Raising care levels, lowering costs: can a hospitalist program help?
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BACKGROUND AND PURPOSE: The changes in the health care environment during the last decade have had an impact on the roles and responsibilities of all health care professionals. The purpose of this phenomenological study was to describe the experience of staff physical therapists during a time of systemic change within a large urban academic medical center. SUBJECTS AND METHODS: Participants were 5 physical therapists working in various clinical settings within the medical center. The participants were interviewed and asked the question "Over the past 4 years, there have been major changes in your work environment. What has it been like for you working as a clinician during this time of change?" Interviews were recorded, transcribed, and analyzed to find thematic patterns of responses. RESULTS: Four common themes emerged in which participants described experiencing loss of control, stress, discontent, and disheartenment. A fifth theme showed that despite these negative feelings, participants were able to "find the silver lining" in their daily work lives (ie, they were able to find positive aspects of their professional lives despite the perceived unpleasant changes with which they had to cope). DISCUSSION AND CONCLUSION: This study provides insight into the experiences of a group of staff physical therapists during a time of systemic change in their work environment. Although the themes reflect largely unsettling and negative experiences, there seems to be an underlying ability to find affirmative aspects of work.
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This article describes the results of studies among dental care providers regarding tobacco cessation in the past two decades. In the early period, surveys described what dentists were doing in their own practices. The results suggested that they were not adequately communicating to their patients the importance of quitting. There is good evidence that brief interventions from health professionals can increase rates of smoking cessation. The outcome from a number of trials that examined the feasibility of conducting smoking cessation in dental practices is reviewed here. The pivotal role of a team approach is highlighted in many studies. Dentists who implement an effective smoking cessation program can expect to achieve quit rates up to 10-15 percent each year among their patients who smoke or use smokeless tobacco. The challenge is implementing effective treatment in one's practice or institution while using available primary care resources to provide additional benefit.
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Mr. Spaeth writes about the relationship between hospital administration and the physician, and how that relationship affects the quality of medical care delivered to the patient. The article focuses on the differences between the employment structure in an academic teaching hospital, and the open, independent contractor medical staff typical of a traditionally smaller community hospitals. The individual traits and nuances of these structures and how they can be distinguished from one another create dynamic differences in the approach for quality care. Peer review, credentialing, and management of adverse outcomes are just a few of the ways in which hospitals continue to strive to provide higher quality care, but the way these methods are implemented and performed in different hospital structures are dramatically different, yielding distinct results. Mr. Spaeth argues that the challenges faced by community hospitals in their effort to provide higher quality care and eliminate medical error are exacerbated because of their unique structure and the particular relationship physicians share with the hospital and its administration.