Biomedical subjects
Publications and source records attributed to D Neuhauser.
Firms research combines parallel providers of care, ongoing patient randomization, and continuous experimental changes and improvement. This form of efficient research now has a substantial track record of published studies by a growing number of hospitals.
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In the future, health care delivery systems may need to respond to requests from payers to demonstrate the quality of care they provide for types of patients or diseases. Here, asthma is used as an example of what such a response might look like in the context of continuous quality improvement.
This article describes a medical school's effort to introduce quality improvement (QI) concepts and methods through experiential learning to students as part of a required eight-week primary care clerkship. Each student describes a patient with asthma, investigates the cost of care, and assesses the outcome through an interview with the patient. These patients are considered together as recipients of an areawide process of care. The statistical tools of QI were adapted in a workbook to help students understand care as a process and their role as physicians in improving it.
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Costa Rica has been unusually successful in providing high levels of health for its people given its economic resources. It is proposed that there are two reasons for its success. Having no military, Costa Rica has had resources to invest in health care. Having a relatively equal income and education distribution and a democratic government, it has been able to provide health care widely rather than just to the elites. This paper examines production functions for health and possible directions for appropriate management of health as Costa Rica confronts the chronic disease pattern of the developed world.
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A professional layman speculates on the role of public voice in medical care--on ways of making organizations responsive to the public's wishes. Research conducted as a participant observer in the functioning of human subjects committees, hospital trustees, and a government regulatory body reveals the public interest to be no match for the special interest. Unusual proposals are offered to improve the public's control mechanisms; the marketplace and the polling place may yet serve well.
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Explore the source record for details and available documents.
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The six sequential stool guaiac protocol has been advocated for screening of colonic cancer. Analysis of the expenditures involved in such a program shows that the cost of detecting cancer rises exponentially so that the marginal cost of the sixth test may be 20,000 times the average cost. The marginal cost is decreased with lower test sensitivity and increased with lower prevalence of colonic cancer. This result shows that even an inexpensive test can become quite costly in terms of cases detected. The marginal cost per case detected depends on the prevalence of the condition in the population screened and the sensitivity of the test applied.
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Explore the source record for details and available documents.