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Biomedical subjects

L G Hart

Publications and source records attributed to L G Hart.

At least 73 records · Page 4Linked to original sources
PubMed1990

Access to obstetric care in rural areas: effect on birth outcomes.

Hospital discharge data from 33 rural hospital service areas in Washington State were categorized by the extent to which patients left their local communities for obstetrical services. Women from communities with relatively few obstetrical providers in proportion to number of births were less likely to deliver in their local community hospital than women in rural communities with greater numbers of physicians practicing obstetrics in proportion to number of births. Women from these high-outflow communities had a greater proportion of complicated deliveries, higher rates of prematurity, and higher costs of neonatal care than women from communities where most patients delivered in the local hospital.

Adolescent↗
PubMed1990

Obstetric practice patterns in Washington state after tort reform: has the access problem been solved?

We surveyed all potential obstetric providers in Washington state in the spring of 1989 to determine whether the passage of tort reform in 1986 had improved access to care for rural and medically indigent women. We found that, although the exodus of family physicians from obstetric practice that had been observed between 1985-1986 appears to have slowed, there is still substantial net attrition among family physicians. As a result, rural patients are having increasing difficulty obtaining local access to obstetric care. By contrast, the supply of obstetricians and midwives seems to be stable. All three groups of providers are increasingly reluctant to provide care to the growing number of Medicaid patients. Although tort reform may have slowed the rate at which providers are quitting obstetrics, equilibrium has not yet been achieved. Shortages of rural physicians and inadequate Medicaid reimbursement rates must be addressed to improve obstetric access for underserved groups.

Health Services Accessibility↗
PubMed1990

Why do physicians stop practicing obstetrics? The impact of malpractice claims.

We studied all physicians who purchased obstetric malpractice insurance from the Washington State Physicians Insurance Exchange and Association between January 1, 1982 and July 1, 1988. Of the 690 physicians studied, 171 (32% of the family physicians and 10% of the obstetricians) discontinued obstetrics but remained in practice. Physicians who discontinued obstetric practice were older, more likely to practice in an urban area, and more likely to be in solo practice than those who did not. Obstetricians who discontinued obstetric practice had a higher rate of new obstetric malpractice claims than did those who did not quit practicing obstetrics--14.5 versus 6.2 claims per 100 physician-years of coverage. By contrast, those family physicians leaving obstetrics had a lower rate of new claims than their peers who did not quit. We conclude that older physicians--particularly those in urban and solo practice--are most likely to stop practicing obstetrics, regardless of specialty. In addition, being named as the target of an obstetric malpractice claim plays a significant role in the decision of some obstetricians to discontinue obstetric practice.

Attitude of Health Personnel↗
PubMed1989

The economic impact and multiplier effect of a family practice clinic on an academic medical center.

Academic medical centers are facing the need to expand their primary care referral base in an increasingly competitive medical environment. This study describes the medical care provided during a 1-year period to 6304 patients registered with a family practice clinic located in an academic medical center. The relative distribution of primary care, secondary referrals, inpatient admissions, and their associated costs are presented. The multiplier effect of the primary care clinic on the academic medical center was substantial. For every $1 billed for ambulatory primary care, there was $6.40 billed elsewhere in the system. Each full-time equivalent family physician generated a calculated sum of $784,752 in direct, billed charges for the hospital and $241,276 in professional fees for the other specialty consultants. The cost of supporting a primary care clinic is likely to be more than offset by the revenues generated from the use of hospital and referral services by patients who received care in the primary care setting.

Age Factors↗
PubMed1988

Patient satisfaction with family physicians and general internists: is there a difference?

Although general internists and family physicians see similar types of patients, they have been found to have different styles of practice. It is not known whether these differences in practice style are associated with differences in outcomes of care such as patient satisfaction. This study examined whether patients of family physicians and general internists have different perceptions of the care they receive. National samples of recently trained family physicians and general internists were asked to complete questionnaires about their practices and to record information on all patient encounters during a three-day period. Three patients were randomly sampled from among those seen by each physician during the study period and were sent questionnaires that included questions about their satisfaction with the medical care they were receiving from the physician. Two hundred thirteen adult patients who saw 124 family physicians and 218 adult patients who saw 98 general internists participated in this study. Patients of general internists and of family physicians reported similar levels of satisfaction on all four dimensions measured (access, humaneness, quality, and general satisfaction) even after controlling for the effects of a variety of patient, practice, physician, and encounter characteristics. It is concluded that the fundamental differences in practice style that have been reported between family physicians and general internists do not seem to be associated with differences in patient satisfaction.

Consumer Behavior↗
PubMed1988

Outcomes of regionalized perinatal care in Washington State.

We evaluated the extent to which the regionalization of perinatal care in Washington State has succeeded in concentrating high-risk pregnancies in technologically appropriate referral centers and in reducing differences in neonatal outcome among hospitals. Of all infants weighing less than 1,500 grams born between 1980 and 1983, nearly 68% were delivered in level III hospitals, although only 24% of all babies are born in these hospitals, indicating that the state is highly regionalized. Neonatal outcomes-as measured by standardized mortality ratios-are similar in level I, II and III hospitals and are not greatly influenced by the rural or urban location of the hospital. The most promising strategy for further reducing neonatal mortality is to decrease the number and proportion of very-low-birth-weight births.

Female↗
PubMed1987

The functional status of ESRD patients as measured by the Sickness Impact Profile.

This study describes and compares the perceived sickness-related behavioral dysfunction of 859 end-stage renal disease (ESRD) patients from 11 centers according to treatment modality via the Sickness Impact Profile (SIP). The unadjusted functional status of ESRD patients differed significantly by treatment modality. Transplantation patients were least functionally limited followed in order by home dialysis, continuous peritoneal dialysis, and in-center dialysis patients. The largest overall differences were for the sleep and rest, work, recreation and pastimes, and home management SIP categories. Regression analysis revealed that many of the large observed intermodality differences in functional status may have resulted from casemix variations (e.g. age and comorbidity differences). Only SIP score differences between transplantation and other treatment modality patients remained significant following the introduction of casemix controls. Results do not justify choosing one dialysis modality over another because of differences in perceived dysfunction.

Adult↗
PubMed1987

The use of medical resources by residency-trained family physicians and general internists. Is there a difference?

This study compared the use of medical resources by recently trained family physicians and general internists. Analyses are based on records of 3,737 adult office encounters with 132 family physicians and 2,250 adult office encounters with 102 general internists. General internists are twice as likely as family physicians to order blood tests, blood counts, chest x-rays, and electrocardiograms for their adult patients. Internists also spend more time with patients, and refer and hospitalize them at slightly higher rates. The different practice styles of general internists and family physicians were evident for adult patients of all ages and for patients with essential benign hypertension. The average per visit charge for diagnostic tests ordered during follow-up visits with hypertensive patients was estimated to be $11.97 for patients seen by general internists and $5.67 for patients seen by family physicians. These findings persisted after controlling for a variety of patient, practice, and physician characteristics.

Diagnostic Tests, Routine↗
PubMed1987

The use of large data bases in health care studies.

The growing number of large health data bases available represents a valuable resource for health care research. Many available data bases, however, have subtle and/or complex defects in their design as well as in the quality of the data themselves. The apparent ease and economy of using pre-collected data cannot eliminate the need for careful selection, examination, and analysis of these data. Existing documentation should be critically reviewed to assess the appropriateness of the data base for its intended use. Once in hand, the completeness and coding of the data should be examined in detail before attempting to test hypotheses. In conducting data analysis, the investigator must be aware of the potential problems related to the size of the data base, the unit of analysis, and the sampling strategy--particularly if sampling involved stratification or clustering. Awareness of the potential pitfalls inherent in the use of large health data bases can help prevent many problems and disappointments, as well as improve the validity and efficiency of statistical analysis.

Computer Communication Networks↗
PubMed1986

A comparison of the patients and practices of recent graduates of family practice and general internal medicine residency programs.

This study compares the characteristics of the practices and patients of recent graduates of family practice and general internal medicine residency programs. National samples of 104 family physicians and 134 general internists completed questionnaires and provided log-diary data for more than 7,500 office visits and 1,100 hospitalized patients. Family physicians and general internists were generally similar in demographic and practice characteristics, though family physicians were more likely to have entered office-based practice (90% versus 70%). Among office-based physicians, family physicians saw more patients per week in ambulatory settings (117.3 versus 74.6), whereas general internists had more patients in the hospital (6.45 versus 3.81) and provided more hospital consultations per week (2.74 versus 0.45). Family physicians practiced in smaller communities and were more likely to practice on Saturday mornings, to accept walk-in patients, and to schedule appointments for new patients within 1 week. Both specialties functioned as first-contact generalists for at least 95% of office encounters. Although pediatrics and obstetrics are practiced only by family physicians and general internists see proportionately more older patients, within specific age groups the patients of general internists and family physicians were similar in terms of their main health problems, functional status, and diagnoses.

Data Collection↗
PubMed1986

Diagnosis clusters adapted for ICD-9-CM and ICHPPC-2.

An ad hoc committee of the North American Primary Care Research Group (NAPCRG) was appointed to adapt the diagnosis clusters instrument for use with the International Classification of Diseases (ICD-9-CM) and the International Classification of Health Problems in Primary Care (ICHPPC-2). This article describes the development and testing of the final roster of 110 diagnosis clusters for family physicians. Almost 90 percent of all diagnoses recorded by family physicians in a variety of settings were included in the clusters. The diagnosis clusters can be used in the analysis of large databases and facilitate comparisons between different providers and practices.

Ambulatory Care↗
PubMed1985

The quality of life of patients with end-stage renal disease.

We assessed the quality of life of 859 patients undergoing dialysis or transplantation, with the goal of ascertaining whether objective and subjective measures of the quality of life were influenced by case mix or treatment. We found that 79.1 per cent of the transplant recipients were able to function at nearly normal levels, as compared with between 47.5 and 59.1 per cent of the patients treated with dialysis (depending on the type). Nearly 75 per cent of the transplant recipients were able to work, as compared with between 24.7 and 59.3 per cent of the patients undergoing dialysis. On three subjective measures (life satisfaction, well-being, and psychological affect) transplant recipients had a higher quality of life than patients on dialysis. Among the patients treated with dialysis, those undergoing treatment at home had the highest quality of life. All quality-of-life differences were found to persist even after the patient case mix had been controlled statistically. Finally, the quality of life of transplant recipients compared well with that of the general population, but despite favorable subjective assessments, patients undergoing dialysis did not work or function at the same level as people in the general population.

Adult↗
PubMed1985

Wearing contact lenses in space shuttle operations.

More and more mission specialists are being trained to operate in the Space Shuttle and to eventually maintain a permanent station in space. Since up to 48% of the general population wears a visual correction of some sort, it is logical to assume that this percentage will also be found in the astronaut population. This paper proposes that the soft contact lens can be worn successfully in the space environment. The contact lens of choice is the continuous-wear soft contact lens which is proving to be quite successful for the general public. These lenses must be fitted at least 6 months before space flight in order to make sure they can be worn successfully.

Aerospace Medicine↗
PubMed1984

Interspecialty variation in office-based care.

Analysis of national survey data on physician-patient encounters raises questions about physician education and manpower policy. Data compiled by the University of Southern California Medical Activities and Manpower Projects and the United States Bureau of Health Professionals reveal differences among internists, cardiologists, family practitioners, and pediatricians in procedures used for diagnosing and treating several frequently encountered conditions. Differences are observed in expenditure of time and use of a broad range of diagnostic and therapeutic techniques. These differences remain significant even after several important characteristics of individual physicians, patients, and the practice environment have been controlled. Findings from this study underscore the necessity of reviewing the content of medical education and policies that encourage a broad range of specialists to provide primary care. The findings also emphasize the need to address the physician's knowledge base in promoting changes in practice patterns.

Cardiology↗
PubMed1984

The impact of residency training on the productivity of family physicians.

Because of a projected rapid increase in the proportion of family physicians who are residency graduates, it is important to understand the impact of residency training on practice patterns. In this study of the effect of family practice residency training on productivity, residency graduates were found to have seen 21.5% fewer patients per hour but to have spent commensurately more time per patient visit than did their counterparts without residency training. This relationship persisted even after controlling for a variety of physician and practice characteristics, including physician age, practice organization, and geographic region.

Adult↗
PubMed1984

Inpatient diagnosis clusters: analyzing hospital care in family practice.

Hospital care is an important component of family practice in the United States, but the study of this area has been impeded by the lack of a simple and clinically meaningful method of categorizing the diagnostic problems that make up the inpatient workload. This paper extends the method of diagnosis clusters--first used in the analysis of ambulatory care--to the hospital setting. Using the University of Southern California Medical Activities and Manpower Study of office-based general and family physicians, 52 clinically discrete diagnosis clusters were developed that include 78 percent of all principal diagnoses recorded in the hospital during the study interval. Fifty percent of all hospital encounters can be incorporated in only 15 clusters. Data clustered using this technique demonstrate that clinical problems such as ischemic heart disease and malignant neoplasms represent a major part of the family physician's hospital workload, a fact that has important implications for training and practice. Diagnosis clustering should facilitate further study of the hospital activities of primary care physicians.

California↗