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Biomedical subjects

S M Ornstein

Publications and source records attributed to S M Ornstein.

At least 19 recordsLinked to original sources
PubMed1997

The computer-based patient record as a CQI tool in a family medicine center.

BACKGROUND: In 1994 the Department of Family Medicine (DFM) at the Medical University of South Carolina (MUSC) developed an innovative infrastructure for continuous quality improvement (CQI) which capitalized on its existing computer-based patient record (CPR) system. CQI PROGRAM: The CPR is a key element in all components of the DFM patient care CQI activities. Computerized record reviews, online queries, and special reports provide the background information needed to establish CQI projects and, in some cases, diagnose the cause. Any data entered into the CPR, including progress notes text, is searchable for use by the quality improvement teams. The most compelling aspect of DFM's CPR-based CQI system is the use of quality control charts that are regularly generated by the research division from CPR data. These charts allow the CQI teams to determine whether any changes in the process measurements are due to chance causes or are caused by specific interventions introduced to improve the process. ONGOING IMPROVEMENT PROJECTS: Four ongoing improvement projects that rely on CPR data and use electronically created control charts are discussed--optimizing the treatment of acute bronchitis, improving adherence to practice guidelines for patients with adult onset diabetes mellitus, improving the recognition and treatment of tobacco abuse, and improving blood pressure control in patients with hypertension. Each improvement project has a unique set of goals and objectives, against which the project's success is measured. CONCLUSION: A CPR system can be used to provide fast, organized access to large amounts of patient information to support structured quality improvement activities.

Academic Medical Centers↗
PubMed1995

Implementation and evaluation of a computer-based preventive services system.

BACKGROUND AND OBJECTIVES: Insufficient attention has been paid to the role that modern information systems can play in improving the delivery of and education about preventive services in family medicine training and practice sites. From September 1990-September 1993, the Department of Family Medicine at the Medical University of South Carolina conducted a demonstration project designed to develop, implement, and evaluate a comprehensive, computer-based preventive services delivery and educational system, based on the recommendations in the US Preventive Services Task Force (USPSTF) Report. METHODS: A computer-based patient record (CPR) system was implemented. The system had sophisticated preventive services tracking and reminder, physician, and patient education features. Twenty-nine basic USPSTF recommendations were incorporated in the system. An extensive physician education series was also implemented. A multi-method evaluation system, including patient exit surveys, physician interviews, and practice audits was used to evaluate and design improvements to the CPR and education systems. RESULTS: Although the system initially had no effect on patient perceptions about the frequency of preventive services delivery, there was reasonable concordance between patient desires and physician behavior for the discussion of preventive services (Kappa = .5 to .6). Physician acceptance of the system was good--in 1992, 30% of physicians used the preventive services reminders in most of their patient visits, and in 1993, 88% of physicians reported more frequent use. Practice audits from February 1992-July 1993 showed increased adherence with all seven counseling services, 10 of 15 screening services, and one of five immunization services. CONCLUSIONS: A CPR-based preventive services system coupled with an adaptable physician education about and delivery of preventive services. an ideal solution to improving the education about and delivery of preventive services.

Adolescent↗
PubMed1995

Family practice educators' perceptions of computer-based patient records.

BACKGROUND: Despite the National Institute of Medicine's endorsement of computer-based patient records (CPRs), the majority of family practice residency programs continue to use paper records. This study examined the perceptions of family medicine educators about CPRs to understand their limited use of computerized patient record systems. METHODS: A survey was mailed to the directors of 247 family practice residency programs; 199 were completed and returned (response rate 81%). Respondents were asked to identify their concerns about CPRs, what they perceived as the advantages and disadvantages of CPRs compared with paper records, and the likelihood that their program will implement a CPR within the next year and within the next 5 years. RESULTS: The perceived benefits of CPR were greater efficiency, accuracy, and quality in patient care. However, many respondents were concerned about cost, mechanical breakdowns, conversion hardships, training needs, and physicians' attitudes. Despite these objections, the majority of respondents reported it is ¿somewhat¿ or ¿very¿ likely that their program will implement a CPR system within the next 5 years. CONCLUSIONS: Although the surveyed family medicine educators believed that CPRs offer significant benefits, they also perceived several disadvantages of converting from paper to computer-based patient records. Widespread use of CPRs among family practice programs in the near future depends on the extent to which vendors and others heighten awareness and knowledge about the benefits of CPRs and address concerns about cost, mechanical breakdowns, and transition difficulties.

Attitude of Health Personnel↗
PubMed1994

Improving a preventive services reminder system using feedback from focus groups.

OBJECTIVE: To improve the computer-generated preventive services patient reminder letter used by a department of family medicine at a medical university in South Carolina. DESIGN: A qualitative method chosen because of its demonstrated efficacy in generating in-depth attitude and opinion data was used for 12 focus groups (111 participants) in which participants were asked to evaluate the reminder letter and other preventive services reminder materials. Information from these groups was used to design a revised patient reminder system that was tested in six additional focus groups (50 participants). SETTING: University-based family medicine center. PARTICIPANTS: Adults 19 years of age or older of whom approximately one half were selected from a random sample of family medicine center patients and the remainder from volunteers recruited from the general community by newspaper advertisement. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Participants' perceptions and attitudes about the reminder letter and other materials as well as suggestions for improving the preventive services reminder system. RESULTS: The revised patient reminder materials resulted in a warmer, more personal letter sent to patients at the time of their birthdays in an envelope containing a prevention message. A leaflet describing the rationale for preventive services and answering common questions about prevention and a booklet describing the preventive services available at the family medicine center were also developed. CONCLUSION: This study illustrated the benefits of incorporating patients' perspectives in the design of preventive services reminders.

Adult↗
PubMed1993

Barriers to adherence to preventive services reminder letters: the patient's perspective.

BACKGROUND: Despite an emerging consensus as to which preventive services are appropriate, a minority of patients receive them. Although adherence to recommendations for some interventions has increased, research studies have shown that adherence rates can be further improved through a better understanding of patient attitudes and motivations regarding preventive services. METHODS: Using components of the Patient Path Model, this study examined the response to patient reminder letters for cholesterol screening sent to 1077 adult patients between August and October 1990. The research strategy incorporated both quantitative and qualitative methods, including a telephone survey and focus group interviews of nonresponders to the reminder letter. RESULTS: Three hundred seven patients were surveyed by telephone to ascertain their reasons for nonresponse. One hundred fifty-four (50.2%) did not recall receiving the reminder letter, 84 (27.4%) recalled receiving the letter but did not recall its content, and 69 (22.5%) recalled both receiving the letter and its content. No consistent reason for nonadherence emerged among the 69 nonresponders who recalled the reminder. Twenty-seven of the nonresponders who did not recall receiving the cholesterol reminder participated in the focus groups. The participants stressed the importance of distinguishing the reminder letter from a bill, conveying a personally relevant message, and addressing logistical barriers to preventive services. CONCLUSIONS: Careful attention to the format and content of patient reminder letters is necessary to improve adherence to preventive services recommendations.

Adult↗
PubMed1992

The computer-based medical record: current status.

At the turn of the century, neither hospitals nor physicians routinely kept clinical records. Since then, the medical record has gradually evolved. More recently, as society and medicine have become more complex and sophisticated, inadequacies of the paper medical record have become increasingly apparent. The computer-based medical record addresses many of the deficiencies of the paper record. Meanwhile, barriers to computer-based records have decreased; hardware has become more affordable, powerful, and compact, and software has been refined. Socially, the major payers for health care are demanding verification of the effectiveness and quality of care, information that involves data-intensive research. The electronic medical record promises to improve quality of care by providing point-of-care reminder and decision support tools as well as a database for substantiating the effectiveness of care. In conjunction with the growing integration of computers into all facets of life, government agencies, computer giants, and medical organizations are currently laying the groundwork for the development of standardized elements and formats for computer-based medical information systems. As part of the continuing evolution of the medical record, we foresee these forces culminating in the computerization of the clinical record. In this review, we briefly describe the developments that led us to this conclusion and describe computer-based clinical record systems in use in two family practice settings.

Decision Support Techniques↗
PubMed1991

Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services.

Despite an emerging consensus on appropriate preventive services, a minority of patients receive them. A study was undertaken to assess the impact of computer-generated reminders to adult patients, their physicians, or both patients and physicians on adherence to five recommended preventive services: cholesterol measurements, fecal occult blood testing, mammography, Papanicolaou smears, and tetanus immunization. During the academic year 1988-1989, all 7397 adult patients and their 49 physicians in a university family medicine clinical practice were randomized by practice group into one of four study groups: control, physician reminders, patient reminders, and both physician and patient reminders. Adherence was defined in community-oriented terms: the percentage of patients within each group who had received the preventive service in the recommended interval. During the study period, adherence to four of the five preventive services increased significantly, with the largest increases in the physician and patient reminder group: cholesterol measurements increased from 19.5% to 38.1%, fecal occult blood testing 9.3% to 27.0%, mammography 11.4% to 27.1%, and tetanus immunization 23.4% to 35.4% (for each increase, P less than .0001, McNemar's chi-square test). In general, increases were greater in blacks and in patients with any form of insurance coverage. Computer-based physician and patient reminder systems have great promise of improving adherence to preventive services in primary care settings.

Adult↗
PubMed1990

Obstetric ultrasound by family physicians. Adequacy as assessed by pregnancy outcome.

Quality assessment is an important component of family medicine research. Actual obstetric outcomes of patients studied by family physician sonographers have not been reported but are relevant to quality assessment. A review of 498 obstetric ultrasound examinations performed by four family physician sonographers at the Medical University of South Carolina and the University of Michigan assessed these physicians' competence by outcome evaluations. The findings are that these physicians accurately predicted the estimated date of confinement, the presence or absence of fetal death, and multiple gestation. They infrequently assessed the fetal sex and were occasionally incorrect when they did so. More study is needed of their competence in the diagnosis of placenta previa, ectopic pregnancy, and fetal anomalies.

Adult↗
PubMed1990

Management of hypercholesterolemia in a family practice setting.

A study was undertaken to assess physician adherence and patient compliance with the National Cholesterol Education Program guidelines for the management of newly detected hypercholesterolemia. The study site was the Department of Family Medicine, Medical University of South Carolina, Charleston, a university-based family medicine residency program. All serum cholesterol levels measured between July 1, 1988, and September 30, 1988, were reviewed. Patients were classified as normal, borderline, or hypercholesterolemic based on serum cholesterol levels and coronary heart disease risk factors. Patients previously recognized to be hypercholesterolemic were excluded. Six months later, medical record reviews were performed for the 192 hypercholesterolemic and 107 borderline hypercholesterolemic patients. Only 39 of the hypercholesterolemic patients (20%) had received appropriate dietary therapy and follow-up. Patient compliance with physician recommendations was excellent. There was minimal unnecessary testing or treatment of borderline hypercholesterolemia. Low rates of appropriate management of hypercholesterolemia may be related to inadequate physician knowledge, low physician-perceived self-efficacy regarding dietary counseling, or time constraints.

Adolescent↗
PubMed1989

Compliance with five health promotion recommendations in a university-based family practice.

Although numerous recommendations are available to guide the primary care physician's provision of preventive health services, a minority of Americans receive recommended care. This study assessed the extent to which patients in a large, university-based family medicine program were receiving five well-accepted health promotion services. These services included fecal occult blood testing, Papanicolaou smears, mammography, serum cholesterol measurements, and tetanus immunization. Demographic factors associated with receipt of these services were assessed. A minority of active patients received the five health promotion services in the recommended interval: fecal occult blood testing 13%, Papanicolaou smear 41%, mammography 16%, cholesterol measurements 20%, and tetanus immunization 19%. The patient's physician practice group, type of medical insurance, physician visit frequency, and increasing age were associated with compliance with the five studied health promotion services.

Academic Medical Centers↗
PubMed1988

The effect of physician personality on laboratory test ordering for hypertensive patients.

Laboratory tests are responsible for a large percentage of health care expenses in the United States. In a retrospective study of the outpatient test ordering by residents for hypertensive patients between the years 1980 and 1986 at the Department of Family Medicine at the Medical University of South Carolina, we found great variability in laboratory test ordering as well as an association between personality as measured by the Myers-Briggs Type Indicator (MBTI) and test ordering. Introverts ordered more than extroverts, and intuitives ordered more than sensors. This association was confirmed by a multiple regression analysis controlling for potential confounders of test ordering, such as severity of disease, the presence of coexisting diabetes mellitus, the demographic characteristics of the patient population, and the number of initial evaluations for hypertension. Elucidation of a relationship between resident personality and laboratory test ordering has important implications for planning intervention strategies to reduce excessive laboratory test ordering in ambulatory care.

Clinical Laboratory Techniques↗
PubMed1988

Obstetric ultrasound training for family physicians. Results from a multi-site study.

A practical program to train family physicians in obstetric ultrasound was tested with 13 family physicians. Each physician completed 6.5 days of course work and ultrasound laboratory apprenticeship prior to beginning a clinical preceptorship of approximately 14 months' duration. During the clinical preceptorship the physicians performed ultrasound studies in their own offices. All studies were reviewed by a local consultant radiologist utilizing examination data sheets and videotapes. At the conclusion of the training program, the physicians took a combined practical and written proficiency examination administered by an independent sonographer. Eight physicians completed the training, performing during the preceptorship an average of 78 examinations. The rated performance of the physicians improved markedly over the course of the preceptorship. During the last segment of the preceptorship the radiologist preceptors rated 94 percent of the ultrasound studies as acceptable, compared with 79 percent rated acceptable at the beginning of the preceptorship. Seven of the eight physicians completing the protocol took the proficiency examination: all passed. This study can provide a blueprint for an individual family physician to design his own training, or it can guide an academic department of family medicine in developing and evaluating ultrasound training programs for residents and practicing physicians.

Education, Medical, Continuing↗