ordering, while pharmaceutical manufacturers' representatives were important sources of information concerning new therapeutic agents. The dissemination of information is a complex process. Physicians frequently use multiple sources of information in the decision making process. Physicians and planners of CME must be aware of what types of educational activities are best suited for their needs.
Communication↗
The effects of a cost-education program on hospital charges.
An educational intervention designed to change physicians' use of inpatient services was implemented on two general medical services for a year. The intervention consisted of a brief orientation to cost containment issues, a pamphlet that outlined practical cost containment strategies and listed the charges for commonly ordered tests and services, and access to detailed interim patients' bills generated during the hospitalization. Two concurrent control services received no intervention. Over 1,600 admissions were evaluated. The geometric mean length of stay was 0.61 days shorter on intervention services compared with control (5.15 vs. 5.76 days, p less than 0.01). The geometric mean hospital charges were $388 less for intervention patients ($3,199 vs. $3,587, p less than 0.005). Neither patients' demographic characteristics nor case mix could explain the reductions. The authors conclude that a simple program utilizing information already in existence in most hospitals can result in a significant and meaningful reduction in length of stay and charges.
Cost Control↗
The effects of a low-cost intervention program on hospital costs.
OBJECTIVE: To assess the impact of a low-cost education and feedback intervention designed to change physicians' utilization behavior on general medicine services. DESIGN: Prospective, nonequivalent control group study of 1,432 admissions on four general medicine services over 12 months. Two services were randomly selected to receive the intervention. The other two served as controls. Admissions alternated between control and intervention services each day. Results were casemix-adjusted using diagnosis-related groups (DRGs). Three internists blinded to patient study group assignment assessed quality of care using a structured implicit instrument. SETTING: Four general medicine services at a university hospital. INTERVENTIONS: A brief orientation, a pamphlet of cost strategies and common charges, detailed interim bills, and information about projected length of stay and usual hospital reimbursement for each patient. PATIENTS/PARTICIPANTS: Each service was staffed by a full-time internal medicine faculty member, one third-year and two first-year internal medicine houseofficers, three medical students, and a clinical pharmacist. Physicians were assigned to services for one-month periods by a physician unaware of the study design. To prevent crossover, houseofficers assigned to a service returned to the same service for all subsequent general medical inpatient assignments. MEASUREMENTS AND MAIN RESULTS: Geometric mean length of stay was 0.44 days (7.8%) shorter for the intervention services than for the control services (p less than 0.01), and geometric mean charges were $341 (7.1%) less (p less than 0.01). Effects persisted despite using a more precise cost estimate or casemix adjustment. Intervention houseofficers demonstrated superior cost-related attitudes but no difference in knowledge of charges. Audits of quality of care detected no significant difference between groups. CONCLUSION: This low-intensity intervention reduced length of stay and charges, even under the cost-constrained context of the prospective payment system.
Cost Control↗
House officer interviewing techniques: impact on data elicitation and patient perceptions.
The relationships among physicians' interviewing techniques, the amount and type of data gathered, and patients' perceptions of the interviewing process were studied. Thirty-one Internal Medicine house officers each interviewed one of three standardized patients. The house officers' thoroughness of data collection was assessed by the patients and by a trained evaluator. A videotape of each interview was analyzed at the National Board of Medical Examiners using the interaction analysis system for interview evaluation, ISIE-81, to define house officers' interviewing techniques. From the physicians' problem-solving perspective, data elicitation was positively related to the length of the interview, asking psychosocial questions, the use of narrow questions, and the amount of time the patient talked. The patients' assessments of house officers' data-gathering thoroughness were also positively influenced by interview length, the use of narrow questions, and inquiries about their psychosocial histories. The use of broad questions by the house officer was positively related to the patient's feelings about and reaction to the interaction. This study potentially explains some of the differences that appear to exist between patients' and physicians' judgments about and perceptions of the medical interviewing process.
Aged↗
Continuing education for coronary care nurses.
Coronary care nurses were surveyed to determine their perceptions of their initial training and ongoing continuing education. Eighty-one per cent (162 of 200) completed formal training, 65 per cent (105 of 162) felt this training adequately prepared them, but only 42 percent (84 of 200) successfully passed a test of competency prior to beginning work. Nurses' perceptions of their abilities were compared to actual performance of physical assessment and no significant differences were noted. Continuing education programs were ongoing for 57 per cent (114 of 200) of the nurses but physician participation was rare. Physician involvement in the overall management of CCUs was satisfactory for only 40.5 per cent of nurses (81 of 200). In view of these data, physicians and nurses have been remiss in the training and evaluation of coronary care nurses and must work together to define educational objectives and institute evaluation mechanisms. It is through this type of joint cooperation that the quality of care will improve as will morale.
Attitude of Health Personnel↗
Dissemination of relevant information on hypertension.
The timely dissemination of new medical information to the practicing physician has been identified as a problem. To examine the magnitude of this problem and useful strategies for correction, we surveyed primary care physicians to determine their knowledge of the Hypertension Detection and Follow-up Program, a recent clinical trial with important treatment implications. Forty percent of family physicians (44/110) were aware of the study within two months of publication, and 63% of internists (114/182) learned of it within six months. Eighty percent of the family physicians and 50% of the internists listed medicine journals as the source of their knowledge, while 40% of the internists learned of it from continuing medical education (CME) courses. These findings indicate that rapid dissemination of new information can occur when relevant journals are used and that CME courses also provide a timely and effective means of dissemination.
Adult↗