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Biomedical subjects

B C Payne

Publications and source records attributed to B C Payne.

7 recordsLinked to original sources
PubMed1991

Developing criteria for ordering common ancillary services.

This article describes the process utilized to develop criteria for appropriately ordering five ancillary services frequently performed in hospitals: 1) arterial blood gases, 2) electrocardiograms (ECGs), 3) serum electrolytes, 4) chest x-rays, and 5) complete blood counts (CBCs). The development of each set of criteria involved an initial consultant, a panel of six additional regional expert consultants, and three national reviewers. Each criteria set was developed through a process involving seven steps: 1) an initial working draft, 2) revisions at an initial meeting of the regional experts, 3) revisions at a second meeting of the regional experts, 4) written comments from the regional experts, 5) written comments from national reviewers, 6) additional written comments from regional experts, and 7) application of the criteria to cases in a community hospital. The change in item content was measured between steps and agreement with individual items was measured at steps 2, 3, and 4. The results indicate that appreciable change in content occurred with each step except step 4. Agreement started fairly high and was over 90% by step 4. The discussion considers the utility of each developmental step, factors affecting the utility of the criteria, the extent to which the results can be generalized, and the need for more research to identify optimal processes for the development of criteria to evaluate quality of care.

Ancillary Services, Hospital↗
PubMed1979

Patient race and physician performances: quality of medical care, hospital admissions and hospital stays.

The study has attempted to determine the extent of the relationship between patient race and physicians' performances in patient care. The sample of the study consisted of 3175 hospital episode of patients discharged from 22 short-term general hospitals in the state of Hawaii. The episodes were derived from 15 major diagnostic categories. Physicians performances were measured on the basis of the quality of medical care provided, the appropriateness of hospital admissions, and the appropriateness of hospital stays, including understays and overstays. The study has found: 1) that patient race had very limited influence on physicians' performances: the quality of medical care, the appropriateness of hospital admissions, and the appropriateness of hospital stays; 2) that Asian-Americans receive medical care equal to that of the white Americans (once they had access to the health care systems), at least in the state of Hawaii; 3) that among Asian-Americans, there was no distinct difference in medical care received by Japanese, Chinese, and Filipino; 4) that there was clear evidence of racial mutual selection between patients and physicians; and 5) that patients treated by the physicians with the same racial/ethnic backgrounds received care neither superior nor inferior to the care received by patients from the physicians with different backgrounds.

Analysis of Variance↗
PubMed1979

The medical record as a basis for assessing physician competence.

The medical record can be used for evaluating physician performance. Within the limitations described, it is an essential source of information on the delivery of care as well as a measure of proficiency. The process of care should be particularly emphasized, without neglecting appropriate outcome measures. The confounding of outcome measures by compliance factors, natural history of the disease process, severity of illness, status of defense mechanisms, performance of ancillary services, and personnel does not make this an attractive single measure of physician performance. Knowledge assessment and performance assessment play a complementary role; both are necessary to identify competency. The potential for improving medical care and the recording of essential findings by such an emphasis on individual assessment based on medical records is enormous. Technologic progress in recording and retrieving medical information is facilitating use of the record to measure proficiency. A carefully structured blend of cognitive examination to establish a knowledge base and review of the medical record to measure performance will provide better measures of competency.

Ambulatory Care↗
PubMed1977

Interdiagnosis relationships of physician performance measures in hospitals.

Correlations among ten diagnostic categories of hospital care physican performance measures are reported. Using measures of conformance to predetermined criteria for optimal performance, mean scores of individual physican performances within diagnostic categories were calculated and correlated. Measurement reliability estimates were computed and it was suggested that a minimum of four cases in each diagnostic category be used for measurement of performance on the individual physician level of analysis. There appeared to be homogeneity of performance measures among some but not all diagnoses studied. This finding reinforces the need to examine interdiagnostic correlations before attempting to measure overall individual physican performance by combining measures from separate diagnostic categories.

Acute Disease↗
PubMed1976

Patient responses to request for written permission to review medical records.

2,163 patients of 55 physicians in one county, were sent letters asking for their written permission to have their medical records audited by the University of Michigan research team. The overall positive response rate was 64.1% for one county. Differences in response rates were statistically significant among specialties, among diagnoses, and among individual physicians.

Community Participation↗
PubMed1975

The use of item importance weights in assessing physician performance with predetermined criteria indices.

Conditions for using single measures or combinations of measures of physician performance are discussed. Studies reporting combination indices of proficiency are reviewed for their use of equally or differentially weighted components and for the use of these with many or with single diagnoses, Comparisons of diagnostic-specific measures are made using differential and equal item weights. Under the general conditions of this research, few psychometric differences existed. The use and acceptability of differential item weights in this research are also discussed.

Clinical Competence↗