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Biomedical subjects

L G Hart

Publications and source records attributed to L G Hart.

At least 91 records · Page 5Linked to original sources
PubMed1983

The content of ambulatory medical care in the United States. An interspecialty comparison.

Ambulatory care, accounting for over half a billion visits to physicians per year, is a major component of the health-care system and is the core of primary health care. This study uses data from the National Ambulatory Medical Care Survey to describe the most common problems seen in an ambulatory-care setting, to identify the medical specialties that provide the greater part of this care, and to characterize the major specialties in terms of the diagnoses in the patients who constitute their ambulatory practice. Fifteen diagnosis clusters account for 50 per cent of all ambulatory-care visits; only 8 of the 28 specialties account for a substantial amount (more than 25 per cent) of the ambulatory care rendered to patients with any of these 15 diagnoses. General and family physicians, general internists, and general pediatricians account for 65.9 per cent of all outpatient visits to physicians for the 15 most common problems; general and family physicians alone are responsible for more than half this total. The individual specialties differ markedly in the diagnostic and demographic variety of their outpatient workload. These differences have important implications for the training of physicians and the organization of their practices.

Ambulatory Care↗
PubMedDate not supplied

Physician staffing ratios in staff-model HMOs: a cautionary tale.

Predictions of imminent large physician surpluses stem from two observations: rapid increases in the proportion of Americans in managed care plans, and the relatively lean physician staffing ratios reported for health maintenance organizations (HMOs). We use internal data from two large, mature staff-model HMOs to determine precise specialty-specific physician staffing ratios, to see whether these HMOs use fewer physicians than the fee-for-service sector uses. The two HMOs provided the equivalent of 180 physicians per 100,000 enrollees, which is near the national average and far above figures that typically are reported in the literature. Thus, caution regarding current workforce predictions is warranted.

Fee-for-Service Plans↗
PubMedDate not supplied

Influence of provider characteristics and insurance status on maternal serum alpha-fetoprotein screening.

BACKGROUND: The maternal serum alpha-fetoprotein test (MSAFP) was developed to screen for neural tube defects. Little is known about the adoption of the MSAFP test. This study examines the effect of provider specialty and geographic location and patient insurance status on MSAFP test use in Washington State. METHODS: We conducted a retrospective cohort study of MSAFP use in low-risk obstetric patients of five provider groups. MSAFP use was examined for Medicaid and privately insured patients, as well as for the patients of the five provider types. RESULTS: Patients of urban and rural obstetrician-gynecologists were most likely to have MSAFP testing (80.4 percent and 77.0 percent, respectively); patients of urban certified nurse midwives and rural family physicians were least likely to have MSAFP testing (64.2 percent and 62.2 percent, respectively). Patients of certified nurse midwives were more likely to decline MSAFP testing when offered (26.1 percent). Medicaid-insured women were significantly less likely to have MSAFP testing than privately insured women (60.5 percent versus 79.1 percent, P < or = 0.05). CONCLUSIONS: Providers and patients did not uniformly use MSAFP screening. Efforts should be made to ensure that all patients are adequately informed of screening tests for neural tube defects.

Female↗
PubMedDate not supplied

Abortion services in rural Washington State, 1983-1984 to 1993-1994: availability and outcomes.

CONTEXT: Fewer rural health providers offer abortion services than a decade ago. It is unknown how the reduction in service availability has affected women's pregnancy outcomes, the extent to which they must travel to obtain an abortion or whether abortions are delayed as a result. METHODS: Population, birth and fetal death data, as well as pregnancy termination reports, obtained from Washington State were used to calculate abortion rates and ratios and birthrates for Washington residents in 1983-1984 and in 1993-1994. Residence of abortion patients was classified by county only, and location of providers was recorded as large urban county, small urban county, large rural county or small rural county. Distances that women traveled to obtain an abortion were calculated. Chi-square tests were used to compare urban and rural rates and ratios within time periods, and to compare changes that occurred between time periods. RESULTS: Birthrates and abortion rates decreased for both rural and urban Washington women between 1983-1984 and 1993-1994, but the magnitude of the decrease was greater for rural women. The rural abortion rate fell 27%, from 14.9 abortions per 1,000 women to 10.9 per 1,000, while the urban rate dropped 17%, from 21.8 to 18.2 per 1,000. The decline in the abortion rate was larger for adolescents than it was for other age-groups. In rural areas, the abortion rate decreased from 16.5 per 1,000 adolescents aged 10-19 in 1983-1984 to 10.8 per 1,000 in 1993-1994, while it declined from 23.3 per 1,000 to 16.9 per 1,000 in urban areas. From the earlier to the later time period, rural women traveled on average 12 miles farther each way to obtain an abortion, and the proportion who obtained the procedure in a rural county decreased from 25% to 3%. In the earlier time period, 62% of rural women traveled 50 miles or more to obtain an abortion, compared with 73% in 1993-1994. From 1983-1984 to 1993-1994, the proportion of rural women who traveled out of state for an abortion increased from 8% to 14%. The proportion of rural women terminating their pregnancy after the first trimester increased from 8% in 1983-1984 to 15% in 1993-1994. CONCLUSION: Rural Washington women are traveling farther and more often to urban and out-of-state locations for abortion services, and are obtaining their abortions at a later gestational age, which is associated with a decade-long decline in the number of abortion providers.

Abortion, Legal↗
PubMedDate not supplied

Which medical schools produce rural physicians?

OBJECTIVE: To examine the hypothesis that medical schools vary systematically and predictably in the proportion of their graduates who enter rural practice. DESIGN: The December 1991 version of the American Medical Association Physician Masterfile was used to examine the rural and urban practice locations of physicians who graduated from American medical schools between 1976 and 1985. Selected characteristics of the medical schools--including location, ownership, and funding--were linked to the Physician Masterfile. MAIN OUTCOME MEASURES: The percentage of the graduates from each medical school who were practicing in rural areas in December 1991, disaggregated by physician specialty. RESULTS: Of the practicing graduates from our study, 12.6% were located in rural counties; family physicians were much more likely than members of other specialties to select rural practice, particularly in the smallest and most isolated rural counties. Women were much less likely than men to enter rural practice. Medical schools varied greatly in the percentage of their graduates who entered rural practice, ranging from 41.2% to 2.3% of the graduating classes studied. Twelve medical schools accounted for over one quarter of the physicians entering rural practice in this time period. Four variables were strongly associated with a tendency to produce rural graduates: location in a rural state, public ownership, production of family physicians, and smaller amounts of funding from the National Institutes of Health. DISCUSSION: The organization, location, and mission of medical schools is closely related to the propensity of their graduates to select rural practice. Increasing policy coordination among medical schools and state and federal governmental entities would most effectively address residual problems of rural physician shortages.

Career Choice↗