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Biomedical subjects

J D Goodson

Publications and source records attributed to J D Goodson.

At least 19 recordsLinked to original sources
PubMed2001

The future of capitation: the physician role in managing change in practice.

Capitation-based reimbursement significantly influences the practice of medicine. As physicians, we need to assure that payment models do not jeopardize the care we provide when we accept higher levels of personal financial risk. In this paper, we review the literature relevant to capitation, consider the interaction of financial incentives with physician and medical risk, and conclude that primary care physicians need to work to assure that capitated systems incorporate checks and balances which protect both patients and providers. We offer the following proposals for individuals and groups considering capitated contracts: (1) reimbursement for primary care physicians should recognize both individual patient encounters and the administrative work of patient care management; (2) reimbursement for subspecialists should recognize both access to subspecialty knowledge and expertise as well as patient care encounters, but in some situations, subspecialists may provide the majority of care to individual patients and will be reimbursed as primary care providers; (3) groups of physicians should accept financial risk for patient care only if they have the tools and resources to manage the care; (4) physicians sharing risk for patient care should meet regularly to discuss care and resource management; and (5) physicians must disclose the financial relationships they have with health plans and medical care organizations, and engage patients and communities in discussions about resource allocation. As a payment model, capitation offers opportunities for primary care physicians to influence the future of health care by improving the management of resources at a local level.

Capitation Fee↗
PubMed1990

The diagnostic value of upper gastrointestinal radiography.

We reviewed the indications for and results of 788 consecutive upper gastrointestinal radiographs (UGIs) performed for ambulatory patients. Sixty-three percent of tests were ordered for the evaluation of abdominal pain, dyspepsia, or esophageal reflux. Of these tests, only 4.8% yielded results of major clinical importance to patient management. The yield for patients greater than 50 years of age was greater than for patients less than 50, 6.9 versus 3.0% (p = 0.04). There was a significant increase in yield with increasing age (chi trend = 11.6, p less than 0.001). Among patients with an indication of esophageal reflux alone (n = 62), there were no patients younger than age 60 with a test result that would significantly affect therapy or outcome. Among patients evaluated for fecal occult blood or weight loss (n = 120), 11.7% of tests ordered showed a finding of major clinical importance. In this group, the yield was higher in those greater than or equal to 50 years of age than in those less than 50, 14.7 versus 6.7%, (p = 0.2). These results indicate that UGIs ordered to evaluate pain or symptoms of esophageal reflux in the absence of bleeding or weight loss rarely yield results that significantly influence therapy. Such patients may be best served by an initial trial of empiric therapy or some other test. The UGI has greatest value when indications for it include bleeding or weight loss.

Age Factors↗
PubMed1989

Medical diagnostic technology in the home.

This article studies the issues surrounding the assessment of several home diagnostic tests. First, the authors review the current data and proper use of fecal occult blood and pregnancy tests. Second, they evaluate the roles of blood and urine glucose monitoring in the management of diabetes mellitus and home pressure monitoring in the management of hypertension. The authors conclude that while home measurement of blood pressure or blood sugar can be recommended to improve compliance with medical programs, home fecal occult blood testing, while helpful, has not been fully investigated.

Blood Pressure Determination↗
PubMed1986

The training of physicians outside the hospital.

The current ambulatory training of medical residents in the primary care program and the traditional program of the Massachusetts General Hospital, Boston, are described. All residents are assigned to work in a single medical group practice unit during their three years of training. Block outpatient rotations make up 32% of the primary care program and 6% of the traditional program schedules, while total ambulatory experiences, including weekly continuity sessions, make up 39% and 15%, respectively. Several components are important for a successful program. Above all is a vigorous group practice providing a sizable panel of patients with complex clinical problems from which residents can learn. Also important are financial support from the hospital and government or private grants and a commitment to outpatient teaching by the medical and nonmedical specialty staff.

Boston↗
PubMed1985

Comparing ambulatory care practices of primary care and traditional medicine residents.

Although special residency programs preparing internists for primary care have been in existence for a decade, little is known about whether these tracks have achieved their goals. As part of a multicenter evaluation of ambulatory care at four university hospitals, 1,040 patient care encounters were reviewed for 16 primary-care and 41 traditional medicine residents. Using a chart-based audit, the authors examined 16 discrete items of patient care to assess resident management in the following areas: screening for colorectal carcinoma, management of hypertension, benzodiazepine drug prescribing, and management of chronic lung disease. Their hypothesis that primary care residents would score higher than traditional medicine residents in the areas of screening, prevention, and prescribing of drugs was not supported. There was no association between type of training and performance of a task with the following exception: second-year primary care residents screened for colorectal carcinoma in 86% (126) of patients whose charts were audited, while second-year traditional medicine residents did so in 77% (160) (P less than 0.025). This difference was not maintained when the residents were reaudited 1 year later. Both groups of residents scored high in all areas with the following exceptions: documentation of the amount of sedative dispensed and immunization of susceptible patients against pneumococcus and influenza. The ambulatory practices of both groups of residents exceeded expectations, probably because of the wider influence of primary care training.

Ambulatory Care↗
PubMed1984

The clinical information value of the glycosylated hemoglobin assay.

We evaluated the clinical information value of the glycosylated hemoglobin assay by comparing it with practitioners' estimates of glucose control over the preceding 10 weeks in 216 patients with diabetes. Twenty-four per cent of the practitioners' estimates, which were based on historical and laboratory data collected during a routine office visit, differed by more than +/- 75 mg per deciliter from the actual mean blood glucose levels calculated with the glycosylated hemoglobin assay. One third of the mean blood glucose concentration fell outside the confidence intervals physicians used to bound their estimates. When examined individually or in the aggregate, historical information, such as polyuria, nocturia, or home urine testing for glucose, and laboratory information, such as fasting or random blood glucose levels, were weak predictors of the actual mean concentration of blood glucose. We conclude that the glycosylated hemoglobin assay provides information about the degree of long-term glucose control that is not otherwise obtainable in the usual clinical setting.

Blood Glucose↗
PubMed1982

The clinical course of acute hepatitis in the elderly patient.

We have reviewed the clinical course of acute hepatitis in 23 patients 60 years or older. There were four patients with acute hepatitis B, two patients with sporadic hepatitis, and 17 patients with posttransfusion non-B hepatitis. Hepatitis, in the latter group, is presumed to have been caused by the transmission of non-A, non-B hepatitis agents by blood transfusion. Regardless of the cause, the acute episode of clinical hepatitis resolved in 20 patients. Eight patients had completely normal liver function test results on follow-up. Eleven patients had chronic elevations of bilirubin, alkaline phosphatase, or SGOT values without clinical or biochemical evidence of deterioration of their condition during 20.5 +/- 3.5 months (mean +/- SEM) of observation. The majority of patients with posttransfusion non-B hepatitis either recovered spontaneously or entered into a chronic phase characterized by mildly or intermittently abnormal liver function test results without clinical deterioration of their condition.

Acute Disease↗
PubMed1981

Characteristics of older patients in an urban teaching practice.

This study describes demographic, residential, health, and utilization characteristics of patients over 70 years of age followed in a hospital-based teaching group practice. Most of the patients were able to maintain an independent or semi-independent life, living either alone or with relatives. The use of formal support services, such as the visiting nurse association and social services, was common in all age groups. While 25 percent of the patients younger than 80 years used some formal support service, the frequency increased dramatically with age, doubling to 50 percent for those in their 80s and reaching 65 percent among those 90 or older. The training of physicians should include opportunities to manage for an extended period of time a cohort of elderly, independent, ambulatory patients. A hospital-based group-teaching practice provides a setting where residents have the opportunity to develop these skills with the assistance of experienced practitioners, nurses, and social workers.

Age Factors↗
PubMed1979

Diagnosis of lymphomatous leptomeningitis by cerebrospinal fluid lymphocyte cell surface markers.

We present a patient with metastatic lymphomatous leptomeningitis in whom the diagnosis was made on the basis of cerebrospinal fluid lymphocyte surface markers and later confirmed by cerebrospinal fluid cytology. The diagnosis of metastatic leptomeningitis can be elusive, and the differential includes a wide variety of infectious and noninfectious processes. We propose that lymphocyte surface marker studies can be a useful technique in expediting the evaluation of certain patients with lymphoma who have evidence of central nervous sytem involvement.

Adult↗