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Biomedical subjects

P Camp

Publications and source records attributed to P Camp.

At least 19 recordsLinked to original sources
PubMed2001

Are better ratings of the patient-provider relationship associated with higher quality care for depression?

BACKGROUND: The interpersonal patient-provider relationship (PPR) is an essential part of health care quality, particularly for patients with depression, yet little is known neither about how to measure this relationship nor about its association with quality of care. OBJECTIVES: To evaluate properties of patient rating measures, understand the relation between 2 types of ratings, and determine the association of ratings with quality depression care. SETTING AND PARTICIPANTS: 1,104 patients with current depressive symptoms and lifetime or 12-month disorder identified through screening 27,332 consecutive primary care visitors in 6 managed care organizations participating in Partners in Care (PIC). DESIGN: Cross-sectional analysis of 18-month data (collected in 1998) after the start of PIC depression quality improvement (QI) interventions (in which clinics were randomized to 1 of 2 QI interventions or usual care). MEASURES: Patient ratings of the interpersonal relationship with the primary care provider and satisfaction with health care, and quality of depression care indicators. ANALYSIS: Factor analysis and multitrait scaling to evaluate the psychometric properties of multiitem constructs and analysis of covariance to evaluate associations between patient ratings and quality. RESULTS: Patient ratings had high internal consistency and met criteria for discriminant validity tapping unique aspects of care. Patients receiving quality care, especially for medication use, had significantly higher ratings of the interpersonal relationship (by 22% to 27% of a SD) and were more satisfied (by 26% to 34% of a SD) than patients who did not receive quality care. CONCLUSIONS: Ratings of the interpersonal relationship and satisfaction measure distinct aspects of care and are positively associated with quality care for depression.

Adult↗
PubMed2001

Effects of cost-containment strategies within managed care on continuity of the relationship between patients with depression and their primary care providers.

BACKGROUND: Continuity of the relationship between patients and primary care providers (PCPs) is an important component of care from the consumer perspective that may be affected by variation in cost containment strategies within managed care. OBJECTIVE: To evaluate the effects of cost containment strategies on the continuity of the relationship between their patients with depression and their PCPs. DESIGN: Observational analysis of a 2-year panel of depressed patients who participated in a quality improvement intervention trial in 46 managed care practices. PARTICIPANTS: One thousand two hundred four patients with current depression who enrolled in a longitudinal study, completed the baseline survey, and were followed for 2 years. MAIN MEASURES: The dependent variable is probability of continuing the relationship between patients and their PCPs; explanatory variables include individual patient mental health benefits and cost-sharing, individual provider financial incentives, supply-side managed care policies, and patient ratings of the care received. RESULTS: The average duration of the patient-PCP relationship was significantly longer among depressed patients who initially had less generous benefits for specialty care (higher copays, P = 0.02 and fewer visits covered, P = 0.002) and for patients whose PCPs received a performance-based salary bonus from a risk pool (P = 0.07). CONCLUSIONS: For depressed patients, cost containment strategies, such as limits on specialty benefits and presence of clinician bonus payments typically used within managed care may increase, rather than decrease, PCP continuity. Whether increased PCP continuity is a desirable outcome depends on whether health care systems can provide high quality primary care and this merits further study.

Adult↗
PubMed2000

Depression and health-related quality of life in ethnic minorities seeking care in general medical settings.

BACKGROUND: To examine ethnic groups differences in (a) prevalence of depressive disorders and (b) health related quality of life in fee-for-service and managed care patients (n=21504) seeking care in general medical settings. METHODS: Data are from the Medical Outcomes Study, a multi-site observational study of outpatient practices. The study screened patients of clinicians (family practice, internal medicine, cardiology, diabetology and endocrinology) for four chronic medical conditions; depression, coronary heart disease, hypertension and diabetes. A brief eight-item depression screener followed by the Diagnostic Interview Schedule-Depression Section (DIS) for screener positives identified depressed patients (n=2195). The Short Form Health Survey (SF-36) assessed health-related quality of life. Patient self-report determined ethnicity. RESULTS: Before adjusting for demographic factors, African-Americans and Hispanics had highest rates of depressive symptoms. Asian-Americans had the lowest. After adjusting for demographics (particularly gender and income), we found few statistically significant differences in prevalence or severity of depression. However, among the depressed, Whites were the most, and African-Americans the least likely to report suicidal ideation (p<0. 01), and Hispanics and Whites were more likely to have melancholia (p<0.01). African-Americans reported the poorest quality of life. LIMITATIONS: DSM III criteria (though few changes in DSM IV), and relatively small sample size of Asian-Americans compared to other groups. CONCLUSIONS: Gender and socioeconomic status are more significant factors than ethnicity in determining risk for depressive disorder. However, ethnic differences in symptom presentation, and health-related quality of life could have clinical and social consequences, and merit further study.

Adult↗
PubMed2000

Who is at risk of nondetection of mental health problems in primary care?

OBJECTIVE: To determine patient and provider characteristics associated with increased risk of nondetection of mental health problems by primary care physicians. DESIGN: Cross-sectional patient and physician surveys conducted as part of the Medical Outcomes Study. PARTICIPANTS: We studied 19,309 patients and 349 internists and family physicians. MEASUREMENTS AND MAIN RESULTS: We counted "detection" of a mental health problem whenever physicians reported, in a postvisit survey, that they thought the patient had a mental health problem or that they had counseled or referred the patient for mental health. Key independent variables included patient self-reported demographic characteristics, health-related quality of life (HRQOL), depression diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, and physician demographics and proclivity to provide counseling for depression. Logistic regression analysis, adjusted for HRQOL, revealed physicians were less likely to detect mental health problems in African Americans (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.46 to 0.86), men (OR, 0.64; 95% CI, 0.54 to 0.75), and patients younger than 35 years (OR, 0.61; 95% CI, 0.44 to 0.84), and more likely to detect them in patients with diabetes (OR, 1.4; 95% CI, 1.0 to 1.8) or hypertension (OR, 1.3; 95% CI, 1.1 to 1.6). In a model that included DSM-III diagnoses, odds of detection remained reduced for African Americans as well as for Hispanics (OR, 0.29; 95% CI, 0.11 to 0.71), and patients with more-severe DSM-III diagnoses were more likely to be detected. Physician proclivity toward providing counseling for depression influenced the likelihood of detection. CONCLUSIONS: Patients' race, gender, and coexisting medical conditions affected physician awareness of mental health problems. Strategies to improve detection of mental health problems among African Americans, Hispanics, and men should be explored and evaluated.

Asian↗
PubMed2000

Quality improvement for depression enhances long-term treatment knowledge for primary care clinicians.

OBJECTIVE: We evaluated the effect of implementing quality improvement (QI) programs for depression, relative to usual care, on primary care clinicians' knowledge about treatment. DESIGN AND METHODS: Matched primary care clinics (46) from seven managed care organizations were randomized to usual care (mailed written guidelines only) versus one of two QI interventions. Self-report surveys assessed clinicians' knowledge of depression treatments prior to full implementation (June 1996 to March 1997) and 18 months later. We used an intent-to-treat analysis to examine intervention effects on change in knowledge, controlling for clinician and practice characteristics, and the nested design. PARTICIPANTS: One hundred eighty-one primary care clinicians. INTERVENTIONS: The interventions included institutional commitment to QI, training local experts, clinician education, and training nurses for patient assessment and education. One intervention had resources for nurse follow-up on medication use (QI-meds) and the other had reduced copayment for therapy from trained, local therapists (QI-therapy). RESULTS: Clinicians in the intervention group had greater increases compared with clinicians in the usual care group over 18 months in knowledge of psychotherapy (by 20% for QI-meds, P =.04 and by 33% for QI-therapy, P =.004), but there were no significant increases in medication knowledge. Significant increases in knowledge scores (P =.01) were demonstrated by QI-therapy clinicians but not clinicians in the QI-meds group. Clinicians were exposed to multiple intervention components. CONCLUSIONS: Dissemination of QI programs for depression in managed, primary care practices improved clinicians' treatment knowledge over 18 months, but breadth of learning was somewhat greater for a program that also included active collaboration with local therapists.

Adult↗
PubMed1999

Treating depression in staff-model versus network-model managed care organizations.

OBJECTIVE: To compare primary care providers' depression-related knowledge, attitudes, and practices and to understand how these reports vary for providers in staff or group-model managed care organizations (MCOs) compared with network-model MCOs including independent practice associations and preferred provider organizations. DESIGN: Survey of primary care providers' depression-related practices in 1996. SETTING AND PARTICIPANTS: We surveyed 410 providers, from 80 outpatient clinics, in 11 MCOs participating in four studies designed to improve the quality of depression care in primary care. MEASUREMENTS AND MAIN RESULTS: We measured knowledge based on depression guidelines, attitudes (beliefs about burden, skill, and barriers) related to depression, and reported behavior. Providers in both types of MCO are equally knowledgeable about treating depression (better knowledge of pharmacologic than psychotherapeutic treatments) and perceive equivalent skills in treating depression. However, compared with network-model providers, staff/group-model providers have stronger beliefs that treating depression is burdensome to their practice. While more staff/group-model providers reported time limitations as a barrier to optimal depression treatment, more network-model providers reported limited access to mental health specialty referral as a barrier. Accordingly, these staff/group-model providers are more likely to treat patients with major depression through referral (51% vs 38%) or to assess but not treat (17% vs 7%), and network-model providers are more likely to prescribe antidepressants (57% vs 6%) as first-line treatment. CONCLUSIONS: Whereas the providers from staff/group-model MCOs had greater access to and relied more on referral, the providers from network-model organizations were more likely to treat depression themselves. Given varying attitudes and behaviors, improving primary care for the treatment of depression will require unique strategies beyond enhancing technical knowledge for the two types of MCOs.

Chi-Square Distribution↗
PubMed1998

Increasing immunization rates among inner-city, African American children. A randomized trial of case management.

CONTEXT: Immunization rates in the inner city remain lower than in the general US population, but efforts to raise immunization levels in inner-city areas have been largely untested. OBJECTIVE: To assess the effectiveness of case management in raising immunization levels among infants of inner-city, African American families. DESIGN: Randomized controlled trial with follow-up through 1 year of life. SETTING: Low-income areas of inner-city Los Angeles, Calif. PATIENTS: A representative sample of 419 African American infants and their families. INTERVENTIONS: In-depth assessment by case managers before infants were 6 weeks of age, with home visits 2 weeks prior to when immunizations were scheduled and additional follow-up visits as needed. MAIN OUTCOME MEASURES: Percentage of children with up-to-date immunizations at age 1 year, characteristics associated with improved immunization rates, and cost-effectiveness of case management intervention. RESULTS: A total of 365 newborns were followed up to age 1 year. Overall, the immunization completion for the case management group was 13.2 percentage points higher than the control group (63.8% vs 50.6%; P=.01). In a logistic model, the case management effect was limited to the 25% of the sample who reported 3 or fewer well-child visits (odds ratio, 3.43; 95% confidence interval, 1.26-9.35); for them, immunization levels increased by 28 percentage points. Although for the case management group intervention was not cost-effective ($12022 per additional child immunized), it was better ($4546) for the 25% of the sample identified retrospectively to have inadequate utilization of preventive health visits. CONCLUSIONS: A case management intervention in the first year of life was effective but not cost-effective at raising immunization levels in inner-city, African American infants. The intervention was demonstrated to be particularly effective for subpopulations that do not access well-child care; however, currently there are no means to identify these groups prospectively. For case management to be a useful tool to raise immunizations levels among high-risk populations, better methods of tracking and targeting, such as immunization registries, need to be developed.

Black or African American↗
PubMed1998

Biosynthesis and metabolism of native and oxidized neuropeptide Y in the hippocampal mossy fiber system.

Neuropeptide Y (NPY) gene expression is known to be modulated in the mossy fiber projection of hippocampal granule cells following seizure. We investigated NPY biosynthesis and metabolism in an attempt to characterize NPY biochemically as a neurotransmitter in the granule cell mossy fiber projection. NPY biosynthesis was compared in normal control animals and in animals that had experienced a single pentylenetetrazole-induced seizure. In situ hybridization analysis established the postseizure time course of preproNPY mRNA expression in the hippocampal formation, localizing the majority of increased preproNPY mRNA content to the hilus of the dentate gyrus. Radioimmunoassay analysis of the CA3/mossy fiber terminal subfield confirmed a subsequent increase in NPY peptide content. Biosynthesis of NPY peptide by granule cells and transport to the CA3/mossy fiber subfield was demonstrated by in vivo radiolabel infusion to the dentate gyrus/hilus followed by sequential HPLC purification of identified radiolabeled peptide from the CA3/mossy fiber terminal subfield. Additional in vivo radiolabeling studies revealed a postseizure increase in an unidentified NPY-like immunoreactive (NPY-LI) species. HPLC/radioimmunoassay analyses of CA3 subfield tissue extracts comparing normal control animals and pentylenetetrazole-treated animals confirmed the increased total NPY-LI, and demonstrated that the increased NPY-LI was comprised of a minor increase in native NPY and a major increase in the unknown NPY-LI. Data from subsequent and separate analyses incorporating immunoprecipitation with anti-C-terminal flanking peptide of NPY, further HPLC purification, and matrix-assisted laser desorption/ionization mass spectrometry support the conclusion that the unknown NPY-LI is methionine sulfoxide NPY. NPY and NPY-sulfoxide displayed differential calcium sensitivity for release from mossy fiber synaptosomes. Similar to NPY, NPY sulfoxide displayed high-affinity binding to each of the cloned Y1, Y2, Y4, and Y5 receptor subtypes. Postrelease inactivation of NPY was demonstrated in a mossy fiber synaptosomal preparation. Thus, the present study in combination with previously reported electrophysiological activity of NPY in the CA3 subfield demonstrates that NPY fulfills the classical criteria for a neurotransmitter in the hippocampal granule cell mossy fiber projection, and reveals the presence of two molecular forms of NPY that display differential mechanisms of release while maintaining similar receptor potencies.

Amino Acid Sequence↗
PubMed1996

Prevalence of comorbid anxiety disorders in primary care outpatients.

OBJECTIVE: To estimate the extent to which anxiety disorders (eg, panic disorder, phobia, and generalized anxiety disorder [GAD]) co-occur in patients with major medical and psychiatric conditions. DESIGN: Observational study. SETTING: Offices of primary care providers in three US cities, with mental health specialty providers included for comparative purposes. PATIENTS: Adult patients (N = 2494) with hypertension, diabetes, heart disease (congestive heart failure or myocardial infarction), current depressive disorder, or subthreshold depression. MEASURES: Current (past 12 months) and lifetime panic disorder, phobia, GAD, perceived need for help for emotional or family problems, and unmet need (ie, failure to get help that was needed). METHODS: Comparisons of the prevalence of anxiety comorbidity in medically ill nondepressed patients of primary care providers and in depressed patients of both primary care and mental health specialty providers. RESULTS: Among primary care patients, those with chronic medical illnesses or subthreshold depression had low rates of lifetime (1.5% to 3.5%) and current (1.0% to 1.7%) panic disorder, but those with current depressive disorder had much higher rates (10.9% lifetime and 9.4% current panic disorder). Concurrent phobia and GAD were more common (10.4% to 12.4% current GAD), especially among depressed patients (25% to 54% current GAD). Depending on the type of medical illness or depression, 14% to 66% of primary care patients had at least one concurrent anxiety disorder. Patient-perceived unmet need for care for personal or emotional problems was high among all primary care patients (54.6% to 72.9%). CONCLUSION: Primary care clinicians should be aware of the possible coexistence of anxiety disorders (especially GAD) among their patients with chronic medical conditions, but especially among those with current depressive disorder.

Adult↗
PubMed1996

Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers.

BACKGROUND: The comorbidity of psychiatric disorders with chronic health conditions has emerged as a topic of considerable clinical and policy interest, in part owing to the evidence that anxiety disorders themselves are associated with morbidity. However, the implications for health-related quality of life that result from anxiety disorders, which are comorbid to chronic medical or psychiatric illness, are not well understood, especially in primary care samples. METHODS: A 2-year observational study of 875 adult patients with hypertension, diabetes, heart disease, and current depressive disorder or subthreshold depression receiving care from general medical providers was conducted. The unique effect of any comorbid anxiety disorder on functioning and well-being (determined with the use of the 36-Item Short-Form Health Survey [SF-36]) was estimated, as well as the differential impact at baseline, 2-year follow-up, and change over time, of any comorbid anxiety disorder for patients with chronic medical conditions or depression. RESULTS: Patients with comorbid anxiety who received general medical care had lower levels of functioning and well-being than those without comorbid anxiety. These differences were most pronounced in mental health-related quality-of-life measures and when anxiety was comorbid with chronic medical conditions rather than with depression. Hypertensive and diabetic patients with comorbid anxiety were as debilitated as patients with depression or heart disease, and this low health-related quality of life persisted over time. Comorbid anxiety had less of an effect on patients with heart disease who already had a low health-related quality of life. CONCLUSION: The finding of substantial differences in the quality of life between hypertensive and diabetic patients with and without comorbid anxiety disorder highlights the clinical and societal importance of identifying comorbid anxiety in these patients.

Adult↗
PubMed1995

Severity of depression in prepaid and fee-for-service general medical and mental health specialty practices.

This study compares severity of depression for patients of general medical clinicians, psychiatrists, and nonphysician therapists receiving prepaid or fee-for-service care. Cross-sectional severity comparisons were conducted among 715 outpatients with current major depression or dysthymia, by independent assessment. Severity was assessed by counts of current and lifetime depressive symptoms, prognostic and treatment response indicators, and global measures of psychological and physical sickness. Patients of psychiatrists were the most psychologically ill, patients of nonphysician therapists were intermediate, and general medical patients were least ill; but even in the general medical sector, depression severity was at least ill; but even in the general medical sector, depression severity was at least moderate. No differences in global physical sickness by specialty remained after demographic adjustment. General medical patients whose depression had been detected were only slightly sicker than undetected cases. Type of payment was not consistently related to either psychological or physical aspects of sickness, and payment did not interact with specialty. Mental health specialists, especially psychiatrists, encountered more severely depressed patients, but patients in all sectors were sick enough to warrant treatment. Even undetected patients in the general medical sector were relatively sick, raising questions about gatekeeper policies. There was no evidence of a greater severity gradient by specialty in prepaid care. Because payment was unrelated to severity, treatment implications are similar under prepaid and fee-for-service care. Implications for clinical practice, public policy, and outcomes research design are discussed.

Adult↗
PubMed1994

Clinician specialty and treatment style for depressed outpatients with and without medical comorbidities.

BACKGROUND: The advent of clinical practice guidelines for the management of depression increases the importance of understanding variation across clinician specialty groups in treatment styles for depression and the role of medical comorbidities. METHODS: Data are reported by clinicians (N = 470) and patients (N = 2545). Multiple regression was used to compare the treatment styles (counseling and prescribing antidepressants) of family physicians with those of psychiatrists, medical subspecialists, internists, psychologists, and other therapists for depressed patients with different medical comorbidities. RESULTS: Relative to other primary care specialists, family physicians had the strongest preferences for both counseling and prescribing antidepressants for depressed patients. Family physicians reported preferences for treating with antidepressants that were similar to those of psychiatrists. However, in actual practice, medication use was higher among the patients of psychiatrists than those of family physicians. Mental health care specialists reported the strongest counseling preferences and provided the most counseling in actual practice, compared with general medicine physicians. Internists and subspecialists had similar preferences for prescribing antidepressants, but, compared with internists, subspecialists had lower preferences for counseling. Clinician preferences for counseling were similar for depressed patients with or without medical comorbidities, but preferences for prescribing antidepressants were lowest for patients with depression and myocardial infarction, compared with other patient groups. CONCLUSIONS: Measures of clinician treatment style for depression are good proxies for counseling but not for prescribing practices. Among general medical physicians, family physicians have the strongest reported preferences in treating depression but, especially in terms of medication therapy, do not always follow those preferences. Preferred treatments of patients with and without medical comorbidities were similar. Findings have implications for improving the quality of treatment of depressed patients.

Adult↗
PubMed1994

Use of minor tranquilizers and antidepressant medications by depressed outpatients: results from the medical outcomes study.

OBJECTIVE: The purpose of this study was to compare use of minor tranquilizers and antidepressant medications by depressed outpatients across different treatment settings. METHOD: The study subjects were 634 patients with current depressive disorder or depressive symptoms who visited general medical clinicians, psychiatrists, psychologists, or other therapists. Data on use of medication in different types of clinical practices with different types of payment plans were gathered from structured interviews by study clinicians and from surveys of patients. RESULTS: Of the depressed patients, 23% had recently used an antidepressant medication and 30% had used a minor tranquilizer. The level of use was similar for different types of depression. Patients of psychiatrists were the most likely to use medications. In the practices of physicians, but not nonphysicians, the more severely distressed patients were more likely to use antidepressant medications. Of the patients taking an antidepressant medication, 39% used an inappropriately low dose. Patients in prepaid health care plans were twice as likely as those in fee-for-service care to use minor tranquilizers. CONCLUSIONS: Less than one-third of the depressed outpatients used antidepressant medications, and the probability of use was similar for major depression and other types of depression for which efficacy is less well established. Use of antidepressant medications among patients of nonphysicians was unrelated to the level of psychological sickness, suggesting the need for more cooperation among provider groups. Minor tranquilizers were used more often than antidepressants, particularly among patients in prepaid plans, despite controversy over their efficacy.

Adult↗
PubMed1994

Joint Commission for Accreditation of Hospital Organization education standards: perioperative applications.

The Joint Commission for Accreditation of Hospital Organization, as a major accrediting body for health care organizations, has identified patient and family education as a critical element in the delivery of quality health care services as a means to improve overall outcomes for consumers. This belief is evidenced in the fact that they have created a new chapter in the accreditation manual that targets this aspect of the care delivery process. Health care organizations are now being challenged as a requirement for accreditation to show that they have operationalized education in their care delivery processes. Education of surgical patients, although not a new concept, has taken on a new dimension given the increased shift to ambulatory and short stay surgery. This article explores the standards related to patient and family education as applied to the surgical experience and provides information for the perioperative nurse on how these standards can be incorporated into existing processes in caring for surgical patients.

Joint Commission on Accreditation of Healthcare Or↗
PubMed1993

Course of depression in patients with hypertension, myocardial infarction, or insulin-dependent diabetes.

OBJECTIVE: The authors examined the course of depression over 2 years for outpatients with and without a history of hypertension, a history of myocardial infarction, or current insulin-dependent diabetes. METHOD: Among outpatient visitors to the practices of 523 general medical clinicians and mental health specialists, 626 depressed patients were followed for 1 or 2 years with a telephone-administered interview based on the format of the National Institute of Mental Health Diagnostic Interview Schedule. RESULTS: Depressed patients with and without medical illness had high rates of persistent depressive symptoms and spells over 2 years. Patients with a lifetime history of myocardial infarction had significantly more spells of depression over the first follow-up year, more total symptoms of depression in the second follow-up year, and more depressive symptoms at the end of each follow-up year than depressed patients without myocardial infarction. The course of depression did not differ significantly for depressed patients with and without a lifetime history of hypertension or current insulin-dependent diabetes. CONCLUSIONS: Among depressed adult outpatients, a history of myocardial infarction is associated with a particularly poor clinical prognosis. A relatively high percentage of all depressed patients in this study had persistent depression regardless of the extent of medical comorbidity.

Adolescent↗
PubMed1992

The course of depression in adult outpatients. Results from the Medical Outcomes Study.

OBJECTIVE: To compare the course of depression during a 2-year period in adult outpatients (n = 626) with current major depression, dysthymia, and either both current disorders ("double depression") or depressive symptoms with no current depressive disorder. METHODS: Depressed patients visiting 523 clinicians (mental health specialists and general medical providers) were identified using a two-stage screening procedure including the Diagnostic Interview Schedule. The course of depression was assessed in 2 follow-up years with a structured telephone interview based on the format of the Diagnostic Interview Schedule. RESULTS: Baseline severity of depressive symptoms was greatest in patients with double depression, but initial functional status was poor in those with dysthymia with or without concurrent major depression. Patients with dysthymia had the worst outcomes, those with current major depression alone had intermediate outcomes, and those with subthreshold depressive symptoms had the best outcomes. Even the latter group, however, had a high incidence (25%) of major depressive episode over 2 years. Initial depression severity and level of functional status accounted for more explained variance in outcomes than did type of depressive disorder. CONCLUSIONS: The findings emphasize the poor prognosis associated with dysthymia even in the absence of major depression; the prognostic significance of subthreshold depressive symptoms; and the clinical significance of assessing level of severity of symptoms as well as functional status and well-being, regardless of type of depressive disorder.

Adult↗
PubMed1992

Cross-training: a staffing alternative in ambulatory surgery.

Content plateauing, which occurs when one's work becomes too routine, may be prevented by the cross-training and cross-utilization of staff. This article tracks the process of cross-training and cross-utilization from its inception at Lutheran Medical Center in Denver, Colorado.

Ambulatory Surgical Procedures↗