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PubMed1998

Nutrition Practice Guidelines for Type 1 Diabetes Mellitus positively affect dietitian practices and patient outcomes. The Diabetes Care and Education Dietetic Practice Group.

OBJECTIVES: Assess the acceptance and ease of use of Nutrition Practice Guidelines for Type 1 Diabetes Mellitus by dietitians in a variety of settings; determine if nutrition care activities of dietitians change when practice guidelines are available; measure changes in patient control of blood glucose level, measured as glycated hemoglobin (HbA1c); compare patient satisfaction with care and perceptions about quality of life. DESIGN: Using the approach of outcomes research, volunteer dietitians were recruited and assigned randomly to a usual care group or a practice guidelines group. Patients with type 1 diabetes were enrolled by dietitians and followed up for a 3-month period. Outcome measures included dietitian care activities, changes in patient HbA1c levels, and patient satisfaction and perceptions about quality of life. SUBJECTS/SETTINGS: Dietitians from across the United States who responded to a recruitment notice participated. Their work settings included diabetes referral centers, endocrinology clinics, primary care and community health clinics, hospitals, and a worksite clinic. They recruited patients from their setting for the study. Outcome data were available from dietitians providing care to 24 patients using the new practice guidelines and dietitians providing care to 30 patients using more traditional methods. STATISTICAL ANALYSIS: chi 2 Test, t test, and analysis of covariance. RESULTS: Dietitians in the practice guidelines group spent 63% more time with patients and were more likely to do an assessment and discuss results with patients than dietitians in the usual care group. Practice guidelines dietitians paid greater attention to glycemic control goals. Levels of HbA1c improved at 3 months in 21 (88%) of practice guidelines patients compared with 16 (53%) of usual care patients. Practice guidelines patients achieved greater reductions in HbA1c level than usual care patients (-1.00 vs -0.33). This difference was statistically significant and clinically meaningful. CONCLUSIONS/APPLICATIONS: Dietitians responded positively to practice guidelines for type 1 diabetes. Use of guidelines resulted in changes in dietitian practices and produced greater improvements in patient blood glucose outcomes at 3 months compared with usual care. Practice guidelines did not significantly influence patient satisfaction with care of perceived quality of life.

Adolescent↗
PubMed1986

Management by objectives in medical group practice.

When the concept of management by objectives first emerged, it was heralded by many as the long-sought secret to employee motivation. The MBO technique, involving the three primary functions of objective setting, objective using, and employee involvement, is described here in terms of both theory and practice. Although it does have its pitfalls and is certainly not the "ultimate answer," MBO in medical group practice does have its merits when properly introduced. It is much more than a purely academic concept, and its major strength lies in its recognition of the importance of human resources in getting the job done.

Group Practice↗
PubMed1978

Group practice options for chiefs of service.

The Talmadge bill and other changes in the health care field have created an impetus for the establishment of group practice plans. These plans pose a variety of administrative and policy issues for chiefs of service. A framework is described for assessing the managerial implications of whether the plan is centralized or decentralized and internal or external to the hospital.

Group Practice↗
PubMedDate not supplied

Implementation of legislative requirements for emergency medical services in prepaid group practice organizations.

The Health Maintenance Organization Act of 1973, the Emergency Medical Services (EMS) Systems Act of 1973, and other laws are examined for their effects on the organization and management of emergency services in prepaid group practice plans (PPGP). The study was conducted in 1974-75 by the Group Health Association of America. The data were gathered through interviews with administrators and providers of seven PPGPs and with leaders of health planning agencies in the same communities, as well as through reviews of internal documents and a 1-month utilization survey of emergency and urgent care services in each PPGP. Effects of the laws were found to be limited, with the health maintenance legislation appearing to have the greastes effect on the design of emergency servide models. In most localities, two parallel systems may operate in offering round-the-clock emergency care and programs to educate members and the public about the appropriate use of emergency facilities. The EMS legislation has had minimal effects on the design of emergency services in the PPGPs. The emergency services component is the most transitional aspect of the PPGS nad the one most amenable to change. Revisions have come through changes in internal management policy and from demands of subscribers. A regulating inference in the operation of the PGP, in the area of emergency services as well as in the delivery of primary care services, is that the plans must compete, both in costs and benefits, with available indemnity insurance coverage. The market dictates premium levels without regard to associated benefits. Additional costs for broader coverage and administrative regulatory mechanisms must be borne by the subscriber in the form of increased premiums. As a result, the utilization of expensive emergency care must be carefully controlled, and this restraint is often accomplished by requirements specifying which health problems are appropriate for the provision of emergency care, rather than by delaying assistance until the plan's office hours. The furtherance of the PPGP concept, that the entire health care of the individual person is provided and financed by one organization, definancedby one organization, detracts from the viability of a central body charged with the coordination of the delivery of all emergency services in the community. It results not only in duplication of effort but often in the establishment of potentially antagoistic organizations.

Consumer Organizations↗
PubMedDate not supplied

Managing for change. Models and questions for group practice leaders.

The health care environment continues to be characterized by rapid change and unpredictability. Perhaps the only constant is change itself. Managing successfully in this environment demands an increasing level of sophistication. In a rapidly changing environment, the manager must provide focus and direction and at the same time stay flexible so that the organization can quickly adjust to environmental demands. This article describes models for successful change management, followed by questions for the leader in a group practice.

Group Practice↗
PubMedDate not supplied

Benefits and pitfalls in applying the experience of prepaid group practices to the U.S. physician supply.

The paper by Jonathan Weiner includes important improvements in the methodology used to compare the physician workforce in prepaid group practices (PGPs) with the U.S. physician workforce. It also provides valuable insights for policymakers and researchers. Despite the improvements, concerns remain regarding the comparability of the populations served and physician activities in PGPs and the country as a whole. While PGPs appear to offer valuable lessons on how to use physicians effectively and efficiently, it is inappropriate to use the PGP physician rates to determine the number of physicians needed in the United States.

Group Practice, Prepaid↗
PubMed1994

The relative impact of chiropractic vs. medical management of low back pain on health status in a multispecialty group practice.

PURPOSE: The objective of the study was to compare chiropractic management and medical management of low back pain of musculoskeletal etiology in a multispecialty group practice. STUDY DESIGN: The design was a retrospective cohort study in which the subcohorts were defined by source of low back pain care and identified before follow-up was complete. Data collection occurred at the end of the third month following their initial visits. One hundred and three chiropractic patients and 187 medical patients aged 16 or greater who had not been treated within the preceding month of their initial visit participated. MAIN FINDINGS: A greater proportion of chiropractic than medical patients perceived their treatment to be successful (RR = 1.91, 95% CI = 1.29, 2.82), had 0 days with low back pain during the week preceding the evaluation (RR = 1.60, 95% CI = 1.00, 2.59), and had no functional impairment due to low back pain after 3 months following their initial visit according to the Roland-Morris Disability Questionnaire (RR = 1.42, 95% CI = 0.81, 2.50). General health status was similar for both chiropractic and medical patients. CONCLUSIONS: Chiropractic care was at least as effective as medical care in reducing low back pain and functional disability due to low back pain. Chiropractic patients were more likely to perceive their treatment to be successful in reducing low back pain compared to medical patients.

Adult↗
PubMed1990

Intrapreneurial group practice.

The authors carry notions of team nursing practice into nursing management. What would happen if teams of nurses contracted to staff and manage patient units? They explore the opportunities and hazards of such intrapreneurial group practice.

Efficiency↗
PubMed1993

Equity buy-in structures of emergency medical group practice.

The authors polled emergency medicine groups in an attempt to identify whether equity was offered and the time, costs, and methods of achieving equity. Several characteristics of equity and nonequity groups were compared. A survey was distributed to 514 groups from a list identified by the American College of Emergency Physicians. Nonresponders received a second mailing. Valid responses were received from 127 groups representing 3,405 physicians. Of the respondent groups, 69 allowed full equity participation. The mean time to full partnership was 2.2 years for new physicians. Single hospital groups tended to have shorter (1.6 years) buy-in periods compared with multihospital groups (3-4 years). The most common method of buy-in was a differential in the "bonus" structure between new physicians and partners. The actual cost to attain full equity varied greatly with a range of from $0 to $500,000. Groups not owning their accounts receivable had a total mean buy-in cost of approximately $40,000 as compared with those that did own their accounts receivable, where the average buy-in cost was approximately $106,000. The proportion of equity groups that had two thirds or more physicians board-certified in emergency medicine was significantly greater than those groups without equity. The detailed structure for attaining equity varied greatly between groups. The authors conclude that many emergency physician groups allow full equity participation. The average time to full partnership is generally less than 3 years. There are many diverse schemes of entering into partnership. The cost of acquiring full equity varies greatly.

Certification↗
PubMed1995

The health beliefs and behaviors of three groups of complementary medicine and a general practice group of patients.

Patients (n = 256), consulting either a general practitioner (GP) or one of three complementary practitioners (osteopath, homeopath, or acupuncturist), completed a seven-part questionnaire that looked at demographic data, medical history, familiarization with complementary therapies, health beliefs and life-style, health locus of control, scientific health beliefs, and their perceptions of the consultation style of general and complementary practitioners. The four subject groups did not differ significantly on the demographic variables of sex, years of schooling, whether or not they had a degree, marital status, or income, but did differ on age and number of children. The effects of both the significant demographic variables and some aspects of patients medical history were controlled for in subsequent analyses. Acupuncture patients stood out as having the most different chronic medical history. They were also least satisfied with their GP, had least confidence in prescribed drugs, and were most concerned with leading a healthy life-style. The acupuncture patients were most skeptical about orthodox medicine. The main finding was that patients of complementary practitioners are not a homogeneous group, but do differ in their views on satisfaction with GPs, healthy life-style, global environmental issues, confidence in prescribed drugs, faith in medical science, importance of a "healthy mind," harmful effects of medical science, and scientific methodology. The results imply that patients consult different practitioners, general or alternative, on the basis of a combination of their level of skepticism about orthodox medicine, their life-style, and other health beliefs. To talk of patients of complementary practitioners as a homogeneous group is fundamentally wrong.

Acupuncture Therapy↗