Biomedical subjects
Publications and source records attributed to R M Boyle.
A 57-year-old man presenting with a retrosternal mass was found to have a malignant thymoma. This was treated with surgery and radiotherapy. It recurred 5 years later as an intra-cardiac mass causing tricuspid valve obstruction.
Morbidity records from eight practices participating for three years in the Virginia Family Practice Data System are analyzed with respect to two mutually exclusive groups of patients: those who return from one year to the next and those who do not return. Initially, substantial interpractice variation in patient return rates is presented, and age and sex characteristics of these patients are examined. The data indicate that approximately 40 percent of patients visiting the practice in one year return in the next, 25 percent return in each of two subsequent years, and only 12 percent return two years hence. Returning patients are found to be significantly older and more likely to be female than non-returning patients. These two groups of patients are then compared in terms of recorded morbidity and workload rates. Specific categories of problems, such as Diseases of the Circulatory System, are associated with returning patients. This paper thus presents empirical evidence which supports common assumptions concerning patients and problems seen in family practice.
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By implementing a hospice program in three phases, each of which can be integrated with existing services in general acute care and long-term care facilities, a health care institution can provide the community with an important new service. And the parent organization incurs only the cost or providing additional inservice and medical education.
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Data representing Fiscal Years 1975 and 1976 as well as the aggregate 1975--1976 data set are reviewed in this paper. Information on 92,410 discrete patients and the 333,709 transactions they generated is studied. The transactions per patient rate of 3.6 varies greatly among the eight practices under investigation. This interpractice variation is complemented by remarkable year-to-year consistency within each practice. Age and the percent of continuing patients are presented as possible explanations for this variation. These data are useful to the physician in identifying the high-use patients and to the health planner for manpower and funding appropriations.
Determination of the number of patients served by a family practice is important for health services delivery and research. A sound estimate of the practice population should enhance the patient management responsibilities of the family physician. This methodology uses the Age/Sex Register to provide a series of estimations of a "teaching" unit population. Results of a sample survey indicate that 21.3% of "inactive patients" (those who have not received services from the practice in two years) still consider themselves under the care of the practice. Replication of this approach is suggested for other practices to improve planning and resource allocation.