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Biomedical subjects

R Schneeweiss

Publications and source records attributed to R Schneeweiss.

At least 37 records · Page 2Linked to original sources
PubMed1987

The use of medical resources by residency-trained family physicians and general internists. Is there a difference?

This study compared the use of medical resources by recently trained family physicians and general internists. Analyses are based on records of 3,737 adult office encounters with 132 family physicians and 2,250 adult office encounters with 102 general internists. General internists are twice as likely as family physicians to order blood tests, blood counts, chest x-rays, and electrocardiograms for their adult patients. Internists also spend more time with patients, and refer and hospitalize them at slightly higher rates. The different practice styles of general internists and family physicians were evident for adult patients of all ages and for patients with essential benign hypertension. The average per visit charge for diagnostic tests ordered during follow-up visits with hypertensive patients was estimated to be $11.97 for patients seen by general internists and $5.67 for patients seen by family physicians. These findings persisted after controlling for a variety of patient, practice, and physician characteristics.

Diagnostic Tests, Routine↗
PubMed1987

Content of the model teaching unit ambulatory care training and continuity of care in six family practice residency programs.

This article summarizes the practice content and continuity for 35 senior residents in six family medicine residency model teaching units utilizing a computerized information management system. Comparisons are drawn with the content of family practices in the National Ambulatory Medical Care Survey (NAMCS), showing that family medicine third-year residents provide a large proportion of pregnancy care and general medical examinations and treat a smaller number of chronic illness patients compared with family physicians in practice. Third-year residents performed few surgical procedures in the model teaching units. Continuity of care, though espoused by family medicine residencies in principle, was deficient in the model teaching units studied. Intensive training to compensate for these deficiencies is recommended.

Ambulatory Care↗
PubMed1986

Diagnosis clusters adapted for ICD-9-CM and ICHPPC-2.

An ad hoc committee of the North American Primary Care Research Group (NAPCRG) was appointed to adapt the diagnosis clusters instrument for use with the International Classification of Diseases (ICD-9-CM) and the International Classification of Health Problems in Primary Care (ICHPPC-2). This article describes the development and testing of the final roster of 110 diagnosis clusters for family physicians. Almost 90 percent of all diagnoses recorded by family physicians in a variety of settings were included in the clusters. The diagnosis clusters can be used in the analysis of large databases and facilitate comparisons between different providers and practices.

Ambulatory Care↗
PubMed1985

Diagnosis clusters: a new approach for reporting the diagnostic content of family practice residents' ambulatory experiences.

Effective documentation and monitoring of the ambulatory care experiences of residents have been elusive goals of family practice educators. This article describes a method of aggregating the diagnostic (morbidity) data recorded by the residents using diagnosis clusters. Reports organized by diagnosis clusters are useful and easily interpreted. They facilitate the monitoring and documentation of the diagnostic profile and the recording habits of each resident.

Ambulatory Care↗
PubMed1984

Clinical comparison of microscopic and culture techniques in the diagnosis of Candida vaginitis.

This study compares potassium hydroxide (KOH), Microstix-Candida, and Nickerson's medium with Sabouraud agar in the isolation of Candida. Of 204 symptomatic and asymptomatic women, 36 had Sabouraud cultures positive for Candida. The KOH preparation demonstrated both poor sensitivity and poor predictive value in the isolation of Candida, while Microstix-Candida and Nickerson's medium were statistically indistinguishable from Sabouraud agar. The use of either Microstix-Candida or Nickerson's medium is recommended in the evaluation of Candida vaginitis when the KOH preparation is negative.

Adult↗
PubMed1984

Inpatient diagnosis clusters: analyzing hospital care in family practice.

Hospital care is an important component of family practice in the United States, but the study of this area has been impeded by the lack of a simple and clinically meaningful method of categorizing the diagnostic problems that make up the inpatient workload. This paper extends the method of diagnosis clusters--first used in the analysis of ambulatory care--to the hospital setting. Using the University of Southern California Medical Activities and Manpower Study of office-based general and family physicians, 52 clinically discrete diagnosis clusters were developed that include 78 percent of all principal diagnoses recorded in the hospital during the study interval. Fifty percent of all hospital encounters can be incorporated in only 15 clusters. Data clustered using this technique demonstrate that clinical problems such as ischemic heart disease and malignant neoplasms represent a major part of the family physician's hospital workload, a fact that has important implications for training and practice. Diagnosis clustering should facilitate further study of the hospital activities of primary care physicians.

California↗
PubMed1984

Clinical applications of computers in office practice.

The power to store and integrate vast amounts of information and to extract selected data rapidly makes the computer an obvious tool for physicians, particularly for family physicians, who attend to a large number of patients, deal with a great variety of problems, and provide comprehensive and long-term continuity of care. The ideal office computer system should be designed to permit each practice to select the business and clinical modules appropriate to that practice. The clinical modules would need to be sufficiently flexible to allow every physician to define the parameters he or she would wish to monitor for surveillance or health maintenance programs. There is an urgent need to arrive at some national consensus regarding the integration of clinical and business functions for office computers, particularly in family practice. Some pioneering physicians have shown the way. It now remains to translate the concepts into a generalizable system that would be suitable for a variety of settings.

Computers↗
PubMed1983

The content of ambulatory medical care in the United States. An interspecialty comparison.

Ambulatory care, accounting for over half a billion visits to physicians per year, is a major component of the health-care system and is the core of primary health care. This study uses data from the National Ambulatory Medical Care Survey to describe the most common problems seen in an ambulatory-care setting, to identify the medical specialties that provide the greater part of this care, and to characterize the major specialties in terms of the diagnoses in the patients who constitute their ambulatory practice. Fifteen diagnosis clusters account for 50 per cent of all ambulatory-care visits; only 8 of the 28 specialties account for a substantial amount (more than 25 per cent) of the ambulatory care rendered to patients with any of these 15 diagnoses. General and family physicians, general internists, and general pediatricians account for 65.9 per cent of all outpatient visits to physicians for the 15 most common problems; general and family physicians alone are responsible for more than half this total. The individual specialties differ markedly in the diagnostic and demographic variety of their outpatient workload. These differences have important implications for the training of physicians and the organization of their practices.

Ambulatory Care↗
PubMed1983

Diagnosis clusters: a new tool for analyzing the content of ambulatory medical care.

A clustering method for the analysis of ambulatory morbidity data is presented. This approach reduces spurious variations resulting from idiosyncratic diagnosis labeling and coding habits of physicians and facilitates the analysis of the content of ambulatory medical care through the use of aggregate morbidity data. The clusters provide a tool that allows for the comparison of the content of practice based on different factors such as provider training, practice organization, and patient characteristics. Ninety-two diagnosis clusters were derived using the 1977 and 1978 National Ambulatory Medical Care Survey (NAMCS). These clusters incorporate 86 per cent of all ambulatory visits to office-based physicians in the contiguous United States. The clusters were constructed based on the consensus of a group of clinicians including both generalists, as well as selected subspecialists representing the spectrum of ambulatory medical practice. The diagnosis clusters presented are compatible with the International Classification of Diseases (ICDA-8 and ICD-9-CM) and the International Classifications of Health Problems in Primary Care (ICHPPC and ICHPPC-2). Several applications demonstrating the utility of the method are presented, and directions for future applications are suggested.

Ambulatory Care↗
PubMed1982

Do postcard reminders improve influenza compliance? A prospective trial of different postcard "cues".

A randomized trial of various postcard reminder "cues" was performed to improve understanding of health-related behavior and to find better strategies for improving influenza vaccination compliance. Data were gathered on 283 high-risk patients (92 per cent response rate) who received: 1) a "neutral" cue simply announcing the availability of vaccine; 2) a "Health-Belief-Model" card written to take advantage of the association between certain health beliefs and vaccination behavior; 3) a "personal" card signed by the patient's physician; or 4) no postcard. The highest rate of vaccination occurred among recipients of the Health-Belief-Model postcard (51.5 per cent vs. 20.2 per cent for control, p less than 0.001). Linear logistic regression analysis found that age, prior vaccination history and experimental group had a significant effect on likelihood of being vaccinated. After adjusting for age and prior vaccination experience, the vaccination rate was found to be significantly higher for persons receiving the Health-Belief-Model postcard compared with persons receiving no postcard or a neutral postcard. We conclude that reminder postcards emphasizing elements of the health belief model may help increase vaccination rates.

Aged↗
PubMed1982

Characteristics of the residency interview process preferred by medical student applicants.

This study elucidates the characteristics of the interview day preferred by medical students applying to family practice residencies. Interviews and informal meetings with residents were regarded as being the most helpful, followed by interviews with the director or faculty. Perceptions of other components of the interview day are also described. October was the month most students preferred, and two interviews each lasting 20 to 30 minutes were considered ideal. Group interviews were regarded negatively. The results of this survey are generalizable to other residency programs and could be helpful in planning the interview day.

Attitude of Health Personnel↗
PubMed1981

A conversion code from ICHPPC-1 to ICHPPC-2.

Faculty members from four departments of family medicine participated in the production of a definitive conversion from the first to the second versions of the International Classification of Health Problems in Primary Care (ICHPPC). A detailed conversion code with the appropriate ICHPPC-2 equivalent for each ICHPPC-1 diagnostic title is provided. Differences between the two classifications are discussed and suggestions are made for the use of the conversion code.

Disease↗