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Biomedical subjects

H D Scott

Publications and source records attributed to H D Scott.

At least 19 recordsLinked to original sources
PubMed2000

Physicians helping the underserved: the Reach Out program.

In the current health care environment of competition and market forces, concern has arisen that the classic principle of serving disadvantaged persons may not be fulfilled due to pressures from managed care. Reach Out, a $12 million national program of the Robert Wood Johnson Foundation, was developed to recruit leaders from among practicing physicians to organize projects to care for the uninsured and underserved. Physician volunteerism was a key component of all projects. Thirty-nine Reach Out projects were implemented and carried out across the United States, with average funding per project of $300000 distributed over a period of 4 years. Seven model types emerged, the most common of which, the free clinic and the referral network, accounted for two thirds of the total. At the program's conclusion, 199584 patients were enrolled and 11252 physicians recruited. Project execution was more complex than initially supposed, and major progress commonly was not evident until the third or fourth year, but at least two thirds of the projects are likely to continue with local support. With strong physician leadership and a funded administrative core, organized community efforts can develop and sustain an effective program. Programs such as Reach Out cannot solve the national problem of access to health care, but they can make a small but important impact on the number of uninsured and underserved persons without access to health care.

Altruism↗
PubMed1995

Peer review of mammography interpretations in a breast cancer screening program.

Mammograms from a statewide screening program were subjected to a blind review by a panel of expert mammographers. Ninety-five percent (173/182) of original normal mammograms and 53% (164/311) of original abnormal mammograms were reread as normal. In comparison with the expert panel community radiologists were more likely to request a repeat mammogram in 6 months than to interpret a mammogram as normal or address their uncertainty with an immediate diagnostic workup.

Breast Neoplasms↗
PubMed1993

The Uniform Clinical Data Set: an evaluation of the proposed national database for Medicare's quality review program.

The accuracy, reliability, and validity of the Medicare Peer Review Organization (PRO) review process have all been questioned. Evidence concerning the PRO program's effect on cost and quality of care remains lacking. The Health Care Financing Administration has thus committed itself to reform, and the Uniform Clinical Data Set (UCDS) has been proposed as the national database for Medicare's quality review program. The UCDS is an automated, computerized data set designed to standardize the evaluation of quality. It should allow an objective, consistent, and efficient process for peer review, based on explicit decision criteria and on aggregated information about patterns of care and quality. But is this truly so? We review the existing evidence on the UCDS and compare it with the current PRO reviews of quality, concluding that although the UCDS can potentially improve the accuracy and the reliability of data abstraction and the validity of reviews, this remains to be shown. Preliminary data on the UCDS suggest that work is needed before it can meet appropriate expectations for a national database for quality assessments. We also propose a model for reviews of quality in which we show that reviews of care done in the context of internal quality improvement programs will differ in goals and intensity from reviews of care done at the national level. We suggest that the UCDS has a unique, but limited role--that of national surveillance of practice patterns. Detailed assessments of quality are more appropriately done at local or institutional levels.

Data Collection↗
PubMed1993

Infection with the human immunodeficiency virus in prisoners: meeting the health care challenge.

The magnitude and the scope of health care problems posed by human prison inmates seropositive for the human immunodeficiency virus (HIV) are enormous. Prisoners represent a substantial proportion of HIV-infected individuals in North America. A high proportion of prisoners are intravenous drug users who often have not received appropriate health care or HIV-directed services prior to incarceration. Health care of HIV-seropositive prisoners and follow-up medical care after prison release has often been less than optimal. Among inmates at the prison facility in Rhode Island, 4% of the men and 12% of the women are HIV seropositive. The Brown University medical community, in conjunction with the Rhode Island Department of Health and Corrections, has developed an effective program for the health care of such prisoners, both during incarceration and after release from prison. Academic medical centers are uniquely poised to assume the leading role in meeting this obligation. We believe that this general approach, with region-specific modifications, may be effectively applied in many correctional institutions in North America.

Female↗
PubMed1992

The Breast Cancer Screening Program in Rhode Island.

The Rhode Island Department of Health has undertaken a Breast Cancer Screening Program which incorporates assessment, policy development, and assurance functions, following the model proposed in the Institute of Medicine (IOM) report, The Future of Public Health. With the community's help, projects have been implemented to increase screening capacity with dedicated, state-of-the-art equipment, to increase screening accessibility, to publicize the need for mammography, and to minimize false test results. In the program's first 15 months, the proportion of women ages 40 and over who were screened with mammography according to current guidelines increased from 35 to 46 percent (from 38 to 49 percent among women ages 40-49; from 31 to 43 percent among women ages 50 and over), including 15 percent who received their first screening mammogram. Providers' recommendations and knowledge of screening guidelines were important in explaining first-time use. The Department plans to apply the IOM model in other program areas. Its adoption by others is urged.

Adult↗
PubMed1990

Physician reporting of adverse drug reactions. Results of the Rhode Island Adverse Drug Reaction Reporting Project.

The Food and Drug Administration, Rockville, Md, contracted with the Rhode Island Department of Health, Providence, to conduct a project to increase reporting of suspected adverse drug reactions through physician education. Voluntary reporting, an important part of postmarketing surveillance that signals potential problems with marketed drugs, historically has been underused by physicians. After 2 years, there was a more than 17-fold increase in reports submitted directly from Rhode Island compared with the yearly average before initiation of the project. Increases in the total numbers of reports were paralleled by significant increases in the numbers of reports of severe reactions. Similar increases were not experienced nationally. Physicians in Rhode Island were surveyed before and 2 years after interventions began to determine changes in knowledge and attitudes about reporting of adverse drug reactions. Significant gains in knowledge and positive attitudes toward the reporting system occurred. We conclude that physicians can be stimulated to increase their reporting of suspected reactions, thereby improving the viability of the federal reporting system.

Attitude of Health Personnel↗
PubMed1990

The future of public health: a survey of the states.

A survey of state health agencies was conducted to determine agreement and disagreement of state health officers with the recommendations contained in The Future of Public Health issued by the Institute of Medicine in 1988. The survey also measured the extent to which the IOM recommendations were judged currently in place or in the process of being implemented in the states. The survey showed almost unanimous consensus among the nation's state health officers for the vast majority of the recommendations. There was less consensus concerning the appropriateness of locating substance abuse, Medicaid, mental health, and regulation of health professions within state departments of health. However, a significant proportion of health officers favored a health agency location for these responsibilities (72%, 52%, 48%, and 38% respectively).

Forecasting↗
PubMed1990

Cancer control in Rhode Island: blueprint for the 1990s.

Rhode Island has one of the highest cancer mortality rates in the nation. In an average year, about 5000 new cancers are reported to the Rhode Island Cancer Registry, and more than 2300 Rhode Islanders succumb to the disease. In response to this problem the Rhode Island Department of Health assembled cancer experts from around the state to plan priority cancer control activities for the 1990s. Their plan for 1990-1992 is the subject of this report. Five cancers were selected as the foci of cancer control activities: cancers of the lung, colon-rectum, breast, cervix, and oral cavity. The plan proposes prevention, screening, and treatment interventions to reduce morbidity and mortality from these diseases. Rhode Islanders will have to work together to achieve the 33% reduction in cancer mortality proposed as a goal for the year 2000. Surveillance suggests progress on some fronts, but marching in place on others.

Adolescent↗
PubMed1990

Mammography referral patterns among Rhode Island physicians.

In 1987, the Rhode Island Department of Health conducted a survey of Rhode Island primary care physicians to determine their attitudes and practices regarding breast cancer screening, particularly their use of clinical breast exam (CBE) and referral for screening mammography, and compared the data with information obtained from primary care physicians in the US in 1984 and 1989. The survey showed that the same percentage of Rhode Island physicians (71%) and physicians nationally (72%) agree with American Cancer Society (ACS) guidelines for breast cancer screening, but Rhode Island physicians refer for mammography (43 vs 37%) and perform CBE (97 vs 80%) according to ACS guidelines more frequently. Cost, reliability and availability were of greater concern to physicians nationally than in Rhode Island. Despite better use of breast cancer screening by Rhode Island physicians, only 43% reported referring for mammography according to guidelines. Since studies indicate that the recommendation of her physician is a key determinant of a woman's decision to have a screening mammogram, physician referral needs to increase in order to meet the Year 2000 Objectives of 80% for screening mammography for women 40 and older.

Adult↗