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Results for “Ambulatory assessment”

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At least 19 recordsLinked to original sources
PubMed1976

Assessment of ambulatory care: application of the tracer methodology.

Utilizing a tracer method in the assessment of care was investigated in a large pediatric clinic. A set of tracers were selected and agreement was obtained concerning the relevance of care criteria by at least 80 per cent of the facility physicians. One tracer, iron-deficiency anemia, was studied using two nonphysician abstractors to review a sample of 100 patient records with hemoglobins of 11.0 gm/100 ml or less. Results were compared with an implicit review by a panel of physicians. In 52 patients, the low hemoglobin level was not recognized. Only 25 patients proceeded through the care levels of evaluation, diagnosis, treatment, and follow-up. Poor compliance was found with the approved criteria. Weighted scores of the explicit tracer method were closely related to ratings by the implicit reviewers. Utilizing tracer assessment with nonphysician abstractors demonstrated remediable deficiencies in health care services.

Ambulatory Care↗
PubMed1979

Dietetic assessment of ambulatory cancer patients: with special attention to problems of patients suffering from head--neck cancers undergoing radiation therapy.

The prime objective of nutritional surveillance of cancer patients is to set up screening criteria for those who are likely to be at risk of nutrition problems and to further assess those so identified. Interventions to improve nutritional status or comfort are called for. The single most useful item with respect to screening is careful weight measurement at every visit. Subjective reports of appetite and food intake, 24-hour recalls of dietary intake, and therapy being undergone by the patient are also useful. Assessment involves obtaining the 24-hour recall data and in some cases keeping food records, and determining the patients' food likes and dislikes. Taken together, dietary, biochemical, clinical, anthropometry, and patient history data permit us to achieve greater certainty as to the problem. Usually energy intakes are problematic, but other nutrition difficulties may also be present. Intervention with respect to diet may involve therapeutic diets, special nutrition advice, or general advice. Food assistance, help with food management, and general health education may also be necessary. Constant surveillance consisting of short encounters and follow-up are mandatory. Examples of these principles as they apply to head--neck cancers will be presented.

Alcoholism↗
PubMed1977

A system for coding the presenting requests of ambulatory patients.

Effective methods developed to review and study the care of patients in hospital have not been applicable to ambulatory care, in which definitive diagnosis is the exception rather than the rule. A reasonable alternative to using diagnosis as the basis for assessing ambulatory care is to use the problems or requests presented by the patients themselves. A system has been developed for classifying and coding this information for flexible computer retrieval. Testing indicates that the system is simple in design, easily mastered by nonphysicians and provides reliable, useful data at a low cost.

Ambulatory Care↗
PubMed1979

Measuring provider continuity in ambulatory care: an assessment of alternative approaches.

A comparison is made of existing measures of provider continuity in ambulatory care to assess differences and limitations. New measures are proposed that complement and improve upon certain limitations of existing measures. These measures are applied to a pilot study of hypertensive patients being seen in a medical outpatient clinic of a teaching hospital. The need for further development and refinement of continuity measures is indicated, and a unifying framework for measuring provider continuity is suggested.

Adult↗
PubMed1979

Ambulatory calf volume plethysmography in the assessment of venous insufficiency.

Ambulatory calf volume plethysmography has been used to study venous insufficiency in 50 lower limbs. The results demonstrate that it is possible to determine the presence of venous insufficiency and differentiate between normal limbs, limbs with superficial venous insufficiency only, limbs with deep venous insufficiency and limbs with deep venous insufficiency and occlusion by determining the ambulatory volume change and maximum venous outflow or venous volume.

Female↗
PubMed1978

Assessing the timeliness of ambulatory medical care.

The extent to which individuals receive necessary and timely care (timeliness) is one dimension of the process of care that has received little attention. Timeliness can be viewed as the interaction between patient care-seeking behavior and system accessibility,both of which are expected to influence the effectiveness of medical care. This study examines the provider's assessment of the timeliness of care received in the department of medicine of a prepaid program. Provider judgments are found to be significantly related to the provider's perception of problem severity and to the patient's prognosis. Anaylsis of patient-reported problem status one week later are also found to be related to the timeliness of care. Implications of timeliness assessments for monitoring and improving access and care-seeking behavior are discussed.

Ambulatory Care↗
PubMed1976

The staging concept--an approach to the assessment of outcome of ambulatory care.

The paper describes a method to evaluate patient care. The technique is based on the staging concept. Its basic premise is that the seriousness of a patient's condition at some point in the treatment process is a good indicator of the outcome of the previous parts of the process. Data were collected for 5,000 patients who had been admitted to a sample of hospitals in two California cities with a primary diagnosis matching one of the diseases for which staging criteria had been developed. The results indicate that the staging technique can be used to distinguish between the outcomes of ambulatory care received by different population groups.

Ambulatory Care↗
PubMed1978

Assessing technical performance at diverse ambulatory care sites.

The purpose of the large study reported here was to develop and test methods for assessing the quality of health care that would be broadly applicable to diverse ambulatory care organizations for periodic comparative review. Methodological features included the use of an age-sex stratified random sampling scheme, dependence on medical records as the source of data, a fixed study period year, use of Kessner's tracer methodology (including not only acute and chronic diseases but also screening and immunization rates as indicators), and a fixed tracer matrix at all test sites. This combination of methods proved more efficacious in estimating certain parameters for the total patient populations at each site (including utilization patterns, screening, and immunization rates) and the process of care for acute conditions than it did in examining the process of care for the selected chronic condition. It was found that the actual process of care at all three sites for the three acute conditions (streptococcal pharyngitis, urinary tract infection, and iron deficiency anemia) often differed from the expected process in terms of both diagnostic procedures and treatment. For hypertension, the chronic disease tracer, medical records were frequently a deficient data source from which to draw conclusions about the adequacy of treatment. Several aspects of the study methodology were found to be detrimental to between-site comparisons of the process of care for chronic disease management. The use of an age-sex stratified random sampling scheme resulted in the identification of too few cases of hypertension at some sites for analytic purposes, thereby necessitating supplementary sampling by diagnosis. The use of a fixed study period year resulted in an arbitrary starting point in the course of the disease. Furthermore, in light of the diverse sociodemographic characteristics of the patient populations, the use of a fixed matrix of tracer conditions for all test sites is questionable. The discussion centers on these and other problems encountered in attempting to compare technical performance within diverse ambulatory care organizations and provides some guidelines as to the utility of alternative methods for assessing the quality of health care.

Adolescent↗
PubMed1979

Developing criteria for quality of assessment: effect of the Delphi technique.

We examined the effect of the Delphi iteration procedure in developing explicit criteria for ambulatory care assessment. Practicing internists chose items they believed to be essential with regard to the care of certain specified conditions. The initial responses were tabulated and "fed-back" to the participants. The second round of criteria selection, with the first-round summary available, produced few and relatively minor changes in the items chosen by group consensus.

Ambulatory Care↗
PubMed2026

Ecological momentary assessment studies on food craving among healthy adults: A systematic review.

Ecological Momentary Assessment (EMA) can capture the dynamic nature of food craving in free-living conditions, addressing limitations of laboratory and retrospective reporting methods. This systematic review synthesized findings from EMA studies to characterize 1) methodological features, 2) the temporal dynamics of food craving, and 3) the relationship between craving and eating behaviors. A systematic search of PubMed and PsycINFO databases was conducted following PRISMA guidelines. The review included 23 studies that utilized EMA designs to assess food craving repeatedly in daily life among healthy adults. Most studies employed EMA protocols that prompted participants to respond at pre-specified time points and utilized single-item craving measures. Most craving measures (71%) lacked specificity regarding the type of food craved. Results revealed a consistent positive within-person association between hunger and food craving. Conversely, associations between stress/negative affect and craving were inconsistent, varying by individual traits and context. Momentary food craving appeared to predict subsequent eating outcomes. Evidence suggested food craving may be a dynamic, transient state that co-fluctuates with hunger, functioning as a proximal antecedent to food intake. However, reliance on non-specific food craving measures and EMA protocols prompting at fixed schedules limits the granular understanding of craving mechanisms. Future research requires refining food craving measurement and incorporating randomized prompting within predefined windows, or participant-initiated sampling triggered by specific events (e.g., eating occasion), to better characterize food craving dynamics in relation to eating behaviors.

Humans↗
PubMed1977

A population-based assessment of the continuity of ambulatory care.

A strategy is described in which explicit patient care criteria are used to measure the continuity of the health problem solving process. Prevalent diseases are selected to represent the work load of the health system. Continuity is defined in terms of rates of transition between the major clinical elements: screening, the definitive diagnostic evaluation, treatment, and follow-up evaluation. Results define critical dropout patterns and promote constructive assessment of the health care system. Sample data from the Indian Health Service are presented and discussed.

Ambulatory Care↗