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PubMed2002

Practice management: a third-year clerkship experience.

BACKGROUND AND OBJECTIVES: This report describes a curricular experience that introduces the basics of practice management to third-year family medicine students. The curriculum includes evidence-based medicine, managed care concepts and terminology, financial management terms and concepts, laws and legal issues, and insurance and coding. METHODS: In 1999-2000, a three-session practice management curriculum was implemented in five family medicine third-year clerkship rotations at the University of North Carolina at Chapel Hill, Wilmington site. The learning activities included readings, a "quiz show" game, and a patient practice-centered project. RESULTS: Students reported greater knowledge and confidence in the selected topics. The practice management curriculum was positively evaluated overall. CONCLUSIONS: This interactive learning module for the family medicine students begins the process of incorporating practice management skills and knowledge.

Clinical Clerkship↗
PubMed1996

Veterinary involvement in management practices of beef cow-calf producers.

Management practices of 53 beef cow-calf producers were surveyed by use of a mail questionnaire. Producers were randomly selected from those who employ veterinarians to perform herd pregnancy examinations. Questions were asked about animal management, grazing and feeding, vaccination, and record-keeping practices. Median herd size was 250 breeding cows, and 2,329 of 2,491 (93%) randomly sampled cows in these herds were pregnant. Less than half of producers associated with these herds reported adoption of many beneficial practices related to bull management, infectious disease management, nutrition, and individual-animal record keeping, suggesting that a considerable number of producers are missing opportunities to optimize production and, thus, economic return. Use of individual-animal production records, which would enable more objective decision making on the basis of production and economic data, was not widespread. These findings suggested that veterinarians serving beef ranches have opportunities to provide additional services incorporating these management practices.

Animal Husbandry↗
PubMed2003

Practice managers. Value added facts.

South Manchester PCT set up a one-day-a-month course to aid the professional development of practice managers. This was the first time practice managers had been engaged through a tailored programme. GPs now encourage their practice managers to attend the course having seen the benefits.

Administrative Personnel↗
PubMed2000

Psychological morbidity in general practice managers: a descriptive and explanatory study.

BACKGROUND: Proposals to establish an occupational health service for primary care should be informed by knowledge of the health needs of general practice employees. AIM: To determine the prevalence and occupational correlates of stress, anxiety, and depression among practice managers in two contrasting health authorities in England. METHOD: A postal questionnaire, soliciting information about stress induced by work-related activities, which contained the General Health Questionnaire (GHQ) and Hospital Anxiety and Depression Scale (HADS), was sent to all 149 practice managers in two health authorities areas of south-east England. RESULTS: Completed questionnaires were returned by 111 (75%) managers; 41/111 (37%) achieved GHQ case status with scores on HADS indicating that 49/111 (44%) classified themselves as anxious and 19/111 (17%) as depressed. The likelihood of being a case was found to be higher in managers from practices with larger numbers of GP partners (P = 0.02) and in managers from practices not in receipt of deprivation payments (P = 0.03). Multiple logistic regression showed that managers' perceived difficulties with general practice administration duties (relative ratio [RR] = 3.27, 95% confidence interval [CI] = 1.22-8.75) and dealings with GPs (RR = 1.86, 95% CI = 1.03-3.34) were the most powerful predictors of case status. CONCLUSION: The questionnaire uncovered high prevalences of self-reported stress, anxiety, and depression in general practice managers. Although the vast majority of National Health Service (NHS) employees have access to an occupational health service, no such source of support exists for those working in general practice. The NHS needs to establish an occupational health service that caters to the needs of clinical and non-clinical members of primary health care teams.

Administrative Personnel↗
PubMed2006

A somewhat unorthodox explanation for the rise and fall of physician practice management companies: the application of Gaia theory.

PURPOSE: The purpose of this article is to present an alternative theory to why publicly-traded physician practice management companies in the US were popular and successful for a limited number of years and then essentially self-destructed. DESIGN/METHODOLOGY/APPROACH: The short history of publicly-traded practice management companies suggests that they had limited value and utility in the US healthcare industry. It is the premise of the paper that the sudden appearance these for-profit companies upset the natural order within the healthcare industry and created a disequilibria which ultimately resulted in their demise. While Gaia theory is most commonly applied to the natural sciences, it has been applied to a number of interdisciplinary issues. FINDINGS: Physicians gravitated to these for-profit companies either out of fear of encroaching managed care or out a desire to sell their practice to the highest bidder. Physician practice management companies, on the other hand, saw a way to entice stockholders to invest in a growth industry. The paper suggests that the physician practice management companies added little new value to the health care industry and applies Gaia theory as a possible explanation for this phenomena. Gaia theory was first postulated in 1979 to address the evolution of the material environment and corresponding organisms as a tightly coupled system which attempt to manipulate the environment for the purpose of creating biologically favorable conditions. ORIGINALITY/VALUE: The paper is one of the first to suggest that the laws of nature, as understood from the perspective of Gaia theory, may have applicability to the US health care industry.

Models, Theoretical↗
PubMedDate not supplied

Physician practice management companies: should physicians be scared?

Physician practice management companies (PPMCs) manage nonclinical aspects of physician care and control physician groups by buying practice assets. Until recently, PPMCs were a favorite of Wall Street. Suddenly, in early 1998, the collapse of the MedPartners-PhyCor merger led to the rapid fall of most PPMC stock, thereby increasing wariness of physicians to sell to or invest in PPMCs. This article explores not only the broken promises made by and false assumptions about PPMCs, but also suggests criteria that physicians should use and questions would-be PPMC members should ask before joining. Criteria include: demonstrated expertise, a company philosophy that promotes professional autonomy, financial stability, freedom from litigation, and satisfied physicians already in the PPMC. The authors recommend that physicians seek out relatively small, single-specialty PPMCs, which hold the best promise of generating profits and permitting professional control over clinical decisions.

Contract Services↗
PubMed1992

Revolution in real time. Physician practice management in the 21st century.

Change in the health care system is stimulating the interest of physicians policymakers, and third-party payers in practice management activities. New analytic techniques and management concepts enable interested parties to obtain more and better information about the overall results of practice. These new techniques and concepts offer physicians an opportunity to exert more influence on the direction and productivity of practice than in the past. This report reviews the development of three emerging fields and projects their impact on practice management. Outcomes management technology involves adjusting for the differences in patient biology between practices and describes outcomes of patient interventions in standard ways. Medical informatics involves the conversion of data into information that allows the physician manager to direct outcomes, quality, and costs. Quality management involves empowering employees and physicians to participate in improving the overall performance of the practice. The use of techniques for analysis and intervention is changing the definition of practice management beyond its conventional preoccupation with billing and accounts receivable. In fact, a new science of practice management is emerging that describes the interactions between the health care organization and the outcomes of services to patients. These tools empower physicians to direct the performance of the practice, to match services to patient needs, and to manage the costs of practice operations. Thus, the new methods and technologies of practice management have the potential to bring substantial benefits to patients, office staff, and physicians.

Delivery of Health Care↗
PubMed2003

A description of the Southern Rural Access Program's practice management strategies.

CONTEXT: Many state, federal, and foundation resources have been invested in improving the recruitment of primary care providers to rural communities. The Southern Rural Access Program of the Robert Wood Johnson Foundation (RWJF) has provided varying levels of support to several southern states to assist with retention of those providers. PURPOSE: This study describes the strategies that 6 states used to develop and implement practice management technical assistance services for rural health care providers. METHODS: Practice managers in each of the 6 states were surveyed regarding how their service was structured, what types of entities were eligible, and the nature of the technical assistance offered. Information regarding what types of entities used the service, characteristics of the practices, and the number of practices served was also collected. FINDINGS: The survey results showed that almost half (46%) of all practices assisted were private stand-alone physician practices, with overall practice assessments being the practice management service rendered most often. Although the type of organisational home for the technical assistance services varied by state, overall states employed an average of 1.67 full-time equivalent practice managers (0.81 full-time equivalent supported by RWJF) and received an average of $136,055 per state from the RWJF for the 2-year period beginning April 2002 for practice management support. CONCLUSIONS: Overall, the study found that the type of organizational home did not appear to affect the type of technical assistance services offered. However, the type of orgnizational home did appear to affect what types of providers used the service, with trade associations assisting their members or constituents at least half the time.

Community Health Planning↗
PubMed2005

How do ethnicity and primary language spoken at home affect management practices and outcomes in children and adolescents with asthma?

BACKGROUND: Lower rates of preventive medication use and higher rates of hospitalization and emergency department use have been documented among Latino children and adolescents with asthma. However, little is known about how language barriers influence asthma management practices and outcomes. OBJECTIVE: To examine the effects of language on asthma management practices and asthma-related outcomes. DESIGN: Cross-sectional survey of asthma management practices, perceived efficacy, asthma knowledge, family functioning, and health-related quality of life in 405 white non-Latino, African American non-Latino, and Latino children and adolescents from English- and Spanish-speaking homes. RESULTS: Latino children and adolescents from Spanish-speaking homes had lower rates of goal setting and peak flow monitoring, poorer asthma knowledge, and greater negative family impact than white children and adolescents (P < .05 for all). Although Latino children and adolescents from English-speaking homes did worse than their non-Latino white peers, the decrements were modest and not statistically significant (P>.16 for all). Management practices and outcomes for non-Latino African American children and adolescents closely approximated those of white children and adolescents. CONCLUSIONS: Language barriers seem to contribute to poorer asthma management practices and knowledge among Latino children and adolescents. Efforts to increase knowledge in this group may enhance asthma self-care and limit the morbidity associated with asthma.

Adolescent↗
PubMedDate not supplied

Practicing management and leadership: creating the information network for public health officials.

The Management Moment" is a regular column within the Journal of Public Health Management and Practice. Janet Porter, PhD, and Edward Baker, MD, MPH, MSc, are serving as The Management Moment Editors. Dr Porter is Associate Dean for Executive Education, The North Carolina Institute for Public Health, School of Public Health, at the University of North Carolina at Chapel Hill, and Dr Baker is Director of The North Carolina Institute for Public Health, School of Public Health, at the University of North Carolina at Chapel Hill. This column provides commentary and guidance on timely management issues commonly encountered in public health practice.

Information Services↗
PubMed2005

Evaluation of farm management practices as risk factors for clinical listeriosis and fecal shedding of Listeria monocytogenes in ruminants.

OBJECTIVE: To assess seasonal variation in prevalence of Listeria monocytogenes on ruminant farms and identify management practices associated with ruminant listeriosis and fecal shedding of L. monocytogenes. STUDY DESIGN: Case-control study. SAMPLE POPULATION: 2056 samples of feces, feed, soil, and water from 24 case farms with listeriosis and 28 control farms without listeriosis. PROCEDURE: Samples were collected and evaluated via bacterial culture for L. monocytogenes. Univariate associations between farm management practices and listeriosis and fecal shedding of L. monocytogenes were assessed. Multivariate models were developed to identify farm management practices associated with listeriosis and fecal shedding of L. monocytogenes. RESULTS: The prevalence of L. monocytogenes on cattle, goat, and sheep farms was seasonal, especially in fecal samples, with peak prevalence in winter. Although the prevalence of L. monocytogenes in feedstuffs from small-ruminant farms also peaked during winter, the bacterium was detected at a constant rate in cattle farm feedstuffs throughout the year. Farm management practices, animal health and hygiene, and feedstuff quality and storage were associated with ruminant listeriosis and fecal shedding of L. monocytogenes. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the prevalence of L. monocytogenes on ruminant farms is seasonal, management practices are associated with ruminant listeriosis and fecal shedding of L. monocytogenes, and the epidemiologic features of listeriosis differ in cattle versus small ruminants. Awareness of risk factors may be used to develop control measures to reduce animal disease and introduction of L. monocytogenes into the human food chain.

Animal Husbandry↗
PubMed2001

Practice management software for the equine practitioner.

Practice management software benefits the equine practitioner in many ways. Ready access to patient records, rapid entry and lookup of clinical findings, easy invoicing and monitoring of revenues, inventory management, rapid search and sorting of data, reminder and recall maintenance, and integrated word processing are just some of the software functions that assist the successful practitioner. Computer use in veterinary practice may have seemed to many to be a gimmick at one time. Now that computers have become a part of our everyday life, it is clear that they can be an essential component of the modem, successful, and profitable equine practice.

Animals↗
PubMedDate not supplied

Public physician practice management companies. Present issues and recommendations for future viability.

For years, physician practices have been perceived as a "cottage industry". Like the old fashioned grocery stores, the opinion of some was that they were ripe for incorporation into organizations which could take advantage of economies of scale and other synergies. Today, many physicians and organizations are beginning to rethink their approach to physician practice management companies (PPMCs). Is it a viable long term strategy for physicians? Does it promote optimal patient care? Can investor-owned companies realistically respond to the health care needs of patients while meeting the financial demands of investors? This article seeks to explore these issues, to examine the current nature of the physician practice management industry, and discuss what PPMCs might do to add value to the practices they manage.

Contract Services↗
PubMedDate not supplied

Nursing homes as complex adaptive systems: relationship between management practice and resident outcomes.

BACKGROUND: Despite numerous clinical and regulatory efforts, problems of poor quality of care in nursing homes continue, suggesting a need for effective management practices. OBJECTIVE: To test complexity hypotheses about the relationship between management practices (communication openness, decision making, relationship-oriented leadership, and formalization) and resident outcomes (aggressive behavior, restraint use, immobility of complications, and fractures), while controlling for case mix, size, ownership, and director's tenure and experience. METHOD: A cross-sectional correlational field study design was used. Primary data were obtained from directors of nursing and registered nurses employed in 164 Texas nursing homes. Investigators administered self-report surveys onsite. Secondary data were obtained from 1995 Medicaid Cost Reports and the Texas nursing home Minimum Data Set (MDS) and were linked to primary data using a unique identifier. RESULTS: Hypotheses were supported in that each management practice explained one or more of the resident outcomes. Larger size and longer director of nursing tenure and experience also explained better resident outcomes. Predictors explained 11% ñ 21% of the variance. DISCUSSION: Complexity science was used to explain the results. The findings open the door to rethinking nursing home management practice. Practices that increase communication and interaction among people are needed for better resident outcomes.

Adult↗
PubMed2003

Customization of a standard practice management software program to satisfy the needs of a dental hygiene program.

The University of New England (UNE) Dental Hygiene Program converted from a paper format to a digital format to manage the daily, dental hygiene clinic transactions. The use of this practice management software created new opportunities to enhance the program's teaching mission, monitor the progress of individual students, and facilitate the data collection necessary to meet accreditation standards. This report will describe how this dental hygiene program customized a standard practice management software program to enhance the specific requirements of a clinical teaching institution.

Accreditation↗
PubMed2001

Factors influencing hospital implementation of acute pain management practice guidelines.

STUDY OBJECTIVE: To identify factors that may influence the implementation of acute pain management guidelines in hospital settings. DESIGN: Two questionnaire surveys. SETTING: Healthcare Association of New York State, Albany, NY. MEASUREMENT: The surveys were administered to 220 hospitals in New York State regarding their acute pain management practices and resources available. One survey was addressed to each hospital's chief executive officer (CEO) and the second survey was addressed to the clinical director of the Department of Anesthesiology or Acute Pain Service. The barriers and incentives to guideline implementation identified by CEOs were analyzed using factor analysis. Logistic regression was employed to determine predictors of guideline implementation by linking the CEOs' survey data with the clinical directors' report of guideline usage. MAIN RESULTS: According to clinical directors, only 27% of the responding hospitals were using a published pain management practice guideline. Factors predictive of guideline implementation include resource availability and belief in the benefits of using guidelines to improve quality of care or to achieve economic/legal advantages. Guideline implementation, however, does not necessarily include applying all key elements recommended by the federal Agency for Healthcare Research and Quality (formerly Agency for Health Care Policy and Research) guideline. For example, a collaborative, interdisciplinary approach to pain control was used in only 42% of the hospitals, and underutilization of nonpharmacologic therapies to control pain was widespread. Resource availability, particularly staff with expertise in pain management and existence of a formal quality assurance program to monitor pain management, was significantly predictive of compliance with key guideline elements. CONCLUSIONS: Resource availability significantly influences the implementation of pain management practice guidelines in hospital settings. Implementation is often incomplete because various factors affect the feasibility of individual guideline elements and may explain the varying results that guidelines have had on clinical practices.

Decision Making, Organizational↗
PubMed2004

Trends in diabetes management practices of patients from an Australian insulin-treated diabetes register.

AIMS: To compare diabetes management practices in 2001 among individuals from Tasmania, Australia, with a previous management survey conducted in 1995-7. METHODS: Subjects were ascertained through the Tasmanian Insulin-Treated Diabetes Register. General demographic data were collected by telephone interview, and participants mailed a questionnaire on their diabetes management practices. RESULTS: The response rate in 2001 was 80.8% (n=1336). There was a trend to more frequent blood glucose self-monitoring, notably in those less than 25 years (P<0.001 for monitoring >2 times/day), together with continued uptake of the pen system of insulin administration. More intensive shared management by general practitioner and diabetes specialist was noted, including a greater proportion visiting their doctor more than five times per year (P=0.006 for those <50 years). Most patients continue to be appropriately screened for hypertension and retinopathy. Dietitian visits declined overall (P=0.03 for at least annual visits), and there appeared to be an inadequate level of foot examination by patients and doctors. CONCLUSIONS: The survey indicated that most patients were taking greater responsibility for their metabolic control, and intensive management practices and more convenient methods of administration may be contributors. Two areas of possible concern are access to dietitian services, and patient and health provider education on appropriate foot care.

Adolescent↗