Medical care
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Because of health care inequities that still persist under federal and state sponsorship plans, many local government agencies are starting to consider ways of directly providing medical services to the poor. Over 100 years' experience with direct provision programs in the City of Cincinnati, however, have been ultimately counterproductive. A unique three-way contract developed by the Board of Health, a private multispecialty physicians' group and a consumer advocate organization has recently allowed Cincinnati to implement a delivery system that integrates mechanisms for prepaid public health care into a fee-for-service private group practice, all within the context of a community-based neighborhood health care facility. While it is still too early to make a full evaluation of this public health care group practice model, there are already indications that is services will be superior to those offered in Cincinnati's traditional public clinics.
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This paper examines the relationship between problems in anesthesia care delivery and the availability and utilization of trained anesthesia manpower. The 1972 and 1980 projected supply and mix of anesthesiologists and nurse anesthestists is described and compared to the current and projected need for their services. The need estimates developed for anesthesia manpower are based upon published data on operations, productivity and theoretical team configurations. ⋯ Two estimates of need are developed based upon differing degrees to which anesthesia teams can be effectively employed, this being contingent upon the size of the hospital operative workload. While the need estimates developed for anesthesiologists for 1972 and 1980 were fairly close in aggregate number to the actual and projected supply; the need estimates for nurse anesthetists fell far short of their 1972 and 1980 projected supply. The 1972 need estimates are then compared on a statewide basis to the actual supply and mix of anesthesia personnel to reveal a severe maldistribution which is quantified in terms of shortage and execesses of anesthesiologists and nurse anesthetists for each state.
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This paper presents a descriptive narrative of a mathematical manpower model and the results of an analysis of the effect physician extenders have on medical costs and manpower requirements. The model is extensively developed, through the use of a new medical classification system in the area of delegation of specific task areas and patient visits to physician extenders. ⋯ Results are presented that analyze the use of physician extenders from the following viewpoints: minimum cost solution for adult medicine, pediatrics and obstetrics/gynecology (OB/GYN); maximum physician extender use; effect of physician extender salary on minimum cost utilization; level of independence exercised; size of clinic and regional manpower planning; and a case study of HMO planning. The type of results presented include cost analysis, manpower analysis, and the types of patient visits best delegated to physician extenders (PE).
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Emergency ward doctors and nurses define patients whose illnesses require prolonged and comprehensive care as threats to the mission of the ward. Data were collected by means of direct observation and interviewing of emergency ward doctors and nurses in a 600-bed hospital in the Midwestern United States. In 1973, a total of 270 hours of observational data was collected as part of a larger study of emergency ward social organization. ⋯ Since these patients often present behavior problems on the ward, one way for medical staff to cope with such patients is to define these patients as management problems rather than as medical cases to be diagnosed and treated. Success or failure with management problems is no longer based on medical criteria, but upon the outcome of management activities. The most successful outcomes are those where the amount of patient's disruptive behavior and the amount of staff time and resources devoted to the patient are held to a minimum.
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A retention study was implemented in Marshfield, Massachusetts in May 1974 in order to ascertain if cardiopulmonary resuscitation (CPR) skills could be retained by secondary school students who had 15 months previously received training in mouth to mouth resuscitation and cardiac compression. The retention study also addressed itself to the question whether a 28-minute "refresher" film on CPR skills prior to the test would serve to improve performance of CPR skills. (In the initial study, the students had been divided into two groups: those that received both didactic and practice sessions and those who received didactic training only.) All the initial practice group students (178 students who had received both didactic and practical CPR training) were divided equally into "film" and "no film" groups. A small sample of students (38) who had initially learned CPR skills from didactic materials only were also tested. ⋯ In summary, this study would indicate that training of secondary students in CPR leads to good retention of essential skills. As indicated in the previous study, retention of the ancillary decision-making skills was not satisfactory. Methods for teaching these skills so that they will be retained over time need further development.