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Biomedical subjects

L G Pawlson

Publications and source records attributed to L G Pawlson.

At least 37 records · Page 2Linked to original sources
PubMed1989

Financing long-term care. The growing dilemma.

The financing of long-term care is one of the largest and most vexing health care problems facing our society. The problem will be further exacerbated when the rate of growth in the number of persons needing long-term care is further accelerated by the graying of those in the "baby boom" generation. The current financing mechanism, which relies almost entirely on concurrent funding through either a means tested welfare program (Medicaid) or self-pay, is inequitable and inadequate even for our present needs. Despite the magnitude of the problem, only recently has sufficient attention been focused on finding alternatives to the current means of financing long-term care. The search for a solution has been hampered by multiple, and sometimes conflicting, policy and political considerations. After reviewing the demographic and social roots of our current dilemma and listing the major alternatives for financing long-term care, a series of basic principles and definitions are reviewed. These elements are meant to serve as guidelines to compare and evaluate the growing number of proposals which seek to create a more effective and equitable system for financing long-term care. Future articles in this section will detail some of the more promising approaches to the dilemma of financing long-term care.

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PubMed1989

Clinical funding for geriatric fellowship programs.

The Medicare program provides the largest single source of funding for the clinical portion of housestaff training programs. Despite the fact that the clinical training in geriatric fellowship programs focuses heavily on the care of Medicare recipients, the proportion of funds supporting geriatric fellowships that is derived from Medicare is actually smaller than that of most other fellowship programs. Legislation passed by Congress in 1986, and just recently implemented, creates an opportunity to increase Medicare funding for geriatrics. Those concerned with geriatric fellowship training must have a clear understanding of how Medicare funding for graduate medical education will occur under the new legislation if the opportunity is to be used effectively. Finally, other barriers created by general pressures on housestaff budgets that may interfere with capitalizing on the opportunity are discussed.

Fellowships and Scholarships↗
PubMed1989

Physician Payment Reform. Implications for geriatrics.

A consensus has developed on the need for a major revision of physician reimbursement in the Medicare program. The Physician Payment Review Commission has recommended to Congress a series of far-reaching changes in the payment system, based on the development of a fee schedule using a Resource Based Relative Value System (RBRVS). This article explores the rationale for the recommendations and the probable impact on Medicare beneficiaries and their physicians if the changes are enacted. Special consideration is given to unique aspects of geriatric medicine, including comprehensive geriatric assessment.

Fee Schedules↗
PubMed1988

Hospital length of stay of frail elderly patients. Primary care by general internists versus geriatricians.

Hospitalized patients in a medical diagnosis-related group (DRG) who were cared for by physicians in a division of Geriatric Medicine (geriatric group) were compared with a control group drawn from a stratified random sample of patients cared for by general internists (internist group) in the same hospital. Despite an older age, longer predicted length of stay, and higher DRG reimbursement, the geriatric group patients had a significantly shorter length of stay (8.8 vs 15.8 days; P less than 0.05) than the internist group. A shorter length of stay for the geriatric group was noted in each of five subgroups, sorted by admission and discharge status. Comparison to national data reveals that, despite the shorter length of stay in the geriatric group, length of stay data used by hospitals for management purposes would still classify the patients of the geriatrics group as "revenue losers" under the Medicare hospital reimbursement system.

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PubMed1986

Wheelchair use by ambulatory nursing home residents.

In a survey of wheelchair use in two nursing homes, the authors found a substantial number of cognitively intact nursing home residents who walked, but who also used a wheelchair. Using chart review and interviews with the residents, it was found that multiple physical factors, including pain, strength, endurance, vision and balance, and multiple social and environmental factors, including the fear of falling, were related to the resident's decision to use a wheelchair as an alternative means of mobility. A physical examination focused on aspects of mobility was completed on each resident and was intended to characterize the physical limitations in groups studied. In the nursing home environment, use of the wheelchair is viewed by the residents as a self-initiated choice which the residents believed significantly enhanced their sense of well-being. Finally, there was minimal recognition of mobility as a problem on the part of the medical and nursing staff. The study raises a number of important issues concerning walking versus wheelchair use in the nursing home.

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PubMed1985

Patient compliance.

Compliance is a highly individual phenomenon, and the decision to comply is a dynamic process. The physician who wishes to respond to compliance problems must offer behavioral strategies that are tailored to the individual patient and are continuously applied. Compliance behavior is complex and multifactorial. No single compliance-improving strategy is as effective as multiple approaches within the context of a good physician-patient relationship.

Behavior↗
PubMed1984

The Medicare Prospective Payment System and the care of the frail elderly.

The development of the Medicare Prospective Payment System based on diagnosis-relating groupings is reviewed. Special emphasis is placed on analysis of the provisions that have a potential impact on geriatric medicine and on the care of the frail elderly. The authors conclude that in its present form, the DRG system may systematically undercompensate hospitals for treating the frail elderly and, therefore, result in attempts by some hospitals to reduce or avoid altogether programs in geriatric medicine and admissions of frail elderly persons. These effects, together with federal and state efforts to limit nursing home and home care costs, may result in a major under-provision of care for the frail elderly and exclusion of clinical geriatric medicine from the medical care system.

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PubMed1983

Medical students' attitudes toward the elderly.

A study was designed to examine the relationship between students' attitudes, their willingness to work with elderly patients, and the impact of a geriatric rotation on a randomly selected subset of the group. A pretest/post-test design was used in which 148 third-year medical students completed a multidimensional questionnaire on two occasions eight weeks apart. Highly significant correlations were found between the expressed intention of the student to work with the elderly and positive feelings about previous professional contact (r = .26, P less than .001), previous personal contact (r = .17, P less than .002), belief that working with the elderly is rewarding (r = .30, P less than .0001), high degree of comfort in working with the elderly (r = .21, P less than .01), and positive stereotypes about the elderly (r = .14, P less than .05). Despite the students' positive rating of the geriatric rotation, multiple regression analysis indicated that the best predictor of an index of intentions to work with elderly patients on the post-test was this same index of intentions on the pretest (multiple r = .58, P less than .001). These findings, as well as the actual attitudes and stereotypes held by the students, have major implications for the planning and development of medical students' experiences in geriatrics.

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PubMed1982

Clinical medical education in the nursing home: opportunities and limits.

The nursing home has been proposed as a potential site for clinical medical education. Before medical schools can reasonably devote increasingly scarce resources to such an endeavor, questions of what the nursing home might uniquely provide to medical students and whether such experiences are really necessary must be clearly answered. Evidence is presented to support the development of the nursing home as a required clinical educational site. Analogies and differences between the current situation in the nursing home and the situation of the hospital in medical education in the early 20th century are explored as a means of understanding the potential and limits of the nursing home's role in medical education.

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