Journal of community health
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A study was carried out to determine factors affecting place of death (home, hospital, nursing home or "other places") among all 426,115 resident deaths in Washington State during 1968-1981, using death certificate information. Sixteen percent of deaths occurred at home, 74% in institutions (51% in hospitals, 23% in nursing homes) and 9% at "other places." Age, marital status and cause of death all strongly affect place of death. Further, the effect of each factor was strongly dependent on the others. ⋯ There was a marked difference in the terminal cancer caseload by hospital. The number of cancer deaths per cancer diagnosis varied widely across hospitals (0.1 to 1.6) and was unrelated to size of the hospital or level of services offered. Intervention aimed at affecting place of death, such as increasing the number of deaths at home, will need to take account of the joint effect of age, marital status and disease.
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In April 1979, 41 Alabama medical students who had received scholarships from the National Health Service Corps (NHSC) were surveyed. The students were predominantly single urban individuals who received their initial NHSC scholarship in the first or second year of medical school. ⋯ Based on their response, it is suggested that medical schools, The American Medical Student Association, and the NHSC develop a series of activities designed to facilitate the NHSC scholarship recipients subsequent activities in the NHSC. These suggestions include elective credit for NHSC/AMSA (American Medical Student Association) preceptorships, curriculum offering that facilitate the physician's practice in underserved communities, and activities that facilitate the medical school faculties' understanding of the NHSC.
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In 1975, the Johns Hopkins Medical house staff was reorganized into four Firms. Each Firm provides inpatient and outpatient care to a group of patients. Two of the goals of the reorganization were to improve accessibility and continuity of care. ⋯ Continuity was assessed by observing changes in use of emergency and walk-in clinic services, the proportion of Medical Clinic patients lost to follow-up care, the proportion of hospital readmissions returning to the same nursing unit, and the proportion of patients discharged from the hospital who returned to the Medical Clinic. The results showed that use of emergency and walk-in clinic services fell slightly, from 24% of all visits before to 22% of all visits after the Firm System (p < 0.001); no change occurred in the proportion of patients lost to Medical Clinic follow-up (21% before and after the Firm System); the proportion of hospital readmissions returning to the same nursing unit increased from 35% to 73% (p < 0.005); and the proportion of patients discharged from the hospital who returned to the Medical Clinic increased from 21% to 35% (p < 0.001). These data suggest that implementing the Firm System led to improvement in several selected aspects of accessibility and continuity of care but that further improvements could be made.