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Biomedical subjects

J T Kelly

Publications and source records attributed to J T Kelly.

17 recordsLinked to original sources
PubMed1991

Medicare Peer Review Organization preprocedure review criteria. An analysis of criteria for three procedures.

The Medicare Peer Review Organization (PRO) program includes preprocedure review using explicit criteria to assess the appropriateness of specific procedures. This study evaluates the variability in the PRO preprocedure criteria for the three procedures most frequently reviewed by PROs: carotid endarterectomy, cataract removal, and cardiac pacemaker implants. In August 1989, the PRO review criteria were received from the Health Care Financing Administration. To provide a reference point for reviewing the PRO criteria, national practice guidelines for these three procedures were identified. Wide variability was demonstrated in the PRO procedure-specific carotid endarterectomy and cataract removal review criteria among PROs, and the criteria differed significantly from the identified practice guidelines. The criteria for cardiac pacemaker implants were somewhat less variable, and were based, to varying degrees, on practice guidelines developed by the American College of Cardiology (ACC). Greater attention is needed to improve the development of review criteria, including the use of relevant practice guidelines, to ensure that review criteria are optimal.

Arterial Occlusive Diseases↗
PubMed1991

Assisting physicians in decision-making.

The American Medical Association's long-standing commitment to improving the quality of medical care has been marked by a variety of efforts, from improvement of medical education and accreditation to technology assessment and peer review. But with increasing nationwide attention on evaluating quality of care, the AMA, as well as many other physician organizations, has focused on developing practice parameters that identify appropriate medical care.

Practice Patterns, Physicians'↗
PubMed1990

Appropriateness of medical care. Findings, strategies.

Concerns regarding significant levels of inappropriate medical services--as high as 20% or more--continue to influence discussions regarding medical care quality, utilization, and costs. The basis of these concerns are findings from a series of studies of the appropriateness of use of several medical and surgical services provided in the late 1970s and early 1980s--cardiac pacemaker implants, carotid endarterectomy, coronary artery bypass surgery, coronary angiography, and upper gastrointestinal endoscopy. More recent data from Medicare peer review organizations, however, indicate lower levels of unnecessary hospital admissions and medical services. Despite uncertainties regarding the extent of inappropriate care, additional efforts are required to better define appropriate medical care. A promising effort to meet this need is the development of practice parameters, which include practice guidelines and standards.

Quality of Health Care↗
PubMed1990

Knowledge resource preferences of family physicians.

Because of the pivotal role of medical knowledge in clinical problem solving, it is important to understand how clinicians decide to seek additional knowledge for patient care decisions and how they choose among the resources available to them. Using a self-administered questionnaire, 126 family physicians reported their use of 11 types of knowledge resources for answering patient-specific questions arising in clinical practice. They reported almost daily use of the Physicians' Desk Reference and more often than weekly use of colleagues. There was little use reported of Index Medicus or computer-based bibliographic retrieval systems. The research literature of medicine was used infrequently and rated among the lowest of resources in terms of credibility, availability, searchability, understandability, and applicability. In deciding among a subset of knowledge resources for answering a clinical practice question, resource cost variables related to clinical availability and applicability of the information to the problem at hand appeared to be more influential in the minds of physicians than factors related to quality of the resource. These findings have important implications for the development and deployment of knowledge resources intended to be useful and used in clinical practice.

Diagnosis↗
PubMed1988

Assessing quality.

Explore the source record for details and available documents.

Military Medicine↗
PubMed1987

Quality review in the Peer Review Organization Program.

Several major, national forces have created the mandate of the Peer Review Organizations (PROs) for the evaluation of the quality of care received by Medicare patients. The shift of the Medicare Program to prospective payment to hospitals has caused concern that this change in financial incentives may have adverse effects on quality. An analysis and review of the experience of the California PRO (California Medical Review, Inc.)--including the application of sanctions--suggests that corrective actions have been successful in addressing quality deficiencies. However, the relationship between those deficiencies and the prospective payment mechanism remains unclear.

California↗
PubMed1978

The treatment of anxiety with a polyfluorinated benzodiazepine derivative.

Following 4 weeks of treatment with ORF-8063 a polyfluorinated benzodiazepine derivative, 8 hospitalized patients manifesting a primary pathology of anxiety showed marked general improvement. 2 other persons were treated, but for shorter periods: 9 and 14 days. Both are included in the pre-post analysis. Mean optimal dosage was 66.5 mg. The five instruments used to measure therapeutic effect showed pre- to posttreatment change with high level of statistical significance in serveral of the pathological factors. When measures of change are considered, patients showed more improvement related to psychic than somatic components of anxiety. Change data also indicates more patients improvement in anxiety than depression. Side effects reported more were dizziness, faintness and insomnia; these were reported in 8 patients. 6 patients noted drowsiness, and 4 noted excitement. 5 persons tolerated optimum dosages with no extreme reactions; 5 others (including the 2 subjects who terminated treatment early) were unable to maintain optimum dosages because of side effects.

Adult↗
PubMed1977

An operational model for teaching geriatric medicine in a family practice residency program.

Increased concern for our aging population has necessitated an evaluation of the role of gerontology and geriatric medicine in both undergraduate and graduate medical education programs. The instructional model developed for the Family Practice Residency Program at the University of Minnesota Medical School emphasizes removing barriers to health care for the aged and modifying attitudes of physicians toward normal aging. Three general components make up the Geriatric Medicine Program: (1) clinical rotations in geriatric medicine in ambulatory residential facilities, in multilevel long-term care facilities, and in an acute care hospital; (2) geriatric case conferences; and (3) a seminar in gerontology and geriatric medicine. Evaluation of these components by the residents indicates a high degree of satisfaction with the experience and belief in its applicability to future practice.

Aged↗
PubMed1976

Lithium carbonate in juvenile manic-depressive illness.

A case of juvenile manic-depressive illness associated with mental retardation is reported having been treated successfully with lithium carbonate. During four years of maintenance treatment with daily doses of 600 mgs. to 900 mgs. per day of lithium carbonate, disruptive manic behavior has been controlled and a subjective leveling out of mood has allowed that patient to develop more fully her cognitive and psychomotor capacities. There was one exascerbation of disruptive behavior during the first year of treatment that was easily controlled with haloperidol together with continued lithium carbonate maintenance treatment. No measurable adverse developmental or thyroid effects have been noted. The Shaffer acquiescence scale of the MMPI correctly predicted that the patient would be a positive responder to lithium carbonate treatment.

Adolescent↗