Medical care
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The ambulatory component of residency training jointly produces two products, namely, training and patient services. In costing educational programs of this type, two approaches are frequently taken. The first considers the total costs of the educational program, including training and patient services. ⋯ This article reports such a study of costs in a primary-care residency training program in a hospital outpatient setting. The costs of the product, i.e., on-the-job training, are evaluated using a replacement-cost concept under different levels of patient services. The results show that the cost of the product, training, is small at full clinical utilization and is sensitive to changes in the volume of services provided.
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Comparative Study
An evaluation of the Illinois trauma registry: the completeness of case reporting.
The Illinois Trauma Registry (ITR) was developed as the principal evaluative tool for the comprehensive set of medical programs known as the Illinois Trauma System. In order to determine the completeness of case reporting to the ITR, a 10% sample of traumatic injuries was drawn at 33 hospitals designated as Trauma Centers. An attempt was then made to link the cases found at the Trauma Centers with those in the ITR; theoretically, all cases found in the Trauma Center should appear in the ITR. ⋯ Inclusion in the ITR is significantly associated with the categorization of hospital emergency capability, the method of patient transport to the hospital, the mechanism of injury and subsequent admittance to the intensive care unit. Of particular interest for evaluative studies is the marginally significant difference between the case fatality rate as reported in the ITR (5.0%) and that found in the hospital (2.8%). Guidelines are suggested to improve the development, management and data quality of future registries.
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The relationship between physicians' nonverbal communication skills (their ability to communicate and to understand facial expression, body movement and voice tone cues to emotion) and their patients' satisfaction with medical care was examined in 2 studies. The research involved 71 residents in internal medicine and 462 of their ambulatory and hospitalized patients. Standardized, reliable and valid measures of nonverbal communication skills were administered to the physicians. ⋯ Across both samples, physicians who were more sensitive to body movement and posture cues to emotion (the channel suggested by nonverbal researchers as the one in which true affect can be perceived) received higher ratings from their patients on the art of care than did less sensitive physicians. In addition, physicians who were successful at expressing emotion through their nonverbal communications tended to receive higher ratings from patients on the art of care than did physicians who were less effective communicators. The implications of successfully identifying characteristics of physicians with whom patients are satisfied are discussed.
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The mobile coronary care unit (MCCU) as a means of reducing coronary artery disease (CAD) morbidity and mortality cannot be realized unless patients, lay others, and medical personnel use it. The initial medical care decision of 1,102 patients who experienced acute cardiac symptomatology was studied to determine factors contributing to expedient care-seeking and the decision to use emergency medical services (EMS), direct emergency room services, or physician consultation. An expedient decision to utilize the EMS, the only means of obtaining the MCCU, occurred when symptoms began suddenly and were incapacitating, lay others advised the EMS, and patients relinquished and lay others usurped control of care-seeking process. To increase MCCU utilization and effectiveness, it is suggested that public education about CAD be refined and the teaching of cardiopulmonary resuscitation expanded, physicians be encouraged to educate patients realistically as to CAD prognosis, and a cardiac crisis center be instituted that incorporates a registery for patients at high risk of myocardial infarction or sudden cardiac death.
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The burn problem in the United States, as reflected in published data, is serious. More than 2,000,000 people are injured in burn accidents each year; 70,000 are hospitalized, involving approximately 9,000,000 disability days; and an estimated 9,000 die from their injuries. In 1964, the National Burn Information Exchange (NBIE) was established in Michigan. ⋯ NBIE provides information or morbidity by etiology, treatment patterns and mortality by cause and institution. The organized data are a major and valuable information resource helpful for establishing criteria and policy guidelines for organizing burn care services based on need, severity, and quality measures as reflected by outcomes of care. Based on NBIE analyses of current information, it is recommended 1) that only 10 per cent of the acute general hospitals in the United States need be involved directly in the provision of specialized burn patient care; 2) that 3 levels of care be established as determined by severity of injury and intensity of care; and 3) that burn care should be organized within a comprehensive regionalized Emergency Medical Service (EMS) system in accordance with the EMS Act of 1973 and the 1976 amendments.