Medical care
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Case mix complexity measurements are essential to determine health care efficiency and effectiveness. Measures of patient care processes and outcomes must be adjusted for case mix before valid comparisons can be made. Hospital reimbursement, particularly prospective reimbursement, must take into account differences in case mix. ⋯ There are, however, no widely accepted easily computed case mix measures. Information theory measures of case mix have been developed but their acceptance has been limited by a lack of verification of their basic assumption that concentration of disease is related to clinical complexity. We discuss the rationale underlying the mathematical computaton of information theory measures and demonstrate a statistically significant relationship between clinical measures of case mix complexity and information theory measures of case mix complexity.
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This paper examines job satisfaction of primary care physicians and paramedical personnel in traditional office practices and in modern medical organizations. A series of two-way analyses of variance using work settings and occupational level as independent variables showed consistent effects of setting on job satisfaction. ⋯ Only with respect to income, were physicians, on the average, more satisfied than paramedical workers. The relationships between job satisfaction and the variety and complexity of work as well as ownership of work settings are analyzed and discussed.
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The utilization of the emergency room (E. R.) at a small community hospital located in a black inner-city area is investigated. Patients are classified according to a criterion for psychiatric intervention for the purpose of making staffing pattern recommendations. ⋯ R., and circumstances of mode of arrival in the E. R. The criterion of psychiatric intervention is viewed as providing an additional dimension in the study of the emergency room, a hospital service which is providing increasing routine and non-routine medical care to the general population.
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The impact of the introduction of Medicare in Quebec on hospital emergency room services was examined in Metropolitan Montreal. After Medicare, the emergency room visit rate increased 14 per cent per year compared to a 7 per cent per year increase in the five years preceding Medicare. The outpatient clinic visit rate continued an upward trend (4 per cent per year). ⋯ Before Medicare, 47 per cent of patients said that their usual source of care was a private physician, and only 17 per cent usually sought care in the emergency room. After Medicare 58 per cent reported a private physician and 31 per cent the emergency room. These findings together with the increased population density of physicians and increased annual number of physician visits per person suggest that there has been a substantial rise in demand from the public for medical care of which one important early manifestation is an increased reliance on emergency rooms.