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This article is the first of several dealing with medical education and recruitment in Oklahoma and generated at the request of the OSMA-OUHSC Liaison Committee. The articles were sought out and submitted with the assistance of Edward N. Brandt, Jr., MD, PhD, executive dean at the University of Oklahoma College of Medicine.
This is the second of several articles dealing with medical education and recruitment in Oklahoma and generated at the request of the OSMA-OUHSC Liaison Committee. The articles were sought out and submitted with the assistance of Edward N. Brandt, Jr., MD, PhD, executive dean of the University of Oklahoma College of Medicine.
Many Oklahoma physicians face the problem of treating minors without parental consent. For them, this review of current Oklahoma law should prove especially useful.
Medical savings accounts (MSAs) and medical IRAs are important components of a "market-based" strategy for health care reform that have been opposed by many physicians for several reasons including lack of the applicability of these concepts to solving the problem of the uninsured. On closer inspection of the uninsured in Oklahoma, it is apparent that the majority of the uninsured in Oklahoma are in groups with annual incomes which allow a majority of persons within those groups to afford health insurance. Medical savings accounts are flexible, affordable, and portable forms of health coverage which are already being used in other states by significant numbers of persons with annual incomes similar to the majority of Oklahomans who are uninsured. Physicians are encouraged to support the implementation of these concepts as well as other market-based concepts in order to bring about fiscally responsible and truly effective health care reform.
Oklahoma leads the nation in the proportion of women who smoke, and is sixth in the proportion in the childbearing ages. Furthermore, the incidence of deaths from carcinoma of the lung in women is increasing, as is the number of low birthweight babies. Both of these conditions are associated with smoking. It is clear that Oklahoma physicians should become aggressive in encouraging women to stop smoking.
The Clinton administration has been busy for many months devising a new health care plan to address national needs. Over the last three years, rural health providers and consumers in the State of Oklahoma have also been actively reviewing their state health issues and concerns and determining the priorities. The purpose of this paper is threefold: (1) to illustrate why it is vital to have a strong health care sector in rural Oklahoma; (2) to review the issues and concerns identified by rural Oklahomans; and, (3) to provide a philosophical basis for possible solutions to the barriers identified.
We examined the spectrum of vision care intensity, and the relationships of the three principal providers of vision care in Oklahoma. They were active family and general physicians (MD and DO), ophthalmologists (MD and DO), and optometrists. There were 1,356 surveys mailed to the three groups. We determined that vision care services in Oklahoma appear very accessible, are well distributed and generally affordable. The referral patterns appear to be less than optimal and optometrists are not fully utilized. This added cost and travel time for patients.
Data from the Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) were assessed to determine the prevalence of maternal cigarette smoking and its relationship to pregnancy outcomes. A mail and telephone questionnaire was used to survey mothers between four and six months postpartum to obtain information about smoking and other maternal behaviors. Monthly samples were drawn from the state's live birth registry utilizing a systematic stratified sampling approach based on infant birth weight. A total of 3,051 responses were received between 1988 and 1990 for an overall return rate of 70%. Results of the study show approximately one-third (32%) of women in Oklahoma smoked 3 months prior to pregnancy, 22% smoked in their last 3 months of pregnancy, and 29% smoked shortly after delivery. Women who smoked during pregnancy were 2.2 times more likely to deliver a low birth weight (LBW) infant than nonsmokers, and 1.4 times more likely to have gained less than the recommended amount of weight. Additionally, women who smoked during pregnancy were 1.4 times more likely to begin prenatal care in the second or third trimester, or to receive no care at all. In conclusion, maternal smoking cessation has the potential for dramatically reducing preventable adverse outcomes of pregnancy.
Training of physicians to meet the health care needs of rural residents has long been a priority of the University of Oklahoma College of Medicine. With establishment of the much imitated Rural Preceptorship Program in 1948, the college launched an ongoing series of efforts all directed toward increasing the number of graduates choosing to practice in rural locations. In addition to the required senior Preceptorship Program, a series of educational programs is available in each year of medical school, actually beginning prior to freshman enrollment. As a result, the college now offers a comprehensive series of educational experiences involving not only four years of medical school, but graduate training in the primary care specialties as well. This report summarizes the various activities of the college that now make up the rural emphasis program, all of which are designed to help ensure an adequate supply of physicians for rural Oklahoma.
Each year, traumatic brain injury (TBI) is associated with 52,000 deaths and accounts for one third of all injury deaths in the United States; in addition approximately 80,000 persons who survive TBI incur some loss of function, residual disability, and increased medical-care needs because of these injuries. Major causes of TBI are motor-vehicle crashes, falls, assaults, and sports and recreational activities. During 1992-1993 in Oklahoma, horseback riding was the leading cause of sports-related TBI. To further characterize horseback-riding-associated TBIs, the Oklahoma State Department of Health (OSDH) and CDC analyzed these injuries for 1992-1994. This report summarizes the findings of this analysis.
OBJECTIVE: To provide an epidemiologic description of physical injuries and fatalities resulting from the April 19, 1995, bombing of the Alfred P. Murrah Federal Building in Oklahoma City. DESIGN AND SETTING: Descriptive epidemiologic study of all persons injured by the bombing and of all at-risk occupants of the federal building and 4 adjacent buildings. Data were gathered from hospital emergency and medical records departments, medical examiner records, and surveys of area physicians, building occupants, and survivors. STUDY POPULATION: All persons known to have been exposed to the blast. MAIN OUTCOME MEASURES: Characteristics of fatalities and injuries, injury maps, and injury rates by building location. RESULTS: A total of 759 persons sustained injuries, 167 persons died, 83 survivors were hospitalized, and 509 persons were treated as outpatients. Of the 361 persons who were in the federal building, 319 (88%) were injured, of whom 163 (45%) died, including 19 children. Persons in the collapsed part of the federal building were significantly more likely to die (153/175, 87%) than those in other parts of the building (10/186, 5%) (risk ratio [RR], 16.3; 95% confidence interval [CI], 8.9-29.8). In 4 adjacent buildings, injury rates varied from 38% to 100%; 3 persons in these buildings and 1 person in an outdoor location died. The most frequent cause of death was multiple injuries. Among survivors, soft tissue injuries, fractures, sprains, strains, and head injuries were most common; these injuries were most often caused by flying glass and other debris and collapsed ceilings. CONCLUSIONS: The Oklahoma City bombing resulted in the largest number of fatalities of any terrorist act in the United States, and there were 4 times as many nonfatal injuries as fatalities. Disaster management plans should include the possibility of terrorist bombing, and medical preparedness should anticipate that most injuries will be nonfatal. The role of building collapse in fatal injuries should be considered in the design of buildings at high risk of being bombed so as to reduce injuries.
The Oklahoma Foundation for Medical Quality initiated a cooperative project to evaluate the management of community-acquired pneumonia in Oklahoma Medicare beneficiaries. We reviewed the medical records of 767 patients discharged with a principal diagnosis of pneumonia during fiscal year 1993 from 20 hospitals. Of the 757 cases that met criteria for analysis, 92 (12%) died during hospitalization. There were significant differences between patients who survived and those who died with respect to patient age, admission source, and absence of indicators of severe pneumonia. Deviations from the American Thoracic Society guidelines for the treatment of community-acquired pneumonia were demonstrated with regards to the collection of routine sputum gram stains and cultures, blood cultures, and thoracentesis. We also demonstrated variations between hospitals in the timing of the first dose of antibiotic administered after admission of the patient. Based on this project, there appear to be opportunities for improvement in the care provided to patients admitted to the hospital with pneumonia.
BACKGROUND: The serious health consequences of smoking have been known to us for more than 30 years. Every year, research brings forth more serious consequences of this risk factor. These are reviewed by us. The year 2000 will soon be with us. We need to know where we stand in relation to the year 2000 objectives with regard to smoking. STUDY DESIGN: The study design is cross-sectional. METHODS: This study is based on the data obtained during the years 1989 through 1995 from the Oklahoma Behavioral Risk Factor Surveillance System. RESULTS AND CONCLUSIONS: There has been a significant decrease in the prevalence of smoking in Oklahoma in the last seven years. Although there has been no significant change in smoking among females in the last seven years, smoking among males has dropped significantly, especially in the last two years of the study, 1994 and 1995. The prevalence of smoking in 1995 was the same among males and females, at about 22%. In age groups 18-24 and 25-34, there has been no significant change in smoking since 1990. The prevalence of smoking is related to the level of education; the higher the education the lower the prevalence of smoking. Smoking among those with college or higher level education has remained at about the same level, 15%, in the last seven years. Among those with less than high school education, smoking has remained the same at about 30% over the last seven years. Prevalence of smoking is the highest among American Indians. Smoking among whites (non-Hispanic) shows a significant decrease from about 26% in 1990-91 to about 22% in 1994-95. Among white males, smoking has significantly dropped from 31% in 1989 to about 22% in 1995. In 1995, smoking was almost the same in the two sexes at about 22%. We need to achieve a reduction of 7% in the overall prevalence rate of smoking in the coming years to achieve the Year 2000 objective. To effect this reduction, our efforts at health promotion and community mobilization will have to be strengthened. Further, with the prevalence rate of around 25% in 1995 among women of reproductive age, and the year 2000 target of 12%, it is apparent that very strenuous efforts will have to be made among this group in our population to achieve Year 2000 objectives.
BACKGROUND AND OBJECTIVES: Acute myocardial infarction is the leading cause of death in the United States and a common cause for admission of Oklahoma Medicare beneficiaries. Based on guidelines for the management of acute myocardial infarction published by a joint committee of the American College of Cardiology and the American Heart Association, the Cooperative Cardiovascular Project was developed by the Health Care Financing Administration to measure performance on quality indicators that describe care provided to Medicare beneficiaries. The objective of the project is to use those performance measures to assist hospitals in the development of quality improvement efforts for acute myocardial infarction care. METHODS: Retrospective review was performed on the inpatient medical records of 3,436 patients from 102 hospitals in Oklahoma and a random national sample of 2,441 patients discharged with a principal diagnosis of acute myocardial infarction. RESULTS: The diagnosis of acute myocardial infarction was confirmed in 3,055 (89%) of the cases reviewed. For patients considered to be ideal candidates for an intervention, 62% received reperfusion therapy (thrombolytic or PTCA), 84% received aspirin during the hospitalization, 76% received aspirin at discharge, and 40% received beta-blockers at discharge. There were significant variations in performance between hospital peer groups in the use of reperfusion therapy, aspirin, beta-blockers, and smoking cessation counseling. CONCLUSIONS: Potentially life-saving treatments for Medicare patients hospitalized with an acute myocardial infarction are often underutilized. Improving quality of care for Medicare beneficiaries with acute myocardial infarction has been identified as a national priority.
On August 29, 1996, the Jackson County Health Department (JCHD) in southwestern Oklahoma notified the Oklahoma State Department of Health (OSDH) of a cluster of Campylobacter jejuni infections that occurred during August 16-20 among persons who had eaten lunch at a local restaurant on August 15. This report summarizes the investigation of these cases and indicates that C. jejuni infection was most likely acquired from eating lettuce cross-contaminated with raw chicken. This report also emphasizes the need to keep certain foods and cooking utensils separate during food handling.
Sweeping national changes in health care financing and delivery are forcing major modifications in the numbers, types, and distribution of physician manpower thought to be appropriate for the new paradigms. Not surprisingly, these changes are exerting great pressure on medical education institutions to also adapt to the changing requirements. In Oklahoma, these financial and policy changes are accompanied by demands upon the colleges of medicine to increase the numbers of physicians who locate their practices in rural locations. The maintenance of a comprehensive and well balanced basic and advanced medical education effort within these complex and shifting requirements continues to tax the abilities of all faculties, including the Oklahoma University College of Medicine (OUCOM).
OBJECTIVES: To determine characteristics of working dogs used during the disaster response after the bombing in Oklahoma City and risk factors for injuries and illnesses of those dogs, and to document recommendations for future disaster responses. DESIGN: Survey. STUDY POPULATION: Information for 74 working dogs used at the bombing site. PROCEDURES: Dog handlers were identified and asked to complete a questionnaire. Questions were asked about the training and use of each dog, use of paw protection, injuries and illnesses incurred, possible effects after completion of duty at Oklahoma City, and handler's experience. RESULTS: Data were obtained for all 74 dogs used at the site. Handlers of 69 of 74 (93%) dogs responded. The dogs had been extensively trained and were used 491 dog-days at the site, with 46 dogs used in search, 14 in patrol, 12 in explosive-detection duty, and 2 in search/patrol. Fifteen (22%) dogs became ill. Nineteen (28%) dogs incurred 20 injuries. Footpad injuries constituted 18 of the injuries. Only 16 of 69 (23%) dogs were provided with paw protection. Dogs were more likely to be injured when they were used in a search capacity, were used during the first 2 days after the bombing, were German Shepherd Dogs, or were older. CLINICAL IMPLICATIONS: Although working in a high-risk environment, injuries to dogs were few, and most were minor. Specific recommendations could facilitate use of dogs in disaster situations and improve safety for those dogs.
BACKGROUND AND OBJECTIVES: Epidemiologic surveillance reports that focus on hospital utilization are limited in number. The objective of this study was to provide a current profile of the demographic characteristics of the Oklahoma Medicare population and to profile trends in hospital utilization. METHODS: Using the Medicare enrollment files and discharge claims data sets for 1994 through 1996, demographic characteristics and surveillance measures were calculated for enrollees based on age, sex, race/ethnicity, principal diagnosis, and primary procedure. In addition, average hospital charge and average reimbursement were evaluated by diagnosis-related group. RESULTS: The Oklahoma Medicare population has grown by 2.5% from 1994 through 1996. The majority (87.5%) of the enrollees are aged 65 or greater. Of those less than 65 years of age, most are enrolled in the program because of disability. Less than 5% of the Medicare population was enrolled in a managed care plan during 1996. The overall length of stay, in-hospital mortality, and 30-day mortality rates have declined for all age groups and principal diagnoses profiled. More than one fifth of all of the Medicare discharge claims were related to heart disease. CONCLUSIONS: The Medicare discharge claims files represent a useful source of data from which to conduct surveillance on this population. The declining rates of mortality and length of stay that were demonstrated for all Medicare age groups must be taken into account in any evaluation of health care services that seeks to address the impact of quality improvement or utilization management strategies over time.