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Results for “Mid-Atlantic Region”

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PubMedDate not supplied

Impact of divergent evaluations by physicians and patients of patients' complaints.

Physicians' estimates of patients' anxiety, discomfort or pain, and activity limitation were compared with reports by their patients on the same dimensions. The data were collected as part of a series of quality assessment studies at a prepaid group practice serving 19,000 people in a Mid-Atlantic metropolitan area. Analysis of the data showed that physicians underestimated the three dimensions 35 percent of the time and that activity limitation was the dimension most often underestimated. Patients whose physicians correctly estimated their discomfort or pain were more likely to receive prescriptions than patients whose physicians underestimated their discomfort or pain. Patients whose physicians underestimated their activity limitation were most likely to report dissatisfaction with the treatment given. The results are consistent with a growing body of evidence suggesting that physicians who show concern about their patients and a desire to understand their problems establish better therapeutic relationships.

Adult↗
PubMedDate not supplied

Ambulatory care in the community.

To document the volume and kinds of ambulatory care, particularly primary care, being provided in a medically self-contained community, a survey was conducted in a county in a Middle Atlantic State during the summer of 1974 at all sites where physicians provided ambulatory care. These sites included not only physicians' offices, but also the emergency room, public health clinics, and physician-patient telephone encounters. Primary care was found to constitute 77 percent of all ambulatory care in the county and to account for 96 percent of all visits to primary care physicians. It also accounted for more than 50 percent of the visits to all physicians except the surgical subspecialists. Most of the primary care visits were for common disorders, common procedures, and common preventive measures. Distinct patterns were observed in the primary care morbidity treated by primary care physicians and that treated by specialists--patterns that seemed appropriate for those practices. The specialties of the physicians who were available to the population may have influenced morbidity patterns in the community surveyed. The primary care provided by primary care specialists appeared to differ in some functional aspects from that provided by other specialists.

Adult↗
PubMed1993

Acceptance of direct physician access to a computer-based patient record in a managed care setting.

Kaiser Permanente Mid-Atlantic States has developed a fully integrated outpatient information system which currently runs on an IBM ES9000 on a VM platform written in MUMPS. The applications include Lab, Radiology, Transcription, Appointments. Pharmacy, Encounter tracking, Hospitalizations, Referrals, Phone Advice, Pap tracking, Problem list, Immunization tracking, and Patient demographics. They are department specific and require input and output from a dumb terminal. We have developed a physician's work station to access this information using PC compatible computers running Microsoft Windows and a custom Microsoft Visual Basic 2.0 environment which draws from these 14 applications giving the physician a comprehensive view of all electronic medical records. Through rapid prototyping, voluntary participation, formal training and gradual implementation we have created an enthusiastic response. 95% of our physician PC users access the system each month. The use ranges from 0.2 to 3.0 screens of data viewed per patient visit. This response continues to drive the process toward still greater user acceptance and further practice enhancement.

Ambulatory Care Information Systems↗
PubMedDate not supplied

A survey of the qualifications, special training, and levels of personnel working emergency department triage.

Emergency department triage is a challenging position for the Registered Nurse, and one that requires special qualifications, training, and skills to adequately assess, prioritize, and intervene in a variety of client presentations. This survey, conducted throughout the United States in 1991, reports the varied qualifications and special training required by hospitals for nurses to work triage. The categories of personnel who work triage are also reported. The reasons for the variability and diversity in qualifications and training between geographical zones are discussed, along with some creative suggestions for providing additional education and training.

Certification↗
PubMed1994

SERVQUAL: a tool for evaluating patient satisfaction with nursing care.

Rising health care costs and competition among hospital facilities have resulted in the need to recognize patient satisfaction as an important indicator of quality care. Nurses provide the primary service to patients; therefore, their role is influential in overall satisfaction. Several instruments have been developed to measure patient satisfaction with nursing care; however, most of them focus only on patient perceptions. One such approach to evaluating patient satisfaction with nursing care involves an instrument, SERVQUAL, derived from a marketing service perspective. Adapting SERVQUAL for use in evaluating nursing care is the focus of this article. SERVQUAL assesses both patient perceptions and expectations of quality service and permits managers and clinicians to view the gaps between the two; thus, the overall areas of improvement in nursing services can be determined.

Attitude to Health↗
PubMed1989

The Mid-Atlantic Oncology Program's comparison of two data collection methods.

The Mid-Atlantic Oncology Program (MAOP) compared clinical trial data collected by circuit riding data managers (CDMs) from the MAOP statistical center with data collected by local data managers (LDMs) from clinics and practices, the latter being the standard data capture method in cancer clinical trials. LDMs and CDMs filled out identical study forms, using the same patient charts, for randomly selected patients on MAOP protocols. All coded answers on the forms were compared by one of the authors (DJ) and discrepant items were resolved in a blinded manner by the local MAOP physician acting as the principal investigator (PI). Thirty-three patient charts were reviewed with 53 pairs of forms completed and 1023 pairs of codes compared. A total of 129 (13%) pairs of codes were considered discrepant. Of the 100 discrepancies resolved (29 items were answered differently by the CDM, LDM, and PI) the PI's answers matched 66 of 100 codes as recorded by the CDMs and 34 of 100 codes as recorded by the LDMs. This results in chi 2 = 9.61 (p less than 0.005), demonstrating a significant difference between the frequency with which the PI's answers matched data collected by the CDMs and LDMs. It was also determined that CDMs consistently coded toxicities as more severe than did LDMs and were more often correct. Given the results of this study, CDMs should be considered an acceptable alternative to LDMs in the context of regional programs.

Bias↗
PubMed1989

National surveillance of Lyme disease, 1987-1988.

In 1987 and 1988, 6876 Lyme disease cases from 43 states were reported to the Centers for Disease Control. The 4507 cases reported in 1988 was nearly double the case number reported in 1987, and ninefold the number reported in 1982, when a systematic system of national surveillance was established. The average annual incidence of reported Lyme disease in the United States in 1987-1988 was 1.4/100,000. New York led the nation in reported cases in 1988 with 57% of the cases reported nationally. Eight states, New York, New Jersey, Pennsylvania, Connecticut, Massachusetts, Rhode Island, Wisconsin, and Minnesota, reported 92% of the nation's cases. The state reporting the highest incidence rate in 1987-88 was Rhode Island, with 9.9 cases/100,000. Regionally, incidence rates were highest in Northeastern and Mid-Atlantic states, intermediate in North Central and Pacific states, lower in the Southeast, and lowest in the Great Plains and Mountains states. The seven remaining states in which Lyme disease has not been transmitted all lie west of the 100th meridian.

Humans↗
PubMed1995

Explanatory factors for the geographic distribution of U.S. civil aviation mortality.

BACKGROUND: State-specific aviation-related mortality rates differ substantially between various geographical regions of the United States. PURPOSE: The purpose of this study was to ascertain important explanatory factors that account for the geographical distribution of mortality. METHODS: National Center for Health Statistics sources were used to calculate state-specific, age-adjusted mortality rates. Fatalities studied were those attributed to select civil aviation-related causes (ICD-9 E-codes 840.2-.6, 841.2-.6, 842.2-.6) that occurred from 1979-89. State-specific information on a variety of selected variables was obtained from census, commerce, and Federal Aviation Administration (FAA) sources. Multiple linear regression techniques were used to assess the relationship between selected variables and state-specific mortality rates. RESULTS: There were 13,048 deaths for a U.S. 11-year mean mortality rate of 4.9 deaths/1,000,000 general population. Mountainous states of the western U.S. had the highest 11-year mean mortality rates (range 8.6-79.6 deaths/1,000,000). Mid-Atlantic states had the lowest rates (range 1.6-2.9 deaths/1,000,000). Regression analysis identified pilot density (number of pilots per 1,000,000 general population), top elevation (highest point of land within state boundaries), and flight intensity (number of general aviation flight hours flown per pilot) as important factors in explaining 92% of state mortality differences. CONCLUSIONS: Highest aviation-related mortality rates are found in states with expanses of mountainous terrain, and relatively high pilot densities and flight activity levels.

Accidents, Aviation↗