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Biomedical subjects

R L Kane

Publications and source records attributed to R L Kane.

At least 217 records · Page 12Linked to original sources
PubMed1978

Giving and getting surgery in Utah: an urban-rural comparison.

Using the Blue Cross/Blue Shield and Medicare records for 1 year in Utah, we examined the pattern of surgical performance for 15 selected procedures. Only 60% of those identifying themselves as general surgeons had their specialty boards. General practitioners performed 24% of the procedures. Urban general practitioners performed proportionately more surgery than did their rural counterparts. There was no clear pattern of difference in fees or length of stay by specialty or board certification status. For most procedures studied, at least a third of the rural patients had their operations in urban hospitals. In only 3% of the cases did an urban physician operate in a rural hospital. The pattern of surgery for rural and urban residents was strikingly similar.

Certification↗
PubMed1977

Costs and outcomes for different primary care providers.

This study examined the relationship between levels of medical training and direct costs for 1,700 episodes of acute illness treated in ambulatory-care clinics. Faculty, family practice residents, and physician assistants were included as the providers. Total cost and four component costs were examined. An outcome was defined as good if the patient returned to his usual level of functioning after an acute illness episode. Average total cost per episode was not related to type of provider, but there were significant (P less than .05) differences among providers in laboratory and medication costs. Faculty and physician assistants produced higher costs, especially for patients who experienced bad outcomes. Both costs and percentage of good outcomes achieved were similar in first-, second-, and third-year residents.

Acute Disease↗
PubMed1977

The mentally ill in nursing homes. New back wards in the community.

The reduction in state hospital populations in the last two decades is most often attributed to psychotropic medication and community mental health centers. The role the proprietary nursing home has played in this reduction has not been adequately studied. Using data routinely collected for Medicaid utilization review, we studied characteristics of psychiatric nursing home patients in Utah. One third of the nursing home patients had a psychiatric diagnosis; more than half of this group were classified as psychotic. Most psychotic patients were significantly younger than their nonpsychiatric counterparts. Nonpsychiatric patients received a higher mean number of psychoactive drugs than did psychiatric or mentally retarded patients. Over time, all groups of patients showed an increase in prescribed psychoactive medication and a decrease in activity. The consequence of this pattern of care raise serious questions about our current reliance on nursing homes for the care of the psychiatric patient.

Adult↗
PubMed1977

Rating the lecturer: a study of how different disciplines used comparative criteria.

Faculty members from medicine, nursing, social work, and law, as well as a group of medical students, tested their own criteria for a good lecturer; each group focused on different aspects of the behaviors sought in the good lecture. The "Dr. Fox" paradigm was the lecture chosen; all groups failed to identify the deliberately incorporated failings. These results were then compared with the results obtained by using a standardized rating form in current use within a major university.

Criminal Law↗
PubMed1977

Getting care to nursing-home patients: a problem and a proposal.

Data abstracted from transportation company records showed that nursing home patients made an average of 3.6 trips per year for care out of the nursing home. The bulk of this care (55 per cent) was provided at University Hospital with over a quarter provided at private physicians' offices and community health centers. On the basis of chart abstracts over half the patients had been seen within the previous month, but the quality of that visit was open to question. A means of providing cost-effective primary medical care in the nursing homes using a team of nurse practitioner and social worker is proposed.

Community Health Services↗
PubMed1977

Relationship between process and outcome in ambulatory care.

The outcomes of a series of some 410 acute episodes from two family practice centers were rated on the degree to which the patient regained his usual functional status and his satisfaction with the outcome and the process of care. A portion of outcomes (251) were then compared to process scores obtained using explicit criteria and the rest to implicit process ratings based on the problem-oriented record. In both instances those cases with good outcomes had better process scores than those with bad outcomes; neither measure of satisfaction had a consistent relationship with either process measure.

Ambulatory Care↗
PubMed1977

Community aftercare of patients discharged from Utah state hospital: a follow-up study.

To find out whether patients discharged from mental hospitals to the community are following recommended courses of aftercare treatment, the authors, with the assistance of five medical students, studied a sample of patients discharged from Utah State Hospital during 1973 and 1974. The discharge plans of 143 patients admitted from Salt Lake County indicated that 125 of them should have received aftercare services from a community mental health center. A review of CMHC records and interviews with the patients indicated that only 100 actually had contact with a center. Only 43 of the patients were still receiving aftercare services in the summer of 1975.

Adult↗
PubMed1977

A method for assessing the outcome of acute primary care.

Some 1,700 acute care episodes were studied to assess the outcomes in terms of the extent to which patients regained their usual functional status. Involving active follow-up of each patient, the study serves as a prototype for measuring several components of quality of care including actual outcomes, patient expectation of outcome, physician expectation of outcome, and patient satisfaction with outcome and care. Because this study was conducted in a family practice residency training setting, we hope that it will serve as a model of how such information may be used to increase residents' sensitivity to the course of illness commonly seen in primary care, and to encourage the residents to set expectations for the care they give.

Consumer Behavior↗
PubMed1977

The new health practitioner--the past as prologue.

The training and utilization of New Health Practitioners (NHP's) has moved within a decade from a small tentative beginning in the mid-1960's to a major health manpower policy issue. Its discussion transcends a number of important and emotionally charged areas including the role of various professions in providing health care services, the renaissance of primary care, the geographic and economic maldistribution of medical services, and the cost of care. It is valuable to highlight what is known, what is professed and what needs to be studied further about this issue.

Allied Health Personnel↗
PubMed1976

Medex and their physician preceptors. Quality of care.

Studies of selected indicators of the process of care provided by a Medex and by a physician preceptor in seven rural practices suggest that the Medex is more likely to use appropriate laboratory tests and less likely to use inappropriate treatments. When outcomes of care were determined in 13 practices with a Medex and a preceptor, the patients seen by the Medex tended to fare about as well as those seen by a physician (71% versus 74%, respectively) in regaining their usual functional status. The addition of a Medex to a rural practice may thus produce both direct and indirected benefits.

Diagnosis↗
PubMed1976

A controlled trial of multiphasic screening.

A clinical controlled trial was designed to determine the impact of Automated Multiphasic Health Testing on morbidity and attitudes. Three strata comprising 574 families (lower-income group enrolled in health maintenance organization, lower-income not enrolled in such a project, and a middle-income group employed by a utility company) were interviewed to obtain information on utilization, morbidity, health status, and attitudes. Sixty percent of adults in each stratum were then screened. All families were interviewed again one year later. The only significant difference found between screened and non-screened subjects was an increase in nights hospitalized for screened subjects. Physicians were interviewed to determine what abnormalities were found and what treatment was required for project and privately referred patients of these physicians. Previously unknown abnormalities prompted retesting for confirmation in only 28 per cent of the cases and even less often led to treatment.

Adolescent↗