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Biomedical subjects

Stephen C Schoenbaum

Publications and source records attributed to Stephen C Schoenbaum.

10 recordsLinked to original sources
PubMed2006

U.S. health system performance: a national scorecard.

This paper presents the findings of a new scorecard designed to assess and monitor multiple domains of U.S. health system performance. The scorecard uses national and international data to identify performance benchmarks and calculates simple ratio scores comparing U.S averages to benchmarks. Average ratio scores range from 51 to 71 across domains of health outcomes, quality, access, equity, and efficiency. The overall picture that emerges from the scorecard is one of missed opportunities and room for improvement. The findings underscore the importance of policies that take a coherent, whole-system approach to change and address the interaction of access, quality, and cost.

Benchmarking↗
PubMed2006

Adoption of patient-centered care practices by physicians: results from a national survey.

BACKGROUND: Little is known about the extent to which primary care physicians (PCPs) practice patient-centered care, 1 of the Institute of Medicine's 6 dimensions of quality. This article describes the adoption of patient-centered practice attributes by PCPs. METHODS: Mail survey; nationally representative physician sample of 1837 physicians in practice at least 3 years postresidency. RESULTS: Eighty-three percent of PCPs surveyed are in favor of sharing of medical records with patients. Most physicians (87%) support team-based care. But, only 16% of PCPs communicate with their patients via e-mail; only 36% get feedback from their patients. Seventy-four percent of PCPs still experience problems with availability of patients' medical records or test results; less than 50% have adopted patient reminder systems. Thirty-three percent of physicians practicing in groups of 50 or more have adopted 6 to 11 of the 11 patient-centered care practices targeted in the survey compared with 14% of solo physicians. CONCLUSION: Although some patient-centered care practices have been adopted by most PCPs, other practices have not yet been adopted as broadly, especially those targeting coordination, team-based care, and support from appropriate information systems.

Aged↗
PubMed2006

Keys to a high-performance health system for the United States.

Five keys to better performance in the U.S. healthcare system are: Coverage of the uninsured, reduction in cost shifting, and administrative simplification. More primary care and less specialty care. Interoperable health IT. Mass customization of care. Delivery of near perfect care.

Benchmarking↗
PubMed2005

A 2020 vision of patient-centered primary care.

Patient-centered care has received new prominence with its inclusion by the Institute of Medicine as 1 of the 6 aims of quality. Seven attributes of patient-centered primary care are proposed here to improve this dimension of care: access to care, patient engagement in care, information systems, care coordination, integrated and comprehensive team care, patient-centered care surveys, and publicly available information. The Commonwealth Fund 2003 National Survey of Physicians and Quality of Care finds that one fourth of primary care physicians currently incorporate these various patient-centered attributes in their practices. To bring about marked improvement will require a new system of primary care payment that blends monthly patient panel fees with traditional fee-for-service payment, and new incentives for patient-centered care performance. A major effort to test this concept, develop a business case, provide technical assistance and training, and diffuse best practices is needed to transform American health care.

Family Practice↗
PubMed2004

Malpractice reform must include steps to prevent medical injury.

In the current malpractice insurance crisis, physicians have focused their advocacy and energy primarily on rapidly increasing liability premiums; problems in access to care; and demands for legal reform, especially caps on damages. An even more important focus, however, is prevention of injury and improvement of patient safety. Physicians largely control patient care and can play a critical role in systematically reducing injury. Reforms should go beyond liability issues; they should also harness and enhance physicians' ability to act. More visible efforts by physicians to reduce harm, better communication with patients and others, and true evidence of improved patient safety should reduce patient anger and litigiousness. Individually and collectively, physicians can and should ensure that "doing no harm" comes first in the malpractice debate.

Health Care Reform↗
PubMedDate not supplied

Obtaining greater value from health care: the roles of the U.S. government.

The problems of quality and cost in the U.S. health care system are unlikely to be solved without strong leadership from the federal government, which can mobilize action to set national priorities for quality; develop and promulgate standards for care; and stimulate implementation of performance measures and standards for providers. All of these functions would best be carried out by a new federal agency. Furthermore, the federal government should design payment policies based on the performance standards, invest in needed information technology, and invest in research related to improving care and in training professionals to support nationwide quality improvement.

Federal Government↗
PubMedDate not supplied

Measure, learn, and improve: physicians' involvement in quality improvement.

Payers, accreditors, and consumers are using quality improvement (QI) methods, but little is known about whether physicians do so. The results from this 2003 national physician survey indicate that most do not. Physicians do not routinely use data for assessing their performance and are reluctant to share those data. They infrequently participate in redesign activities. Physicians in larger and salaried groups are more likely to be engaged in QI. The science of QI has been "institutionalized" but not yet "professionalized."Accelerating physicians' adoption of and participation in QI requires building the infrastructure to support quality and paying attention to professionalism, knowledge, and skills.

Female↗
PubMedDate not supplied

Physicians and prepaid group practices.

Prepaid group practices (PGPs) are complex organizations that directly combine prepayment for health care with a comprehensive health care delivery system. PGPs' ability to manage their physician staffing efficiently must be placed in context with the cost and quality of their care. It seems unlikely that PGPs or their use of staff will proliferate. With increased integration of care through disease management programs and use of clinical information technology, it should be possible for the United States as a whole to come closer to achieving the care delivery goals that PGPs have set in the past.

Costs and Cost Analysis↗