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Biomedical subjects

W C Richardson

Publications and source records attributed to W C Richardson.

33 records · Page 2Linked to original sources
PubMed1979

Increased access to medical care: the impact on health.

Many federally financed programs have been launched to improve the access of the poor to medical care, under the assumption that this will improve their health. The effectiveness of these programs, however, has generally been measured by increased utilization rather than by improved health. The few studies which have considered health status have shown small or negative effects. Here, data are presented from a project which provided fully prepaid care to near poor families through existing sources in the community. A group of 748 enrollees was found to report worse health on four of five health indicators after one year of enrollment in the program; further, they appeared sicker on all five measures than a group without free medical care. It is suggested: 1) that the impact of health programs on the health of a population is a complex and poorly understood issue; and 2) that increasing access to health care may not be an effective way to improve health.

Adolescent↗
PubMed1978

A causal model of health services for diabetic patients.

A causal model of health services which includes patient and provider variables, perceived access to care, utilization of services, continuity of care, technical quality of the care process, technical quality of the care outcome, and patient satisfaction is applied to a group of diabetic patients enrolled in the Seattle Prepaid Health Care Project. The enrollees received comprehensive health services at zero out-of-pocket cost from either a prepaid group practice plan or an independent practice plan. Surveys were periodically conducted to determine health status, satisfaction, and demographic characteristics of the enrollees; utilization of services was monitored throughout the experiment. The causal model is operationalized through the use of path analysis. Significant relationships (p less than or equal to .10) were established between satisfaction and perceived access to care, family size, sex, and professional qualifications of the provider; between outcome of care and health status, female education, and physician performance; between physician performance and professional qualifications; between continuity of care and health status and female education; between utilization and perceived access, specialty of provider, and provider system; and between access to care and provider system. The policy implications of the results are discussed.

Consumer Behavior↗
PubMed1978

Assessing the quality of care for urinary tract infection in office practice: a comparative organizational study.

As part of a comprehensive evaluation of care received by enrollees in a prepaid community health care project, we studied the process of care for enrollees reported to have a urinary tract infection. The care given to 98 patients enrolled in a large prepaid group practice (PGP) and 69 patients seen by 45 physicians in the independent practice setting (IPP) was analyzed. We found the process of care to be significantly better in the PGP, with a large part of the difference due to more appropriate utilization of urine cultures. This occurred despite a higher visit rate to internists in the IPP, and suggests that the organization of practice strongly affects the process of care received by patients even when all care is fully prepaid.

Ambulatory Care↗
PubMed1978

Tonsillectomies, adenoidectomies, audits: have surgical indications been met?

In the Seattle Prepaid Health Care Project, we studied medical records and claims information for all 97 children undergoing tonsillectomy and/or adenoidectomy in an independent practice plan from February 1971, through January 1975. Overall only 32 per cent of the procedures met commonly promulgated indications of surgery. Of 77 persons having one of these procedures performed because of recurrent pharyngeal or ear infections, 86 per cent did not meet the indications for surgery suggested by screening criteria adapted from model guidelines for PSRO use. The average number of episodes of illness was estimated to be 1.71/per year in the year prior to surgery using lenient assumptions. It is concluded that a major reduction in the frequency of these procedures would be effected by developing an audit strategy that assures the stated indications meet commonly recommended guidelines. The reduction in surgery would occur irrespective of the debate about the efficacy of these procedures.

Adenoidectomy↗
PubMed1976

Magement education for health services.

This paper examines the implications of the recent emergence in the United States of three major factors for management education in health services. The factors are: new organizational forms for delivery of services, increased emphasis on public accountability, and the proliferation of agencies intended to monitor and coordinate health services providers. Several questions are considered, including the degree to which training for various managerial careers within health services should be differentiated; the degree to which professional education should occur in the academic setting as distinct from the work setting; and, most importantly, the appropriate content of graduate education. It is argued that formal education for health services management should place substantial emphasis on the development of a student's analytic skills, with particular reference to quantitative methods. While these technical skills are not likely to become the dominant ingredient of successful and effective management, they do provide the manager with the ability to identify courses of action which will benefit the organization, and strengthen his hand in dealing with groups that are necessarily in conflict with its goals. It is stressed that training in this area should be oriented toward the needs of the prospective manager rather than the quantitative methods specialist.

Administrative Personnel↗
PubMed1975

Soft tissue response to four dense ceramic materials and two clinically used biomaterials.

Disk-shaped implants of spinel, alumina, mullite, zircon, a cast Co-Cr-Mo alloy, and ultra-high molecular weight polyethylene (UHMWPE), were implanted in the paraspinalis muscle of 12 adult, male, white New Zealand rabbits. Prior to implantation the implants were characterized with respect to size and shape, weight and surface roughness. After periods of 1 month, 2 months, and 4 months, the rabbits were sacrificed and the tissue specimens were retrieved with the implants still intact. Histological examination of the tissues surrounding the implants along with changes in the size and shape, weight, and surface roughness of the implants were used as criteria for evaluating these materials for implant purposes. No surfaces degradation of any of the materials was detected using scanning electron microscopy. Fibrous tissue seemed to adhere to the UHMWPE implants more than any other material used in this study. Large amounts of fibrous tissue were also found to adhere to the cast Co-Cr-Mo alloy implants. The histological results indicated that within the limits of this investigation, the biocompatibility of the ceramic materials used in this study compared favorably with the clinically used Co-Cr-Mo alloy implants and the UHMWPE implants.

Aluminum↗
PubMedDate not supplied

Quantitative stereological investigations of porous alumina implant biomaterials.

We made several conclusions from this study on a candidate porous alumina bioceramic. First, the volume fraction of porosity varied from 64 to 79%, whereas Archimedes density shows 62% porosity. Second, the mean lineal intercept and tangent diameter varied from 0.048 to 0.058 cm and 0.034 to 0.040 cm, respectively, and did not provide a good concept of the minimum pore size neck dimensions for the specimen. Third, the pore-size dimension varied from 0.0185 to 0.1157 cm which indicated a minimum pore neck size large enough for tissue ingrowth and ossification if located in bone. Fourth, the pore structure was totally interconnected with considerable side branching and multi-interconnections. Fifth, the serial sectioning of the porous alumina ceramic biomaterial provides considerable insight into the critical features of the material as a candidate for a surgical implant material and a better understanding of the relationships between two-dimensional and three-dimensional structural components.

Aluminum↗