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This paper examines the uses of some health status indices in measuring equity of access to medical care. Empirical examples are provided using data from national surveys of the U.S. population conducted from 1964 through 1976. A simple indicator, mean number of physician visits, suggests that between 1963 and 1976 the poor improved their position relative to the rest of the population and, indeed, currently enjoy the highest level of access. However, a second measure, the use-disability ratio indicates that the poor may still receive less care relative to their need. A third measure, the symptoms-response ratio suggests how norms of appropriate behavior might be incorporated into an access measure. [ABSTRACT FROM AUTHOR]

This paper describes (1) the design, methods and baseline data of the first smoking cessation clinical trial for Chinese Americans with medical conditions - Chinese Community Smoking Cessation Project (CCSCP); (2) the collaborative process between researchers and the Chinese community; and (3) the barriers and facilitators of implementing the study. CCSCP was a culturally tailored, randomized, smoking cessation trial testing the efficacy of an intensive (physician advice, in-person counseling with nicotine replacement therapy, 5 telephone calls) compared to a minimal (physician advice and self-help manual) intervention. The study applied a community-sensitive research method involving community members in all phases of the research process in San Francisco Bay Area during 2001–2007. CCSCP recruited 464 smokers from health care facilities (79%) located in Chinese neighborhoods and through Chinese language media (21%). Baseline assessments and interventions were conducted in-person using translated and tested questionnaire and intervention materials. The majority of the participants were men (91%) with a mean age of 58.3 years, foreign born (98%), with less than high school education (58%), spoke no English (42%) and in non-skilled or semi-skilled occupations (60%) with <$20,000 household income (51%). Participants smoked regularly on an average 38.6 ± 17 years, smoked 9.1 ± 8 cigarettes per day and 85% smoked daily. Cultural tailoring of recruitment methods and intervention design led to successful enrollment and retention of participants, overcoming barriers faced by the participants. Community sensitive collaborative process facilitated implementation of study protocol in community health care settings. [ABSTRACT FROM AUTHOR]

As some preventive medicine physicians have been denied medical licenses for not engaging in direct patient care, this paper attempts to answer the question, "Do preventive medicine physicians practice medicine?" by exploring the requirements of licensure, the definition of "practice" in the context of modern medicine, and by comparing the specialty of preventive medicine to other specialties which should invite similar scrutiny. The authors could find no explicit licensure requirement for either a certain amount of time in patient care or a number of patients seen. No physicians board certified in Public Health and General Preventive Medicine sit on any state medical boards. The authors propose that state medical boards accept a broad standard of medical practice, which includes the practice of preventive medicine specialists, for licensing purposes. [ABSTRACT FROM AUTHOR]

This article examines the history and effect of the Consensus Development Program (CDP) at the National Institutes of Health (NIH). Introduced at a time when the relationship between the U.S. public and the medical profession was at a nadir, the CDP frequently placed the NIH in the middle of broader debates in medical practice and health policy during the last quarter of the 20th century. Drawing on published and archival sources, this paper sheds light on the challenges associated with collecting, assessing, and communicating evidence to medical professionals and convincing them to act on it in the name of improved health care. Administrators at the NIH sought a middle ground between changing medical practice and respecting professional autonomy, with varying degrees of success. This debate has continued implications today as tensions persist between scientific guidelines and the clinical medicine practiced by physicians and expected by patients. [ABSTRACT FROM AUTHOR]

The fundamental problems that beset the U.S. health care system--cost, quality, and access--differ in scope and intensity in inner cities. Current trends in health care are systemwide but are more difficult to accommodate in inner cities because of scarce resources and stresses to the health care system. In this position paper, the American College of PhysiCians seeks to highlight directions and innovations in public policy for inner-city health care with renewed determination that health care problems in the United States must be solved, especially in cities, where they are most extreme. Many persons in inner cities experience an urban health penalty because of the concentration of economic decline, job loss, and major health problems. Because the problems originate in a complex interaction of socioeconomic factors, behavior, environment, and disease that is related to race and ethnicity, multifaceted approaches that extend beyond the medical model are needed to improve health status. The College argues for tackling health problems of the inner city in the context of a comprehensive urban policy that addresses the root: causes of poverty. In addition, this position paper contains more specific recommendations to improve health care delivery to inner cities. The College calls for a comprehenSiVe urban partnership initiative to address all aspects of the urban penalty-social, economic, and health-related--and recommends solutions through public and private collaborations that can be adapted to the circumstances of each Community in addition, policy recommendations address health care coverage, providers, public hearth initiatives, community involvement, and short-term improvements to such existing programs as Medicaid. [ABSTRACT FROM AUTHOR]

This article focuses on problems in the delivery of health care services in the United States. The two problems are: the difficulty of access to primary care physicians and long patient waiting times in the office or clinic. Long waiting times are dependent primarily upon poor functioning of the appointment system and secondarily on patient flow in the office or clinics. A health care facility that recognizes these problem areas and is interested in taking steps to reduce patient waiting time and to better utilize its professionals is still faced with the question of how to measure the changes. The purpose of this paper is to present two techniques--work sampling and patient flow analysis, which can serve as tools to accomplish this task.

Background: The many challenges in health care today create a special need for great leadership. However, traditional criteria for physicians' advancement to leadership positions often regard academic and/or clinical accomplishments rather than the distinctive competencies needed to lead. Furthermore, physicians' training can handicap their developing leadership skills. In this context, an emerging trend is for health-care institutions to offer physician-leadership programs.Methods and Results: This paper reviews the rationale for developing physician-leaders. Factors that underscore this need include: (1) physicians may lack inclinations to collaborate and to follow, (2) health-care organizations pose challenging environments in which to lead (e.g., because of silo-based structures, etc.), (3) traditional criteria for advancement in medicine regard clinical and/or academic skills rather than leadership competencies, and (4) little attention is currently given to training physicians regarding leadership competencies.Conclusion: Definition of these competencies of ideal physician-leaders will inform the curricula and format of emerging physician leadership development programs. [ABSTRACT FROM AUTHOR]

This paper analyzes the evolution of consumer-driven health care in terms of its original vision, its subsequent implementation, and the transformations it has endured as it moves into its second decade. The market is generating product designs that combine elements of consumerism with elements of managed care, but the trend is always toward a stronger role for consumer choice and a weaker role for management of those choices by physicians, insurers, employers, and regulators. [ABSTRACT FROM AUTHOR]

This article presents a paper that outlines some possible bioterror threats, possible neuromusculoskeletal symptoms and how doctors of chiropractic can be better prepared. Since the anthrax attacks of 2001, Americans have come to realize that bioterror attacks can and likely will occur on their own soil. Health care providers would be the first responders to this type of attack and hospitals could be overrun with infected persons. Chiropractic physicians and their employees could be more vulnerable to this type of attack than other providers.

This paper considers the role of statistical discrimination as a potential explanation for racial and ethnic disparities in health care. The underlying problem is that a physician may have a harder time understanding a symptom report from minority patients. If so, even if there are no objective differences between Whites and minorities, and even if the physician has no discriminatory motives, minority patients will benefit less from treatment, and may rationally demand less care. After comparing these and other predictions to the published literature, we conclude that statistical discrimination is a potential source of racial/ethnic disparities, and worthy of research. [ABSTRACT FROM AUTHOR]

This article documents the public positions taken by the American Academy of Pediatrics, the American College of Physicians, and the American Medical Association on five topics with implications for public health: access to care for undocumented patients, fracking, gun control, climate change, and same-sex marriage. There are stark divisions on each of these issues between political parties, and taking a strong public position on them runs the risk of alienating some members of Congress, but each of these associations has done so. At the same time, there is a clear distinction between the public positions of these organizations and the priority given to them by their offices in Washington, DC. Drawing on an organizational maintenance framework, the author argues that taking these public positions is explained, in part, by a growth in the number of women and the number of physicians that affiliate with the Democratic Party in the United States. [ABSTRACT FROM AUTHOR]

Objective: To identify factors that promote the effective performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program.Data Sources/study Setting: Data come from a convenience sample of 16 Medicare Shared Savings ACOs that were organized around large physician groups. We use claims data from the Center for Medicaid and Medicare Services and data from 60 interviews at three high-performing and three low-performing ACOs.Study Design: Explanatory sequential design, using qualitative data to account for patterns observed in quantitative assessment of ACO performance.Data Collection Methods: A total of 16 ACOs were first rank-ordered on measures of cost and quality of care; we then selected three high and three low performers for site visits; interview data were content-analyzed.Principal Findings: Results identify several factors that distinguish high- from low-performing ACOs: (1) collaboration with hospitals; (2) effective physician group practice prior to ACO engagement; (3) trusted, long-standing physician leaders focused on improving performance; (4) sophisticated use of information systems; (5) effective feedback to physicians; and (6) embedded care coordinators.Conclusions: Shorter interventions can improve ACO performance-use of embedded care coordinators and local, regional health information systems; timely feedback of performance data. However, longer term interventions are needed to promote physician-hospital collaboration and skills of physician leaders. CMS and other stakeholders need realistic timelines for ACO performance. [ABSTRACT FROM AUTHOR]

As the US health care delivery system undergoes rapid transformation, there is an urgent need to define a comprehensive, evidence-based role for the family physician. A Role Definition Group made up of members of seven family medicine organizations developed a statement defining the family physician's role in meeting the needs of individuals, the health care system, and the country. The Role Definition Group surveyed more than 50 years of foundational manuscripts including published works from the Future of Family Medicine project and Keystone III conference, external reviews, and a recent Accreditation Council on Graduate Medical Education Family Medicine Milestones definition. They developed candidate definitions and a "foil" definition of what family medicine could become without change. The following definition was selected: "Family physicians are personal doctors for people of all ages and health conditions. They are a reliable first contact for health concerns and directly address most health care needs. Through enduring partnerships, family physicians help patients prevent, understand, and manage illness, navigate the health system and set health goals. Family physicians and their staff adapt their care to the unique needs of their patients and communities. They use data to monitor and manage their patient population, and use best science to prioritize services most likely to benefit health. They are ideal leaders of health care systems and partners for public health." This definition will guide the second Future of Family Medicine project and provide direction as family physicians, academicians, clinical networks, and policy-makers negotiate roles in the evolving health system. [ABSTRACT FROM AUTHOR]

Objective. To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics. Data Source. We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dartmouth Atlas. Study Design. We constructed two measures of physician network overlap for all health plans in our sample and linked them to selected measures of plan performance. Two linear regression models were estimated to assess the relationship between the measures of physician network overlap and the plan performance measures. Principal Findings. The results indicate that in the presence of a higher degree of provider network overlap, plan performance measures tend to converge to a lower level of quality. Conclusions. Standard health plan performance measures reflect physician practice patterns rather than plans' effort to improve quality. This implies that more provider-oriented measurement, such as would be possible with accountable care organizations or medical homes, may facilitate patient decision making and provide further incentives to improve performance. [ABSTRACT FROM AUTHOR]

Background: The persistence of a large quality gap between what we know about how to produce high quality clinical care and what the public receives has prompted interest in developing more effective methods to get evidence into practice. Implementation research aims to supply such methods.Purpose: This article proposes a set of recommendations aimed at establishing a common understanding of what implementation research is, and how to foster its development.Methods: We developed the recommendations in the context of a translation research conference hosted by the VA for VA and non-VA health services researchers.Impacts: Health care organizations, journals, researchers and academic institutions can use these recommendations to advance the field of implementation science and thus increase the impact of clinical and health services research on the health and health care of the public. [ABSTRACT FROM AUTHOR]

To examine whether racial and ethnic differences in the distribution of individuals across types of health plans explain differences in satisfaction and trust with their physicians.Data were derived from the 1998–1999 Community Tracking Household and Followback Studies and consisted of a nationwide sample of adults (18 years and older).The data were collected by telephone survey. Surveys were administered in English and Spanish. The response rate for the Household Survey was 63 percent, and the match rate for the Followback Survey was 59 percent.Multivariate analyses used regression methods to detect independent effects of respondent race and ethnicity on satisfaction and trust with physician, while controlling for enrollment in different types of health plans.Racial and ethnic minorities are more likely than whites to have lower levels of trust and satisfaction with their physician. The most prominent differences occurred within the Latino and Native American/Asian American/Pacific Islander/Other (“Other”) populations. Plan type does not mitigate the relationship between race/ethnicity and trust and satisfaction for the overall adult population.Disparate levels of trust and satisfaction exist within ethnic and minority populations, even when controlling for the distribution of individuals across types of health plans. The results demonstrate a need to better understand the health care-related factors that drive disparate trust and satisfaction. [ABSTRACT FROM AUTHOR]

Abstract: To determine whether differences exist in the performance of United States Medical Graduate (USMG) and Foreign Medical Graduate (FMG) House Staff physicians, inpatient hospital audits evaluating individual physician performance on patient histories and physical examinations were conducted in 14 Maryland and Pennsylvania non-federal, short-term hospitals. A total of 3,204 medical records were abstracted from eight diagnostic categories for 898 house staff physicians. 556 of which were USMGs and 342 were FMGs. The results from these audits indicate that while there is evidence of a strong hospital/type of physician interaction for many of the diagnoses, there was no significant overall difference in performance of USMG and FMG house staff physicians. The largest and most consistent differences in physician performante were associated with hospital characteristics, not physician characteristics. [ABSTRACT FROM AUTHOR]

The article focuses on the implications of a medical service known as contract or lodge practice to the health insurance in the U.S. In a lodge practice, a medical practitioner agrees to provide medical service to group of patients, such as members of benevolent organizations, fraternal lodges, or employees of industrial companies, for a fixed remuneration per year. It has been noted that this form of medical practice usually leads to substandard applications because some of the physicians provide slipshod services. They are pursuing this service as a means of obtaining a reputation and a clientele. The prevalent practice of these physicians was rooted from the point of view of a practitioner who felt exploited and threatened economically, particularly by the health insurance.

This study introduces a social indicator of access to medical care--the symptoms-response ratio-- that reflects the difference between the number of visits in response to symptoms that actually occur and the number that a panel of physicians indicate is appropriate for these same symptoms. Findings on the index fro a national sample of the United States population affirm differentials in access that are generally thought to exist in terms of other access indicators (conventional use measures, insurance coverage, etc.). Nonwhites, rural farm people, the poor, and those who have no usual place to go for medical care were found to have less access to care than would be judged appropriate, based on the symptoms-response index. The index also suggests possible "over-utilization" among certain groups such as children and people who see specialists as their regular source of care. [ABSTRACT FROM AUTHOR]

The article discusses the impact of technological innovations on training future physicians on health care interviewing through the use of standardized patients (SP) and computer-simulated patients (CSP) in the U.S. It focuses on the practical experiential activities of students who does not possess the medical knowledge required to complete a diagnostic interview. Moreover, SP is a non-physician who is hired to simulate illnesses in a standardized fashion to provide medical students with an early introduction to patient care. In addition, through the technology the replacement of human SPs with CSPs has made possible for it offer cases with chief complaints to the student who interacts with the patient by requesting additional history and interviewing laboratory data and x-ray.

We evaluated a program for improving influenza immunization performance in a health maintenance organization (HMO). The HMO implemented several interventions successively from 1984-87: a postcard reminder to members at high risk for complications of influenza, a computer-generated reminder to the physician at the time of any primary care visit by high-risk patients, performance feedback to chiefs of service, and, finally, retrospective feedback to each physician comparing his/her performance with that of the other physicians. We examined immunization rates for a group of members older than age 65, a high-risk group under age 65, and a group of diabetic members who had not been subject to the reminders (vs a group who had been covered by the program). Vaccination rates were increased in those diabetic members who received reminders. Nevertheless, among members younger and older than age 65 whose experience was observed over three flu seasons, a significant increase in vaccination rates was not achieved until physician feedback was added to the program. We conclude that each element of the reminder and feedback program has contributed to the overall increase in vaccination rates at the HMO and that effective ongoing influenza immunization programs can be implemented in practice settings with appropriate systems support. (Am J Public Health 1990; 80:534-536.) [ABSTRACT FROM AUTHOR]

Sixty STD patients were followed during the course of their clinic visit which averaged 2.75 professional contacts. Based on audiotape analysis, virtually all patients received a diagnosis; however, 25 percent of the patients did not receive any information about treatment or prevention, and only 57 percent of patients were given complete information. Patient recall of the information they were given averaged about 43 percent. Patients not seen by a physician during their clinic visit achieved higher recall rates than patients seen by a physician. (Am J Public Health 1990; 80:605-606.) [ABSTRACT FROM AUTHOR]