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PubMed1996

The future of medical practice.

Managed care of some kind will dominate the future of health care, but the unresolved crucial question concerns ownership of the managed care plans. An investor-owned managed care industry now holds sway, but I do not expect it to last very long. In the long run, physicians must be in charge of medical care, but they must live within budgets and be accountable to payers and to their patients. The only solution that makes sense to me is one based on multiple local physician networks, organized on a not-for-profit basis. I predict that staff and group-model HMOs will be the mainstay of the medical care delivery system within a few decades.

Community Networks↗
PubMedDate not supplied

Improving medical practice outcomes by retaining clinicians.

Turnover of medical care providers has become so commonplace that callous disregard or weary resignation are prevailing sentiments among remaining staff members when a colleague leaves. This article analyzes reasons for turnover of caregivers and the consequences. Turnover is particularly detrimental in medical practice because it undermines learning, as well as acquisition of judgment and adaptability. Medical practice managers may be unaware of the magnitude of the hidden costs-financial, strategic, and quality-associated with turnover. Strategies are proposed to assist medical care organizations in retaining clinicians and thereby improving healthcare effectiveness and efficiency.

Humans↗
PubMedDate not supplied

The value of Doppler echocardiography in the management of patients with valvular heart disease: analysis of one year of clinical practice.

Management recommendations based on Doppler echocardiographic examination and cardiac catheterization were compared in a prospective study in 100 consecutive patients who were admitted for evaluation and treatment of suspected valvular heart disease during 1988. Management recommendations were provided independently after both Doppler echocardiography and cardiac catheterization by different and blinded investigators. Criteria for severe (clinically significant) and moderate to mild (insignificant) valvular lesions and management recommendations were agreed on in advance. There was disagreement on the severity of aortic stenosis based on the aortic valve area and maximum instantaneous pressure gradient in 1 of 54 patients, which resulted in differing management recommendations. Mitral stenosis was severe (valve area less than or equal to 1 cm2) at Doppler echocardiography but not at cardiac catheterization in 5 of 14 patients. Because pulmonary artery pressure increase during exercise at cardiac catheterization also suggested severe obstruction, management recommendations were similar. There was a potentially significant disagreement on the severity of aortic regurgitation in 9 of 76 patients and of mitral regurgitation in 14 of 90 patients; however, this did not produce differing management recommendations because with most patients coexistent valvular lesions or an impaired ventricular function mainly determined the ultimate management decision. Although of good quality, Doppler echocardiographic examination was nonconclusive for clinical decision-making in 15% of the study population because of uncertainty about the severity of mitral regurgitation or aortic regurgitation or because of problems in assessing the degree of left ventricular dysfunction in patients with severe regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1997

Interventions for improving information management in family practice.

Information management training has been neglected in family practice in the UK in the past. An adult learning model for such training is introduced. A pilot study using the adult learning approach showed improvements in information management processes over the six-month study period. The research project described in this paper compares the effectiveness of on-site training using adult learning methods, written information, and no intervention, in 33 family practices in the UK. Nine of the eleven practices in the on-site training group completed the training sessions and provided data, whereas only four of the eleven practices in the written information group provided data, and only three of the eleven practices in the control group did so. Preliminary analysis demonstrates that on-site training practices made considerable changes to the information systems in their practices, and appreciated the importance of high-quality data, both for patient care and reporting requirements. Full comparisons of data quality and information management methods are presented, and an assessment of priority training needs for maximum benefit is made.

Adult↗
PubMed2003

Organisational determinants of cardiovascular prevention in general practice.

OBJECTIVE: To assess organisational determinants in the prevention of cardiovascular disease. DESIGN: A cross-sectional study. SETTING AND SUBJECTS: 130 general practices in The Netherlands. Data were collected using questionnaires. A causal model was designed and analysed by path analysis. MAIN OUTCOME MEASURES: Relationships between preventive activities, practice management and practice characteristics. RESULTS: Important differences between adequacy of equipment and practice organisation were found. Record-keeping was significantly better when working experience of the GPs was less than 15 years, when the practice consisted only of female GPs, and when the practice had written protocols for cardiovascular disease management and the staff held regular scheduled meetings (teamwork). Teamwork also showed a significant relation with follow-up activities. The influence of non-measured variables in the model was considerable. CONCLUSION: In exploring the organisational setting as a barrier to prevention and disease management, the designed model showed no major effects. Despite the wide variety of practice organisational items investigated, a strong influence of non-measured variables was evident. Teamwork in the practices proved to be related to both follow-up and record-keeping. Younger and female GPs were further predictors of adequate record-keeping.

Cardiovascular Diseases↗
PubMed2002

Characteristics of eye care practices with managed care contracts.

OBJECTIVES: To describe the variation in practice structure, financial arrangements, and utilization and quality management systems for eye care practices with managed care contracts. STUDY DESIGN: Cross-sectional survey of 88 group and 56 solo eye care practices that contract with 6 health plans affiliated with a national managed care organization. The survey contained modules on practice structure, financial arrangements, utilization management, and quality management. The survey response rate was 85%. RESULTS: Group practices with both ophthalmologists and optometrists were triple the size of ophthalmology-only groups, and 5 times the size of optometry-only groups. Fee-for-service payments were the primary source of group practice revenues, although 60% of groups derived some revenues from capitation payments. Group practices paid their physicians almost exclusively with fee-for-service payments or salary arrangements, with minimal capitation at the individual level. Almost no practices used both capitation and bonuses to compensate providers. Most practices received practice profiles and three fourths were subject to utilization review, which mainly consisted of preauthorization for procedures, tests, or referrals. Nearly all practices used clinical guidelines, protocols, or pathways in managing patients with diabetic retinopathy or glaucoma. Further, nearly all group practices used computerized information systems to assist in delivering care, and most had provider education programs. CONCLUSIONS: Managed care has affected the way eye care providers organize, finance, and deliver healthcare. In general, our findings paint an optimistic picture of eye care practices that contract with managed care organizations. Few practices bear substantial financial risk, and nearly all practices use quality management tools that could help to improve the quality of care.

Capitation Fee↗
PubMed1994

Identifying and comparing competencies for social work management: a practice driven approach.

The study explicates a competency-based model of contemporary social work management practice and compares this model with frameworks derived from earlier studies. Using a purposive sample of 184 social work managers throughout the country, an exploratory factor analysis yielded twelve sets of competencies required of today's social work manager. A comparison of the present model to earlier management frameworks reveals that substantive changes in the nature, scope, complexity, and priorities assigned to management competencies and skills have transformed the role of the social work manager over the last decade. Implications for social work manager education are reviewed and future research directions are proposed.

Administrative Personnel↗
PubMed1997

Evolution of community mental health case management: considerations for clinical practice.

Case management has been the preferred method of helping persons with mental illness live in the community. This report examines the historical development of case management practice over the past 30 years. The analysis revealed that evolutionary growth in case management developed in response to expansion of community mental health services rather than consumer interests to improve their quality of life. Consequently, this reveals itself in the lack of outcome criteria needed to measure case management effectiveness. Currently, the concept of case management is undergoing a revolutionary paradigm shift that is "consumer-driven" and responds to consumer concerns. However, as mental health care costs rise within a rapidly growing community mental health care system, managed care is being implemented as a method to contain these rising costs. Because of major differences in philosophical underpinnings, developments in support of public mental health managed care may jeopardize the genesis of consumer-driven case management by supporting case management models that reflect managed care ideology.

Case Management↗
PubMed2002

Three perspectives on physical therapist managerial work.

BACKGROUND AND PURPOSE: The nature of managerial work in the commercial sector has not been studied since the 1970s, and little is known about the work of managers in the health care sector. In this study, the perceived importance of managerial role and skill categories among 3 groups of physical therapists were studied to better understand the work priorities of physical therapist managers. SUBJECTS: Two groups of subjects were physical therapist managers in hospitals or private practices. A third group consisted of faculty members in professional physical therapist education programs. METHODS: Respondents (n=343) rated the importance of 75 managerial activities. Responses related to 16 predetermined work categories were placed in rank order by group. A multivariate analysis of variance (MANOVA) was used to identify differences among groups. RESULTS: All groups identified communication, financial control, entrepreneur, resource allocator, and leader as the 5 most important categories and rated technical expert and figurehead as least important. The MANOVA showed differences between faculty members and private practice managers in 15 work categories, between hospital-based managers and private practice managers in 9 categories, and between faculty members and hospital-based managers in 8 categories. DISCUSSION AND CONCLUSION: Work setting appears to have an impact on level of importance placed on managerial work categories. The strongest candidates for "universal" physical therapist managerial work categories were communication, financial control, and resource allocator.

Health Care Sector↗
PubMed1996

Impact of environmental regulations on cattle production.

A greater focus of legislative mandates is directed toward nonpoint sources of pollution. This article focuses on environmental regulations and their impact on cattle production. Key legislation will be reviewed to stress how variations in the type of law, degree of impact, enforcement mechanism, and time line for compliance affect the ability for research to be designed and accomplished in a desired time frame and to yield data on which imposed management practices should be based. Science-based regulations are desired to maximize beneficial impacts of management practices; however, many regulations are developed and management practices are imposed prior to research to minimize liability of the regulatory agency in case natural resources are degraded in the absence of management practices. The technology adoption process will be reviewed. Documented impact of imposed management practices (technology adoption) will be presented. Of particular interest is the importance of documenting the economic and resource impacts of regulations on livestock operators. Types of research needed prior to implementing management practices will be reviewed. Local involvement can increase the adoption rate of practices and technologies.

Animal Husbandry↗
PubMed2004

Construction workers' perceptions of management safety practices: a qualitative investigation.

BACKGROUND AND GOALS: The purpose of this study was to identify perceptions of management safety practices from the viewpoint of union and nonunion construction workers. A complementary investigation was conducted with construction managers. METHODS: A semi-structured interview guide was used to elicit information from 64 workers (95% male) in ten focus groups. Questions were designed to elicit information about management practices that facilitate or discourage safe working conditions, including communication style, attitude, expectations, and unspoken messages. Data were analyzed using thematic content analysis. RESULTS: Workers identified management commitment to safety, concern for workers, congruence between spoken messages and practice, professionalism, and communication skills as key qualities in successful managers. Workers provided vivid examples of excellent and poor management strategies. CONCLUSIONS: Construction managers play a pivotal role in the definition and implementation of safety practices in the workplace and workers look to them for guidance and modeling. Given the high rates of injury in construction, deeply imbedded protective policies that rely on input from a broad range of stakeholders, including construction workers, should be developed.

Administrative Personnel↗
PubMedDate not supplied

Institutional forces in the acceptance of managed care practices by physicians.

We evaluated physicians' acceptance of managed care using data from Connecticut physicians. We grouped physicians' attitudinal responses on three dimensions and applied an institutional distance framework to evaluate factors that influence physicians' acceptance of managed care practices. Our results demonstrate the potency of institutional forces in affecting physician attitudes: health care organizations must more effectively integrate their values and beliefs with the physician community. The institutional distance theory evaluated in this article provides new information for policymakers and managers as gaining physician acceptance of certain practices is necessary to ongoing efforts to reform the health care system.

Adult↗
PubMed2001

Improving IDS performance through group practice expense management.

IDSs can turn around an owned group practice's poor financial performance by taking steps to more effectively manage the practice's expenses. The primary areas on which an IDS should focus its expense-management efforts are physician compensation, nonprovider staffing, and facility planning. The physician compensation system, for example, should include incentives for physicians to improve performance and increase productivity, and the size of the nonprovider staff should be adjusted according to patient volumes. Other areas in which changes in strategy may be required include information system investments; budgeting, accounts-payable, and purchasing processes; and corporate allocations of practice revenues to recover practice acquisition costs.

Costs and Cost Analysis↗
PubMedDate not supplied

Reduction of nitrate leaching with haying or grazing and omission of nitrogen fertilizer.

In some high-fertility, high-stocking-density grazing systems, nitrate (NO(3)) leaching can be great, and ground water NO(3)-N concentrations can exceed maximum contaminant levels. To reduce high N leaching losses and concentrations, alternative management practices need to be used. At the North Appalachian Experimental Watershed near Coshocton, OH, two management practices were studied with regard to reducing NO(3)-N concentrations in ground water. This was following a fertilized, rotational grazing management practice from which ground water NO(3)-N concentrations exceeded maximum contaminant levels. Using four small watersheds (each approximately 1 ha), rotational grazing of a grass forage without N fertilizer being applied and unfertilized grass forage removed as hay were used as alternative management practices to the previous fertilized pastures. Ground water was sampled at spring developments, which drained the watershed areas, over a 7-yr period. Peak ground water NO(3)-N concentrations before the 7-yr study period ranged from 13 to 25.5 mg L(-1). Ground water NO(3)-N concentrations progressively decreased under each watershed and both management practices. Following five years of the alternative management practices, ground water NO(3)-N concentrations ranged from 2.1 to 3.9 mg L(-1). Both grazing and haying, without N fertilizer being applied to the forage, were similarly effective in reducing the NO(3)-N levels in ground water. This research shows two management practices that can be effective in reducing high NO(3)-N concentrations resulting from high-fertility, high-stocking-density grazing systems, including an option to continue grazing.

Animals↗
PubMedDate not supplied

Becoming a better delegator.

Most medical practice managers know that delegation is a useful practice management tool to streamline both personal and practice efficiency. However, delegation is often underused, misused, and misunderstood. What, precisely, should be delegated in a medical practice and to whom? What are some of the obstacles to successful delegation, and how can the astute medical practice manager identify and overcome them? Which tasks should not be delegated? Finally, why do members of the professional practice staff sometimes resist delegation? In this article, the author provides answers to these intriguing questions, as well as a useful self-quiz to rate delegation skills. In addition, the author provides strategies and sample language you can use with your staff to make your own delegated tasks and responsibilities more enthusiastically accepted.

Administrative Personnel↗
PubMed1987

The economic contribution of dental hygienists' activities to dental practice: review of the literature.

This article reviews studies of dental practice and essays on practice management that have included information on the economic contributions of oral hygiene services. Several studies found that these services were less remunerative than other services and recommended that dentists delegate these functions when possible. However, one study noted that performance time, as well as delegation, influenced practice productivity and also reflected the practice's concept of care. Some practice management authors indicated that poorly managed practices without an excess of patients do not benefit economically from hiring a hygienist; but for practices with good management capabilities and an excess of patients, a hygienist may be able to make a major contribution to practice productivity. The lower remuneration for hygiene services and the high percentage of practice time required to provide a complete prophylaxis once or twice a year to each patient led several authors to doubt that dentists would or could provide these services themselves. The data in the reported studies, however, are insufficient to support firm conclusions about the profitability of hygienists' activities in dental practice.

Dental Hygienists↗