Problem-oriented approach to practice. II. Development of the system through audit and implication.
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R E Bouchard
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Problem-oriented approach to practice. I. Economic impact.
The problem-oriented system provides a unique management tool for medical practice. It follows basic management principles for any complex human endeavor (ie, define goals, set standards, audit performance to those standards, and assess results). The basic tool is the problem-oriented record, which demands that statements of medical action be explicit to permit audit. This concept can be extended to provide and assess care for an entire practice. Five years of cumulative data were assessed. The following changes were noted: (1) The ratio of patients to physicians doubled. (2) The total hospitalization rate fell by more than 20% and general medical portion by 60%. (3) Ambulatory use and cost decreased by approximately 20%. (4) Expenditures for services fell by 22%, while national expenditures for physician services increased by 28%.
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A dynamic primary care curriculum based on the problem-oriented system.
The audit of behaviors of health care providers is a valuable tool for learning the essentials of primary care and health care delivery. At the University of Vermont a dynamic curriculum has evolved from the student audits of the practice sites where the training takes place. Evaluation studies to date indicate a positive effect on career goals leading to primary care specialties and a desire to practice in rural settings in underserved areas. This approach to teaching primary care has proven to be effective and has gained high acceptance with the students. They learn that audit is a valuable means of self-education as well as method for providing quality assurance to the patient.
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