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Biomedical subjects

J T Brown

Publications and source records attributed to J T Brown.

76 records · Page 5Linked to original sources

Quantitative analysis of the outpatient oral case presentation: piloting a method.

OBJECTIVE: To measure the content of oral outpatient case presentations and to assess the correlation of objective assessments of this content with subjective ratings provided by the clinic attending physician. DESIGN: Blinded assessment via audiotape of 36 oral case presentations of new patient evaluations by 23 medical residents. SETTING: Outpatient general medical clinic. PARTICIPANTS: Duke University Medical Center medical residents during their outpatient rotation. MEASUREMENTS AND MAIN RESULTS: Important deficiencies were found in oral case presentation content. Specifically, psychosocial data were often missing (employment history) was mentioned in 28% of presentations; illicit drug use, in 17%; household social structure, in 11%; sexual history, in 6%). An assessment and a plan were mentioned only 56% and 69% of the time, respectively. No correlation was seen between an objective "content score" and the attending physician's subjective rating of the quality of the presentation (r = 0.09). CONCLUSIONS: 1) The outpatient care presentation can be quantitatively assessed in a simple, straightforward manner; 2) outpatient case presentations have important deficiencies in content; and 3) preceptors' evaluations of case presentations may be based upon factors other than content of the presentation.

Ambulatory Care↗

The unit of analysis error in studies about physicians' patient care behavior.

OBJECTIVE: To estimate the frequency with which patients are incorrectly used as the unit of analysis among statistical calculations in published studies of physicians' patient care behavior. DESIGN: Retrospective review of studies published during 1980-1990. ARTICLES: 54 articles retrieved by a computerized search using medical subject headings for physicians and study characteristics. Article selection criteria included the requirement that the physician should have been the correct unit of analysis. INTERVENTION: Presence of the error was determined by consensus using published criteria. MAIN RESULTS: The error was present in 38 articles (70%). The number of study physicians was reported in 35 articles (65%). The error was found in 57% of articles that reported the number of study physicians and in 95% of those that did not. The error rate was not lower among articles published more recently nor among those published in journals with higher rates of article citations in the medical literature. CONCLUSION: The unit of analysis error occurs frequently and can generate artificially low p values. Failure to report the number of study physicians can be a clue that this type of error has been made.

Data Interpretation, Statistical↗

The resident leaves the clinic: the effects of changing physicians on appointment-keeping behavior.

To understand the effect that termination of an established physician-patient relationship has on patient attendance patterns in a medical clinic, appointment scheduling and patient attendance were measured for 210 patients before and after 11 senior resident physicians left the clinic. There was no significant change in appointment scheduling, although the number of unscheduled or "drop-in" visits increased (p = 0.02). Likewise, patient attendance patterns did not differ between study periods. Overall the termination of an established relationship between an internist and a patient in this hospital-based general medicine clinic had no effect on appointment scheduling and patient attendance.

Adult↗