PubMed Health⌕ Search

Biomedical subjects

J L Michener

Publications and source records attributed to J L Michener.

15 recordsLinked to original sources
PubMed1997

Duke Case-Mix System (DUMIX) for ambulatory health care.

The Duke Case-Mix System (DUMIX), which combines age, gender, patient-reported perceived and physical health status, and provider-reported or auditor-reported severity of illness to classify patients by their risk of high future utilization, explained 17.1% of the variance in future clinic charges and 16.6% of the variance in return visits. When a random half of 413 ambulatory adults were classified into four risk classes by predictive regression coefficients from the other half, there was a stepwise increase in actual future utilization by risk class. The most accurate classification was for Class 4 (highest risk) patients, with a sensitivity of 40.8%, specificity of 82.1%, and likelihood ratio of 2.3. These 23.7% of patients accounted for 44.2% of charges for all patients. When predictive coefficients from this population were used to classify a different group of 206 ambulatory adults, past utilization also increased in stepwise order by case-mix class.

Adolescent↗
PubMed1995

Computer-prompted diagnostic codes.

BACKGROUND: The purpose of this study was to develop and evaluate a computer system that would translate patient diagnoses noted by a physician into appropriate International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes and maintain a patient-specific up-to-date problem list. METHODS: The intervention consisted of a computerized list (dictionary) of diagnoses, including practice-specific synonyms and abbreviations, linked to their corresponding ICD-9-CM codes. To record the diagnoses for the office visit before the intervention, physicians used International Classification of Health Problems in Primary Care (ICHPPC-2) codes. After the intervention, physicians used their own words or checked previously identified diagnoses on the computer-generated problem list. The computer then identified the correct ICD-9-CM code. Accuracy of coding was compared before and after the new computerized system was implemented. RESULTS: Visits in which all diagnoses matched increased from 58% to 76% (P < .001) with use of the computer system. Visits in which no computer diagnoses matched the chart decreased from 22% to 8% (P < .001). Errors of omission declined from 38% to 18% (P < .001). Errors of commission decreased from 19% to 11% (P = .006). Overall accuracy increased from 62% to 82% (P < .001). CONCLUSIONS: Outpatient medical diagnosis coding can be simplified and accuracy improved by using a computerized dictionary of practice-specific diagnoses and synonyms linked to appropriate ICD-9-CM codes. Such a system provides a computer-generated problem list that accurately reflects the chart and assists with prompted coding on subsequent visits.

Abstracting and Indexing↗
PubMed1994

Attitudes, experience, and influence of family medicine predoctoral education directors.

BACKGROUND AND OBJECTIVES: While debate surrounds the determinants of medical students' specialty choices, the presence of favorable role models is generally agreed upon as beneficial to students' selection of a specialty. This study assessed the influence of family medicine predoctoral education directors on students' choice of family practice careers. METHODS: A nine-question survey was mailed to 120 predoctoral directors identified by American Academy of Family Physicians' listings; 102 completed forms were returned (85% response). RESULTS: The vast majority (97%) of directors responded that they enjoyed their role, although 14% indicated they did not want the position. Almost half (41%) reported they had extensive training in education, but almost 10% had no formal education training. Time as predoctoral director was often short, with a median of 3.5 years. When responses were linked to institutional rates of graduate entry into family practice, the only significant predictor of student entry into family practice with multivariate analysis was the number of years the predoctoral director had served in that position. CONCLUSION: Long-term service of an interested predoctoral director may assist in successful recruitment of students to family practice.

Attitude of Health Personnel↗
PubMed1993

Increasing compliance with mammography recommendations: health assessment forms.

BACKGROUND: Inexpensive reminder systems are needed to ensure that primary care physicians consistently provide health maintenance services to their patients. The purpose of this study was to determine the effectiveness of a simple, inexpensive health assessment form in place of the standard chart note to increase physician compliance with mammography recommendations. METHODS: A health assessment form with a reminder for screening mammography was implemented in a family practice in 1987 and was to be used as the official chart record for health maintenance visits. The charts of all women 50 years of age and older with two or more office visits during the years 1985 through 1988 were audited to determine how many mammograms were completed. Results were compared with mammography completion rates at a similar practice that did not use a health assessment form. RESULTS: The study group showed a significant increase in mammography completion after implementation of the form, with compliance increasing from 7.3% to 32.0% (P < .001). The comparison group had an increase in mammogram completion from 12.0% to 17.8% (P < .001). The difference between the changes in rates of mammography in the two practices was statistically significant (P < .001). Among women in the study group who had a scheduled health maintenance visit during the study period the average rate of mammography completion increased from 21.2% to 65.2% (P < .001). CONCLUSIONS: The addition of a health assessment form with a mammography reminder at the health maintenance visit is an effective and inexpensive method to increase compliance with mammography.

Adolescent↗
PubMed1989

Associations among family support, family stress, and personal functional health status.

The self-reported family support and stress of 249 ambulatory adult patients, aged 18-49 years, were studied relative to their self-reported functional health. Support from family members was found to be related positively with emotional function. Stress from family members was associated negatively with symptom status, physical function, and emotional function. Patients' severity of illness was related negatively to their symptom status, physical function, and social function, but not to their emotional function. During the study a new self-report instrument, the Duke Social Support and Stress Scale (DUSOCS), was developed to measure family and non-family support and stress. Also, a new chart audit methodology, the Duke Severity of Illness Scale (DUSOI), was designed to assess severity in the ambulatory setting. Reliability and validity of the DUSOCS and the DUSOI were supported. The importance of the patient's perception of health and its family determinants is emphasized.

Adolescent↗
PubMed1989

The effect of a telephone family assessment intervention on the functional health of patients with elevated family stress.

A randomized trial of a telephone family assessment intervention was conducted during a 2.5 month period on 224 ambulatory primary care patients, aged 18-49 years, who were selected according to self-report of elevated family stress levels. Family physicians conducted telephone interviews to collect information from patients on their supportive and stressful family members. The working hypothesis was that this process would lead to reduction in the patient's family stress and to improvement in family support and personal health status. Patients reported that the intervention caused them to think about their family support and helped them to feel better. Comparison of family factor and functional health scores before and after intervention also indicated a limited beneficial effect, but only for a small subset of black patients. These results suggest that the telephone family assessment alone is inadequate as an intervention and should be strengthened to include professional assistance to patients for the family problems that are identified by the assessment.

Adult↗
PubMed1986

Clinical skills acquired during a clerkship in family medicine.

The authors report on their study of the perceived acquisition of clinical skills by 151 second-year students in six required clerkships: surgery, internal medicine, pediatrics, obstetrics-gynecology, psychiatry, and family medicine. The students completed self-assessments of their clinical skills concerning 78 problems or procedures when taking the family medicine clerkship as their first and last rotations and when taking any of the other clerkships as their first rotation. Fifty percent of the 36 students who took the family medicine clerkship after completing all five traditional clerkships reported that they learned the management of some of the most common health problems, including osteoarthritis and hypertension, only during the family medicine clerkship. Overall, the skills of these 36 students increased from 60 percent to 89 percent of the items surveyed after taking the family medicine clerkship as their last required rotation. The principal contributions of the family medicine clerkship were in the management of common problems, performance of therapeutic procedures, and recommendation of health maintenance procedures.

Clinical Clerkship↗
PubMed1986

Clinical experience of medical students in model family practices and private family practices.

The clinical experience of 21 Duke medical students during their family medicine clerkship is analyzed to compare experience in model family practices with that in private family practices. In model practices where 50 percent of the time involved patient care, students saw an average of 41 different patients for 45 encounters and 73 problem contacts during the month. In private practices with 100 percent time devoted to patient care, students saw 140 patients for 193 encounters and 346 problem contacts during the month. Most patients were seen in the physician office in both sites (89.0 percent model and 70.4 percent private), but fewer were seen as hospital inpatients in the model than in the private practices (6.3 vs 25.7 percent). The types of patient problems were alike, with the same 11 problems ranking in the top 15 most frequently seen in the two locations. The major difference in experience relates to the larger volume of patients and problems encountered in the private than in the model sites.

Clinical Clerkship↗
PubMed1985

Development and modification of a required family medicine clerkship.

A new required clinical clerkship in family medicine at Duke University School of Medicine is described in terms of planning, implementation, and modification in response to students' evaluations. Seventy-five percent of the eight-week course involves direct clinical experience both in academic practices and community sites, and 25 percent is spent in small group seminars and workshops. Evaluations by students have been highest for the clinical experience, the clinical competence of the faculty, the teaching effectiveness of the faculty and house staff, and the overall learning experience. The ratings have been lowest for seminars, workshops, and required written projects. Several modifications made in the clerkship over a three-year period have raised the students' ratings to near their ratings of the five traditional clerkships. The data demonstrate that family medicine can be taught effectively as a core clinical rotation and can broaden the general education of medical students.

Attitude of Health Personnel↗
PubMedDate not supplied

Tracking medical students' clinical experiences with a computerized medical records system.

A fully computerized system for recording and reporting of medical students' patient contacts has been developed and successfully used in a high-volume outpatient practice. In contrast to previously described systems, the need for manual recording and/or entry of patient data has been eliminated by the use of an existing, integrated computerized medical records system. This makes possible the generation of frequent reports and timely review and adjustment of student experiences. The system has broad applicability and may also be useful for research in medical education.

Clinical Clerkship↗
PubMedDate not supplied

The medical record: a comprehensive computer system for the family physician.

BACKGROUND: Despite the early excitement regarding the possible uses of computers in medical care in the 1980s, the computer has not had much effect on routine outpatient medicine except for billing and accounting. METHODS: An emerging comprehensive ambulatory care computer system, The Medical Record (TMR), is used extensively in a large family practice, the Duke Family Medicine Center. TMR is the central system for accounting, appointments, billing, and reporting of laboratory results, radiographic findings, and medications. TMR also records problem lists and generates prompts to the clinicians for needed health maintenance, laboratory tests, and reminder letters. The most innovative function of TMR is the computerized obstetric patient record, which can be accessed from multiple sites. Cost savings compared with a manual system were found to be in excess of $7 per patient visit or approximately $500,000 per year for the Duke Family Medicine Center. RESULTS AND CONCLUSIONS: A comprehensive computer system in a large family practice is cost effective and facilitates better patient care through improved access to patient data.

Costs and Cost Analysis↗