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Biomedical subjects

J P Bunker

Publications and source records attributed to J P Bunker.

At least 19 recordsLinked to original sources
PubMed1994

Improving health: measuring effects of medical care.

The impact of medical care on the quality and length of life of the population has been poorly documented. The rapid growth of evidence of efficacy of therapy for individual medical conditions now offers the opportunity to create an inventory of benefits. A method for creating such an inventory is described, as is its application to a selection of condition-treatment pairs, chosen for their high incidence of prevalence, their serious outcomes, and the demonstrated efficacy of their treatment. An aggregate effect of medical care on life expectancy is found to be roughly five years during this century, with a further potential of two years. Although there is no overall index of quality of life analogous to life expectancy, our inventory demonstrates the enormous burden of pain, suffering, and dysfunction that afflicts the population for which medical care can provide a large measure of relief.

Adolescent↗
PubMed1988

Is efficacy the gold standard for quality assessment?

"Efficacy"-medical care that is achievable under optimal conditions-is generally considered to be the appropriate standard for quality assurance. In this paper I argue that what is needed is a broadened definition of efficacy that includes the appropriateness of an intervention as well as the level of technical skill used in its provision. To establish efficacy, so defined, I suggest that well-designed nonexperimental, as well as experimental, studies be undertaken that employ registries and data banks, as well as formal clinical trials, and that decision analysis be used to synthesize the results. This will require a significant effort and investment in outcome studies of medical and surgical technologies. With growing recognition by the public that quality can be highly variable-aided by the Health Care Financing Administration's publication of hospital mortality and morbidity data-the medical care system will ignore outcome studies and quality assurance at its own peril.

Efficiency↗
PubMed1982

Should surgery be regionalized?

The authors suggest that new surgical procedures be carried out initially in selected institutions and that complex procedures for which it has been or can be demonstrated that mortality is inversely related to the volume of experience also be regionalized. Regionalization in the latter instance can have a small overall impact on surgical practice but a large impact on the adverse consequences of high risk operations that are performed only occasionally.

Female↗