Israel journal of medical sciences
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Comparative Study
Differences in the use of emergency room and hospitalization in relation to primary care pediatric services.
Two pediatric primary care services in Ofakim, Israel, were compared with respect to their use of hospital emergency room facilities and hospitalizations. The services compared were a community-based university pediatric clinic in which preventive and curative care were merged and a traditional service in which preventive and curative care were provided by different agencies. ⋯ The proportion of children who were admitted to hospital, among those referred to the emergency room, was much higher for the university clinic. Consistent differences were not found in the number of hospital admissions/1,000 children in the population, nor in the mean duration of stay of hospitalized children.
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An off-line system for automating the problem-oriented record implemented at Kibbutz Shuval is described. The Shuval problem-oriented record consists of acute and chronic problem lists, a preprinted data base collected by patients and nurses, problem-oriented plan flow sheets, problem-oriented progress notes and a regular record audit. The mean conversion time from a traditional record to a problem-oriented record was 17 min for a child's record and 25 min for an adult's. ⋯ Transfer of data took, on the average, 10 min (range, 5 to 30 min) for a child's record. The following five types of analysis can be performed with the Shuval automated problem-oriented record: administrative, patient care, epidemiologic, demographic and clinical research. Coupled with the manual problem-oriented record, the Shuval automated record provides many advantages of an on-line problem-oriented record at considerably less cost.
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Health services in Israel are provided by various organizations. In most areas, curative, preventive and welfare services are under the administration of separate agencies. Even in small towns, health and social services are provided by many agencies. ⋯ A model is suggested for the organization of comprehensive primary health care at the local level, with integrated curative, preventive and social services. Development of neighborhood health centers with comprehensive services may provide more effective and efficient care for the individual and family and may serve as a suitable framework for the development of community health care programs. The importance of surveillance of the health status of the community and the need for a relevant record system is stressed.