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PubMedDate not supplied

Where is group practice headed?

A CRAHCA educational program was held recently to determine the changes in the health service environment that are most likely to occur in the near future, and how these changes will affect medical group practice.

Canada↗
PubMed1989

Ambulatory medical necessity review in a multispecialty group practice.

The winds of change are constant in medical care delivery, and one of the strongest currents in the last ten years has been the shift from inpatient to ambulatory medical delivery. This paper discusses the search for an ambulatory care paradigm which would differentiate medical necessity on site at a medical group practice.

Ambulatory Care↗
PubMed2002

Privatised family group practices in Mongolia: an initial assessment of service access.

Mongolia is changing the way that primary care is delivered, by replacing salaried government staff with private family group practices (FGPs) paid by risk-adjusted capitation. As part of a mid-project evaluation, we surveyed a sample of FGPs in order to assess the patterns of access to care. We found that generally satisfactory services are being provided in an equitable way, and therefore that the main goals of the new model are being achieved. However, there are some concerns. Inter alia, we argue that more should be done to establish better standards of clinical practice through the distribution of protocols and illustrative pathways, and to increase the extent to which services are organised in a manner that is sensitive to informed consumers' needs. A design limitation meant that few baseline data were available, and the survey will need to be repeated if valid conclusions are to be drawn.

Adolescent↗
PubMed2005

Variation in MRI/CT utilization among FAMILY physicians and general internists in a multi-specialty group practice.

BACKGROUND: The objective of this study was to examine variations in MRI/CT utilization between family physicians (FPs) and general internists (IMs) within a multi-specialty group practice. MATERIAL/METHODS: Using administrative data, we computed ordering rates of MRI/CT per 1,000 outpatient clinic visits and per 1,000 unique patients and rate ratios (RR) to compare rates between 34 FPs and 24 IMs practicing in 7 clinics located within 50 miles of the radiology facility. We also assessed intra-specialty variation. Sources and degree of variation were determined separately for FPs and IMs through multivariate linear regression modeling. RESULTS: The IMs ordered MRI/CTs at twice the rate of FPs (29.6 vs. 14.8 per 1,000). Although the absolute ranges by specialty were statistically similar, the variance was significantly higher for IMs (86.1 vs. 52.3; p<0.0001). FPs' ordering rates ranged from 2.8 to 35.2 (SD=7.23), while IMs' ranged from 16.0 to 47.9 (SD=9.27). Female physicians ordered the tests at a higher rate (RR=1.38; 95% CI=1.17-1.53). After controlling for physician gender, years of practice, and patient panel size, distances from their clinics to the radiology facility site and patient severity index were the only variables that were significantly associated with MRI/CT ordering among FPs, explaining 39% of the total variance. CONCLUSIONS: Although IMs ordered MRI/CTs at a higher rate, as were females from both specialties, there was a higher ratio between high and low FP utilizers. The variation in FPs can be partly explained by their clinic distance to the radiology facility site and their patient severity index.

Ambulatory Care↗
PubMed1978

Imapct of a primary care group practice on emergency room utilization at a community hospital.

This paper reports the effects on a community hospital's emergency room utilization that were brought about by the development of a primary care group practice. The practice, which has replaced the hospital's traditionally structured outpatient clinics, employs full-time, salaried physicians and provides evening office hours and 24-hour coverage. The primary care group appears to have effected a substantial reduction in pediatric emergency room use. To a lesser extent, utilization by former clinic users among the adult atients was also reduced. These reductions, however, created only modest impact in the context of the hospital's total emergency room use, owed in part to the relatively small size of the patient population who formerly had depended upon the hospital for primary care.

Adult↗
PubMed1980

Infant feeding practices of families belonging to a prepaid group practice health care plan.

A survey of the infant feeding practices of 270 families who belonged to a prepaid medical insurance program revealed extensive use of commercially prepared infant formulas during the first months of life, introduction of beikost before 3 months of age and introduction of cow milk into the diet at 3 to 5 months. Ethnic, as well as socioeconomic differences, were observed in the use of milks and formulas, timing of introduction of beikost, and method of feeding solid foods. Average calorie intakes approached or were greater than the recommended dietary allowances. With the exceptions of vitamin D and iron, most infants received much greater than the recommended intake of all nutrients examined. Average sodium intakes were well above advisable intakes. Many infants received supplements of vitamins A, B1, B2, B6, and C in addition to adequate dietary intakes. Results of this survey indicate that many mothers look to pediatricians for advice on how to feed their infants and several findings indicate that nutrition education efforts directed toward pediatricians and parents must be more vigorous than they have been in the past.

Adolescent↗
PubMed1985

The use of negative indexes of health to evaluate quality of care in a primary-care group practice.

A quality assessment method using negative indexes of health as a measure of the quality of medical care was applied in a hospital-based primary-care group practice. During a 5-year period, records of 1,147 patients were analyzed. The study led to several observations regarding the use of this method in this setting: 1) The negative indexes of health method encourages physicians to include both primary and secondary preventive measures in their practice of medicine and to see their role as a broad one, from providing good care to individual patients to influencing public policy. 2) Most medical records do not now contain all the data required for use of this method. 3) In cases where this method identifies only a few instances of possibly preventable disease or untimely death, it is impossible to know whether the care is good and the method of evaluation is sensitive, or whether the care is poor and the method is insensitive to deficiencies in care.

Adult↗
PubMedDate not supplied

Nurse administrator employment in group practices.

The decline in managerial positions in hospitals has resulted in nurses' increased interest in management opportunities in other healthcare system sectors. This study reports the responses of 963 medical group practices to a survey of educational preferences and support mechanisms for the preparation of administrators for this type of setting. The findings raise issues for nurse managers seeking nonhospital employment and for nursing schools that have defined their educational mission as encompassing the preparation of nurse managers.

Commerce↗
PubMed1977

Medicaid utilization of services in a prepaid group practice health plan.

To provide medical service at lower costs without diminishing either quality or coverage, the District of Columbia enrolled approximately 1,000 Medicaid beneficiaries, voluntarily, in a prepaid group practice (PGP). The project was evaluated over a three-year period (1971-1974) with regard to: 1) rate of utilzation of medical care before and after enrollment; 2) costs of care per capita as compared with those of the 160,000 beneficiaries in the Medicaid fee-for-service universe; and 3) patient satisfaction with the PGP. Results indicate that for the 834 individuals aged 1 through 64 enrolled in the PGP; ambulatory physican encounter rates decreased 15 per cent, drug utilization was down 18 per cent, hospital admissions decreased 30 per cent, and hospital days declined 32 per cent after enrollment. For the same benefit package, annual prepaid per capita costs for the Medicaid PGP enrollees for 1972, 1973, 1974 were only +282, +232, and +286 respectively, representing a 37 per cent saving when compared to the fee-for-service per capita costs of the Medicaid Universe which stood of +373, +435 and +465 over the same period. The instrument used to probe patient satisfaction showed the Study Group was satisfied with the PGP, and received better dental care. The voluntary dropout rate from the PGP was only 2.5 per cent; and out-of-plan utilization was low, indicating good acceptance of the PGP service.

Adolescent↗