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Sample records for change physician performance

  1. A physician's due: measuring physician billing performance, benchmarking results.

    PubMed

    Woodcock, Elizabeth W; Browne, Robert C; Jenkins, Jennifer L

    2008-07-01

    A 2008 study focused on four key performance indicators (KPIs) and staffing levels to benchmark the FYO7 performance of physician group billing operations. A comparison of the change in the KPIs from FYO3 to FYO7 for a number of these billing operations disclosed across-the-board improvements. Billing operations did not show significant changes in staffing levels during this time, pointing to the existence of obstacles that prevent staff reductions in this area.

  2. [The changing role of physicians].

    PubMed

    Siegrist, J

    2012-09-01

    Despite a very successful process of professionalisation during the past 150 years, today's physicians face several challenges urging them to adapt their traditional professional role and the patient-physician relationship inherent in this role. Among these challenges, a growing economic influence on physicians' practices, new demands from particular groups of patients (consumerism, role of the Internet etc.), and increasing inter-professional competition deserve special attention. New evidence of an association between a stressful work environment and physician's increased health risks provides additional support in favour of this notion. This contribution suggests potential directions of change of the physician's role by pointing to (a) a growing 'feminisation' of medicine, (b) an even stronger emphasis on patient needs and (c) extended teamwork and inter-professional cooperation.

  3. Career changes among Saskatchewan physicians.

    PubMed Central

    Shaw, S; Goplen, G; Houston, D S

    1996-01-01

    OBJECTIVE: To determine how often Saskatchewan physicians changed career paths during medical training and practice. DESIGN: Population survey (mailed questionnaire). SETTING: Saskatchewan. PARTICIPANTS: All 1077 active members of the Saskatchewan Medical Association were sent a questionnaire; 493 (45.8%) responded. OUTCOME MEASURES: Long-term career goal or plan in next-to-last year of undergraduate medical school, probable choice of career if forced to choose at that time, and number of physicians who changed their field of training or practice at any time since graduation. RESULTS: In all, 57.8% (237/410) of the respondents were currently practising in a field different from that planned in their next-to-last year of medical school, 63.5% (275/436) were not practising in the field they would have chosen if forced to at that time, and 42.9% (211/492) had changed their field of training or practice at some time since graduation. Older physicians, those who graduated outside of Canada and specialists were the most likely to have changed career paths, family physicians, and those who graduated in Saskatchewan were the least likely to have changed. CONCLUSION: The current system of postgraduate training in Canada does not permit career changes of the sort made by most of the practising Saskatchewan physicians in the survey sample. The implications of this new system are as yet unknown but require careful monitoring. PMID:8625024

  4. Relationships of physician characteristics to performance quality and improvement.

    PubMed Central

    Payne, B C; Lyons, T F; Neuhaus, E

    1984-01-01

    The quality of ambulatory medical care provided by 1,135 physicians in five separate practice settings in the Midwest was measured using predetermined process criteria. Specialists performed better in their own areas of specialized training than did family/general practitioners or specialists performing outside their specialty areas. Physicians with fewer years of practice performed somewhat better than physicians with more years since medical school graduation. Board certification was not consistently related to performance. Performances of the physicians improved following quality assurance interventions in these sites. Differences in the rates of change in performance quality were not consistently related to any of the physician characteristics studied. PMID:6746295

  5. The Crucible of Physician Performance Reports

    PubMed Central

    2010-01-01

    Individualized physician performance reports are an emerging phenomena. The narrative piece examines one physician’s experience with individualized physician performance reports. Reforming the data collection process could enhance the value of the reports to stakeholders. PMID:20838915

  6. Physician Performance Assessment: Prevention of Cardiovascular Disease

    ERIC Educational Resources Information Center

    Lipner, Rebecca S.; Weng, Weifeng; Caverzagie, Kelly J.; Hess, Brian J.

    2013-01-01

    Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight…

  7. Physician Performance Assessment: Prevention of Cardiovascular Disease

    ERIC Educational Resources Information Center

    Lipner, Rebecca S.; Weng, Weifeng; Caverzagie, Kelly J.; Hess, Brian J.

    2013-01-01

    Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight…

  8. Measurement of Physicians' Performance Using Existing Techniques

    PubMed Central

    Sanazaro, Paul J.

    1980-01-01

    Existing techniques permit objective and valid measurement of limited elements of physicians' performance. These limited aspects, however, are of considerable importance to patients. The basic components of performance in medicine and surgery can be defined and used as the basis of organized programs for such evaluation. Interhospital comparisons can provide an effective impetus for assessing and improving performance of individual staff members when this is indicated. Professional auspices are needed for the development and application of methods that can provide continuing assurance that the clinical activity of physicians corresponds to contemporary standards. A system of incentives should be provided to physicians to promote their participation in voluntary programs of self-assessment. The incentives should be in the form of performance assessment credits, comparable in definition to continuing medical education credits, but granted for participation in an accredited program that objectively measures physicians' performance against national standards of the respective specialty. PMID:7222656

  9. Physician specialty societies and the development of physician performance measures.

    PubMed

    Ferris, Timothy G; Vogeli, Christine; Marder, Jessica; Sennett, Cary S; Campbell, Eric G

    2007-01-01

    Efforts to increase accountability in the delivery of care include attempts to measure performance of individual doctors. Although physician specialty societies may be best positioned to define best practices, they have not yet played a major role in the development of measures. We examined specialty society involvement in measure development through interviews and review of Web sites. We found that a minority (35 percent) of societies were engaged in developing performance measures. Key barriers included member reluctance, lack of resources for development, and problems with data collection; facilitators included strong leadership and the perception of increasing pressure for accountability.

  10. The physician executive in a changing world.

    PubMed

    Kaiser, L R

    1999-01-01

    Physicians are losing their historic franchise as sole and primary providers of medical care. In addition to eroding moral and scientific authority, physicians are also losing income and status. It is no wonder that physicians are retrenching--confused and angry about the increasing marginalization of their profession and about society's changing expectations. Physicians are caught in a transition zone between the world that was and the one that will soon be. This is destabilizing and causes great anxiety. Rather than being buffeted by changing social and cultural definitions of health care, physicians must become proactively involved in the future of their profession. Physicians can only do this by offering a better mental model of health, medicine, and the community. This cannot be a defensive retreat from engagement. Rather, it must be an imaginative vision, vigorously set forth--a vision that will enlist the support of all constituencies involved in the effort to improve the health and well-being of all members of our society. The physician executive needs to work with physicians to orchestrate this effort to create a new vision of health in the 21st century.

  11. Developing physicians as catalysts for change.

    PubMed

    George, Aaron E; Frush, Karen; Michener, J Lloyd

    2013-11-01

    Failures in care coordination are a reflection of larger systemic shortcomings in communication and in physician engagement in shared team leadership. Traditional medical care and medical education neither focus on nor inspire responses to the challenges of coordinating care across episodes and sites. The authors suggest that the absence of attention to gaps in the continuum of care has led physicians to attempt to function as the glue that holds the health care system together. Further, medical students and residents have little opportunity to provide feedback on care processes and rarely receive the training and support they need to assess and suggest possible improvements.The authors argue that this absence of opportunity has driven cynicism, apathy, and burnout among physicians. They support a shift in culture and medical education such that students and residents are trained and inspired to act as catalysts who initiate and expedite positive changes. To become catalyst physicians, trainees require tools to partner with patients, staff, and faculty; training in implementing change; and the perception of this work as inherent to the role of the physician.The authors recommend that medical schools consider interprofessional training to be a necessary component of medical education and that future physicians be encouraged to grow in areas outside the "purely clinical" realm. They conclude that both physician catalysts and teamwork are essential for improving care coordination, reducing apathy and burnout, and supporting optimal patient outcomes.

  12. The physician's response to climate change.

    PubMed

    Sarfaty, Mona; Abouzaid, Safiya

    2009-05-01

    Climate change will have an effect on the health and well-being of the populations cared for by practicing physicians. The anticipated medical effects include heat- and cold-related deaths, cardiovascular illnesses, injuries and mental harms from extreme weather events, respiratory illnesses caused by poor air quality, infectious diseases that emanate from contaminated food, water, or spread of disease vectors, the injuries caused by natural disasters, and the mental harm associated with social disruption. Within several years, such medical problems are likely to reach the doorsteps of many physicians. In the face of this reality, physicians should assume their traditional roles as medical professionals, health educators, and community leaders. Clinicians provide individual health services to patients, some of whom will be especially vulnerable to the emerging health consequences of global warming. Physicians also work in academic medical institutions and hospitals that educate and provide continuing medical education to students, residents, and practitioners. The institutions also produce a measurable carbon footprint. Societies of physicians at national, state, and local levels can choose to use their well-developed avenues of communication to raise awareness of the key issues that are raised by climate change as well as other environmental concerns that have profound implications for human health and well-being.

  13. Defining competencies and performance indicators for physicians in medical management.

    PubMed

    Lane, D S; Ross, V

    1998-04-01

    The recent and profound changes in the American health care delivery system have created a need for physicians who are trained and willing to assume a high level of responsibility for managing evolving health care organizations. Yet most physicians receive no formal training in medical administration and management because changes in medical school and residency education have lagged behind changes in clinical practice and reimbursement. To avoid haphazard approaches and unnecessary duplication of resources, it is important for physicians involved in managerial medicine to collectively identify competencies in this area needed in the marketplace. The American College of Preventive Medicine (ACPM), with funding from the Health Resources and Services Administration (HRSA), undertook an effort to identify competencies essential for physicians who will fill leadership roles in medical management. Like ACPM's earlier effort to develop core competencies in preventive medicine, this project drew upon the theoretical model of competency-based education. This article describes the strategy we followed in reaching consensus among a diverse group of physician executives and preventive medicine residency program directors, and includes the list of medical management competencies and performance indicators developed. Recurrent issues that can sidetrack competency development projects are also presented as well as suggestions for overcoming them. The competencies can serve as a framework for expanding current core preventive medicine training in management and administration and for developing new training programs to equip physicians with the special expertise they will need to provide management leadership within the changing landscape of health care delivery.

  14. Medicare physician payments: impacts of changes on rural physicians.

    PubMed

    Mueller, Keith J; MacKinney, A Clinton; McBride, Timothy D

    2006-09-01

    Medicare payment disproportionately impacts rural physicians compared to urban. For example, 51% of rural physicians, compared to 44% of urban physicians, receive at least 38% of their payments from Medicare.1 Thus, the Medicare physician payment system is of significant rural interest. In this policy brief, we present the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas. Specifically, we examine the impact of creating a floor of 1.00 in the geographic practice cost index (GPCI) for work expense. We also show the effects of the Medicare incentive payment (MIP) for providing services in shortage areas and of the bonus for practicing in a physician scarcity area. Our principal findings are the following: (1) Increases to the GPCI for work expense accounted for a substantial percentage of the two-year increases in total payment to physicians in rural payment areas. (2) Increases in the conversion factor (CF) (base payment) accounted for most of the increases in total payment in all but 6 of the 89 Medicare payment localities; in those 6 areas, the dominant factor was GPCI adjustment. (3) Bonus payments are a more direct means of targeting increased payments to physicians in specific areas than is a general increase in one part of the payment formula.

  15. Professional activity. How is family physicians' work time changing?

    PubMed Central

    Woodward, C. A.; Ferrier, B.; Cohen, M.; Brown, J.

    2001-01-01

    OBJECTIVE: To examine hours worked professionally, work preferences, and changes in both of these and their correlates. DESIGN: Repeated surveys done in 1993 and 1999. SETTING: Ontario family practices. PARTICIPANTS: Cohort of physicians certified in family medicine between 1989 and 1991 after family medicine residency who were surveyed in 1993 when they resided in Ontario. MAIN OUTCOME MEASURES: Self-reported hours spent weekly on professional activities, desired hours of professional work, and balance between work and other activities. RESULTS: Fifty-three percent (293) of 553 physicians responded to the 1999 survey; 91% had remained family physicians; 85% of these had participated in the 1993 survey. The difference between the hours that family physicians preferred to work professionally and their actual hours of work had increased since 1993. Childless physicians, women physicians with preschool children, and women physicians married to other physicians worked fewer hours professionally than other physicians in 1999. Female physicians and physicians without children worked closer to their preferred hours than other physicians. Reporting a preference to work fewer hours professionally in 1993 was linked with a reduction in professional activities by 1999. CONCLUSION: Greater attention should be paid in physician resource planning to the family life cycle of female physicians. Lifestyle changes could lead to a reduction in professional activity among these physicians. PMID:11494929

  16. Physician performance feedback in a Canadian academic center.

    PubMed

    Garvin, Dennis; Worthington, James; McGuire, Shaun; Burgetz, Stephanie; Forster, Alan J; Patey, Andrea; Gerin-Lajoie, Caroline; Turnbull, Jeffrey; Roth, Virginia

    2017-09-11

    Purpose This paper aims at the implementation and early evaluation of a comprehensive, formative annual physician performance feedback process in a large academic health-care organization. Design/methodology/approach A mixed methods approach was used to introduce a formative feedback process to provide physicians with comprehensive feedback on performance and to support professional development. This initiative responded to organization-wide engagement surveys through which physicians identified effective performance feedback as a priority. In 2013, physicians primarily affiliated with the organization participated in a performance feedback process, and physician satisfaction and participant perceptions were explored through participant survey responses and physician leader focus groups. Training was required for physician leaders prior to conducting performance feedback discussions. Findings This process was completed by 98 per cent of eligible physicians, and 30 per cent completed an evaluation survey. While physicians endorsed the concept of a formative feedback process, process improvement opportunities were identified. Qualitative analysis revealed the following process improvement themes: simplify the tool, ensure leaders follow process, eliminate redundancies in data collection (through academic or licensing requirements) and provide objective quality metrics. Following physician leader training on performance feedback, 98 per cent of leaders who completed an evaluation questionnaire agreed or strongly agreed that the performance feedback process was useful and that training objectives were met. Originality/value This paper introduces a physician performance feedback model, leadership training approach and first-year implementation outcomes. The results of this study will be useful to health administrators and physician leaders interested in implementing physician performance feedback or improving physician engagement.

  17. Physician’s Assistants Attitudes and Performance

    DTIC Science & Technology

    1978-06-01

    Sick Call 2 Physicals Exams 43 ’Heekend Sick Call 2 Field Duty/Down Range 29 Preventive Med Officer 2 Stockade 27 OIC 2 Sports coverage 21 Lecturer...Psychiatry Primary/Health Care Clinic 23 Podiatry Aid Station/Squadron Air Station 19 Surgery In Bn 15 Where Needed Dispensary 13 Delivering Babies...in ER 1 Dealing with TM Problem 1 As Physician under supervision 1 Replacement for GMO 1 Podiatry /Orthopedics 1 Help physician TMC level deal with

  18. Can visual arts training improve physician performance?

    PubMed

    Katz, Joel T; Khoshbin, Shahram

    2014-01-01

    Clinical educators use medical humanities as a means to improve patient care by training more self-aware, thoughtful, and collaborative physicians. We present three examples of integrating fine arts - a subset of medical humanities - into the preclinical and clinical training as models that can be adapted to other medical environments to address a wide variety of perceived deficiencies. This novel teaching method has promise to improve physician skills, but requires further validation.

  19. Can Visual Arts Training Improve Physician Performance?

    PubMed Central

    Katz, Joel T.; Khoshbin, Shahram

    2014-01-01

    Clinical educators use medical humanities as a means to improve patient care by training more self-aware, thoughtful, and collaborative physicians. We present three examples of integrating fine arts — a subset of medical humanities — into the preclinical and clinical training as models that can be adapted to other medical environments to address a wide variety of perceived deficiencies. This novel teaching method has promise to improve physician skills, but requires further validation. PMID:25125749

  20. Physician Pay-For-Performance: Implementation and Research Issues

    PubMed Central

    Christianson, Jon B; Knutson, David J; Mazze, Roger S

    2006-01-01

    Recent research underscores the gaps that exist between evidence-based medical practices and the care that many patients actually receive. Recognizing this, large purchasers are experimenting with new reimbursement arrangements called pay-for-performance (P4P) that tie a portion of payments for physician services to measures of quality. Agency theory, from the discipline of economics, provides a perspective on the challenges P4P is likely to encounter. The focus of most P4P initiatives on medical group performance raises additional questions about its potential effectiveness as a catalyst for change. PMID:16637965

  1. Performance assessment. Family physicians in Montreal meet the mark!

    PubMed Central

    Goulet, François; Jacques, André; Gagnon, Robert; Bourbeau, Denis; Laberge, Denis; Melanson, Jacques; Ménard, Claude; Racette, Pierre; Rivest, Raymond

    2002-01-01

    OBJECTIVE: To assess the clinical performance of a representative non-volunteer sample of family physicians in metropolitan Montreal, Que. DESIGN: Assessment of clinical performance was based on inspection visits to offices, peer review of medical records, and chart-stimulated recall interviews. The procedure was the one usually followed by the Professional Inspection Committee of the Collège des médecins du Québec. SETTING: Family physicians' practices in metropolitan Montreal. PARTICIPANTS: One hundred randomly selected family physicians. INTERVENTIONS: For each physician, 30 randomly chosen patient charts with data on three to five previous visits were reviewed using explicit criteria and a standard scale using global scores from 1 to 5 (unacceptable to excellent). MAIN OUTCOME MEASURES: Scores were assigned for office practices; record keeping; number of continuing medical education (CME) activities; and quality of clinical performance assessed in terms of investigation plan, diagnostic accuracy, treatment plan, and relevance of care. RESULTS: Overall performance was judged to be good to excellent for 98% of physicians in their private practices; for 90% of physicians concerning CME activities; for 94% of physicians concerning their clinical performance in terms of quality of care; and for 75% of physicians as to record keeping. There was a link between record keeping and quality of care as well as between the number of CME activities and quality of care. CONCLUSION: The overall clinical performance of family physicians in the greater Montreal region is excellent. PMID:12228963

  2. Physician performance and racial disparities in diabetes mellitus care.

    PubMed

    Sequist, Thomas D; Fitzmaurice, Garrett M; Marshall, Richard; Shaykevich, Shimon; Safran, Dana Gelb; Ayanian, John Z

    2008-06-09

    Little information is available regarding variations in diabetes mellitus (DM) outcomes by race at the level of individual physicians. We identified 90 primary physicians caring for at least 5 white and 5 black adults with DM across 13 ambulatory sites and calculated rates of ideal control of hemoglobin A(1c) (HbA(1c)) (<7.0%), low-density lipoprotein cholesterol (LDL-C) (<100 mg/dL), and blood pressure (<130/80 mm Hg). We fitted hierarchical linear regression models to measure the contributions to racial disparities of patient sociodemographic factors, comorbidities, and physician effects. Physician effects modeled the extent to which black patients achieved lower control rates than white patients within the same physician's panel ("within-physician" effect) vs the extent to which black patients were more likely than white patients to receive care from physicians achieving lower overall control rates ("between-physician" effect). White patients (N = 4556) were significantly more likely than black patients (N = 2258) to achieve control of HbA(1c) (47% vs 39%), LDL-C (57% vs 45%), and blood pressure (30% vs 24%; P < .001 for all comparisons). Patient sociodemographic factors explained 13% to 38% of the racial differences in these measures, whereas within-physician effects accounted for 66% to 75% of the differences. Physician-level variation in disparities was not associated with either individual physicians' overall performance or their number of black patients with DM. Racial differences in DM outcomes are primarily related to patients' characteristics and within-physician effects, wherein individual physicians achieve less favorable outcomes among their black patients than their white patients. Efforts to eliminate these disparities, including race-stratified performance reports and programs to enhance care for minority patients, should be addressed to all physicians.

  3. Dynamics of change in local physician supply: an ecological perspective.

    PubMed

    Jiang, H Joanna; Begun, James W

    2002-05-01

    The purpose of this study is to employ an ecological framework to identify factors that have an impact on change in local physician supply within the USA. A particular specialty type of patient care physicians in a local market is defined as a physician population. Four physician populations are identified: generalists, medical specialists, surgical specialists, and hospital-based specialists. Based on population ecology theory, the proposed framework explains the growth of a particular physician population by four mechanisms: the intrinsic properties of this physician population; the local market's carrying capacity, which is determined by three environmental dimensions (munificence, concentration, diversity); competition within the same physician population; and interdependence between different physician populations. Data at the level of Metropolitan Statistical Areas (MSAs) were compiled from the US Area Resources File, the American Hospital Association Annual Surveys of Hospitals, the American Medical Association Census of Medical Groups, the InterStudy National HMO Census, and the US County Business Patterns. Changes in the number and percentage of physicians in a particular specialty population from 1985 to 1994 were regressed, respectively, on 1985-94 changes in the explanatory variables as well as their levels in 1985. The results indicate that the population ecology framework is useful in explaining dynamics of change in the local physician workforce. Variables measuring the three environmental dimensions were found to have significant, and in some cases, differential effects on change in the size of different specialty populations. For example, both hospital consolidation and managed care penetration showed significant positive eflects on growth of the generalist population but suppressing effects on growth of the specialist population. The percentage of physicians in a particular specialty population in 1985 was negatively related to change in the size

  4. Changes in physician antipsychotic prescribing preferences, 2002-2007.

    PubMed

    Donohue, Julie; O'Malley, A James; Horvitz-Lennon, Marcela; Taub, Anna Levine; Berndt, Ernst R; Huskamp, Haiden A

    2014-03-01

    Physician antipsychotic prescribing behavior may be influenced by comparative effectiveness evidence, regulatory warnings, and formulary and other restrictions on these drugs. This study measured changes in the degree to which physicians are able to customize treatment choices and changes in physician preferences for specific agents after these events. The study used 2002-2007 prescribing data from the IMS Health Xponent database and data on physician characteristics from the American Medical Association for a longitudinal cohort of 7,399 physicians. Descriptive and multivariable regression analyses were conducted of the concentration of prescribing (physician-level Herfindahl index) and preferences for and likelihood of prescribing two first-generation antipsychotics and six second-generation antipsychotics. Analyses adjusted for prescribing volume, specialty, demographic characteristics, practice setting, and education. Antipsychotic prescribing was highly concentrated at the physician level, with a mean unadjusted Herfindahl index of .33 in 2002 and .29 in 2007. Psychiatrists reduced the concentration of their prescribing more over time than did other physicians. High-volume psychiatrists had a Herfindahl index that was half that of low-volume physicians in other specialties (.18 versus .36), a difference that remained significant (p<.001) after adjustment for physician characteristics. The share of physicians preferring olanzapine dropped from 29.9% in 2002 to 10.3% in 2007 (p<.001) while the share favoring quetiapine increased from 9.4% to 44.5% (p<.001). Few physicians (<5%) preferred a first-generation antipsychotic in 2002 or 2007. Preferences for specific antipsychotics changed dramatically during this period. Although physician prescribing remained heavily concentrated, the concentration decreased over time, particularly among psychiatrists.

  5. The Changing Distribution of Physicians in Regionville.

    ERIC Educational Resources Information Center

    Sorensen, Andrew A.; Kunitz, Stephen J.

    1978-01-01

    The consequences of medical reform, the myth of the family doctor, the importance of foreign medical graduates in providing medical care, the importance of facilities and innovative practice settings for the attraction of physicians, and the significance of suburbanization in influencing the growth of the local service sector are addressed in this…

  6. Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007

    PubMed Central

    Donohue, Julie; O'Malley, A. James; Horvitz-Lennon, Marcela; Taub, Anna Levine; Berndt, Ernest; Huskamp, Haiden

    2014-01-01

    Objective Evidence on antipsychotic comparative effectiveness, regulatory warnings, and formulary and other restrictions on antipsychotics may have influenced physician prescribing behavior. This study measured changes in the degree to which physicians customize treatment choices to individual patients and changes in physician preferences for specific agents following these events. Methods The study used 2002-2007 data from IMS Health Xponent™ and the AMA on the prescribing and characteristics of a longitudinal cohort of 7,399 physicians. Descriptive and multivariable regression analyses of the concentration of prescribing (physician-level Herfindahl index), and preferences for and likelihood of prescribing 2 first-generation antipsychotics and 6 second-generation antipsychotics adjusting for prescribing volume, specialty, demographics, practice setting and education were conducted. Results Antipsychotic prescribing was highly concentrated at the physician-level, with a mean unadjusted Herfindahl index of .33 in 2002 and .29 in 2007. Psychiatrists reduced the concentration of their prescribing more over time than did other physicians. High volume psychiatrists had a Herfindahl that was half that of low-volume physicians in other specialties (.18 vs. .36), a difference that remained significant (p<.001) after adjusting for physician characteristics. The share of physicians preferring olanzapine dropped from 29.9% in 2002 to 10.3% in 2007 (p<.001) while the share favoring quetiapine increased (from 9.4% to 44.5%, p<.001). Few physicians (<5%) preferred a first-generation antipsychotic in 2002 or 2007. Conclusions Preferences for specific antipsychotics changed dramatically during this period. While physician prescribing remained heavily concentrated, it did decrease over time, particularly among psychiatrists. PMID:24337224

  7. Physicians with MBA degrees: change agents for healthcare improvement.

    PubMed

    Lazarus, Arthur

    2010-01-01

    Increasingly, physicians gravitating toward the fields of quality improvement and healthcare management are seeking MBA degrees to supplement their medical training. Approximately half of all U.S. medical schools offer combined MD-MBA degrees, and numerous executive MBA programs exist for physicians in practice. Physicians who enter management are considered change agents for healthcare improvement, yet they receive little support and encouragement from their medical teachers and practicing colleagues. This situation can be rectified by placing greater value on the role of business-trained physicians and subsidizing their tuition for business school.

  8. Physician leadership: a roadmap for health-system change.

    PubMed

    Solomon, Robert J

    2004-01-01

    Physician involvement in health-system decision making and their support of health-system initiatives can be critical to a health system's success. Many physicians, however, do not have the business skills or perspective to be effective contributors. This paper identifies three levels of physician leader development: awareness and head knowledge; creating an "us" culture; and taking ownership of the marketplace. It also identifies three physician leader-development methods that health systems can use to reach these points: integrated executive education; project-based learning; and facilitating ownership. Based on health-system objectives, top management should choose an appropriate level of physician leader development and then implement an appropriate change plan by using the proposed physician leader-development methods.

  9. Physician practice management organizations: their prospects and performance.

    PubMed

    Conrad, D A; Koos, S; Harney, A; Haase, M

    1999-09-01

    As physician organizations adapt their incentives, processes, and structures to accommodate the demands of an increasingly competitive and performance-sensitive external environment, the development of more effective administrative and managerial mechanisms becomes critical to success. The emergence of physician practice management companies (PPMCs) represents a potentially positive step for physician practices seeking increased economies of scale through consolidation, as well as enhanced access to financial capital. However, economic and finance theory, coupled with some empirical "arithmetic" regarding the financial and operational performance of leading publicly traded PPMCs, suggest caution in one's forecasts of the future prospects for these evolving corporate forms.

  10. Motivating physician behaviour change: social influence versus financial contingencies.

    PubMed

    Goodpastor, W A; Montoya, I D

    1996-01-01

    The recent development of clinical practice heuristics is a logical consequence of outcomes and effectiveness research. Proponents of clinical practice guidelines (CPGs) believe they will lower costs, enhance quality, and reduce the incidence of malpractice claims. Although the process for generating CPGs appears relatively uncomplicated, guidelines alone do not produce lasting changes in physician behaviour. Discusses strategies for implementing CPGs based on the various factors that influence physician behaviour. Recommends direct behaviour management strategy based on financial contingencies.

  11. Assessing individual clinical performance: a primer for physicians.

    PubMed

    Scott, I A; Phelps, G; Brand, C

    2011-02-01

    The assessment of individual physician performance has attracted interest from several quarters, including statutory licensing agencies and credentialing bodies of healthcare institutions. Performance measures and assessment methods have been developed, although their validity, reliability and feasibility in regards to physician specialty practice are open to challenge. Despite this, professional colleges and societies will be increasingly obliged to ensure their members are demonstrating high-quality performance on the basis of assessment methods viewed as being transparent, impartial and reproducible. This article provides an overview of the current state of the art which hopefully will serve to inform future debate both within and outside professional circles.

  12. Misclassification Risk of Tier-Based Physician Quality Performance Systems.

    PubMed

    Adams, John L; Paddock, Susan M

    2017-08-01

    There is increasing interest in identifying high-quality physicians, such as whether physicians perform above or below a threshold level. To evaluate whether current methods accurately distinguish above- versus below-threshold physicians, we estimate misclassification rates for two-category identification systems. Claims data for Medicare fee-for-service beneficiaries residing in Florida or New York in 2010. Estimate colorectal cancer, glaucoma, and diabetes quality scores for 23,085 physicians. Use a beta-binomial model to estimate physician score reliabilities. Compute the proportion of physicians whose performance tier would be misclassified under three scoring systems. In the three scoring systems, misclassification ranges were 8.6-25.7 percent, 6.4-22.8 percent, and 4.5-21.7%. True positive rate ranges were 72.9-97.0 percent, 83.4-100.0 percent, and 34.7-88.2 percent. True negative rate ranges were 68.5-91.6 percent, 10.5-92.4 percent, and 81.1-99.9 percent. Positive predictive value ranges were 70.5-91.6 percent, 77.0-97.3 percent, and 55.2-99.1 percent. Current methods for profiling physicians on quality may produce misleading results, as the number of eligible events is typically small. Misclassification is a policy-relevant measure of the potential impact of tiering on providers, payers, and patients. Quantifying misclassification rates should inform the construction of high-performance networks and quality improvement initiatives. © Health Research and Educational Trust.

  13. How Do Physicians Assess Their Family Physician Colleagues' Performance? Creating a Rubric to Inform Assessment and Feedback

    ERIC Educational Resources Information Center

    Sargeant, Joan; MacLeod, Tanya; Sinclair, Douglas; Power, Mary

    2011-01-01

    Introduction: The Colleges of Physicians and Surgeons of Alberta and Nova Scotia (CPSNS) use a standardized multisource feedback program, the Physician Achievement Review (PAR/NSPAR), to provide physicians with performance assessment data via questionnaires from medical colleagues, coworkers, and patients on 5 practice domains: consultation…

  14. How Do Physicians Assess Their Family Physician Colleagues' Performance? Creating a Rubric to Inform Assessment and Feedback

    ERIC Educational Resources Information Center

    Sargeant, Joan; MacLeod, Tanya; Sinclair, Douglas; Power, Mary

    2011-01-01

    Introduction: The Colleges of Physicians and Surgeons of Alberta and Nova Scotia (CPSNS) use a standardized multisource feedback program, the Physician Achievement Review (PAR/NSPAR), to provide physicians with performance assessment data via questionnaires from medical colleagues, coworkers, and patients on 5 practice domains: consultation…

  15. Developing effective physician leaders: changing cultures and transforming organizations.

    PubMed

    McAlearney, Ann Scheck; Fisher, David; Heiser, Karen; Robbins, Darryl; Kelleher, Kelly

    2005-01-01

    In this article, the authors discuss the problematic issue of transformational change in the face of cultural conflict between the worlds of clinical care and organizational leadership, and describe a case study of organizational cultural change facilitated through a physician leadership development program. A locally developed physician leadership program can be extremely effective at both improving physicians' leadership skills and increasing understanding of the strategic goals and direction of the organization. The transformational change required for physicians to develop and appreciate business and leadership skills can be supported and encouraged in a leadership development program that includes the components of careful curriculum design, program monitoring, and opportunities to apply new skills in practice. For Columbus Children's Hospital, Columbus, Ohio, this organizational transformational change effort was successfully achieved when a new medical leadership development program helped academic and community physicians to become involved in organizational leadership. The authors describe the background and development of this program and provide results of their evaluation of the program, with discussion of future extensions to the program.

  16. Measuring and Reporting Physician's Performance in a University Medical Center.

    ERIC Educational Resources Information Center

    Kazan-Fishman, Ana Lucia

    This paper describes a Patient Satisfaction survey and database used to measure and report on physician performance at the Ohio State University Health System (OSUHS). The OSUHS averages 6,000 inpatients in any given month, and more than 7,000 emergency patients and 70,000 outpatient encounters. Data from the Patient Satisfaction measures are…

  17. The Kubler-Ross model, physician distress, and performance reporting.

    PubMed

    Smaldone, Marc C; Uzzo, Robert G

    2013-07-01

    Physician performance reporting has been proposed as an essential component of health-care reform, with the aim of improving quality by providing transparency and accountability. Despite strong evidence demonstrating regional variation in practice patterns and lack of evidence-based care, public outcomes reporting has been met with resistance from medical professionals. Application of the Kubler-Ross 'five stages of grief' model--a conceptual framework consisting of a series of emotional stages (denial, anger, bargaining, depression, and acceptance) inspired by work with terminally ill patients--could provide some insight into why physicians are reluctant to accept emerging quality-reporting mechanisms. Physician-led quality-improvement initiatives are vital to contemporary health-care reform efforts and applications in urology, as well as other medical disciplines, are currently being explored.

  18. Who, me? An employee? The changing schemes of physician compensation.

    PubMed

    Rodeghero, J A

    1994-11-15

    Politicians may have written a temporary obituary for healthcare reform, but as anyone in medicine knows, reform is alive and (debatably) well. Mergers, acquisitions, and practice changes are happening all across the land, and many a physician is going from being a small-business owner to being an employee. Difficult choices lie ahead that could affect the setting in which you practice, the way you practice, and the amount and way you are paid. Dr Rodeghero, a health compensation analyst and consultant, examines reform from the viewpoint of physician compensation.

  19. A Continuing Medical Education Lecture and Workshop, Physician Behavior, and Barriers To Change.

    ERIC Educational Resources Information Center

    Paprockas, Ken; Parochka, Jacqueline

    2001-01-01

    A 6-month follow-up study of 176 physicians who attended a breast cancer lecture/workshop found that 92 changed practice regarding tamoxifen; many now performed risk assessments on all patients. Barriers to change included lack of colleague consensus, lack of time for assessment and patient counseling, and lack of insurance reimbursement. (SK)

  20. Physician remuneration methods: the need for change and flexibility.

    PubMed

    Wright, C J

    1996-03-01

    Although fee-for-service payment may create an incentive for some physicians to make inappropriate clinical decisions that will maximize income, physicians are no more prone to this kind of behaviour than other professionals. Remuneration methods do not necessarily have a predictable effect upon practice, as shown by Hutchison and associates' report in this issue (see pages 653 to 661) that the capitation system used by Health Service Organizations in Ontario has not had the intended effect of reducing hospital utilization. However, many essential activities performed by physicians do not fit in a fee-for-service system. The real challenge is to achieve flexibility and balance in any payment system to correct the prevailing gross inequities between different areas of practice and to ensure that disincentives for activities such as health promotion and health service evaluation are eliminated.

  1. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    PubMed Central

    Kaye, Alan David; Okanlawon, Olutoyin J; Urman, Richard D

    2014-01-01

    Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The “buy-in” includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care. PMID:24833948

  2. Relationship between job satisfaction and performance of primary care physicians after the family physician reform of east Azerbaijan province in Northwest Iran.

    PubMed

    Jabbari, Hossein; Pezeshki, Mohamad Zakarria; Naghavi-Behzad, Mohammad; Asghari, Mohammad; Bakhshian, Fariba

    2014-01-01

    Following the implementation of family physician program in 2004 in Iranian healthcare system, the understanding in changes in physicians' practice has become important. The objective of this study was to determine the level of family physicians' job satisfaction and its relationship with their performance level. A cross-sectional study was conducted among all 367 family physicians of East Azerbaijan province in during December 2009 to May 2011 using a self-administered, anonymous questionnaire for job satisfaction. The performance scores of primary care physicians were obtained from health deputy of Tabriz Medical University. In this study, overall response rate was 64.5%. The average score of job satisfaction was 42.10 (±18.46), and performance score was 87.52 (±5.74) out of 100. There was significant relationships between working history and job satisfaction (P = 0.014), marital status (P = 0.014), and sex (P = 0.018) with performance among different personal and organizational variables. However, there was no significant relationship between job satisfaction and performance, but satisfied people had about three times better performance than their counterparts (all P < 0.05). The low scores of family physicians in performance and job satisfaction are obvious indications for more extensive research in identifying causes and finding mechanisms to improve the situation, especially in payment methods and work condition, in existing health system.

  3. Part III. Performance measurements of primary care physicians in managed care.

    PubMed

    Dent, T

    1998-08-01

    A fundamental change occurring for physicians is that there are increasingly organized efforts to comprehensively assess physician performance. Managed care is the factor most instrumental in leading to an enhanced focus on physician measurements. Another major factor that has prompted increased attention to the measurement of physicians' performance is that patients are beginning to act more as consumers of health care. Efforts to measure physician performance in geographically dispersed primary care practices is inherently more difficult than measuring hospital care. However, according to some studies that have attempted to do this, the delivery in primary care offices of basic preventive services and the care given to patients with chronic illnesses is surprisingly poor. If primary care physicians don't address these issues, managed care companies will make it policy to refer some patients with chronic disease to specialists, who are comprehensively achieving higher measurement scores. What is being measured is at present quite variable in different primary care offices. Most of the initial measurements have been from claims data or from other data that might be obtained and aggregated outside of the primary care physician's office. As this data is not very rich in clinical information, significant misinterpretation is possible. In order to augment these shortcomings, office records are increasingly being reviewed. A standardization of primary care physicians' office medical records is rapidly occurring and is being driven by the measurable items reviewed by managed care organizations. Measurement of patient complaints and patient surveys is another means that managed care organizations presently use to assess primary care physicians' performance. Extreme caution should be used when interpreting this data, as often the small numbers of patients, multifactorial issues, and ambiguity about responsible parties may skew the results. Measurement processes are

  4. Asian-American Patient Ratings of Physician Primary Care Performance

    PubMed Central

    Taira, Deborah A; Safran, Dana Gelb; Seto, Todd B; Rogers, William H; Kosinski, Mark; Ware, John E; Lieberman, Naomi; Tarlov, Alvin R

    1997-01-01

    OBJECTIVE To examine how Asian-American patients’ ratings of primary care performance differ from those of whites, Latinos, and African-Americans. DESIGN Retrospective analyses of data collected in a cross-sectional study using patient questionnaires. SETTING University hospital primary care group practice. PARTICIPANTS In phase 1, successive patients who visited the study site for appointments were asked to complete the survey. In phase 2, successive patients were selected who had most recently visited each physician, going back as far as necessary to obtain 20 patients for each physician. In total, 502 patients were surveyed, 5% of whom were Asian-American. MAIN RESULTS After adjusting for potential confounders, Asian-Americans rated overall satisfaction and 10 of 11 scales assessing primary care significantly lower than whites did. Dimensions of primary care that were assessed include access, comprehensiveness of care, integration, continuity, clinical quality, interpersonal treatment, and trust. There were no differences for the scale of longitudinal continuity. On average, the rating scale scores of Asian-Americans were 12 points lower than those of whites (on 100-point scales). CONCLUSIONS We conclude that Asian-American patients rate physician primary care performance lower than do whites, African-Americans, and Latinos. Future research needs to focus on Asian-Americans to determine the generalizability of these findings and the extent to which they reflect differences in survey response tendencies or actual quality differences. PMID:9127228

  5. High-performance teams and the physician leader: an overview.

    PubMed

    Majmudar, Aalap; Jain, Anshu K; Chaudry, Joseph; Schwartz, Richard W

    2010-01-01

    The complexity of health care delivery within the United States continues to escalate in an exponential fashion driven by an explosion of medical technology, an ever-expanding research enterprise, and a growing emphasis on evidence-based practices. The delivery of care occurs on a continuum that spans across multiple disciplines, now requiring complex coordination of care through the use of novel clinical teams. The use of teams permeates the health care industry and has done so for many years, but confusion about the structure and role of teams in many organizations contributes to limited effectiveness and suboptimal outcomes. Teams are an essential component of graduate medical education training programs. The health care industry's relative lack of focus regarding the fundamentals of teamwork theory has contributed to ineffective team leadership at the physician level. As a follow-up to our earlier manuscripts on teamwork, this article clarifies a model of teamwork and discusses its application to high-performance teams in health care organizations. Emphasized in this discussion is the role played by the physician leader in ensuring team effectiveness. By educating health care professionals on the fundamentals of high-performance teamwork, we hope to stimulate the development of future physician leaders who use proven teamwork principles to achieve the goals of trainee education and excellent patient care.

  6. Physician group cultural dimensions and quality performance indicators: not all is equal.

    PubMed

    Smalarz, Amy

    2006-01-01

    A group practice culture survey measured the cultural dimensions of physician groups, and their relationship to group quality performance was explored. Cultural dimensions were statistically significant in explaining variance of quality performance among the physician groups studied. However, different cultural dimensions contributed to each of the quality performance indicators measured. Thus, cultural dimensions are important factors influencing physician groups' quality performance.

  7. Forecasting change in Louisiana physician age cohorts: 1994-2020.

    PubMed

    Sessions, Blane A; Hilton, Charles W; Chauvin, Sheila W; Yang, Tong

    2006-01-01

    A shortage of physicians is predicted in the near future, as there is a mismatch between the supply and demand for physicians. Our objective was to examine what effect an aging Louisiana physician population might have on these forecasts using data from the American Medical Association and population projections from the Louisiana Population Data Center. Our results propose a considerable rise in the number of Louisiana physicians who are older, with growth in younger physicians being continually flat. We forecast 44.2 percent of Louisiana physicians will be over 55 years of age in the year 2020. Acknowledging many limitations of a study such as this, we believe an aging physician population might lead to an overall decrease in the effective physician supply of Louisiana in the future.

  8. Night shift decreases cognitive performance of ICU physicians.

    PubMed

    Maltese, François; Adda, Mélanie; Bablon, Amandine; Hraeich, Sami; Guervilly, Christophe; Lehingue, Samuel; Wiramus, Sandrine; Leone, Marc; Martin, Claude; Vialet, Renaud; Thirion, Xavier; Roch, Antoine; Forel, Jean-Marie; Papazian, Laurent

    2016-03-01

    The relationship between tiredness and the risk of medical errors is now commonly accepted. The main objective of this study was to assess the impact of an intensive care unit (ICU) night shift on the cognitive performance of a group of intensivists. The influence of professional experience and the amount of sleep on cognitive performance was also investigated. A total of 51 intensivists from three ICUs (24 seniors and 27 residents) were included. The study participants were evaluated after a night of rest and after a night shift according to a randomized order. Four cognitive skills were tested according to the Wechsler Adult Intelligence Scale and the Wisconsin Card Sorting Test. All cognitive abilities worsened after a night shift: working memory capacity (11.3 ± 0.3 vs. 9.4 ± 0.3; p < 0.001), speed of processing information (13.5 ± 0.4 vs. 10.9 ± 0.3; p < 0.001), perceptual reasoning (10.6 ± 0.3 vs. 9.3 ± 0.3; p < 0.002), and cognitive flexibility (41.2 ± 1.2 vs. 44.2 ± 1.3; p = 0.063). There was no significant difference in terms of level of cognitive impairment between the residents and ICU physicians. Only cognitive flexibility appeared to be restored after 2 h of sleep. The other three cognitive skills were altered, regardless of the amount of sleep during the night shift. The cognitive abilities of intensivists were significantly altered following a night shift in the ICU, regardless of either the amount of professional experience or the duration of sleep during the shift. The consequences for patients' safety and physicians' health should be further evaluated.

  9. Physician-Patient Encounters: The Structure of Performance in Family and General Office Practice

    ERIC Educational Resources Information Center

    Wenghofer, Elizabeth F.; Williams, A. Paul; Klass, Daniel J.; Faulkner, Daniel

    2006-01-01

    Introduction: The College of Physicians and Surgeons of Ontario, the regulatory authority for physicians in Ontario, Canada, conducts peer assessments of physicians' practices as part of a broad quality assurance program. Outcomes are summarized as a single score and there is no differentiation between performance in various aspects of care. In…

  10. Physician-Patient Encounters: The Structure of Performance in Family and General Office Practice

    ERIC Educational Resources Information Center

    Wenghofer, Elizabeth F.; Williams, A. Paul; Klass, Daniel J.; Faulkner, Daniel

    2006-01-01

    Introduction: The College of Physicians and Surgeons of Ontario, the regulatory authority for physicians in Ontario, Canada, conducts peer assessments of physicians' practices as part of a broad quality assurance program. Outcomes are summarized as a single score and there is no differentiation between performance in various aspects of care. In…

  11. Influence of Remedial Professional Development Programs for Poorly Performing Physicians

    ERIC Educational Resources Information Center

    Goulet, Francois; Gagnon, Robert; Gingras, Marie-Eve

    2007-01-01

    Introduction: The College des medecins du Quebec (CMQ) offers an individualized remedial professional development program to help physicians overcome selected clinical shortcomings. To measure the influence of the remedial professional development program, physicians who completed the program between 1993 and 2004 and who were assessed by peer…

  12. Communicating bodily changes: physicians' ways of enabling patient understanding in gastrointestinal cancer consultations.

    PubMed

    Friberg, Febe; Lidén, Eva; Håkanson, Cecilia; Öhlén, Joakim

    2015-06-01

    To explore how physicians communicatively enable patients' understanding of bodily changes in gastrointestinal cancer care consultations. Two datasets were used. The first consisted of transcribed video-recorded palliative care consultations with three oncologists and six patients diagnosed with advanced gastrointestinal cancer, in the context of outpatient palliative care. The second dataset was audio-recorded transcriptions from diagnostic consultations with six surgeons and seven patients diagnosed with colorectal cancer, in the context of cancer surgery. An inductively driven and iterative analysis of interaction was performed, guided by Wetherell et al. (2001). Two overarching communicative strategies were identified: (1) "visualizing strategies," with the dimensions: visible strategies (visualizing with what you actually or potentially can see), sensory strategies (visualizing with what is possible to feel), and imaginative strategies; and (2) "contrasting strategies," with the dimensions: contrasting subjective experiences and contrasting between the patient and other people. The visualizing and contrasting communicative strategies form parts of physicians' tacit and experience-based knowledge. The strategies employed by physicians reveal clear potentials to enable patients' understanding and sense making of bodily changes. However, these strategies need to be explicated and problematized as parts of both consultation practice and basic medical education. By means of increased awareness, physicians can more easily identify turning points in patients' levels of understanding, thereby enriching ordinary medical consultations with reflected pedagogical strategies and skills in how to dialogue in a person-centered manner.

  13. Organizational and market influences on physician performance on patient experience measures.

    PubMed

    Rodriguez, Hector P; von Glahn, Ted; Rogers, William H; Safran, Dana Gelb

    2009-06-01

    To examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures. This study employs Clinician and Group CAHPS survey data (n=105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies. Primary care services area (PCSA) data were used to characterize the market environment of physician practices. We used multilevel models to estimate the relationship between medical group and market factors and physician performance on each Clinician and Group CAHPS measure. Models statistically controlled for respondent characteristics and accounted for the clustering of respondents within physicians, physicians within medical groups, and medical groups within PCSAs using random effects. Compared with physicians belonging to independent practice associations, physicians belonging to integrated medical groups had better performance on the communication ( p=.007) and care coordination ( p=.03) measures. Physicians belonging to medical groups with greater numbers of PCPs had better performance on all measures. The use of patient experience improvement strategies was not associated with performance. Greater emphasis on productivity and efficiency criteria in individual physician financial incentive formulae was associated with worse access to care ( p=.04). Physicians located in PCSAs with higher area-level deprivation had worse performance on the access to care ( p=.04) and care coordination ( p<.001) measures. Physicians from integrated medical groups and groups with greater numbers of PCPs performed better on several patient experience measures, suggesting that organized care processes adopted by these groups may enhance patients' experiences. Physicians practicing

  14. Changes to physician processing times in response to clinic congestion and patient punctuality: a retrospective study

    PubMed Central

    Chambers, Chester G; Dada, Maqbool; Elnahal, Shereef; Terezakis, Stephanie; DeWeese, Theodore; Herman, Joseph; Williams, Kayode A

    2016-01-01

    Objectives We examine interactions among 3 factors that affect patient waits and use of overtime in outpatient clinics: clinic congestion, patient punctuality and physician processing rates. We hypothesise that the first 2 factors affect physician processing rates, and this adaptive physician behaviour serves to reduce waiting times and the use of overtime. Setting 2 urban academic clinics and an affiliated suburban clinic in metropolitan Baltimore, Maryland, USA. Participants Appointment times, patient arrival times, start of service and physician processing times were collected for 105 visits at a low-volume suburban clinic 1, 264 visits at a medium-volume academic clinic 2 and 22 266 visits at a high-volume academic clinic 3 over 3 distinct spans of time. Intervention Data from the first clinic were previously used to document an intervention to influence patient punctuality. This included a policy that tardy patients were rescheduled. Primary and secondary outcome measures Clinicians' processing times were gathered, conditioned on whether the patient or clinician was tardy to test the first hypothesis. Probability distributions of patient unpunctuality were developed preintervention and postintervention for the clinic in which the intervention took place and these data were used to seed a discrete-event simulation. Results Average physician processing times differ conditioned on tardiness at clinic 1 with p=0.03, at clinic 2 with p=10−5 and at clinic 3 with p=10−7. Within the simulation, the adaptive physician behaviour degrades system performance by increasing waiting times, probability of overtime and the average amount of overtime used. Each of these changes is significant at the p<0.01 level. Conclusions Processing times differed for patients in different states in all 3 settings studied. When present, this can be verified using data commonly collected. Ignoring these behaviours leads to faulty conclusions about the efficacy of efforts to improve

  15. Impact of a pay-for-performance program on low performing physicians.

    PubMed

    Chen, Judy Ying; Kang, Ning; Juarez, Deborah Taira; Hodges, Krista A; Chung, Richard S; Legorreta, Antonio P

    2010-01-01

    Studies have shown that the lowest performing physicians in pay-for-performance (P4P) programs improved the most; however, it is unclear whether this would occur without the P4P program or be sustained. The objective of this study is to investigate the impact of P4P in a Preferred Provider Organization (PPO) on low performing physicians over a 4-year period. We used administrative claims data from a PPO health plan in Hawaii, which implemented a P4P program, and a PPO plan in the South, which did not implement a P4P program. The difference-indifference model was used to compare the quality scores between the two physician groups in preventive measures, a heart failure measure, and an HbA1c testing measure. We found that P4P programs may be effective in incentivizing low performing physicians to improvement quality of care and sustain improvement, and the positive benefit of the P4P program may not be realized until the 3rd or 4th year of the program.

  16. Despite regulatory changes, hospitals cautious in helping physicians purchase electronic medical records.

    PubMed

    Grossman, Joy M; Cohen, Genna

    2008-09-01

    While hospitals are evaluating strategies to help physicians purchase electronic medical records (EMRs) following recent federal regulatory changes, they are proceeding cautiously, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Hospital strategies to aid physician EMR adoption include offering direct financial subsidies, extending the hospital's ambulatory EMR vendor discounts and providing technical support. Two key factors driving hospital interest in supporting physician EMR adoption are improving the quality and efficiency of care and aligning physicians more closely with the hospital. A few hospitals have begun small-scale, phased rollouts of subsidized EMRs, but the burden of other hospital information technology projects, budget limitations and lack of physician interest are among the factors impeding hospital action. While it is too early to assess whether the regulatory changes will spur greater physician EMR adoption, the outcome will depend both on hospitals' willingness to provide support and physicians' acceptance of hospital assistance.

  17. The changing academic health center. The death of the traditional academic physician.

    PubMed

    Fargason, C A; Fargason, R E

    1996-08-01

    Organizational change is required if academic health centers (AHCs) are to survive the decreased societal commitment to them. The changes will generate significant emotional responses in the physicians employed by such institutions. This article presents an analogy between the reactions of academic physicians to the changes they are experiencing, and the stages of grief that Dr. Kübler Ross described in terminally ill patients. By placing physician responses in this context, emotional responses to organizational changes can be more easily understood and managed, allowing academic physicians to devote more energy to facing the threats to AHCs in an innovative and constructive manner.

  18. Value-based physician compensation: a link to performance improvement.

    PubMed

    Bunkers, Brian; Koch, Mark; Lubinsky, Jeanie; Weisz, Jeffrey A; Whited, Brian

    2016-03-01

    To prepare for the healthcare industry's transition to value-based care, Mayo Clinic Health System implemented a new, value-focused physician compensation plan as part of a larger initiative aimed at systemwide clinical integration. The plan uses three value-based metrics, focusing on outcomes, safety, and patient experience, that initially would determine 5 percent of a physician's compensation. Notable improvements achieved in the first year of the plan's implementation were strong indicators of the potential effectiveness of such a plan.

  19. The Perceptions of Changing the Entry-Level Degree for Physician Assistants to a Clinical Doctorate among Physician Assistant Students

    ERIC Educational Resources Information Center

    Swanchak, Lori E.

    2010-01-01

    Background: The recent advancements in medicine and the subsequent need for additional clinical training have resulted in the awarding of Clinical Doctorate (CD) Degrees for several allied health professionals. Few studies have been conducted within the physician assistant (PA) profession related to changing the entry-level degree for PAs to a…

  20. As good as it gets? Managing risks of cardiovascular disease in California's top-performing physician organizations.

    PubMed

    Rodriguez, Hector P; Ivey, Susan L; Raffetto, Brian J; Vaughn, Jennifer; Knox, Margae; Hanley, Hattie Rees; Mangione, Carol M; Shortell, Stephen M

    2014-04-01

    The California Right Care Initiative (RCI) accelerates the adoption of evidence-based guidelines and improved care management practices for conditions for which the gap between science and practice is significant, resulting in preventable disability and death. Medical directors and quality improvement leaders from 11 of the 12 physician organizations that met the 2010 national 90th percentile performance benchmarks for control of hyperlipidemia and glycated hemoglobin in 2011 were interviewed in 2012. Interviews, as well as surveys, assessed performance reporting and feedback to individual physicians; medication management protocols; team-based care management; primary care team huddles; coordination of care between primary care clinicians and specialists; implementation of shared medical appointments; and telephone visits for high-risk patients. All but 1 of 11 organizations implemented electronic health records. Electronic information exchange between primary care physicians and specialists, however, was uncommon. Few organizations routinely used interdisciplinary team approaches, shared medical appointments, or telephonic strategies for managing cardiovascular risks among patients. Implementation barriers included physicians' resistance to change, limited resources and reimbursement for team approaches, and limited organizational capacity for change. Implementation facilitators included routine use of reliable data to guide improvement, leadership facilitation of change, physician buy-in, health information technology use, and financial incentives. To accelerate improvements in managing cardiovascular risks, physician organizations may need to implement strategies involving extensive practice reorganization and work flow redesign.

  1. Does physician leadership affect hospital quality, operational efficiency, and financial performance?

    PubMed

    Tasi, Michael C; Keswani, Aakash; Bozic, Kevin J

    2017-07-11

    With payers and policymakers' focus on improving the value (health outcomes achieved per health care dollar spent) of health care delivery, physicians are increasingly taking on senior leadership/management positions in health care organizations (Carsen & Xia, 2006). Little research has been done to understand the impact of physician leadership on the delivery of care. The aim of this study was to examine whether hospital systems led by physicians were associated with better U.S. News and World Report (USNWR) quality ratings, financial performance, and operating efficiency as compared with those led by nonphysician managers. Cross-sectional analysis of nationally representative data from Medicare Cost Reports and the USNWR on the 115 largest U.S. hospitals was performed. Bivariate analysis of physician-led and non-physician-led hospital networks included three categories: USNWR quality ratings, hospital volume, and financial performance. Multivariate analysis of hospital leadership, percent operating margin, inpatient days per hospital bed, and average quality rating was subsequently performed. Hospitals in physician-led hospital systems had higher quality ratings across all specialties and more inpatient days per hospital bed than did non-physician-led hospitals; however, there were no differences in the total revenue or profit margins between the groups. Physician leadership was independently associated with higher average quality ratings and inpatient days per bed. Large hospital systems led by physicians in 2015 received higher USNWR ratings and bed usage rates than did hospitals led by nonphysicians, with no differences in financial performance. This study suggests that physician leaders may possess skills, qualities, or management approaches that positively affect hospital quality and the value of care delivered. Hospital quality and efficiency ratings vary significantly and can impact consumer decisions. Hospital systems may benefit from the presence of

  2. Measuring physicians' performance in clinical practice: reliability, classification accuracy, and validity.

    PubMed

    Weifeng Weng; Hess, Brian J; Lynn, Lorna A; Holmboe, Eric S; Lipner, Rebecca S

    2010-09-01

    Much research has been devoted to addressing challenges in achieving reliable assessments of physicians' clinical performance but less work has focused on whether valid and accurate classification decisions are feasible. This study used 957 physicians certified in internal medicine (IM) or a subspecialty, who completed the American Board of Internal Medicine (ABIM) Diabetes Practice Improvement Module (PIM). Ten clinical and two patient-experience measures were aggregated into a composite measure. The composite measure score was highly reliable (r = .91) and classification accuracy was high across the entire score scale (>0.90), which indicated that it is possible to differentiate high-performing and low-performing physicians. Physicians certified in endocrinology and those who scored higher on their IM certification examination had higher composite scores, providing some validity evidence. In summary, it is feasible to create a psychometrically robust composite measure of physicians' clinical performance, specifically for the quality of care they provide to patients with diabetes.

  3. Non-physician performance of lower and upper endoscopy: a systematic review and meta-analysis.

    PubMed

    Day, Lukejohn W; Siao, Derrick; Inadomi, John M; Somsouk, Ma

    2014-05-01

    Demand for endoscopic procedures worldwide has increased while the number of physicians trained to perform endoscopy has remained relatively constant. The objective of this study was to characterize non-physician performance of lower and upper endoscopic procedures. Bibliographical searches were conducted in Medline, EMBASE, and Cochrane Library databases. Studies were included where patients underwent flexible sigmoidoscopy, colonoscopy, or upper endoscopy done by a non-physician (nurse, nurse practitioner, physician assistant) and outcome measures were reported (detection of polyps, adenomas, cancer, and/or adverse events). Pooled rates were calculated for specific outcomes and rate ratios were determined for selected comparison groups. Most studies involved nurses performing flexible sigmoidoscopies for colorectal cancer screening. Nurses and nurse-practitioners/physician assistants performing flexible sigmoidoscopies showed pooled polyp detection rates of 9.9 % and 23.7 %, adenoma detection rates of 2.9 % and 7.2 %, colorectal cancer detection rates of 1.3 % and 1.2 %, and adverse event rates of 0.3 and 0 per 1000 sigmoidoscopies, respectively. There was no significant difference between polyp and adenoma detection rates in sigmoidoscopy performance studies comparing nurses or nurse-practitioners/physician assistants with physicians. For the 3 studies of non-physician performance of colonoscopy, pooled adenoma detection rate was 26.4 %, cecal intubation rate was 93.5 %, and adverse event rate was 2.2 /1000 colonoscopies. In the few studies examining upper endoscopies, 99.4 % of upper endoscopy procedures performed by nurses were successful with no reported adverse events. Available studies suggest that when non-physicians perform endoscopic procedures, especially lower endoscopies, outcomes and adverse events are in line with those of physicians. © Georg Thieme Verlag KG Stuttgart · New York.

  4. The strategic nature of individual change behavior: How physicians and their staff implement medical home care.

    PubMed

    Hoff, Timothy; Scott, Sarah

    The patient-centered medical home (PCMH) model of care is central to primary care system success and transformation. Less is known about which PCMH activities primary care workers most frequently perform, if or why they might view that work more favorably, and how such work may function strategically to advance individual and organizational adaptation to new demands, as well as deliver good patient care. Understanding better how primary care physicians and staff perceive, experience, and use certain types of PCMH work for adapting to new demands looms a key imperative for gaining insights into PCMH implementation at the workplace level. Using a worker adaptation perspective that emphasizes the role of social learning and individual agency, this study explores the strategic nature of PCMH implementation through 51 in-depth interviews with physicians and staff in six accredited PCMHs. Select medical home activities were identified, in which primary care physicians and staff most engaged on a daily basis, and they fell into five distinct PCMH work domains labeled team care, medical home responsibilities, care management, access, and medication management. These activities had common features such as high levels of familiarity, simplicity, and camaraderie. In addition, through their experiences performing these activities, physicians and staff appeared to gain strategic benefits for themselves and the larger organization including enhanced self-efficacy and readiness for change. The findings show that particular forms of PCMH work not only advance patient care in favorable ways but also enhance individual and organizational capacity for adapting to this innovative model and its demands. This knowledge adds to our understanding of how to implement PCMH care in ways that are good for workers, primary care organizations, and patients and offers practical guidance as to which forms of PCMH work should be encouraged, incented, and rewarded.

  5. Poorly Performing Physicians: Does the Script Concordance Test Detect Bad Clinical Reasoning?

    ERIC Educational Resources Information Center

    Goulet, Francois; Jacques, Andre; Gagnon, Robert; Charlin, Bernard; Shabah, Abdo

    2010-01-01

    Introduction: Evaluation of poorly performing physicians is a worldwide concern for licensing bodies. The College des Medecins du Quebec currently assesses the clinical competence of physicians previously identified with potential clinical competence difficulties through a day-long procedure called the Structured Oral Interview (SOI). Two peer…

  6. Poorly Performing Physicians: Does the Script Concordance Test Detect Bad Clinical Reasoning?

    ERIC Educational Resources Information Center

    Goulet, Francois; Jacques, Andre; Gagnon, Robert; Charlin, Bernard; Shabah, Abdo

    2010-01-01

    Introduction: Evaluation of poorly performing physicians is a worldwide concern for licensing bodies. The College des Medecins du Quebec currently assesses the clinical competence of physicians previously identified with potential clinical competence difficulties through a day-long procedure called the Structured Oral Interview (SOI). Two peer…

  7. Changes to physician processing times in response to clinic congestion and patient punctuality: a retrospective study.

    PubMed

    Chambers, Chester G; Dada, Maqbool; Elnahal, Shereef; Terezakis, Stephanie; DeWeese, Theodore; Herman, Joseph; Williams, Kayode A

    2016-10-18

    We examine interactions among 3 factors that affect patient waits and use of overtime in outpatient clinics: clinic congestion, patient punctuality and physician processing rates. We hypothesise that the first 2 factors affect physician processing rates, and this adaptive physician behaviour serves to reduce waiting times and the use of overtime. 2 urban academic clinics and an affiliated suburban clinic in metropolitan Baltimore, Maryland, USA. Appointment times, patient arrival times, start of service and physician processing times were collected for 105 visits at a low-volume suburban clinic 1, 264 visits at a medium-volume academic clinic 2 and 22 266 visits at a high-volume academic clinic 3 over 3 distinct spans of time. Data from the first clinic were previously used to document an intervention to influence patient punctuality. This included a policy that tardy patients were rescheduled. Clinicians' processing times were gathered, conditioned on whether the patient or clinician was tardy to test the first hypothesis. Probability distributions of patient unpunctuality were developed preintervention and postintervention for the clinic in which the intervention took place and these data were used to seed a discrete-event simulation. Average physician processing times differ conditioned on tardiness at clinic 1 with p=0.03, at clinic 2 with p=10(-5) and at clinic 3 with p=10(-7). Within the simulation, the adaptive physician behaviour degrades system performance by increasing waiting times, probability of overtime and the average amount of overtime used. Each of these changes is significant at the p<0.01 level. Processing times differed for patients in different states in all 3 settings studied. When present, this can be verified using data commonly collected. Ignoring these behaviours leads to faulty conclusions about the efficacy of efforts to improve clinic flow. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  8. Invited Article: Threats to physician autonomy in a performance-based reimbursement system.

    PubMed

    Larriviere, Daniel G; Bernat, James L

    2008-06-10

    Physician autonomy is currently threatened by the external application of pay for performance standards and required conformity to practice guidelines. This phenomenon is being driven by concerns over the economic viability of increasing per capita health care expenditures without a concomitant rise in favorable health outcomes and by the unjustified marked variations among physicians' practice patterns. Proponents contend that altering the reimbursement system to encourage physicians to make choices based upon the best available evidence would be one way to ensure better outcomes per health care dollar spent. Although physician autonomy is most easily justified when decisions are made by appealing to the best available evidence, incentivizing decision-making risks sacrificing physician autonomy to political and social forces if the limitations of evidence-based medicine are not respected. Any reimbursement system designed to encourage physicians to utilize the best available evidence by providing financial incentives must recognize physicians who try to play to the numbers as well as physicians who refuse to follow the best available evidence if doing so would conflict with good medicine or patient preferences. By designing, promulgating, and updating evidence-based clinical practice guidelines, medical specialty societies can limit threats to physician autonomy while improving medical practice.

  9. Detection of Local Cancer Recurrence After Stereotactic Ablative Radiation Therapy for Lung Cancer: Physician Performance Versus Radiomic Assessment.

    PubMed

    Mattonen, Sarah A; Palma, David A; Johnson, Carol; Louie, Alexander V; Landis, Mark; Rodrigues, George; Chan, Ian; Etemad-Rezai, Roya; Yeung, Timothy P C; Senan, Suresh; Ward, Aaron D

    2016-04-01

    Stereotactic ablative radiation therapy (SABR) is a guideline-specified treatment option for early-stage lung cancer. However, significant posttreatment fibrosis can occur and obfuscate the detection of local recurrence. The goal of this study was to assess physician ability to detect timely local recurrence and to compare physician performance with a radiomics tool. Posttreatment computed tomography (CT) scans (n=182) from 45 patients treated with SABR (15 with local recurrence matched to 30 with no local recurrence) were used to measure physician and radiomic performance in assessing response. Scans were individually scored by 3 thoracic radiation oncologists and 3 thoracic radiologists, all of whom were blinded to clinical outcomes. Radiomic features were extracted from the same images. Performances of the physician assessors and the radiomics signature were compared. When taking into account all CT scans during the whole follow-up period, median sensitivity for physician assessment of local recurrence was 83% (range, 67%-100%), and specificity was 75% (range, 67%-87%), with only moderate interobserver agreement (κ = 0.54) and a median time to detection of recurrence of 15.5 months. When determining the early prediction of recurrence within <6 months after SABR, physicians assessed the majority of images as benign injury/no recurrence, with a mean error of 35%, false positive rate (FPR) of 1%, and false negative rate (FNR) of 99%. At the same time point, a radiomic signature consisting of 5 image-appearance features demonstrated excellent discrimination, with an area under the receiver operating characteristic curve of 0.85, classification error of 24%, FPR of 24%, and FNR of 23%. These results suggest that radiomics can detect early changes associated with local recurrence that are not typically considered by physicians. This decision support system could potentially allow for early salvage therapy of patients with local recurrence after SABR. Copyright

  10. Heart rate variability changes in physicians working on night call.

    PubMed

    Malmberg, Birgitta; Persson, Roger; Flisberg, Per; Ørbaek, Palle

    2011-03-01

    Adverse effects by night-call duty have become an important occupational health issue. The aim of this study was to investigate whether the heart rate variability (HRV) differed during recovery from day work and night-call duty between distinct physician specialities. We studied the impact of a 16-h night-call duty on autonomic balance, measured by HRV, among two physician groups differing with respect to having to deal with life-threatening conditions while on call. Nineteen anaesthesiologists (ANEST) and 16 paediatricians and ear, nose and throat surgeons (PENT) were monitored by ambulatory digital Holter electrocardiogram (ECG). Heart rate variability was analysed between 21:00 and 22:00 after an ordinary workday, on night call and in the evening post-call. Absolute and normalized high-frequency power (HF, HFnu) were the main outcome variables, expressing parasympathetic influence on the heart. ANEST had lower HF power than PENT while on night call and post-daytime work (p < 0.05), but not at post-night call. In the whole group of physicians, HFnu was lower on call and post-daytime work compared with post-night-call duty (p < 0.05). The physiological recovery after night duty seemed sufficient in terms of HRV patterns for HFnu, reflecting autonomic balance and did not differ between specialities. However, the less dynamic HRV after daytime work and during night-call duty in the ANEST group may indicate a higher physiological stress level. These results may contribute to the improvement of night-call schedules within the health care sector.

  11. Nurses versus physicians' knowledge, attitude, and performance on care for the family members of dying patients

    PubMed Central

    Abdollahimohammad, Abdolghani; Firouzkouhi, Mohammadreza; Amrollahimishvan, Fatemeh; Alimohammadi, Nasrollah

    2016-01-01

    Purpose: Nurses and physicians must be competent enough to provide care for the clients. As a lack of knowledge and a poor attitude result in a low performance of delivering care, this study aimed to explore the nurses versus physicians’ knowledge, attitude, and performance on care for the family members of dying patients (FMDPs). Methods: This descriptive study was conducted at the educational hospitals in Isfahan, Iran. The samples were 110 nurses and 110 physicians. The data were collected through a convenience sampling method and using a valid and reliable questionnaire. Results: The average knowledge, attitude, and performance on care for the FMDPs were not significantly different between nurses and physicians (p>0.05). The majority of nurses (55.4%) and physician (63.6%) were at a moderate and a fair level of knowledge of care for the FMDPs. Most of the nurses (81%) and physicians (87.3%) had a positive attitude towards caring the FMDPs. Most of the nurses (70%) and physicians (86.3%) had a moderate and fair performance. Conclusion: Having enough knowledge and skills, and a positive attitude are necessary for caring the FMDPs. Nurses’ and physicians' competencies must be improved through continuing educational programs and holding international and national conferences with a focus on the palliative care. PMID:26838571

  12. Using data envelopment analysis for assessing the performance of pediatric emergency department physicians.

    PubMed

    Fiallos, Javier; Patrick, Jonathan; Michalowski, Wojtek; Farion, Ken

    2017-03-01

    In attempting to measure the performance of providers in a service industry such as health care, it is crucial that the measurement tool recognize both the efficiency and quality of service provided. We develop a Data Envelopment Analysis (DEA) model to help assess the performance of emergency department (ED) physicians at a partner hospital. The model incorporates efficiency measures as inputs and quality measures as outputs. We demonstrate the importance of a nuanced approach that recognizes the heterogeneity of patients that an ED physician encounters and the important role s/he plays as a mentor for physicians in training. In the study, patients were grouped according to their presenting complaint and ED physicians were assessed on each group separately. Performance variations were evident between physicians within each complaint group as well as between groups. A secondary grouping divided patients based on whether the attending physician was assisted by a trainee. Almost all ED physicians showed better performance scores when not assisted by trainees or ED fellows.

  13. Effect of a medical care evaluation program on physician knowledge and performance.

    PubMed

    Maxwell, J A; Sandlow, L J; Bashook, P G

    1984-01-01

    A model program designed to increase the educational value of medical care evaluation committee meetings was studied to determine its effect on the knowledge and clinical performance of participating physicians. The members of hospital committees in which the program was successfully implemented showed a statistically significant gain in knowledge of the topics discussed by their committees. In addition, several members made substantial changes in their patient care practices. These changes resulted not so much from the acquisition of new medical information as from a rethinking of patient management strategies, stimulated by peer discussion during committee meetings. A structure that encourages such discussions can be incorporated in other types of patient-care-oriented committee activities as well.

  14. Usefulness of non-lead aprons in radiation protection for physicians performing interventional procedures.

    PubMed

    Zuguchi, Masayuki; Chida, Koichi; Taura, Masaaki; Inaba, Yohei; Ebata, Ayako; Yamada, Shogo

    2008-01-01

    At present, interventional radiology (IVR) tends to involve long procedures (long radiation duration), and physicians are near to the source of scattered radiation. Hence, shielding is critical in protecting physicians from radiation. Protective aprons and additional lead-shielding devices, such as tableside lead drapes, are important means of protecting the physician from scattered radiation. The purpose of this study was to evaluate whether non-lead aprons are effective in protecting physicians from radiation during IVR procedures. In this study, the radiation protection effects of commercially available protective lead and non-lead aprons, when exposed to diagnostic X rays, are compared. The performance of these non-lead and lead aprons was similar for scattered X rays at tube voltages of 60-120 kV. Properly designed non-lead aprons are thus more suitable for physicians because they weigh approximately 20% less than the lead aprons, and are non-toxic.

  15. Physician attitudes, self-estimated performance and actual compliance with locally peer-defined quality evaluation criteria.

    PubMed

    Saturno, P J; Palmer, R H; Gascón, J J

    1999-12-01

    Physicians' agreement with quality evaluation criteria, and estimates of their own and their colleagues' compliance with these criteria were compared with actual compliance. Physicians practicing in 10 health centers in Spain defined 13 quality evaluation criteria for two patient conditions (upper respiratory infections and high serum cholesterol). Compliance with criteria was measured by an external team, using random samples of medical records stratified by condition in each health center (n= 1,000). Concurrently, physicians were surveyed regarding agreement with the criteria, and were asked to estimate their own and their health center's rate of compliance with these criteria. Agreement ratings varied from 5.9 to 9.1 on a 10-point scale. Actual compliance rates ranged from 1.8 to 91.7% of records. Agreement correlated significantly with self-reported compliance but not with actual compliance. Estimates of one's own and one's health center compliance were positive and significantly correlated for all criteria, but were significantly higher for oneself than for one's health center for six of 13 criteria. Wide variation in physicians' agreement on quality criteria and in actual performance reveal a lack of clear guidelines. Agreement on criteria did not always translate into compliance with criteria. Physicians tended to rate their own performance as better than the average of their peers, suggesting that aggregate data may not influence physicians to change. Self-estimate of one's own or one's colleagues performance is not a good proxy for actual performance so that peer ratings are of dubious value for performance appraisal.

  16. Challenges in making therapeutic lifestyle changes among hypercholesterolemic African-American patients and their physicians.

    PubMed Central

    Dailey, Rhonda; Schwartz, Kendra L.; Binienda, Juliann; Moorman, Jessica; Neale, Anne Victoria

    2006-01-01

    OBJECTIVE: We explored challenges faced by hypercholesterolemic African-American primary care patients and their physicians regarding therapeutic lifestyle changes (TLC) and provide patient-influenced recommendations to physicians. METHODS: In this qualitative study, 23 urban family medicine patients and their physicians (N=12) participated in separate focus groups, where they were asked semistructured, open-ended questions about knowledge and barriers to lifestyle treatment of high cholesterol. RESULTS: During the focus groups, barriers mentioned by physicians were: lack of time for TLC counseling, inadequate knowledge about counseling patients, and patient readiness and responsibility to change. Patient-revealed barriers included difficulty adhering to a diet/exercise regimen and a lack of knowledge about high cholesterol. Patients who were successful with adopting a healthy lifestyle identified personal experiences or those of family and friends as motivating. CONCLUSION: Physicians desire training and resources to better help patients adopt diet and exercise regimens specific to their general and health literacy and their access to healthy foods, along with their readiness to change. Patients desire that physicians tailor their TLC advice to be specific to their context and they want help from physicians in setting realistic goals. Such a patient-centered counseling approach may improve adherence to lifestyle guidelines and, thus, clinical outcomes. PMID:17225831

  17. Ready for Change? The Role of Physician and Staff Engagement, Burnout, and Workplace Attributes.

    PubMed

    Hung, Dorothy; Chen, Po-Han

    We examined factors associated with change readiness among 343 primary care physicians and 590 nonphysician staff undergoing "Lean"-based process improvements. Baseline levels of engagement were associated with greater readiness for change across all measured domains. Job-related burnout correlated with greater need for change, but lower self-efficacy and perceived support, whereas a personal sense of accomplishment was associated with higher efficacy to implement changes. At a department level, teamwork, participation in decision making, and change history were associated with higher engagement and lower burnout among physicians and staff; conversely, a busy or stressful department correlated with lower engagement and higher burnout.

  18. The influence of care management tools on physician practice change across organizational settings.

    PubMed

    Haggstrom, David A; Bindman, Andrew B

    2007-11-01

    A study was conducted to assess whether physician reports of practice change were associated with the type of health care organization delivering the tools and the type or number of tools received. A mail survey was sent in 2001 to primary care physicians practicing in the 13 largest urban counties in California. Physicians were more likely to report a practice change if they received care management tools from a medical group (28%) or a group/staff model health maintenance organization (HMO; 24%) than if they received tools from a health plan (9%; p = .01 and p =.005, respectively). HMO physicians were significantly more likely to receive each type of tool than other physicians. After adjusting for the type or number of tools, the receipt of care management tools from medical groups, but not HMOs, remained a significant predictor of practice change. Physicians reported practice change in association with the number of tools received from a medical group (adjusted odds ratio [AOR] 1.49; 95% confidence interval [CI] 1.08-2.06) and the tools received from an independent practice association, health plan, or hospital outside a medical group (AOR 1.21; 95% CI 1.03-1.42). Medical groups have the strongest influence on practice change, whereas group/staff model HMOs have the highest level of implementation.

  19. Performance of physician-certified verbal autopsies: multisite validation study using clinical diagnostic gold standards

    PubMed Central

    2011-01-01

    Background Physician review of a verbal autopsy (VA) and completion of a death certificate remains the most widely used approach for VA analysis. This study provides new evidence about the performance of physician-certified verbal autopsy (PCVA) using defined clinical diagnostic criteria as a gold standard for a multisite sample of 12,542 VAs. The study was also designed to analyze issues related to PCVA, such as the impact of a second physician reader on the cause of death assigned, the variation in performance with and without household recall of health care experience (HCE), and the importance of local information for physicians reading VAs. Methods The certification was performed by 24 physicians. The assignment of VA was random and blinded. Each VA was certified by one physician. Half of the VAs were reviewed by a different physician with household recall of health care experience included. The completed death certificate was processed for automated ICD-10 coding of the underlying cause of death. PCVA was compared to gold standard cause of death assignment based on strictly defined clinical diagnostic criteria that are part of the Population Health Metrics Research Consortium (PHMRC) gold standard verbal autopsy study. Results For individual cause assignment, the overall chance-corrected concordance for PCVA against the gold standard cause of death is less than 50%, with substantial variability by cause and physician. Physicians assign the correct cause around 30% of the time without HCE, and addition of HCE improves performance in adults to 45% and slightly higher in children to 48%. Physicians estimate cause-specific mortality fractions (CSMFs) with considerable error for adults, children, and neonates. Only for neonates for a cause list of six causes with HCE is accuracy above 0.7. In all three age groups, CSMF accuracy improves when household recall of health care experience is available. Conclusions Results show that physician coding for cause of death

  20. Standing out and moving up: performance appraisal of cultural minority physicians.

    PubMed

    Leyerzapf, Hannah; Abma, Tineke A; Steenwijk, Reina R; Croiset, Gerda; Verdonk, Petra

    2015-10-01

    Despite a growing diversity within society and health care, there seems to be a discrepancy between the number of cultural minority physicians graduating and those in training for specialization (residents) or working as a specialist in Dutch academic hospitals. The purpose of this article is to explore how performance appraisal in daily medical practice is experienced and might affect the influx of cultural minority physicians into specialty training. A critical diversity study was completed in one academic hospital using interviews (N = 27) and focus groups (15 participants) with cultural minority physicians and residents, instructing specialists and executives of medical wards. Data were digitally recorded and transcribed verbatim. A thematic and integral content analysis was performed. In addition to explicit norms on high motivation and excellent performance, implicit norms on professionalism are considered crucial in qualifying for specialty training. Stereotyped imaging on the culture and identity of cultural minority physicians and categorical thinking on diversity seem to underlie daily processes of evaluation and performance appraisal. These are experienced as inhibiting the possibilities to successfully profile for selection into residency and specialist positions. Implicit criteria appear to affect selection processes on medical wards and possibly hinder the influx of cultural minority physicians into residency and making academic hospitals more diverse. Minority and majority physicians, together with the hospital management and medical education should target inclusive norms and practices within clinical practice.

  1. Climate Change and Health: A Position Paper of the American College of Physicians.

    PubMed

    Crowley, Ryan A

    2016-05-03

    Climate change could have a devastating effect on human and environmental health. Potential effects of climate change on human health include higher rates of respiratory and heat-related illness, increased prevalence of vector-borne and waterborne diseases, food and water insecurity, and malnutrition. Persons who are elderly, sick, or poor are especially vulnerable to these potential consequences. Addressing climate change could have substantial benefits to human health. In this position paper, the American College of Physicians (ACP) recommends that physicians and the broader health care community throughout the world engage in environmentally sustainable practices that reduce carbon emissions; support efforts to mitigate and adapt to the effects of climate change; and educate the public, their colleagues, their community, and lawmakers about the health risks posed by climate change. Tackling climate change is an opportunity to dramatically improve human health and avert dire environmental outcomes, and ACP believes that physicians can play a role in achieving this goal.

  2. Impact of reference change value (RCV) based autoverification on turnaround time and physician satisfaction.

    PubMed

    Fernández-Grande, Esther; Valera-Rodriguez, Carolina; Sáenz-Mateos, Luis; Sastre-Gómez, Amparo; García-Chico, Pilar; Palomino-Muñoz, Teodoro J

    2017-06-15

    For a quicker delivery of laboratory test results to the hospital emergency department (ED), we implemented an autoverification system based on the reference change value (RCV). The aim of this study was to assess how the RCV based autoverification reflected on turnaround time (TAT) and on physician satisfaction. The laboratory information system (LIS) was programmed to autoverify the results as long as they were within the range settled by RCV, so that the autoverified results were reported to the physician as soon as the tests were carried out, without any further intervention. We analyzed the same three-month periods' TAT and verification time (VFT) from the years prior to and following the implementation of RCV autoverification. The change in physicians' satisfaction levels was assessed using the hospital's Annual Physician Satisfaction Survey (APSS). Over sixty percent of physicians completed the questionnaire, and the amount of daily ED test requests (nearly three hundred) did not vary throughout the duration of this study. Mann-Whitney U test showed that the VFT was significantly reduced in all the test but troponin I. There were substantial reductions in TAT medians (haemogram, 75%; fibrinogen, 41%; prothrombin time, 40%; sodium, 27%). The percentage of physicians satisfied with the haematological and biochemical tests´ TAT increased from 84% to 93% and from 86% to 91% respectively. Our results reveal that VFT and TAT were severely reduced in most emergency tests, greatly improving physicians' satisfaction with TAT.

  3. International medical graduate physicians in the United States: changes since 1981.

    PubMed

    Hart, L Gary; Skillman, Susan M; Fordyce, Meredith; Thompson, Matthew; Hagopian, Amy; Konrad, Thomas R

    2007-01-01

    Nearly a quarter of all active U.S. physicians are international medical graduates (IMGs)--physicians trained outside the United States and Canada. We describe changes in characteristics of IMGs from 1981 to 2001 and compare them with their U.S. medical graduate (USMG) counterparts. Since 1981, the leading source countries for IMGs have included India, the Philippines, and Mexico. IMGs were more likely to be generalists and to practice in designated underserved areas than USMGs but slightly less likely to practice in isolated small rural areas and persistent-poverty counties. IMGs are an important source of primary care physicians in rural and underserved areas.

  4. The changing healthcare landscape: physicians embrace disease management and improve outcomes.

    PubMed

    Selecky, Christobel; Peck, Charles A

    2009-01-01

    The troubled economy and a new administration in Washington have reinvigorated the debate over the merits of disease management programs and the savings they bring to healthcare. At the forefront of the discussion are physicians who are discovering disease management's innovative approach to treating the chronically ill. Across the country, physicians are responding to evidence-based programs designed to improve patient outcomes that, at the same time, assist them in reaching pay-for-performance goals. New research shows that when disease management professionals provide physicians with credible information, course corrections are made more than 85% of the time.

  5. Personality Traits Affect Teaching Performance of Attending Physicians: Results of a Multi-Center Observational Study

    PubMed Central

    Scheepers, Renée A.; Lombarts, Kiki M. J. M. H.; van Aken, Marcel A. G.; Heineman, Maas Jan; Arah, Onyebuchi A.

    2014-01-01

    Background Worldwide, attending physicians train residents to become competent providers of patient care. To assess adequate training, attending physicians are increasingly evaluated on their teaching performance. Research suggests that personality traits affect teaching performance, consistent with studied effects of personality traits on job performance and academic performance in medicine. However, up till date, research in clinical teaching practice did not use quantitative methods and did not account for specialty differences. We empirically studied the relationship of attending physicians' personality traits with their teaching performance across surgical and non-surgical specialties. Method We conducted a survey across surgical and non-surgical specialties in eighteen medical centers in the Netherlands. Residents evaluated attending physicians' overall teaching performance, as well as the specific domains learning climate, professional attitude, communication, evaluation, and feedback, using the validated 21-item System for Evaluation of Teaching Qualities (SETQ). Attending physicians self-evaluated their personality traits on a 5-point scale using the validated 10-item Big Five Inventory (BFI), yielding the Five Factor model: extraversion, conscientiousness, neuroticism, agreeableness and openness. Results Overall, 622 (77%) attending physicians and 549 (68%) residents participated. Extraversion positively related to overall teaching performance (regression coefficient, B: 0.05, 95% CI: 0.01 to 0.10, P = 0.02). Openness was negatively associated with scores on feedback for surgical specialties only (B: −0.10, 95% CI: −0.15 to −0.05, P<0.001) and conscientiousness was positively related to evaluation of residents for non-surgical specialties only (B: 0.13, 95% CI: 0.03 to 0.22, p = 0.01). Conclusions Extraverted attending physicians were consistently evaluated as better supervisors. Surgical attending physicians who display high levels of

  6. Hospital employment of physicians and supply chain performance: An empirical investigation.

    PubMed

    Young, Gary J; Nyaga, Gilbert N; Zepeda, E David

    2016-01-01

    As hospital employment of physicians becomes increasingly common in the United States, much speculation exists as to whether this type of arrangement will promote hospital operating efficiency in such areas as supply chain management. Little empirical research has been conducted to address this question. The aim of this study was to provide an exploratory assessment of whether hospital employment of physicians is associated with better supply chain performance. Drawing from both agency and stewardship theories, we examined whether hospitals with a higher proportion of employed medical staff members have relatively better supply chain performance based on two performance measures, supply chain expenses and inventory costs. We conducted the study using a pooled, cross-sectional sample of hospitals located in California between 2007 and 2009. Key data sources were hospital annual financial reports from California's Office of Statewide Health Policy and Development and the American Hospital Association annual survey of hospitals. To examine the relationship between physician employment and supply chain performance, we specified physician employment as the proportion of total employed medical staff members as well as the proportion of employed medical staff members within key physician subgroups. We analyzed the data using generalized estimating equations. Study results generally supported our hypothesis that hospital employment of physicians is associated with better supply chain performance. Although the results of our study should be viewed as preliminary, the trend in the United States toward hospital employment of physicians may be a positive development for improved hospital operating efficiency. Hospital managers should also be attentive to training and educational resources that medical staff members may need to strengthen their role in supply chain activities.

  7. The Relationship between Health Plan Performance Measures and Physician Network Overlap: Implications for Measuring Plan Quality

    PubMed Central

    Maeng, Daniel D; Scanlon, Dennis P; Chernew, Michael E; Gronniger, Tim; Wodchis, Walter P; McLaughlin, Catherine G

    2010-01-01

    Objective To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics. Data Source We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dartmouth Atlas. Study Design We constructed two measures of physician network overlap for all health plans in our sample and linked them to selected measures of plan performance. Two linear regression models were estimated to assess the relationship between the measures of physician network overlap and the plan performance measures. Principal Findings The results indicate that in the presence of a higher degree of provider network overlap, plan performance measures tend to converge to a lower level of quality. Conclusions Standard health plan performance measures reflect physician practice patterns rather than plans' effort to improve quality. This implies that more provider-oriented measurement, such as would be possible with accountable care organizations or medical homes, may facilitate patient decision making and provide further incentives to improve performance. PMID:20403064

  8. The relationship between health plan performance measures and physician network overlap: implications for measuring plan quality.

    PubMed

    Maeng, Daniel D; Scanlon, Dennis P; Chernew, Michael E; Gronniger, Tim; Wodchis, Walter P; McLaughlin, Catherine G

    2010-08-01

    To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics. We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dartmouth Atlas. We constructed two measures of physician network overlap for all health plans in our sample and linked them to selected measures of plan performance. Two linear regression models were estimated to assess the relationship between the measures of physician network overlap and the plan performance measures. The results indicate that in the presence of a higher degree of provider network overlap, plan performance measures tend to converge to a lower level of quality. Standard health plan performance measures reflect physician practice patterns rather than plans' effort to improve quality. This implies that more provider-oriented measurement, such as would be possible with accountable care organizations or medical homes, may facilitate patient decision making and provide further incentives to improve performance.

  9. The effects of hospital-physician integration strategies on hospital financial performance.

    PubMed Central

    Goes, J B; Zhan, C

    1995-01-01

    STUDY QUESTION. This study investigated the longitudinal relations between hospital financial performance outcomes and three hospital-physician integration strategies: physician involvement in hospital governance, hospital ownership by physicians, and the integration of hospital-physician financial relationships. DATA SOURCES AND STUDY SETTING. Using secondary data from the State of California, integration strategies in approximately 300 California short-term acute care hospitals were tracked over a ten-year period (1981-1990). STUDY DESIGN. The study used an archival design. Hospital performance was measured on three dimensions: operational profitability, occupancy, and costs. Thirteen control variables were used in the analyses: market competition, affluence, and rurality; hospital ownership; teaching costs and intensity; multihospital system membership; hospital size; outpatient service mix; patient volume case mix; Medicare and Medicaid intensity; and managed care intensity. DATA COLLECTION/EXTRACTION. Financial and utilization data were obtained from the State of California, which requires annual hospital reports. A series of longitudinal regressions tested the hypotheses. PRINCIPAL FINDINGS. Considerable variation was found in the popularity of the three strategies and their ability to predict hospital performance outcomes. Physician involvement in hospital governance increased modestly from 1981-1990, while ownership and financial integration declined significantly. Physician governance was associated with greater occupancy and higher operating margins, while financial integration was related to lower hospital operating costs. Direct physician ownership, particularly in small hospitals, was associated with lower operating margins and higher costs. Subsample analyses indicate that implementation of the Medicare prospective payment system in 1983 had a major impact on these relationships, especially on the benefits of financial integration. CONCLUSIONS. The

  10. Aging and cognitive performance: challenges and implications for physicians practicing in the 21st century.

    PubMed

    Durning, Steven J; Artino, Anthony R; Holmboe, Eric; Beckman, Thomas J; van der Vleuten, Cees; Schuwirth, Lambert

    2010-01-01

    The demands of physician practice are growing. Some specialties face critical shortages and a significant percentage of physicians are aging. To improve health care it is paramount to understand and address challenges, including cognitive issues, facing aging physicians. In this article, we outline several issues related to cognitive performance and potential implications associated with aging. We discuss important findings from other fields and draw parallels to the practice of medicine. In particular, we discuss the possible effects of aging through the lens of situated cognition theory, and we outline the potential impact of aging on expertise, information processing, neurobiology, intelligence, and self-regulated learning. We believe that work done in related fields can provide a better understanding of physician aging and cognition, and thus can inform more effective approaches to continuous professional development and lifelong learning in medicine. We conclude with implications for the health care system and areas of future research.

  11. Sociodemographic and Premedical School Factors Related to Postgraduate Physicians' Humanistic Performance

    PubMed Central

    Linn, Lawrence S.; Cope, Dennis W.; Robbins, Alan

    1987-01-01

    In an extensive survey of postgraduate physicians in two teaching hospitals (N = 141) for their humanistic attitudes, values and behavior, all ratings of physicians' humanistic performance, including physicians' own scores on self-report measures, supervising faculty, nurses and patient ratings, were modestly but significantly correlated with each other. Sex, ethnic or racial background, year of training, marital status, number of children, Alpha-Omega-Alpha membership or number of articles published were unrelated to physicians' humanistic behavior. Several measures of humanism were positively correlated with having taken more courses in the social sciences and humanities, having had more early person-centered work experience and reporting that before medical school others had confided in them or sought their advice more frequently. PMID:3424817

  12. Improving emergency physician performance using audit and feedback: a systematic review.

    PubMed

    Le Grand Rogers, R; Narvaez, Yizza; Venkatesh, Arjun K; Fleischman, William; Hall, M Kennedy; Taylor, R Andrew; Hersey, Denise; Sette, Lynn; Melnick, Edward R

    2015-10-01

    Audit and feedback can decrease variation and improve the quality of care in a variety of health care settings. There is a growing literature on audit and feedback in the emergency department (ED) setting. Because most studies have been small and not focused on a single clinical process, systematic assessment could determine the effectiveness of audit and feedback interventions in the ED and which specific characteristics improve the quality of emergency care. The objective of the study is to assess the effect of audit and feedback on emergency physician performance and identify features critical to success. We adhered to the PRISMA statement to conduct a systematic review of the literature from January 1994 to January 2014 related to audit and feedback of physicians in the ED. We searched Medline, EMBASE, PsycINFO, and PubMed databases. We included studies that were conducted in the ED and reported quantitative outcomes with interventions using both audit and feedback. For included studies, 2 reviewers independently assessed methodological quality using the validated Downs and Black checklist for nonrandomized studies. Treatment effect and heterogeneity were to be reported via meta-analysis and the I2 inconsistency index. The search yielded 4332 articles, all of which underwent title review; 780 abstracts and 131 full-text articles were reviewed. Of these, 24 studies met inclusion criteria with an average Downs and Black score of 15.6 of 30 (range, 6-22). Improved performance was reported in 23 of the 24 studies. Six studies reported sufficient outcome data to conduct summary analysis. Pooled data from studies that included 41,124 patients yielded an average treatment effect among physicians of 36% (SD, 16%) with high heterogeneity (I2=83%). The literature on audit and feedback in the ED reports positive results for interventions across numerous clinical conditions but without standardized reporting sufficient for meta-analysis. Characteristics of audit and

  13. Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs

    PubMed Central

    Eckleberry-Hunt, Jodie; Van Dyke, Anne; Lick, David; Tucciarone, Jennifer

    2009-01-01

    Background The existing literature either does not address physician wellness or defines it as a lack of burnout. The goal of this article is to call attention to this important gap in the literature and provide ideas for how to fill it. We need a culture change, and we propose that this change begin within graduate medical education. Methods We describe a case example of culture change and definitions of wellness at William Beaumont Hospitals, Troy Family Medicine Residency Program, a community-based, university-affiliated program in suburban Detroit, Michigan. Results We developed a toolbox of practical steps to create a culture that emphasizes wellness. We present a general timeline illustrating necessary steps toward accomplishing a true cultural change. Discussion The time has come for academic medicine to move beyond a simple discussion of physician burnout. To do this, we must first develop a shared definition of physician wellness followed by interventional strategies to bolster it. The benefits of cultural change include providing a more positive educational environment for residents and faculty, raising awareness of burnout and its symptoms, decreasing the stigma associated with admitting burnout symptoms, enabling the development of prevention strategies, and creating a more positive, strength-based approach to understanding the toll of physician-patient relationships on physicians. PMID:21975983

  14. Hospital Readmissions Following Physician Call System Change: A Comparison of Concentrated and Distributed Schedules.

    PubMed

    Yarnell, Christopher J; Shadowitz, Steven; Redelmeier, Donald A

    2016-07-01

    Physician call schedules are a critical element for medical practice and hospital efficiency. We compared readmission rates prior to and after a change in physician call system at Sunnybrook Health Sciences Centre. We studied patients discharged over a decade (2004 through 2013) and identified whether or not each patient was readmitted within the subsequent 28 days. We excluded patients discharged for a surgical, obstetrical, or psychiatric diagnosis. We used time-to-event analysis and time-series analysis to compare rates of readmission prior to and after the physician call system change (January 1, 2009). A total of 89,697 patients were discharged, of whom 10,001 (11%) were subsequently readmitted and 4280 died. The risk of readmission was increased by about 26% following physician call system change (9.7% vs 12.2%, P <.001). Time-series analysis confirmed a 26% increase in the readmission rate after call system change (95% confidence interval, 22%-31%; P <.001). The increase in readmission rate after call system change persisted across patients with diverse ages, estimated readmission risks, and medical diagnoses. The net effect was equal to 7240 additional patient days in the hospital following call system change. A modest increase was observed at a nearby acute care hospital that did not change physician call system, and no increase in risk of death was observed with increased hospital readmissions. We suggest that changes in physician call systems sometimes increase subsequent hospital readmission rates. Further reductions in readmissions may instead require additional resources or ingenuity. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The Performance of Direct Disk Diffusion for Community Acquired Bacteremia due to Gram-Negative Bacilli and Its Impact on Physician Treatment Decisions

    PubMed Central

    Daley, Peter; Comerford, Adam; Umali, Jurgienne; Penney, Carla

    2016-01-01

    Background. Direct disk diffusion susceptibility testing provides faster results than standard microtitre susceptibility. The direct result may impact patient outcome in sepsis if it is accurate and if physicians use the information to promptly and appropriately change antibiotic treatment. Objective. To compare the performance of direct disk diffusion with standard susceptibility and to consider physician decisions in response to these early results, for community acquired bacteremia with Gram-negative Bacilli. Methods. Retrospective observational study of all positive blood cultures with Gram-negative Bacilli, collected over one year. Physician antibiotic treatment decisions were assessed by an infectious diseases physician based on information available to the physician at the time of the decision. Results. 89 bottles growing Gram-negative Bacilli were included in the analysis. Direct disk diffusion agreement with standard susceptibility varied widely. In 47 cases (52.8%), the physician should have changed to a narrower spectrum but did not, in 18 cases (20.2%), the physician correctly narrowed from appropriate broad coverage, and in 8 cases (9.0%), the empiric therapy was correct. Discussion. Because inoculum is not standardized, direct susceptibility results do not agree with standard susceptibility results for all drugs. Physicians do not act on direct susceptibility results. Conclusion. Direct susceptibility should be discontinued in clinical microbiology laboratories. PMID:27366172

  16. The Performance of Direct Disk Diffusion for Community Acquired Bacteremia due to Gram-Negative Bacilli and Its Impact on Physician Treatment Decisions.

    PubMed

    Daley, Peter; Comerford, Adam; Umali, Jurgienne; Penney, Carla

    2016-01-01

    Background. Direct disk diffusion susceptibility testing provides faster results than standard microtitre susceptibility. The direct result may impact patient outcome in sepsis if it is accurate and if physicians use the information to promptly and appropriately change antibiotic treatment. Objective. To compare the performance of direct disk diffusion with standard susceptibility and to consider physician decisions in response to these early results, for community acquired bacteremia with Gram-negative Bacilli. Methods. Retrospective observational study of all positive blood cultures with Gram-negative Bacilli, collected over one year. Physician antibiotic treatment decisions were assessed by an infectious diseases physician based on information available to the physician at the time of the decision. Results. 89 bottles growing Gram-negative Bacilli were included in the analysis. Direct disk diffusion agreement with standard susceptibility varied widely. In 47 cases (52.8%), the physician should have changed to a narrower spectrum but did not, in 18 cases (20.2%), the physician correctly narrowed from appropriate broad coverage, and in 8 cases (9.0%), the empiric therapy was correct. Discussion. Because inoculum is not standardized, direct susceptibility results do not agree with standard susceptibility results for all drugs. Physicians do not act on direct susceptibility results. Conclusion. Direct susceptibility should be discontinued in clinical microbiology laboratories.

  17. Clinical problems with the performance of euthanasia and physician-assisted suicide in The Netherlands.

    PubMed

    Groenewoud, J H; van der Heide, A; Onwuteaka-Philipsen, B D; Willems, D L; van der Maas, P J; van der Wal, G

    2000-02-24

    The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in The Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with completion, such as a longer-than-expected interval between the administration of medications and death. In 114 cases, the physician's intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5). There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In The Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient's inability to take the medication or because of problems with the completion of physician-assisted suicide.

  18. Chronological changes in Japanese physicians' attitude and behavior concerning relationships with pharmaceutical representatives: a qualitative study.

    PubMed

    Saito, Sayaka; Mukohara, Kei; Miyata, Yasushi

    2014-01-01

    Recent qualitative studies indicated that physicians interact with pharmaceutical representatives depending on the relative weight of the benefits to the risks and are also influenced by a variety of experiences and circumstances. However, these studies do not provide enough information about if, when, how and why their attitudes and behaviors change over time. A qualitative study using semi-structured face-to-face individual interviews was conducted on 9 Japanese physicians who attended a symposium on conflicts of interest held in Tokyo. Interviews were designed to explore chronological changes in individual physicians' attitude and behavior concerning relationships with pharmaceutical representatives and factors affecting such changes. Their early interaction with pharmaceutical representatives was passive as physicians were not explicitly aware of the meaning of such interaction. They began to think on their own about how to interact with pharmaceutical representatives as they progressed in their careers. Their attitude toward pharmaceutical representatives changed over time. Factors affecting attitudinal change included work environment (local regulations and job position), role models, views of patients and the public, acquisition of skills in information seeking and evidence-based medicine, and learning about the concepts of professionalism and conflict of interest. However, the change in attitude was not necessarily followed by behavioral change, apparently due to rationalization and conformity to social norms. Physicians' attitudes toward relationships with pharmaceutical representatives changed over time and factors affecting such changes were various. Paying attention to these factors and creating new social norms may be both necessary to produce change in behavior consistent with change in attitude.

  19. Nurses' evaluation of physicians' non-clinical performance in emergency departments: advantages, disadvantages and lessons learned.

    PubMed

    Alameddine, Mohamad; Mufarrij, Afif; Saliba, Miriam; Mourad, Yara; Jabbour, Rima; Hitti, Eveline

    2015-02-27

    Peer evaluation is increasingly used as a method to assess physicians' interpersonal and communication skills. We report on experience with soliciting registered nurses' feedback on physicians' non-clinical performance in the ED of a large academic medical center in Lebanon. We utilized a secondary analysis of a de-identified database of ED nurses' assessment of physicians' non-clinical performance coupled with an evaluation of interventions carried out as a result of this evaluation. The database was compiled as part of quality/performance improvement initiatives using a cross-sectional design to survey registered nurses working at the ED. The survey instrument included open ended and closed ended questions assessing physicians' communication, professionalism and leadership skills. Three episodes of evaluation were carried out over an 18 month period. Physicians were provided with a communication training carried out after the first cycle of evaluation and a detailed feedback on their assessment by nurses after each evaluation cycle. A paired t-test was carried out to compare mean evaluation scores between the three cycles of evaluation. Thematic analysis of nurses' qualitative comments was carried out. A statistically significant increase in the averages of skills was observed between the first and second evaluations, followed by a significant decrease in the averages of the three skills between the second and third evaluations. Personalized feedback to ED physicians and communication training initially contributed to a significant positive impact on improving ED physicians' non-clinical skills as perceived by the ED nurses. Yet, gains achieved were lost upon reaching the third cycle of evaluation. However, the thematic analysis of the nurses' qualitative responses portrays a decrease in concerns across the various dimensions of non-clinical performance. Nurses' evaluation of the non-clinical performance of physicians has the potential of improving communication

  20. Economies of scope in physicians' work: the performance of multiple surgery.

    PubMed

    Dunn, D L; Sacher, S J; Cohen, W S; Hsiao, W C

    1995-01-01

    While the fees for the large majority of physicians' services in the new Medicare Fee Schedule (MFS) are derived directly from studies of the resource costs involved, payments for one class of procedures, multiple surgery, are based instead on existing policies and conventions. Using surveys of physicians, we measured the work and time involved in performing 146 multiple surgeries. We found economies of scope exist in performing these services, particularly during the preoperative and postoperative periods. We also found some differences in economies across procedures. Based on our findings, we propose payment policies for multiple surgery.

  1. Changes in physicians' sources of pharmaceutical information: a review and analysis.

    PubMed

    Williams, J R; Hensel, P J

    1991-09-01

    Since 1952, 20 datasets have been generated through 17 studies in an attempt to describe the sources and importance and/or use of information about pharmaceuticals by physicians. The authors review the findings of the studies and subject them to three sequentially relevant, but different, meta-analytic procedures. The results of these analyses indicate significant changes in the sources and importance of various commercial/noncommercial and personal/nonpersonal information as they relate to physicians' prescribing behavior. Those changes over time have specific implications for marketers of pharmaceuticals.

  2. Changes in Hospital-Physician Affiliations in U.S. Hospitals and Their Effect on Quality of Care.

    PubMed

    Scott, Kirstin W; Orav, E John; Cutler, David M; Jha, Ashish K

    2017-01-03

    Growing evidence shows that hospitals are increasingly employing physicians. To examine changes in U.S. acute care hospitals that reported employment relationships with their physicians and to determine whether quality of care improved after the hospitals switched to this integration model. Retrospective cohort study of U.S. acute care hospitals between 2003 and 2012. U.S. nonfederal acute care hospitals. 803 switching hospitals compared with 2085 nonswitching control hospitals matched for year and region. Hospitals' conversion to an employment relationship with any of their privileged physicians. Risk-adjusted hospital-level mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions. In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. Relative to regionally matched controls, switching hospitals were more likely to be large (11.6% vs. 7.1%) or major teaching hospitals (7.5% vs. 4.5%) and less likely to be for-profit institutions (8.8% vs. 19.9%) (all P values <0.001). Up to 2 years after conversion, no association was found between switching to an employment model and improvement in any of 4 primary composite quality metrics. The measure of integration used depends on responses to the American Hospital Association annual questionnaire, yet this measure has been used by others to examine effects of integration. The study examined performance up to 2 years after evidence of switching to an employment model; however, beneficial effects may have taken longer to appear. During the past decade, hospitals have increasingly become employers of physicians. The study's findings suggest that physician employment alone probably is not a sufficient tool for improving hospital care. Agency for Healthcare Research and Quality and National Science Foundation Graduate Research Fellowship.

  3. An examination of the relationships between physicians' clinical and hospital-utilization performance.

    PubMed

    Saywell, R M; Bean, J A; Ludke, R L; Redman, R W; McHugh, G J

    1981-01-01

    To examine the relationships between measures of attending physician teams' clinical and utilization performance, inpatient hospital audits were conducted in 22 Maryland and western Pennsylvania nonfederal short-term hospitals. A total of 6,980 medical records were abstracted from eight diagnostic categories using the Payne and JCAH PEP medical audit procedures. The results indicate weak statistical associations between the two medical care evaluation audits; between clinical performance and utilization performance, as measured by appropriateness of admissions and length of stay; and between three utilization measures. Based on these findings, it does not appear valid to use performance in one area to evaluate performance in the other in order to measure or evaluate and ultimately improve physicians; clinical or utilization performance.

  4. An examination of the relationships between physicians' clinical and hospital-utilization performance.

    PubMed Central

    Saywell, R M; Bean, J A; Ludke, R L; Redman, R W; McHugh, G J

    1981-01-01

    To examine the relationships between measures of attending physician teams' clinical and utilization performance, inpatient hospital audits were conducted in 22 Maryland and western Pennsylvania nonfederal short-term hospitals. A total of 6,980 medical records were abstracted from eight diagnostic categories using the Payne and JCAH PEP medical audit procedures. The results indicate weak statistical associations between the two medical care evaluation audits; between clinical performance and utilization performance, as measured by appropriateness of admissions and length of stay; and between three utilization measures. Based on these findings, it does not appear valid to use performance in one area to evaluate performance in the other in order to measure or evaluate and ultimately improve physicians; clinical or utilization performance. PMID:6946048

  5. Model depicting aspects of audit and feedback that impact physicians' acceptance of clinical performance feedback.

    PubMed

    Payne, Velma L; Hysong, Sylvia J

    2016-07-13

    Audit and feedback (A&F) is a strategy that has been used in various disciplines for performance and quality improvement. There is limited research regarding medical professionals' acceptance of clinical-performance feedback and whether feedback impacts clinical practice. The objectives of our research were to (1) investigate aspects of A&F that impact physicians' acceptance of performance feedback; (2) determine actions physicians take when receiving feedback; and (3) determine if feedback impacts physicians' patient-management behavior. In this qualitative study, we employed grounded theory methods to perform a secondary analysis of semi-structured interviews with 12 VA primary care physicians. We analyzed a subset of interview questions from the primary study, which aimed to determine how providers of high, low and moderately performing VA medical centers use performance feedback to maintain and improve quality of care, and determine perceived utility of performance feedback. Based on the themes emergent from our analysis and their observed relationships, we developed a model depicting aspects of the A&F process that impact feedback acceptance and physicians' patient-management behavior. The model is comprised of three core components - Reaction, Action and Impact - and depicts elements associated with feedback recipients' reaction to feedback, action taken when feedback is received, and physicians modifying their patient-management behavior. Feedback characteristics, the environment, external locus-of-control components, core values, emotion and the assessment process induce or deter reaction, action and impact. Feedback characteristics (content and timeliness), and the procedural justice of the assessment process (unjust penalties) impact feedback acceptance. External locus-of-control elements (financial incentives, competition), the environment (patient volume, time constraints) and emotion impact patient-management behavior. Receiving feedback generated

  6. Effects of Paying Physicians Based on their Relative Performance for Quality

    PubMed Central

    Meterko, Mark; Beckman, Howard; Baker, Errol; White, Bert; Sautter, Karen M.; Greene, Robert; Curtin, Kathy; Bokhour, Barbara G.; Berlowitz, Dan; Burgess, James F.

    2007-01-01

    Background Studies examining the effectiveness of pay-for-performance programs to improve quality of care primarily have been confined to bonus-type arrangements that reward providers for performance above a predetermined threshold. No studies to date have evaluated programs placing providers at financial risk for performance relative to other participants in the program. Objective The objective of the study is to evaluate the impact of an incentive program conferring limited financial risk to primary care physicians. Participants There were 334 participating primary care physicians in Rochester, New York. Design The design of the study is a retrospective cohort study using pre/post analysis. Measurements The measurements adhere to 4 diabetes performance measures between 1999 and 2004. Results While absolute performance levels increased across all measures immediately following implementation, there was no difference between the post- and pre-intervention trends indicating that the overall increase in performance was largely a result of secular trends. However, there was evidence of a modest 1-time improvement in physician adherence for eye examination that appeared attributable to the incentive program. For this measure, physicians improved their adherence rate on average by 7 percentage points in the year after implementation of the program. Conclusions This study demonstrates a modest effect in improving provider adherence to quality standards for a single measure of diabetes care during the early phase of a pay-for-performance program that placed physicians under limited financial risk. Further research is needed to determine the most effective incentive structures for achieving substantial gains in quality of care. PMID:17443360

  7. Plain radiologic findings and chronological changes of incipient phase osteosarcoma overlooked by primary physicians.

    PubMed

    Song, Won Seok; Jeon, Dae-Geun; Cho, Wan Hyeong; Kong, Chang-Bae; Cho, Sang Hyun; Lee, Jung Wook; Lee, Soo-Yong

    2014-06-01

    We assessed the plain radiographic characteristics of 10 cases of osteosarcomas during the initial painful period that had been overlooked by a primary physician. In addition, we evaluated chronologic changes in radiographic findings from initial symptomatic period to the time of accurate diagnosis. The clinical records were reviewed for clinical parameters including age, sex, location, presenting symptoms, initial diagnosis, duration from initial symptoms to definite diagnosis, and initial and follow-up plain radiographic findings of the lesion. Initial clinical diagnoses included a sprain in 6, growing pain in 2, stress fracture in 1, and infection in 1 patient. Initial plain radiographic findings were trabecular destruction (100%), cortical disruption (60%), periosteal reaction (60%), and soft tissue mass (10%). Intramedullary matrix changes were osteosclerosis in 6 and osteolysis in 4 patients. On progression, 4 cases with minimal sclerosis changed to osteoblastic lesion in 3 patients and osteolytic lesion in 1. Four cases with faint osteolytic foci transformed into osteolytic lesion in 3 and mixed pattern in 1. Notable plain radiologic findings of incipient-stage osteosarcoma include trabecular disruption along with faint osteosclerosis or osteolysis. In symptomatic patients with trabecular destruction, additional imaging study including magnetic resonance imaging should be performed to exclude osteosarcoma in the incipient phase, even without radiologic findings suggesting malignant tumor, such as cortical destruction or periosteal reaction.

  8. Evaluation of physicians' professional performance: An iterative development and validation study of multisource feedback instruments

    PubMed Central

    2012-01-01

    Background There is a global need to assess physicians' professional performance in actual clinical practice. Valid and reliable instruments are necessary to support these efforts. This study focuses on the reliability and validity, the influences of some sociodemographic biasing factors, associations between self and other evaluations, and the number of evaluations needed for reliable assessment of a physician based on the three instruments used for the multisource assessment of physicians' professional performance in the Netherlands. Methods This observational validation study of three instruments underlying multisource feedback (MSF) was set in 26 non-academic hospitals in the Netherlands. In total, 146 hospital-based physicians took part in the study. Each physician's professional performance was assessed by peers (physician colleagues), co-workers (including nurses, secretary assistants and other healthcare professionals) and patients. Physicians also completed a self-evaluation. Ratings of 864 peers, 894 co-workers and 1960 patients on MSF were available. We used principal components analysis and methods of classical test theory to evaluate the factor structure, reliability and validity of instruments. We used Pearson's correlation coefficient and linear mixed models to address other objectives. Results The peer, co-worker and patient instruments respectively had six factors, three factors and one factor with high internal consistencies (Cronbach's alpha 0.95 - 0.96). It appeared that only 2 percent of variance in the mean ratings could be attributed to biasing factors. Self-ratings were not correlated with peer, co-worker or patient ratings. However, ratings of peers, co-workers and patients were correlated. Five peer evaluations, five co-worker evaluations and 11 patient evaluations are required to achieve reliable results (reliability coefficient ≥ 0.70). Conclusions The study demonstrated that the three MSF instruments produced reliable and valid data

  9. Impact of reference change value (RCV) based autoverification on turnaround time and physician satisfaction

    PubMed Central

    Fernández-Grande, Esther; Valera-Rodriguez, Carolina; Sáenz-Mateos, Luis; Sastre-Gómez, Amparo; García-Chico, Pilar; Palomino-Muñoz, Teodoro J.

    2017-01-01

    Background For a quicker delivery of laboratory test results to the hospital emergency department (ED), we implemented an autoverification system based on the reference change value (RCV). The aim of this study was to assess how the RCV based autoverification reflected on turnaround time (TAT) and on physician satisfaction. Materials and methods The laboratory information system (LIS) was programmed to autoverify the results as long as they were within the range settled by RCV, so that the autoverified results were reported to the physician as soon as the tests were carried out, without any further intervention. We analyzed the same three-month periods’ TAT and verification time (VFT) from the years prior to and following the implementation of RCV autoverification. The change in physicians’ satisfaction levels was assessed using the hospital’s Annual Physician Satisfaction Survey (APSS). Over sixty percent of physicians completed the questionnaire, and the amount of daily ED test requests (nearly three hundred) did not vary throughout the duration of this study. Results Mann-Whitney U test showed that the VFT was significantly reduced in all the test but troponin I. There were substantial reductions in TAT medians (haemogram, 75%; fibrinogen, 41%; prothrombin time, 40%; sodium, 27%). The percentage of physicians satisfied with the haematological and biochemical tests´ TAT increased from 84% to 93% and from 86% to 91% respectively. Conclusions Our results reveal that VFT and TAT were severely reduced in most emergency tests, greatly improving physicians’ satisfaction with TAT. PMID:28694725

  10. Standing Out and Moving Up: Performance Appraisal of Cultural Minority Physicians

    ERIC Educational Resources Information Center

    Leyerzapf, Hannah; Abma, Tineke A.; Steenwijk, Reina R.; Croiset, Gerda; Verdonk, Petra

    2015-01-01

    Despite a growing diversity within society and health care, there seems to be a discrepancy between the number of cultural minority physicians graduating and those in training for specialization (residents) or working as a specialist in Dutch academic hospitals. The purpose of this article is to explore how performance appraisal in daily medical…

  11. Standing Out and Moving Up: Performance Appraisal of Cultural Minority Physicians

    ERIC Educational Resources Information Center

    Leyerzapf, Hannah; Abma, Tineke A.; Steenwijk, Reina R.; Croiset, Gerda; Verdonk, Petra

    2015-01-01

    Despite a growing diversity within society and health care, there seems to be a discrepancy between the number of cultural minority physicians graduating and those in training for specialization (residents) or working as a specialist in Dutch academic hospitals. The purpose of this article is to explore how performance appraisal in daily medical…

  12. Explaining physicians' use of EMR systems and performance in the shakedown phase

    PubMed Central

    Venkatesh, Viswanath; Rai, Arun

    2011-01-01

    Objective This work seeks to complement and extend prior work by using a multidisciplinary approach to explain electronic medical records (EMR) system use and consequent performance (here, patient satisfaction) among physicians during early stages of the implementation of an EMR. Design This was a quantitative study, with data obtained from three distinct sources: individual-level and social-network data from employees; use data from EMR system logs; and patient satisfaction data from patients and/or authorized decision-makers. Responses were obtained from 151 physicians and 8440 patient satisfaction surveys over the course of a 1-year period at the shakedown phase of an EMR system implementation. Results Physicians who were better connected, both directly and indirectly, to their peers—that is, other physicians—for advice on their work, used the system less than those who were less connected. In addition to such social network ties, demographic characteristics (gender and age), three personality characteristics (openness to experience, agreeableness and extroversion) and a key technology perception (perceived usefulness) predicted EMR system use. Conclusions For hospital administrators and other stakeholders, understanding the contributors to, and the relative importance of, various factors in explaining EMR system use, and its impact on patient satisfaction is of great importance. The factors identified in this work that influence a physician's use of EMR systems can be used to develop interventions and applications that can increase physician buy-in and use of EMR systems. PMID:21292704

  13. Demographic change and the supply of physicians, hospitals, and hospital beds: marketing implications.

    PubMed

    Pol, L G; Tymkiw, D R

    1990-01-01

    Demographic conditions are a major component of the business environment in which health care marketers must compete. The following study assesses the impact of demographic factors on health care supply and finds that population size, population change, age structure, and income are important predictors of physician, hospital, and hospital bed supply. The results are discussed in the context of marketing implications.

  14. What doctor shortage? Some experts say changes in delivery will erase need for more physicians.

    PubMed

    Robeznieks, Andis

    2013-11-11

    The conventional wisdom says the U.S. is headed for a big physician shortage. But some policy experts are arguing that changes in healtchare delivery -- medical homes, retail clinics and expanded scope-of-practice laws -- mean there's really no crisis at all.

  15. Major General Spurgeon Neel and the Army Physician Assistant: A Case Study of Policy Change

    DTIC Science & Technology

    2009-01-01

    1 Major General Spurgeon Neel and the Army Physician Assistant: A Case Study of Policy Change Richard Glade ...a survey, which interestingly, made no attempt to study it. In 2005, Captain John Hughes surveyed every battalion and brigade commander at Fort

  16. Physician Education for a Changing Health Care Environment: Council on Graduate Medical Education, Thirteenth Report.

    ERIC Educational Resources Information Center

    Council on Graduate Medical Education.

    This report presents an analysis of the issues influencing the preparation of physicians in the United States and recommends changes in teaching programs. Findings and associated recommendations are organized into eight areas: (1) understanding the system in which health care is delivered; (2) establishing practical and relevant teaching sites;…

  17. The introduction of computerized physician order entry and change management in a tertiary pediatric hospital.

    PubMed

    Upperman, Jeffrey S; Staley, Patricia; Friend, Kerri; Benes, Jocelyn; Dailey, Jacque; Neches, William; Wiener, Eugene S

    2005-11-01

    The objectives of this review were to document the introduction of computerized physician order entry (CPOE)-centered changes in an academic tertiary care center and to review the CPOE-focused literature. We performed a systematic literature review of CPOE-related articles indexed on Medline, with particular emphasis on pediatric applications. We focused our commentary around the concepts involved in the implementation process at a tertiary pediatric hospital. In 2001, the Children's Hospital of Pittsburgh (CHP) embarked on the process of CPOE design and implementation. We determined that CPOE is a tool for improving pediatric care. The CPOE implementation process is more than a technologic change; it involves an organizational cultural transformation. Although the complete transition to CPOE was little more than 1 year ago, CHP has overcome the typical obstacles of CPOE implementation to begin to realize its many benefits. The early success of CHP was achieved by creating a realistic, positive, work environment, which fostered hospital-wide participation and integration. CPOE is an invaluable resource for supporting patient safety in health care settings. The successful implementation of CPOE requires a paradigm shift in hospital policies and processes.

  18. Changes to physician and nurse time burdens when caring for patients under contact precautions.

    PubMed

    Barker, Anna K; Codella, James; Ewers, Tola; Dundon, Adam; Alagoz, Oguzhan; Safdar, Nasia

    2017-03-13

    Contact precautions are complex behavioral interventions. To better understand barriers to compliance, we conducted a prospective study that compared the time burden for health care workers caring for contact precautions patients versus other patients. We found that nurses spent significantly more time in the rooms of contact precautions patients. There was no significant change in physician timing. Future studies need to evaluate workflow changes so that barriers to contact precaution implementation can be fully understood and addressed.

  19. Palliative care professionals' willingness to perform euthanasia or physician assisted suicide.

    PubMed

    Zenz, Julia; Tryba, Michael; Zenz, Michael

    2015-11-14

    Euthanasia and physician assisted suicide (PAS) are highly debated upon particularly in the light of medical advancement and an aging society. Little is known about the professionals' willingness to perform these practices particularly among those engaged in the field of palliative care and pain management. Thus a study was performed among those professionals. An anonymous questionnaire was handed out to all participants of a palliative care congress and a pain symposium in 2013. The questionnaire consisted of 8 questions regarding end of life decisions. Proposed patient vignettes were used. A total of 470 eligible questionnaires were returned, 198 by physicians, 272 by nurses. The response rate was 64 %. The majority of professionals were reluctant to perform euthanasia or PAS: 5.3 % of the respondents would be willing to perform euthanasia on a patient with a terminal illness if asked to do so. The reluctance grew in case of a patient with a non-terminal illness. The respondents were more willing to perform PAS than euthanasia. Nurses were more reluctant to take action as opposed to the physicians. The majority of the respondents would attempt to treat the patient's symptoms first before considering life-ending measures. As regards any decision making process the majority would consult with a colleague. This is the first German study to ask about the willingness of professionals to take action as regards euthanasia and PAS without biased phrasing. As opposed to the general acceptance that is respectively high, the actual willingness to perform life-ending measures is low. The German debate on physician assisted suicide and its possible legalization should also incorporate clarifications regarding the responsibility who should eventually perform these acts.

  20. Physicians in health care management: 2. Managing performance: who, what, how and when?

    PubMed Central

    Lemieux-Charles, L

    1994-01-01

    Physicians are becoming more involved in performance management as hospitals restructure to increase effectiveness. Although physicians are not hospital employees, they are subject to performance appraisals because the hospitals are accountable to patients and the community for the quality of hospital services. The performance of a health care professional may be appraised by the appropriate departmental manager, by other professionals in a team or program or by peers, based on prior agreement on expectations. Appraisal approaches vary. They include behavioural approaches such as rating scales, peer rating, ranking or nomination and outcome approaches such as management by objectives and goal setting. Professionals should give and receive timely feedback on a flexible schedule. Feedback can be provided one-on-one, by a group assessing quality of care or through an anonymous survey. PMID:8313260

  1. The physician mentored implementation model: a promising quality improvement framework for health care change.

    PubMed

    Li, Jing; Hinami, Keiki; Hansen, Luke O; Maynard, Gregory; Budnitz, Tina; Williams, Mark V

    2015-03-01

    Quality improvement (QI) efforts hold great promise for improving care delivery. However, hospitals often struggle with QI implementation and fail to sustain improvement in either process changes or patient outcomes. Physician mentored implementation (PMI) is a novel approach that promotes the success and sustainability of QI initiatives at hospitals. It leverages the expertise of external physician mentors who coach QI teams to implement interventions at their local hospitals. The PMI model includes five core components: (1) a hospital self-assessment tool, (2) a face-to-face training session including direct interaction with a physician mentor, (3) a guided continuous quality improvement and systems approach, (4) yearlong individual physician mentoring, and (5) a learning community supported by a resource center, listserv, and webinars. Mentors provide content and process expertise, rather than offering "one-size-fits-all" technical assistance that might not be sustained after the mentoring year ends. Mentors support and motivate QI teams throughout the planning and implementation phases of their interventions, help to engage hospital leadership, garner local physician buy-in, and address institutional barriers. Mentors also guide hospitals to identify opportunities for the adaptation and customization of original evidence-based models of care while ensuring the fidelity of those models. More than 350 hospitals have used the PMI model to implement successful national and statewide QI initiatives. Academic medical centers are charged with improving the health of patients and reengineering care delivery; thus, they serve as the ideal source for physician mentors and can act as leaders in implementing QI projects using the PMI model.

  2. High-performance teams for current and future physician leaders: an introduction.

    PubMed

    Jain, Anshu K; Thompson, Jon M; Chaudry, Joseph; McKenzie, Shaun; Schwartz, Richard W

    2008-01-01

    The scope of patient management increasingly crosses the defined lines of multiple medical specialties and services to meet patient needs. Concurrently, many hospitals and health-care systems have adapted new multidisciplinary team structures that provide patient-centric care as opposed to the more traditional discipline-centered delivery of care. As health care continues to evolve, the use of teams becomes even more critical in allowing interdependence between multiple disciplines to provide excellent care delivery and ongoing patient management. The use of teams permeates the health-care industry (and has done so for many years), but confusion about the structure, role, and use of teams contributes to limited effectiveness. The health-care industry's underuse of the fundamentals of corporate teamwork has, in part, created ineffective team leadership at the physician level. As the first in a series of documents on teamwork, this article is intended to introduce the reader to the rudiments of team theory and to present an introduction to a model of teamwork. The role of current and future physician leaders in ensuring team effectiveness is emphasized in this discussion. By educating health-care professionals on the foundations of high-performance teamwork, we hope to accomplish two main goals. The first goal is to help create a common and systematic taxonomy that physician leaders and institutional management can agree on and refer to concerning the development of high-performance health-care teams. The second goal is to stimulate the development of future physician leaders who use proven teamwork principles as a powerful modality to achieve efficient and optimal patient care. Most importantly, we wish to emphasize that health care, both philosophically and practically, is delivered best through high-performance teams. For such teams to perform properly, the organizational environment must support the team concept tangibly. In concert, we believe the best manner in

  3. Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes.

    PubMed

    Everett, Christine; Thorpe, Carolyn; Palta, Mari; Carayon, Pascale; Bartels, Christie; Smith, Maureen A

    2013-11-01

    One approach to the patient-centered medical home, particularly for patients with chronic illnesses, is to include physician assistants (PAs) and nurse practitioners (NPs) on primary care teams. Using Medicare claims and electronic health record data from a large physician group, we compared outcomes for two groups of adult Medicare patients with diabetes whose conditions were at various levels of complexity: those whose care teams included PAs or NPs in various roles, and those who received care from physicians only. Outcomes were generally equivalent in thirteen comparisons. In four comparisons, outcomes were superior for the patients receiving care from PAs or NPs, but in three other comparisons the outcomes were superior for patients receiving care from physicians only. Specific roles performed by PAs and NPs were associated with different patterns in the measure of the quality of diabetes care and use of health care services. No role was best for all outcomes. Our findings suggest that patient characteristics, as well as patients' and organizations' goals, should be considered when determining when and how to deploy PAs and NPs on primary care teams. Accordingly, training and policy should continue to support role flexibility for these health professionals.

  4. 42 CFR 414.50 - Physician or other supplier billing for diagnostic tests performed or interpreted by a physician...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Physician or other supplier billing for diagnostic... or other supplier. 414.50 Section 414.50 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER...

  5. 42 CFR 414.50 - Physician or other supplier billing for diagnostic tests performed or interpreted by a physician...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Physician or other supplier billing for diagnostic... or other supplier. 414.50 Section 414.50 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER...

  6. Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort.

    PubMed

    Shanafelt, Tait D; Mungo, Michelle; Schmitgen, Jaime; Storz, Kristin A; Reeves, David; Hayes, Sharonne N; Sloan, Jeff A; Swensen, Stephen J; Buskirk, Steven J

    2016-04-01

    To longitudinally evaluate the relationship between burnout and professional satisfaction with changes in physicians' professional effort. Administrative/payroll records were used to longitudinally evaluate the professional work effort of faculty physicians working for Mayo Clinic from October 1, 2008, to October 1, 2014. Professional effort was measured in full-time equivalent (FTE) units. Physicians were longitudinally surveyed in October 2011 and October 2013 with standardized tools to assess burnout and satisfaction. Between 2008 and 2014, the proportion of physicians working less than full-time at our organization increased from 13.5% to 16.0% (P=.05). Of the 2663 physicians surveyed in 2011 and 2776 physicians surveyed in 2013, 1856 (69.7%) and 2132 (76.9%), respectively, returned surveys. Burnout and satisfaction scores in 2011 correlated with actual reductions in FTE over the following 24 months as independently measured by administrative/payroll records. After controlling for age, sex, site, and specialty, each 1-point increase in the 7-point emotional exhaustion scale was associated with a greater likelihood of reducing FTE (odds ratio [OR], 1.43; 95% CI, 1.23-1.67; P<.001) over the following 24 months, and each 1-point decrease in the 5-point satisfaction score was associated with greater likelihood of reducing FTE (OR, 1.34; 95% CI, 1.03-1.74; P=.03). On longitudinal analysis at the individual physician level, each 1-point increase in emotional exhaustion (OR, 1.28; 95% CI, 1.05-1.55; P=.01) or 1-point decrease in satisfaction (OR, 1.67; 95% CI, 1.19-2.35; P=.003) between 2011 and 2013 was associated with a greater likelihood of reducing FTE over the following 12 months. Among physicians in a large health care organization, burnout and declining satisfaction were strongly associated with actual reductions in professional work effort over the following 24 months. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier

  7. Accuracy of emergency physician performed bedside ultrasound in determining gestational age in first trimester pregnancy

    PubMed Central

    2012-01-01

    Background Patient reported menstrual history, physician clinical evaluation, and ultrasonography are used to determine gestational age in the pregnant female. Previous studies have shown that pregnancy dating by last menstrual period (LMP) and physical examination findings can be inaccurate. An ultrasound performed in the radiology department is considered the standard for determining an accurate gestational age. The aim of this study is to determine the accuracy of emergency physician performed bedside ultrasound as an estimation of gestational age (EDUGA) as compared to the radiology department standard. Methods A prospective convenience sample of ED patients presenting in the first trimester of pregnancy (based upon self-reported LMP) regardless of their presenting complaint were enrolled. EDUGA was compared to gestational age estimated by ultrasound performed in the department of radiology (RGA) as the gold standard. Pearson’s product moment correlation coefficient was used to determine the correlation between EDUGA compared to RGA. Results Sixty-eight pregnant patients presumed to be in the 1st trimester of pregnancy based upon self-reported LMP consented to enrollment. When excluding the cases with no fetal pole, the median discrepancy of EDUGA versus RGA was 2 days (interquartile range (IQR) 1 to 3.25). The correlation coefficient of EDUGA with RGA was 0.978. When including the six cases without a fetal pole in the data analysis, the median discrepancy of EDUGA compared with RGA was 3 days (IQR 1 to 4). The correlation coefficient of EDUGA with RGA was 0.945. Conclusion Based on our comparison of EDUGA to RGA in patients presenting to the ED in the first trimester of pregnancy, we conclude that emergency physicians are capable of accurately performing this measurement. Emergency physicians should consider using ultrasound to estimate gestational age as it may be useful for the future care of that pregnant patient. PMID:23216683

  8. Changing nature of physician licensure. Implications for medical education in California.

    PubMed Central

    Dower, C M; Gragnola, C M; Finocchio, L J

    1998-01-01

    Recent upheavals within health care delivery, technological advances, and changing attitudes among consumers have challenged and changed health professions licensure. At the same time, traditional regulatory frameworks remain in place. Beginning with a comparison of California's physician regulation with other states, we explore this tension between established regulatory systems and emerging reforms. Current trends in regulatory reform across the United States and in California include efforts to standardize practice requirements, expand scopes of practice for nonphysicians, and restructure boards. Because of these trends, medical educators will be expected to prepare physicians to practice under increased scrutiny and expectations of accountability; promote interdisciplinary education, training, and practice; and step up the efforts toward uniformity in medical education, training, and practice. PMID:9614799

  9. A survey of African American physicians on the health effects of climate change.

    PubMed

    Sarfaty, Mona; Mitchell, Mark; Bloodhart, Brittany; Maibach, Edward W

    2014-11-28

    The U.S. National Climate Assessment concluded that climate change is harming the health of many Americans and identified people in some communities of color as particularly vulnerable to these effects. In Spring 2014, we surveyed members of the National Medical Association, a society of African American physicians who care for a disproportionate number of African American patients, to determine whether they were seeing the health effects of climate change in their practices; the response rate was 30% (n = 284). Over 86% of respondents indicated that climate change was relevant to direct patient care, and 61% that their own patients were already being harmed by climate change moderately or a great deal. The most commonly reported health effects were injuries from severe storms, floods, and wildfires (88%), increases in severity of chronic disease due to air pollution (88%), and allergic symptoms from prolonged exposure to plants or mold (80%). The majority of survey respondents support medical training, patient and public education regarding the impact of climate change on health, and advocacy by their professional society; nearly all respondents indicated that the US should invest in significant efforts to protect people from the health effects of climate change (88%), and to reduce the potential impacts of climate change (93%). These findings suggest that African American physicians are currently seeing the health impacts of climate change among their patients, and that they support a range of responses by the medical profession, and public policy makers, to prevent further harm.

  10. A Survey of African American Physicians on the Health Effects of Climate Change

    PubMed Central

    Sarfaty, Mona; Mitchell, Mark; Bloodhart, Brittany; Maibach, Edward W

    2014-01-01

    The U.S. National Climate Assessment concluded that climate change is harming the health of many Americans and identified people in some communities of color as particularly vulnerable to these effects. In Spring 2014, we surveyed members of the National Medical Association, a society of African American physicians who care for a disproportionate number of African American patients, to determine whether they were seeing the health effects of climate change in their practices; the response rate was 30% (n = 284). Over 86% of respondents indicated that climate change was relevant to direct patient care, and 61% that their own patients were already being harmed by climate change moderately or a great deal. The most commonly reported health effects were injuries from severe storms, floods, and wildfires (88%), increases in severity of chronic disease due to air pollution (88%), and allergic symptoms from prolonged exposure to plants or mold (80%). The majority of survey respondents support medical training, patient and public education regarding the impact of climate change on health, and advocacy by their professional society; nearly all respondents indicated that the US should invest in significant efforts to protect people from the health effects of climate change (88%), and to reduce the potential impacts of climate change (93%). These findings suggest that African American physicians are currently seeing the health impacts of climate change among their patients, and that they support a range of responses by the medical profession, and public policy makers, to prevent further harm. PMID:25464138

  11. Medicare reimbursement changes for ambulatory surgery centers and remuneration to urological physician-owners.

    PubMed

    Strope, Seth A; Daignault, Stephanie; Hollingsworth, John M; Wei, John T; Hollenbeck, Brent K

    2008-09-01

    To decrease the cost of surgical care Medicare has introduced a new facility fee schedule for ambulatory surgical centers. This prospective payment system increases reimbursement for many urological procedures, while decreasing reimbursement for others. All stakeholders, including physicians, the Medicare program and hospitals, will be affected by these changes. Using the Agency for Healthcare Research and Quality State Ambulatory Surgery Databases we identified Medicare patients in Florida who underwent urological procedures in ambulatory surgical centers from 1998 to 2005. Three facility groupings were created, including urology dominant, multispecialty and other specialty dominant. The impact of reimbursement changes at the procedure and facility levels was assessed using 2005 data. Projections of ambulatory surgical center use and reimbursement in 2008 were then generated using all available data. In 2008 we project total payments by Medicare to increase by $4,233,080 (26%, range 22% to 32%) under the new reimbursement system compared to the old system. At the facility level reimbursement to multispecialty facilities should increase substantially (49%), while urology specialty facilities will receive less benefit (10% increase). Compared to multispecialty facilities, at urology specialty facilities a higher proportion of cases is performed for which reimbursement is set to decrease. Under the new payment scheme for ambulatory surgical centers winners and losers emerge. Facilities with diversified procedure mixes will find increased revenue, while those with less diversification will find slower growth to their revenue streams. In contrast to the desire of the Medicare program to decrease surgical costs, the new program may increase the payments made for urological surgery.

  12. Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion.

    PubMed

    Jones, Christine D; Scott, Serena J; Anoff, Debra L; Pierce, Read G; Glasheen, Jeffrey J

    2015-01-01

    Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001), uninsured encounters decreased (18.4% to 6.3%, P < 0.001), and private payer encounters also decreased (14.1% to 13.3%, P = .001). The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001). In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for -0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. © The Author(s) 2015.

  13. CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making.

    PubMed

    Pandharipande, Pari V; Reisner, Andrew T; Binder, William D; Zaheer, Atif; Gunn, Martin L; Linnau, Ken F; Miller, Chad M; Avery, Laura L; Herring, Maurice S; Tramontano, Angela C; Dowling, Emily C; Abujudeh, Hani H; Eisenberg, Jonathan D; Halpern, Elkan F; Donelan, Karen; Gazelle, G Scott

    2016-03-01

    To determine how physicians' diagnoses, diagnostic uncertainty, and management decisions are affected by the results of computed tomography (CT) in emergency department settings. This study was approved by the institutional review board and compliant with HIPAA. Data were collected between July 12, 2012, and January 13, 2014. The requirement to obtain patient consent was waived. In this prospective, four-center study, patients presenting to the emergency department who were referred for CT with abdominal pain, chest pain and/or dyspnea, or headache were identified. Physicians were surveyed before and after CT to determine the leading diagnosis, diagnostic confidence (on a scale of 0% to 100%), alternative "rule out" diagnosis, and management decisions. Primary measures were the proportion of patients for whom the leading diagnosis or admission decision changed and median changes in diagnostic confidence. Secondary measures addressed alternative diagnoses and return-to-care visits (eg, to emergency department) at 1-month follow-up. Regression analysis was used to identify associations between primary measures and site and participant characteristics. Both surveys were completed for 1280 patients by 245 physicians. The leading diagnosis changed in 235 of 460 patients with abdominal pain (51%), 163 of 387 with chest pain and/or dyspnea (42%), and 103 of 433 with headache (24%). Pre-CT diagnostic confidence was inversely associated with the likelihood of a diagnostic change (P < .0001). Median changes in confidence were substantial (increases of 25%, 20%, and 13%, respectively, for patients with abdominal pain, chest pain and/or dyspnea, and headache; P < .0001); median post-CT confidence was high (95% for all three groups). CT helped confirm or exclude at least 95% of alternative diagnoses. Admission decisions changed in 116 of 457 patients with abdominal pain (25%), 72 of 387 with chest pain and/or dyspnea (19%), and 81 of 426 with headache (19%). During follow

  14. A survey of advanced trauma life support procedures being performed by physicians and nurses used on hospital aeromedical evacuation services.

    PubMed

    Thomas, F; Clemmer, T P; Orme, J F

    1985-12-01

    Traumatized patients may be transported by a variety of aeromedical transport teams. Frequently, the skills of physicians, nurses, and paramedical personnel overlap. This study was undertaken to determine if nurses used on hospital aeromedical evaluation services perform advanced trauma life support (ATLS) procedures usually reserved for physicians. Forty-seven hospital programs responded to our questionnaire. Flight nurses on programs (26) in which physicians were frequently used were significantly (p less than 0.05) less likely to perform cricothyreotomy, esophageal obturator airway placement, oral intubations, and pericardiocentesis than flight nurses of programs (21) not using flight physicians. Except for cervical tong placement (p less than 0.05), central line placement (p less than 0.05), and the performance of saphenous vein cutdown (p less than 0.05), no differences were found in procedures performed by flight nurses of programs not using physicians and those performed by flight physicians. We conclude that flight nurse abilities are expanding into areas traditionally set aside for physicians in providing advanced trauma life support procedures on hospital aeromedical services. Future studies need to be performed to determine their success and complication rates.

  15. Computer Decision Support Changes Physician Practice But Not Knowledge Regarding Autism Spectrum Disorders

    PubMed Central

    Carroll, A.E.; Saha, C.; Downs, S.M.

    2015-01-01

    Summary Objective To examine whether adding an autism module promoting adherence to clinical guidelines to an existing computer decision support system (CDSS) changed physician knowledge and self-reported clinical practice. Methods The CHICA (Child Health Improvement through Computer Automation) system, a CDSS, was enhanced with a module to improve management of autism in 2 of the 4 community pediatric clinics using the system. We examined the knowledge and beliefs of pediatric users using cross-sectional surveys administered at 3 time points (baseline, 12 months and 24 months post-implementation) between November 2010 and January 2013. Surveys measured knowledge, beliefs and self-reported practice patterns related to autism. Results A total of 45, 39, and 42 pediatricians responded at each time point, respectively, a 95-100% response rate. Respondents’ knowledge of autism and perception of role for diagnosis did not vary between control and intervention groups either at baseline or any of the two post-intervention time points. At baseline, there was no difference between these groups in rates in the routine use of parent-rated screening instruments for autism. However, by 12 and 24 months post-implementation there was a significant difference between intervention and control clinics in terms of the intervention clinics consistently screening eligible patients with a validated autism tool. Physicians at all clinics reported ongoing challenges to community resources for further work-up and treatment related to autism. Conclusions A CDSS module to improve primary care management of ASD in pediatric practice led to significant improvements in physician-reported use of validated screening tools to screen for ASDs. However it did not lead to corresponding changes in physician knowledge or attitudes. PMID:26448791

  16. The Central Role of Physician Leadership for Driving Change in Value-Based Care Environments.

    PubMed

    Lustig, Adam; Ogden, Michael; Brenner, Robert W; Penso, Jerry; Westrich, Kimberly D; Dubois, Robert W

    2016-10-01

    has achieved 72% hypertension control for at-risk patients and continues work towards the 80% campaign goal. The implementation of the Measure Up/Pressure Down campaign by CHC and SMG provides some valuable lessons. To further explore important aspects of successfully implementing the Measure Up/Pressure Down campaign in real-world settings, 6 key themes were identified that drove quality improvement and may be helpful to other organizations that implement similar quality improvement initiatives: (1) transitioning to value-based payments, (2) creating an environment for success, (3) leveraging program champions, (4) sharing quality data, (5) promoting care team collaboration, and (6) leveraging health information technology. The strategies employed by SMG and CHC, such as leveraging data analysis to identify at-risk patients and comparing physician performance, as well as identifying leaders to institute change, can be replicated by an ACO or a managed care organization (MCO). An MCO can provide data analysis services, sparing the provider groups the analytic burden and helping the MCO build a more meaningful relationship with their providers. No outside funding supported this project. The authors declare no conflicts of interest. The authors are members of the Working Group on Optimizing Medication Therapy in Value-Based Healthcare. Odgen is employed by Cornerstone Health Care; Brenner is employed by Summit Medical Group; and Penso is employed by American Medical Group Association. Lustig, Westrich, and Dubois are employed by the National Pharmaceutical Council, an industry-funded health policy research organization that is not involved in lobbying or advocacy. Study concept and design were contributed by Lustig, Penso, Westrich, and Dubois. Lustig, Ogden, Brenner, and Penso collected the data, and data interpretation was performed by all authors. The manuscript was written primarily by Lustig, along with the other authors, and revised by Lustig, Penso, Westrich, and

  17. The changing role of the occupational physician in the private sector: the Canadian experience.

    PubMed

    Guidotti, T L; Cowell, J W

    1997-09-01

    The role of the occupational physician in the private sector is changing. Fewer large corporations maintain medical departments following the 'downsizing' trend of the late 1980's and early 1990's and those that do have extensively redefined the duties of the corporate medical director, often extending these duties to include responsibility for environmental health. Occupational medical services for employees previously covered by in-house services are now often provided by outsourcing. The private practice of occupational medicine has become the major growth area of the specialty in both the US and Canada. These trends have been driven primarily by economic imperatives and new management philosophies; the trend may have gone too far and a 'rightsizing' correction may be in progress. However, it is not clear that corporations in general are deriving the greatest value they can from their physicians or that the current generation of senior managers is utilizing its health professionals as effectively as they might. This is in part because the training, qualifications and capabilities of occupational physicians are not well understood. At least as important, however, is persistent confusion over desirable and appropriate roles that obscures the potential contribution of the medical professional within a management structure. We suggest that the greatest value in occupational medical services may be in the anticipation of risk related to health issues and the flexibility this gives the organization to manage the problem.

  18. Systematic development of a communication skills training course for physicians performing work disability assessments: from evidence to practice

    PubMed Central

    2011-01-01

    Background Physicians require specific communication skills, because the face-to-face contact with their patients is an important source of information. Although physicians who perform work disability assessments attend some communication-related training courses during their professional education, no specialised and evidence-based communication skills training course is available for them. Therefore, the objectives of this study were: 1) to systematically develop a training course aimed at improving the communication skills of physicians during work disability assessment interviews with disability claimants, and 2) to plan an evaluation of the training course. Methods A physician-tailored communication skills training course was developed, according to the six steps of the Intervention Mapping protocol. Data were collected from questionnaire studies among physicians and claimants, a focus group study among physicians, a systematic review of the literature, and meetings with various experts. Determinants and performance objectives were formulated. A concept version of the training course was discussed with several experts before the final training course programme was established. The evaluation plan was developed by consulting experts, social insurance physicians, researchers, and policy-makers, and discussing with them the options for evaluation. Results A two-day post-graduate communication skills training course was developed, aimed at improving professional communication during work disability assessment interviews. Special focus was on active teaching strategies, such as practising the skills in role-play. An adoption and implementation plan was formulated, in which the infrastructure of the educational department of the institute that employs the physicians was utilised. Improvement in the skills and knowledge of the physicians who will participate in the training course will be evaluated in a randomised controlled trial. Conclusions The feasibility and

  19. Effects of Physician-Targeted Pay-for-Performance on Use of Spontaneous Breathing Trials in Mechanically Ventilated Patients.

    PubMed

    Barbash, Ian J; Pike, Francis; Gunn, Scott R; Seymour, Christopher W; Kahn, Jeremy M

    2016-12-12

    Rationale Pay-for-performance is an increasingly common quality improvement strategy despite the absence of robust supporting evidence. Objectives To determine the impact of a financial incentive program rewarding physicians for the completion of daily spontaneous breathing trials (SBTs) in three academic hospitals. Methods We compared data from mechanically ventilated patients from six months before to two years after introduction of a financial incentive program that provided annual payments to critical care physicians contingent on unit-level SBT completion rates. We used Poisson regression to compare the frequency of days on which SBTs were completed among eligible patients and days on which patients were excluded from SBT eligibility among all mechanically ventilated patients. We used multivariate regression to compare risk-adjusted duration of mechanical ventilation and in-hospital mortality. Measurements and Main Results The cohort included 7,291 mechanically ventilated patients with 75,621 ventilator days. Baseline daily SBT rates were 96.8% (Hospital A), 16.4% (Hospital B), and 74.7% (Hospital C). In hospital A, with the best baseline performance, there was no change in SBT rates, exclusion rates, or duration of mechanical ventilation across time periods. In hospitals B and C, with lower SBT completion rates at baseline, there was an increase in daily SBT completion rates and a concomitant increase in exclusions from eligibility. Duration of mechanical ventilation decreased in hospital C but not hospital B. Mortality was unchanged for all hospitals. Conclusions In hospitals with low baseline SBT completion, physician-targeted financial incentives were associated with increased SBT rates driven in part by increased exclusion rates, without consistent improvements in outcome.

  20. Changes in psychosocial work environment and depressive symptoms: a prospective study in junior physicians.

    PubMed

    Li, Jian; Weigl, Matthias; Glaser, Jürgen; Petru, Raluca; Siegrist, Johannes; Angerer, Peter

    2013-12-01

    We examined the impact of changes in the psychosocial work environment on depressive symptoms in a sample of junior physicians, a high risk group for stress and mental disorders. This is a three-wave prospective study in 417 junior physicians during their residency in German hospitals. The psychosocial work environment was measured by the Effort-Reward Imbalance (ERI) Questionnaire at Waves 1 and 2, and the depressive symptoms were assessed with the State-Trait Depression Scales at all three waves. Multivariate linear regression was applied for prospective associations between ERI across Waves 1 and 2, and baseline-adjusted depressive symptoms at Wave 3. Compared with the ERI scores at Wave 1, at Wave 2, and mean scores between the two waves, the baseline-adjusted ERI change scores between the two waves showed slightly better statistical power, predicting depressive symptoms at Wave 3 (β = 0.78, 95% CI = 0.38-1.18 for increased ERI per SD, β = 0.64, 95% CI = 0.22-1.06 for increased effort per SD, β = -0.65, 95% CI = -1.06 to -0.24 for increased reward per SD, and β = 0.68, 95% CI = 0.27-1.09 for increased overcommitment per SD). Negative changes in the psychosocial work environment, specifically increased ERI, are associated with depressive symptoms in German junior physicians. Reducing the non-reciprocity of working life, particularly improving reward at work, may have beneficial effects on prevention of mental health problems in the hospital workplace. © 2013 Wiley Periodicals, Inc.

  1. [The addiction patient in the family physicians' practice: tools and skills for a successful performance].

    PubMed

    Neuner-Jehle, Stefan

    2014-10-01

    Addiction patients are usually perceived as problematic patients in primary care practices: Encounters often are time-consuming and the approach to the patient is difficult. Moreover, patients sometimes are hiding their addictive behaviour and behave shameful. Other barriers are a lack of experience in communication skills among physicians or their own addictive behaviour. Nevertheless, to diagnose and treat addiction as early as possible is an important task for family doctors, as patients' confidence in them is an important factor to induce a behaviour change. We present four screening tests for the early diagnosis of addiction to alcohol (AUDIT, AUDIT-C, CAGE, SMAST-G) and discuss their strengths and shortcomings. The family doctor's practice is also a useful setting for brief interventions based on motivational interviewing (MI) techniques and the transtheoretical model of behaviour change (TTM). We shortly introduce to these techniques and attitudes using addiction to alcohol and nicotine as examples, and we present innovative methods as "defined drinking" and new quit smoking methods. A respectful attitude towards the patient and communication skills seem to be key factors for family physicians to successfully approach their addiction patients.

  2. Zika virus: A call to action for physicians in the era of climate change.

    PubMed

    Yang, Y Tony; Sarfaty, Mona

    2016-12-01

    In February 2016, the World Health Organization declared the mosquito-borne Zika virus to be a "public health emergency of international concern" as the disease linked to thousands of birth defects in Brazil spreads rapidly. The distribution of the Aedes mosquitos has drastically increased over the past few decades, which have been the hottest decades on Earth in more than 1000 years based on climate proxy measures. Although a combination of factors explains the current Zika virus outbreak, it's highly likely that the changes in the climate contribute to the spread of Aedes vector carrying the Zika virus, the pathogen causing serious birth defects. Physicians, both individually and collectively, as trusted and educated members of society have critical roles to play. In addition to clinical management and prevention of Zika, physicians should communicate about the health benefits of addressing climate change in straightforward evidence-based language to their local communities and policymakers, and make clear their support for policies mitigating climate change.

  3. Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living?

    PubMed

    Bolt, Eva Elizabeth; Snijdewind, Marianne C; Willems, Dick L; van der Heide, Agnes; Onwuteaka-Philipsen, Bregje D

    2015-08-01

    Euthanasia and physician-assisted suicide (EAS) in patients with psychiatric disease, dementia or patients who are tired of living (without severe morbidity) is highly controversial. Although such cases can fall under the Dutch Euthanasia Act, Dutch physicians seem reluctant to perform EAS, and it is not clear whether or not physicians reject the possibility of EAS in these cases. To determine whether physicians can conceive of granting requests for EAS in patients with cancer, another physical disease, psychiatric disease, dementia or patients who are tired of living, and to evaluate whether physician characteristics are associated with conceivability. A cross-sectional study (survey) was conducted among 2269 Dutch general practitioners, elderly care physicians and clinical specialists. The response rate was 64% (n=1456). Most physicians found it conceivable that they would grant a request for EAS in a patient with cancer or another physical disease (85% and 82%). Less than half of the physicians found this conceivable in patients with psychiatric disease (34%), early-stage dementia (40%), advanced dementia (29-33%) or tired of living (27%). General practitioners were most likely to find it conceivable that they would perform EAS. This study shows that a minority of Dutch physicians find it conceivable that they would grant a request for EAS from a patient with psychiatric disease, dementia or a patient who is tired of living. For physicians who find EAS inconceivable in these cases, legal arguments and personal moral objections both probably play a role. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Integrating motivational interviewing and narrative therapy to teach behavior change to family medicine resident physicians.

    PubMed

    Oshman, Lauren D; Combs, Gene N

    2016-05-01

    Motivational interviewing is a useful skill to address the common problem of patient ambivalence regarding behavior change by uncovering and strengthening a person's own motivation and commitment to change. The Family Medicine Milestones underline the need for clear teaching and monitoring of skills in communication and behavior change in Family Medicine postgraduate training settings. This article reports the integration of a motivational interviewing curriculum into an existing longitudinal narrative therapy-based curriculum on patient-centered communication. Observed structured clinical examination for six participants indicate that intern physicians are able to demonstrate moderate motivational interviewing skill after a brief 2-h workshop. Participant self-evaluations for 16 participants suggest a brief 2-h curriculum was helpful at increasing importance of learning motivational interviewing by participants, and that participants desire further training opportunities. A brief motivational interviewing curriculum can be integrated into existing communication training in a Family Medicine residency training program. © The Author(s) 2016.

  5. Deterioration of Neurobehavioral Performance in Resident Physicians During Repeated Exposure to Extended Duration Work Shifts

    PubMed Central

    Anderson, Clare; Sullivan, Jason P.; Flynn-Evans, Erin E.; Cade, Brian E.; Czeisler, Charles A.; Lockley, Steven W.

    2012-01-01

    Study Objectives: Although acute sleep loss during 24- to 30-h extended duration work shifts (EDWS) has been shown to impair the performance of resident physicians, little is known about the effects of cumulative sleep deficiency on performance during residency training. Chronic sleep restriction induces a gradual degradation of neurobehavioral performance and exacerbates the effects of acute sleep loss in the laboratory, yet the extent to which this occurs under real-world conditions is unknown. In this study, the authors quantify the time course of neurobehavioral deterioration due to repeated exposure to EDWS during a 3-week residency rotation. Design: A prospective, repeated-measures, within-subject design. Setting: Medical and cardiac intensive care units, Brigham and Women's Hospital, Boston, MA. Participants: Thirty-four postgraduate year one resident physicians (23 males; age 28.0 ± 1.83 (standard deviation) years) Measurements and Results: Residents working a 3-week Q3 schedule (24- to 30-h work shift starts every 3rd day), consisting of alternating 24- to 30-h (EDWS) and approximately 8-h shifts, underwent psychomotor vigilance testing before, during, and after each work shift. Mean response time, number of lapses, and slowest 10% of responses were calculated for each test. Residents also maintained daily sleep/wake/work logs. EDWS resulted in cumulative sleep deficiency over the 21-day rotation (6.3 h sleep obtained per day; average 2.3 h sleep obtained per extended shift). Response times deteriorated over a single 24- to 30-h shift (P < 0.0005), and also cumulatively with each successive EDWS: Performance on the fifth and sixth shift was significantly worse than on the first shift (P < 0.01). Controlling for time of day, there was a significant acute (time on shift) and chronic (successive EDWS) interaction on psychomotor vigilance testing response times (P < 0.05). Conclusions: Chronic sleep deficiency caused progressive degradation in residents

  6. Focused physician-performed echocardiography in sports medicine: a potential screening tool for detecting aortic root dilatation in athletes.

    PubMed

    Yim, Eugene S; Kao, Daniel; Gillis, Edward F; Basilico, Frederick C; Corrado, Gianmichael D

    2013-12-01

    The purpose of this study was to investigate whether sports medicine physicians can obtain accurate measurements of the aortic root in young athletes. Twenty male collegiate athletes, aged 18 to 21 years, were prospectively enrolled. Focused echocardiography was performed by a board-certified sports medicine physician and a medical student, followed by comprehensive echocardiography within 2 weeks by a cardiac sonographer. A left parasternal long-axis view was acquired to measure the aortic root diameter at the sinuses of Valsalva. Intraclass correlation coefficients (ICCs) were used to assess inter-rater reliability compared to a reference standard and intra-rater reliability of repeated measurements obtained by the sports medicine physician and medical student. The ICCs between the sports medicine physician and cardiac sonographer and between the medical student and cardiac sonographer were strong: 0.80 and 0.76, respectively. Across all 3 readers, the ICC was 0.89, indicating strong inter-rater reliability and concordance. The ICC for the 2 measurements taken by the sports medicine physician for each athlete was 0.75, indicating strong intra-rater reliability. The medical student had moderate intra-rater reliability, with an ICC of 0.59. Sports medicine physicians are able to obtain measurements of the aortic root by focused echocardiography that are consistent with those obtained by a cardiac sonographer. Focused physician-performed echocardiography may serve as a promising technique for detecting aortic root dilatation and may contribute in this manner to preparticipation cardiovascular screening for athletes.

  7. Aging and Cognitive Performance: Challenges and Implications for Physicians Practicing in the 21st Century

    ERIC Educational Resources Information Center

    Durning, Steven J.; Artino, Anthony R.; Holmboe, Eric; Beckman, Thomas J.; van der Vleuten, Cees; Schuwirth, Lambert

    2010-01-01

    The demands of physician practice are growing. Some specialties face critical shortages and a significant percentage of physicians are aging. To improve health care it is paramount to understand and address challenges, including cognitive issues, facing aging physicians. In this article, we outline several issues related to cognitive performance…

  8. Aging and Cognitive Performance: Challenges and Implications for Physicians Practicing in the 21st Century

    ERIC Educational Resources Information Center

    Durning, Steven J.; Artino, Anthony R.; Holmboe, Eric; Beckman, Thomas J.; van der Vleuten, Cees; Schuwirth, Lambert

    2010-01-01

    The demands of physician practice are growing. Some specialties face critical shortages and a significant percentage of physicians are aging. To improve health care it is paramount to understand and address challenges, including cognitive issues, facing aging physicians. In this article, we outline several issues related to cognitive performance…

  9. The role of time and risk preferences in adherence to physician advice on health behavior change.

    PubMed

    van der Pol, Marjon; Hennessy, Deirdre; Manns, Braden

    2017-04-01

    Changing physical activity and dietary behavior in chronic disease patients is associated with significant health benefits but is difficult to achieve. An often-used strategy is for the physician or other health professional to encourage behavior changes by providing advice on the health consequences of such behaviors. However, adherence to advice on health behavior change varies across individuals. This paper uses data from a population-based cross-sectional survey of 1849 individuals with chronic disease to explore whether differences in individuals' time and risk preferences can help explain differences in adherence. Health behaviors are viewed as investments in health capital within the Grossman model. Physician advice plays a role in the model in that it improves the understanding of the future health consequences of investments. It can be hypothesized that the effect of advice on health behavior will depend on an individuals' time and risk preference. Within the survey, which measured a variety of health-related behaviors and outcomes, including receipt and compliance with advice on dietary and physical activity changes, time preferences were measured using financial planning horizon, and risk preferences were measured through a commonly used question which asked respondents to indicate their willingness to take risks on a ten-point scale. Results suggest that time preferences play a role in adherence to physical activity advice. While time preferences also play a role in adherence to dietary advice, this effect is only apparent for males. Risk preferences do not seem to be associated with adherence. The results suggest that increasing the salience of more immediate benefits of health behavior change may improve adherence.

  10. Assessment of changes in confidence, attitude, and knowledge of non-psychiatric physicians undergoing a depression training program in Taiwan.

    PubMed

    Wang, Yao-Hsien; Huang, Hui-Chun; Liu, Shen-Ing; Lu, Ru-Band

    2012-01-01

    To assess whether non-psychiatric physicians would benefit from a national depression training program and explore associated factors. Attending physicians were asked to complete survey questionnaires of confidence, attitude, knowledge, and their willingness to implement new strategies to improve care, before and after training. Paired t-test and multiple regression analysis were used to determine the differences and explore factors associated with the domains of confidence, attitude, and knowledge. McNemar's test was used to compare the difference between the physicians' intention to change depression management before and after training. Of 524 eligible physicians, 307 (59%) completed the pre- and post-program assessments. These physicians showed significantly increased knowledge score and willingness to implement new treatment strategies, as well as more positive attitude toward and confidence in treating depression. The lower corresponding baseline score was associated with greater improvement in domains ofknowledge, confidence, and attitude. Completion of the training was associated with an improvement in knowledge and becoming less helpless and avoidant attitude. Other factors including non-family-medicine physicians, post-graduate education, and female gender are associated with greater improvements in various domains. Our study shows that even a brief educational program can positively influence the physicians' knowledge, attitudes, and confidence in treating depression. Further work is needed to monitor whether the effects of training are long-term, and can be translated into behavioral change in practice.

  11. The education of physicians and other health care professionals about climate change

    SciTech Connect

    Hayes, R.L.; Hussain, S.T.

    1996-12-31

    The impact of rapidly changing local and regional environments upon the health of human populations must be appreciated by physicians as well as other public health officials. Any system of health care delivery depends upon an understanding of scientific principles. Current issues of importance include the greenhouse effect, the ozone hole, global warming, sea level rise, emerging and resurgent microbial diseases, air and water pollution, biodiversity losses, UVB-induced immunosuppression, and antibiotic resistance. These concerns must be firmly within the grasp of the health care practitioner for the 21st century. To assure transfer of information, these topics should be integrated into existing course content or should provide the basis for new course offerings during the training of the professional. Focus should be given to scientific principles as the foundation for understanding climate change.

  12. Engaging Physicians in Change: Results of a Safety Net Quality Improvement Program to Reduce Overuse

    PubMed Central

    Cammisa, Chris; Partridge, Gregory; Ardans, Cynthia; Buehrer, Katrina; Chapman, Ben; Beckman, Howard

    2013-01-01

    Identifying, understanding, and addressing clinical variation is a useful tool to promote appropriate care while helping control health care costs. Although accurate, relevant, and useful data are important in the process, successfully engaging physicians to change behavior is often the most significant challenge. Using a commercially available variation analysis process, a California Medicaid managed care plan identified significant network practice pattern variation. A team of panel practitioners then developed a strategy to reduce overuse of 5 identified behaviors. The intervention was evaluated using a pre–post comparison of the panel’s use of the 5 behaviors. During the preintervention period, narcotics, muscle relaxants, magnetic resonance imaging (MRI), and spinal injections increased between 8% and 18% per month. Postintervention, the trends reversed. The differences were statistically significant (P < .0001) for muscle relaxant use, narcotic use, overall MRI use, and spinal injections. Peer comparison data and respectful feedback was associated with significant change in patterns of overuse. PMID:20876341

  13. The Changing Dynamics of Health Care: Physician Perceptions of Technology in Medical Practices

    ERIC Educational Resources Information Center

    Hatton, Jerald D.

    2012-01-01

    Political, economic, and safety concerns have militated for the adoption of electronic health records (EHR) by physicians in the United States, but current rates of adoption have failed to achieve the expected levels. This qualitative phenomenological study of practicing physicians reveals obstacles to adoption. Maintaining the physicians'…

  14. The Changing Dynamics of Health Care: Physician Perceptions of Technology in Medical Practices

    ERIC Educational Resources Information Center

    Hatton, Jerald D.

    2012-01-01

    Political, economic, and safety concerns have militated for the adoption of electronic health records (EHR) by physicians in the United States, but current rates of adoption have failed to achieve the expected levels. This qualitative phenomenological study of practicing physicians reveals obstacles to adoption. Maintaining the physicians'…

  15. Changes in Physician Decision Making after CT: A Prospective Multicenter Study in Primary Care Settings.

    PubMed

    Pandharipande, Pari V; Alabre, Claude I; Coy, David L; Zaheer, Atif; Miller, Chad M; Herring, Maurice S; Tramontano, Angela C; Dowling, Emily C; Eisenberg, Jonathan D; Ashar, Bimal H; Halpern, Elkan F; Donelan, Karen; Gazelle, G Scott

    2016-12-01

    Purpose To determine the effect of computed tomography (CT) results on physician decision making in three common clinical scenarios in primary care. Materials and Methods This research was approved by the institutional review board (IRB) and was HIPAA compliant. All physicians consented to participate with an opt-in or opt-out mechanism; patient consent was waived with IRB approval. In this prospective multicenter observational study, outpatients referred by primary care providers (PCPs) for CT evaluation of abdominal pain, hematuria, or weight loss were identified. Prior to CT, PCPs were surveyed to elicit their leading diagnosis, confidence in that diagnosis (confidence range, 0%-100%), a rule-out diagnosis, and a management plan if CT were not available. Surveys were repeated after CT. Study measures were the proportion of patients in whom leading diagnoses and management changed (PCP management vs specialist referral vs emergency department transfer), median changes in diagnostic confidence, and the proportion of patients in whom CT addressed rule-out diagnoses. Regression analyses were used to identify associations between study measures and site and participant characteristics. Specifically, logistic regression analysis was used for binary study measures (change in leading diagnosis, change in management), and linear regression analysis was used for the continuous study measure (change in diagnostic confidence). Accrual began on September 5, 2012, and ended on June 28, 2014. Results In total, 91 PCPs completed pre- and post-CT surveys in 373 patients. In patients with abdominal pain, hematuria, or weight loss, leading diagnoses changed after CT in 53% (131 of 246), 49% (36 of 73), and 57% (27 of 47) of patients, respectively. Management changed in 35% (86 of 248), 27% (20 of 74), and 54% (26 of 48) of patients, respectively. Median absolute changes in diagnostic confidence were substantial and significant (+20%, +20%, and +19%, respectively; P ≤ .001 for

  16. A case study of team work and performance-linked payment of family physicians in Portugal.

    PubMed

    Conceição, Claudia; Van Lerberghe, Wim; Ramos, Vitor; Hipólito, Fátima; Ferrinho, Paulo

    2007-01-01

    In Portugal, the design and the implementation of models of primary care teams has a history of 30 years. The evolution observed is from individual medical work, in Health Centres, supported on an ad hoc basis by other health professionals, to health centres integrating a diversity of formal working groups, including primary care/family health teams called "Family Health Units" (FHU). This evolution included the creation and gradual affirmation of the speciality of family medicine and the experimentation with different models of primary health care provision: voluntary primary care health teams without financial incentives (Alfa project), voluntary primary care health teams with a performance-related-remuneration system and the current phase of scaling up FHU. The process described here illustrates how a group of physicians has established a non-formal strategy of reform throughout 30 years. This strategy involves mobilization policies and the development of field experiences by individual leaders, groups and organizations.

  17. Influence of ethnicity and language concordance on physician-patient agreement about recommended changes in patient health behavior.

    PubMed

    Clark, Trina; Sleath, Betsy; Rubin, Richard H

    2004-04-01

    The purpose of this study is to examine the association of ethnicity and language concordance with physician-patient agreement about physicians' recommendations for patient health behavior in the following areas: diet, exercise, medication, smoking, stress, and weight. Twenty-seven resident physicians at the University of New Mexico's internal medicine and family practice clinics and 427 of their patients participated. Random effects models were used to estimate the influence of ethnicity and language concordance on whether patients and physicians agreed about specific recommended changes in patient behavior. Ethnicity concordance was not significantly associated with physician-patient agreement. Language concordance positively influenced the likelihood of agreement about exercise but negatively influenced agreement about medications. The lowest percentage of agreement occurred in the area of medication regimens (60%). The results from this study indicate that language is an important barrier to physician-patient agreement, while ethnicity concordance has no effect. However, the influence of whether the physician and patient speak the same language on agreement is unclear and warrants further research.

  18. The more things change: revisiting a comparison of educational costs and incomes of physicians and other professionals.

    PubMed

    Weeks, William B; Wallace, Amy E

    2002-04-01

    The authors previously compared the 1990 educational costs and incomes of physicians and other professional groups. Since then, there have been dramatic changes in the market for the groups examined. This article reports their update of the previous analysis, using 1997 data. For this update, the authors applied standard financial techniques to expected incomes and educational costs to determine the return on educational investment over the working lifetime for five professional groups: primary care physicians, procedure-based physicians, dentists, attorneys, and graduates of the top 20 business schools. The hours-adjusted net present values of the educational investments for attorneys ($10.73) and procedure-based physicians ($10.40) are considerably higher than those for dentists ($8.90) and businessmen ($8.27); the return for primary care physicians ($5.97) remains much lower than all others. Primary care physicians have an hours-adjusted internal rate of return on their educational investment equal to 16%, compared with 18% for procedure-based medicine, 22% for dentistry, 23% for law, and 26% for business. Although it remains the lowest of all professional groups examined, primary care medicine has made the largest percentage gain in net present value of all groups. Although anticipated changes in physician incomes have occurred, the standing of physicians relative to other professional groups has not changed. Students can still anticipate relatively poorer returns on their educational investment when they choose a career in primary care medicine as compared with careers in procedure-based medicine or surgical specialties, business, law, or dentistry.

  19. Toward a better understanding of task demands, workload, and performance during physician-computer interactions.

    PubMed

    Mazur, Lukasz M; Mosaly, Prithima R; Moore, Carlton; Comitz, Elizabeth; Yu, Fei; Falchook, Aaron D; Eblan, Michael J; Hoyle, Lesley M; Tracton, Gregg; Chera, Bhishamjit S; Marks, Lawrence B

    2016-11-01

    To assess the relationship between (1) task demands and workload, (2) task demands and performance, and (3) workload and performance, all during physician-computer interactions in a simulated environment. Two experiments were performed in 2 different electronic medical record (EMR) environments: WebCIS (n = 12) and Epic (n = 17). Each participant was instructed to complete a set of prespecified tasks on 3 routine clinical EMR-based scenarios: urinary tract infection (UTI), pneumonia (PN), and heart failure (HF). Task demands were quantified using behavioral responses (click and time analysis). At the end of each scenario, subjective workload was measured using the NASA-Task-Load Index (NASA-TLX). Physiological workload was measured using pupillary dilation and electroencephalography (EEG) data collected throughout the scenarios. Performance was quantified based on the maximum severity of omission errors. Data analysis indicated that the PN and HF scenarios were significantly more demanding than the UTI scenario for participants using WebCIS (P < .01), and that the PN scenario was significantly more demanding than the UTI and HF scenarios for participants using Epic (P < .01). In both experiments, the regression analysis indicated a significant relationship only between task demands and performance (P < .01). Results suggest that task demands as experienced by participants are related to participants' performance. Future work may support the notion that task demands could be used as a quality metric that is likely representative of performance, and perhaps patient outcomes. The present study is a reasonable next step in a systematic assessment of how task demands and workload are related to performance in EMR-evolving environments. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. Does a year make a difference? Changes in physician satisfaction and perception in an increasingly capitated environment.

    PubMed

    Nadler, E S; Sims, S; Tyrance, P H; Fairchild, D G; Brennan, T A; Bates, D W

    1999-07-01

    Although capitation has become an increasingly common method of payment for heath care, little is known about changes in physician satisfaction as they become more experienced working in a capitated environment. We surveyed the members of a physician hospital organization at an urban teaching hospital in the summers of 1996 and 1997. In 1996, fully capitated contracts covered <5% of patients under 65 years of age, but that figure increased to nearly 25% by 1997. We assessed physicians' satisfaction with their practice, compared satisfaction under fee-for-service and capitated payment, and evaluated ethical issues related to capitation. In 1996, we surveyed 587 physicians with direct patient care responsibilities, of whom 62% responded; 51% of 520 physicians responded in 1997. Overall satisfaction was 57% in 1996 and 71% in 1997. Among physicians who responded in both years, overall satisfaction was unchanged, but increases in satisfaction were noted for patient load (an increase of 0.5 points on a five-point scale, P <0.01), time to discuss patient needs (an increase of 0.3 points, P <0.01), and helpfulness of care coordination (an increase of 0.5 points, P = 0.02). In a direct comparison between fee-for-service and capitation, physicians were more satisfied with both methods of payment in 1997 than they were in 1996, but they were much more satisfied with fee-for-service in both years. For many individual indicators, the difference in satisfaction between fee-for-service and capitation increased between 1996 and 1997. When introduced to capitation, physicians had strong negative perceptions about it. After a year's experience, satisfaction with capitation improved, but perceived differences between capitation and fee-for-service grew even larger. Thus, physicians have serious concerns about capitation that may not be alleviated by experience with it.

  1. Deterioration of neurobehavioral performance in resident physicians during repeated exposure to extended duration work shifts.

    PubMed

    Anderson, Clare; Sullivan, Jason P; Flynn-Evans, Erin E; Cade, Brian E; Czeisler, Charles A; Lockley, Steven W

    2012-08-01

    Although acute sleep loss during 24- to 30-h extended duration work shifts (EDWS) has been shown to impair the performance of resident physicians, little is known about the effects of cumulative sleep deficiency on performance during residency training. Chronic sleep restriction induces a gradual degradation of neurobehavioral performance and exacerbates the effects of acute sleep loss in the laboratory, yet the extent to which this occurs under real-world conditions is unknown. In this study, the authors quantify the time course of neurobehavioral deterioration due to repeated exposure to EDWS during a 3-week residency rotation. A prospective, repeated-measures, within-subject design. Medical and cardiac intensive care units, Brigham and Women's Hospital, Boston, MA. Thirty-four postgraduate year one resident physicians (23 males; age 28.0 ± 1.83 (standard deviation) years) Residents working a 3-week Q3 schedule (24- to 30-h work shift starts every 3(rd) day), consisting of alternating 24- to 30-h (EDWS) and approximately 8-h shifts, underwent psychomotor vigilance testing before, during, and after each work shift. Mean response time, number of lapses, and slowest 10% of responses were calculated for each test. Residents also maintained daily sleep/wake/work logs. EDWS resulted in cumulative sleep deficiency over the 21-day rotation (6.3 h sleep obtained per day; average 2.3 h sleep obtained per extended shift). Response times deteriorated over a single 24- to 30-h shift (P < 0.0005), and also cumulatively with each successive EDWS: Performance on the fifth and sixth shift was significantly worse than on the first shift (P < 0.01). Controlling for time of day, there was a significant acute (time on shift) and chronic (successive EDWS) interaction on psychomotor vigilance testing response times (P < 0.05). Chronic sleep deficiency caused progressive degradation in residents' neurobehavioral performance and exacerbated the effects of acute sleep loss inherent in

  2. Can Emergency Physicians Perform Common Carotid Doppler Flow Measurements to Assess Volume Responsiveness?

    PubMed Central

    Stolz, Lori A.; Mosier, Jarrod M.; Gross, Austin M.; Douglas, Matthew J.; Blaivas, Michael; Adhikari, Srikar

    2015-01-01

    Introduction Common carotid flow measurements may be clinically useful to determine volume responsiveness. The objective of this study was to assess the ability of emergency physicians (EP) to obtain sonographic images and measurements of the common carotid artery velocity time integral (VTi) for potential use in assessing volume responsiveness in the clinical setting. Methods In this prospective observational study, we showed a five-minute instructional video demonstrating a technique to obtain common carotid ultrasound images and measure the common carotid VTi to emergency medicine (EM) residents. Participants were then asked to image the common carotid artery and obtain VTi measurements. Expert sonographers observed participants imaging in real time and recorded their performance on nine performance measures. An expert sonographer graded image quality. Participants were timed and answered questions regarding ease of examination and their confidence in obtaining the images. Results A total of 30 EM residents participated in this study and each performed the examination twice. Average time required to complete one examination was 2.9 minutes (95% CI [2.4–3.4 min]). Participants successfully completed all performance measures greater than 75% of the time, with the exception of obtaining measurements during systole, which was completed in 65% of examinations. Median resident overall confidence in accurately performing carotid VTi measurements was 3 (on a scale of 1 [not confident] to 5 [confident]). Conclusion EM residents at our institution learned the technique for obtaining common carotid artery Doppler flow measurements after viewing a brief instructional video. When assessed at performing this examination, they completed several performance measures with greater than 75% success. No differences were found between novice and experienced groups. PMID:25834666

  3. Physician executive promotes process for managing change. Building consensus for group plan is key to successful transitions.

    PubMed

    Carrigan, V M

    2001-01-01

    Thrust into a leadership position after years in solo practice demanded quick thinking for one physician executive. Faced with a need for change, he developed his own process for turning an individual's idea into a plan of action for an entire group. Learn the steps he took to build consensus and ease resistance to change.

  4. Outcomes of Surgeries Performed in Physician Offices Compared With Ambulatory Surgery Centers and Hospital Outpatient Departments in Florida

    PubMed Central

    Ohsfeldt, Robert L; Li, Pengxiang; Schneider, John E; Stojanovic, Ivana; Scheibling, Cara M

    2017-01-01

    Background: The proportion of outpatient surgeries performed in physician offices has been increasing over time, raising concern about the impact on outcomes. Objective: To use a private insurance claims database to compare 7-day and 30-day hospitalization rates following relatively complex outpatient surgical procedures across physician offices, freestanding ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPDs). Methods: A multivariable logistic regression model was used to compare the risk-adjusted probability of hospitalization among patients after any of the 88 study outpatient procedures at physician offices, ASCs, and HOPDs over 2008-2012 in Florida. Results: Risk-adjusted hospitalization rates were higher following procedures performed in physician offices compared with ASCs for all procedures grouped together, for most procedures grouped by type, and for many individual procedures. Conclusions: Hospitalizations following surgery were more likely for procedures performed in physician offices compared with ASCs, which highlights the need for ongoing research on the safety and efficacy of office-based surgery. PMID:28469457

  5. Pay-for-performance incentives for preventive care: views of family physicians before and after participation in a reminder and recall project (P-PROMPT).

    PubMed

    Kaczorowski, Janusz; Goldberg, Orli; Mai, Verna

    2011-06-01

    The Provider and Patient Reminders in Ontario: Multi-Strategy Prevention Tools (P-PROMPT) project was designed to increase the rates of delivery of 4 targeted preventive care services to eligible patients in primary care network and family health network practices eligible for pay-for-performance incentives. Self-administered fax-back surveys completed before and after participation in the P-PROMPT project. Southwestern Ontario. A total of 246 physicians from 24 primary care network or family health network practices across 110 different sites. The P-PROMPT project provided several tools and services, including physician and patient reminders, office management tools, and administrative database integration. Physicians' views about the delivery of preventive health services and pay-for-performance incentives before and after participation in the P-PROMPT project. The preintervention survey was completed by 86.2% (212 of 246) of physicians and the postintervention survey was completed by 53.3% (131 of 246) of physicians; 46.7% (114 of 246) of the physicians completed both surveys. Overall, 80.5% of physicians indicated that the P-PROMPT project was useful (scores of 5 or higher on a 7-point Likert scale). Patient reminder letters (89.1%), physician approval lists of eligible patients (75.6%), administrative assistance with management fees (79.8%), and annual bonus calculations (75.2%) were rated as the most useful features of the program. Compared with the preintervention survey, there were statistically significant increases in the mean agreement scores that the established target levels and bonuses provided appropriate financial incentive to substantially increase the uptake of mammography (P=.012) and Papanicolaou tests (P=.003) but not to increase uptake of annual influenza vaccination or childhood immunizations. There were statistically significant changes in the mean ratings of relying on an opportunistic approach (P<.001), increased agreement about the

  6. How do we perform and bill for blood bank physician consultative services?

    PubMed

    Jhang, Jeffrey S; Francis, Richard O; Winkler, Anne; Tormey, Christopher

    2017-10-01

    Transfusion medicine (TM) physicians provide medical services that benefit all patients such as providing 24-hour laboratory coverage, advising health care providers on test interpretation and selection, validating new methods, and supervising technical personnel. These services ensure delivery of accurate, reliable, and timely laboratory test results and blood products. TM physicians also provide consultations to individual patients by 1) interpreting and determining the clinical significance of test results (e.g., alloantibodies, direct antiglobulin tests), 2) recommending appropriate component therapy and approving deviations from laboratory policy, and 3) evaluating and recommending treatment of suspected transfusion reactions. The potential benefits of consultations are improved quality and cost of health care, enhanced provider education, and decreased inappropriate testing and product utilization. When physician services are delivered to individual patients, are appropriately requested, provide a diagnosis or recommendation, and are properly documented, TM physicians can receive professional reimbursement. While many TM physicians provide medical direction and oversight of apheresis procedures, billing in this area is sufficiently complex to be reviewed elsewhere. The objective of this article is for educational purposes to describe the 1) benefits of a consultative TM service, 2) development of reimbursement systems in the United States for professional component services and the current regulatory requirements, 3) current procedural terminology codes commonly used for TM physician services, and 4) examples of consultation documentation and daily workflow at tertiary care teaching hospitals. The information provided should help guide physicians to deliver and bill for these services. © 2017 AABB.

  7. Moving from Clinical Practice to Academe: An Analysis of Career Change for Physician Assistants

    ERIC Educational Resources Information Center

    Marciano, Gerard Jude

    2013-01-01

    Recruitment of qualified and motivated faculty for physician assistant education programs is difficult. While the causes of the difficulty may be many, the primary one is the physician assistants (PAs) must choose between clinical and academic practice in order to pursue a career in academe. Little if any research has been conducted in this area.…

  8. The prevalence of excessive daytime sleepiness among academic physicians and its impact on the quality of life and occupational performance.

    PubMed

    Ozder, Aclan; Eker, Hasan Huseyin

    2015-01-01

    Sleep disorders can affect health and occupational performance of physicians as well as outcomes in patients. The purpose of this study was to assess the prevalence of excessive daytime sleepiness (EDS) measured by the Epworth Sleepiness Scale (ESS) among academic physicians at a tertiary academic medical center in an urban area in the northwest region of Turkey, and to establish a relationship between the self-perceived sleepiness and the quality of life using the EuroQol-5 dimensions (EQ-5D). A questionnaire prepared by the researchers after scanning the literature on the subject was e-mailed to the academic physicians of a tertiary academic medical center in Istanbul. The ESS and the EQ-5D were also included in the survey. The e-mail database of the institution directory was used to compile a list of active academic physicians who practiced clinical medicine. Paired and independent t tests were used for the data analysis at a significance level of p < 0.05. Three hundred and ninety six academic physicians were e-mailed and a total of 252 subjects replied resulting in a 63.6% response rate. There were 84 (33.3%) female and 168 (66.7%) male academic physicians participating in the study. One hundred and eight out of 252 (42.8%) academic physicians were taking night calls (p < 0.001). Ninety study subjects (35.7%) felt they had enough sleep and 84 (33.3%) reported napping daily (p < 0.001). In our sample, 28.6% (N = 72) of the physicians felt sleepy during the day (ESS score > 10) (p < 0.001). In the case of the EQ-5D index and visual analogue scale of the EQ-5D questionnaire (EQ-5D VAS), the status of sleepiness of academic physicians was associated with a poorer quality of life (p < 0.001). More than a 1/4 of the academic physicians suffered from sleepiness. There was an association between the poor quality of life and daytime sleepiness. There was also a positive relationship between habitual napping and being sleepy during the day. This work is available in

  9. Assessing the performance of centralized waiting lists for patients without a regular family physician using clinical-administrative data.

    PubMed

    Breton, Mylaine; Smithman, Mélanie Ann; Brousselle, Astrid; Loignon, Christine; Touati, Nassera; Dubois, Carl-Ardy; Nour, Kareen; Boivin, Antoine; Berbiche, Djamal; Roberge, Danièle

    2017-01-05

    With 4.6 million patients who do not have a regular family physician, Canada performs poorly compared to other OECD countries in terms of attachment to a family physician. To address this issue, several provinces have implemented centralized waiting lists to coordinate supply and demand for attachment to a family physician. Although significant resources are invested in these centralized waiting lists, no studies have measured their performance. In this article, we present a performance assessment of centralized waiting lists for unattached patients implemented in Quebec, Canada. We based our approach on the Balanced Scorecard method. A committee of decision-makers, managers, healthcare professionals, and researchers selected five indicators for the performance assessment of centralized waiting lists, including both process and outcome indicators. We analyzed and compared clinical-administrative data from 86 centralized waiting lists (GACOs) located in 14 regions in Quebec, from April 1, 2013, to March 31, 2014. During the study period, although over 150,000 patients were attached to a family physician, new requests resulted in a 30% median increase in patients on waiting lists. An inverse correlation of average strength was found between the rates of patients attached to a family physician and the proportion of vulnerable patients attached to a family physician meaning that as more patients became attached to an FP through GACOs, the proportion of vulnerable patients became smaller (r = -0.31, p < 0.005). The results showed very large performance variations both among GACOs of different regions and among those of a same region for all performance indicators. Centralized waiting lists for unattached patients in Quebec seem to be achieving their twofold objective of attaching patients to a family physician and giving priority to vulnerable patients. However, the demand for attachment seems to exceed the supply and there appears to be a tension between giving

  10. How physicians identify with predetermined personalities and links to perceived performance and wellness outcomes: a cross-sectional study.

    PubMed

    Lemaire, Jane B; Wallace, Jean E

    2014-11-29

    Certain personalities are ascribed to physicians. This research aims to measure the extent to which physicians identify with three predetermined personalities (workaholic, Type A and control freak) and to explore links to perceptions of professional performance, and wellness outcomes. This is a cross-sectional study using a mail-out questionnaire sent to all practicing physicians (2957 eligible, 1178 responses, 40% response rate) in a geographical health region within a western Canadian province. Survey items were used to assess the extent to which participants felt they are somewhat of a workaholic, Type A and/or control freak, and if they believed that having these personalities makes one a better doctor. Participants' wellness outcomes were also measured. Zero-order correlations were used to determine the relationships between physicians identifying with a personality and feeling it makes one a better doctor. T-tests were used to compare measures of physician wellness for those who identified with the personality versus those who did not. 53% of participants identified with the workaholic personality, 62% with the Type A, and 36% with the control freak. Identifying with any one of the personalities was correlated with feeling it makes one a better physician. There were statistically significant differences in several wellness outcomes comparing participants who identified with the personalities versus those who did not. These included higher levels of emotional exhaustion (workaholic, Type A and control freak), higher levels of anxiety (Type A and control freak) and higher levels of depression, poorer mental health and lower levels of job satisfaction (control freak). Participants who identified with the workaholic personality versus those who did not reported higher levels of job satisfaction, rewarding patient experiences and career commitment. Most participants identified with at least one of the three personalities. The beliefs of some participants that

  11. When should we perform a repeat training on adrenaline auto-injector use for physician trainees?

    PubMed

    Topal, E; Bakirtas, A; Yilmaz, O; Karagol, I H E; Arga, M; Demirsoy, M S; Turktas, I

    2014-01-01

    Studies demonstrate that both doctors and patients may use adrenaline auto-injector improperly and the usage skills are improved by training. In this study, we aimed to determine the appropriate frequency of training to maintain skills for adrenaline auto-injector use. We invited all interns of 2011-2012 training period. At baseline, all participants were given theoretical and practical training on adrenaline auto-injector use. The participants were randomly assigned into two groups. We asked those in group 1 to demonstrate the use of adrenaline auto-injector trainer in the third month and those in group 2 in the sixth month. One hundred and sixty interns were enrolled. Compared with the beginning score, demonstration of skills at all the steps and total scores did not change for the group tested in the third month (p=0.265 and p=0.888, respectively). However; for the group examined in the sixth month; the demonstration of skills for proper use of the auto-injector at all steps and the mean time to administer adrenaline decreased (p=0.018 and p<0.001, respectively). Besides, the group which was tested in the third month was better than the group which was tested in the sixth month in terms of demonstrating all steps (p=0.014), the total score (p=0.019), mean time of change to administer adrenaline (p<0.001) and presumptive self-injection into thumb (p=0.029). Auto-injector usage skills of physician trainees decrease after the sixth month and are better in those who had skill reinforcement at 3 months, suggesting continued education and skill reinforcement may be useful. Copyright © 2013 SEICAP. Published by Elsevier Espana. All rights reserved.

  12. Developing physician leaders in academic medical centers. Part 1: Their changing role.

    PubMed

    Bachrach, D J

    1996-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management, intramurally conducted courses in leadership skill development; management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. This article article was prepared by the author from research into and presentation of a thesis entitled. "The Importance of Leadership Training And Development For Physicians In Academic Medical Centers In An Increasingly Complex Healthcare Environment, " prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in the College (ACHE). Part 2 will appear in the next issue of the Journal.

  13. Performance of Certification and Recertification Examinees on Multiple Choice Test Items: Does Physician Age Have an Impact?

    PubMed

    Shen, Linjun; Juul, Dorthea; Faulkner, Larry R

    2016-01-01

    The development of recertification programs (now referred to as Maintenance of Certification or MOC) by the members of the American Board of Medical Specialties provides the opportunity to study knowledge base across the professional lifespan of physicians. Research results to date are mixed with some studies finding negative associations between age and various measures of competency and others finding no or minimal relationships. Four groups of multiple choice test items that were independently developed for certification and MOC examinations in psychiatry and neurology were administered to certification and MOC examinees within each specialty. Percent correct scores were calculated for each examinee. Differences between certification and MOC examinees were compared using unpaired t tests, and logistic regression was used to compare MOC and certification examinee performance on the common test items. Except for the neurology certification test items that addressed basic neurology concepts, the performance of the certification and MOC examinees was similar. The differences in performance on individual test items did not consistently favor one group or the other and could not be attributed to any distinguishable content or format characteristics of those items. The findings of this study are encouraging in that physicians who had recently completed residency training possessed clinical knowledge that was comparable to that of experienced physicians, and the experienced physicians' clinical knowledge was equivalent to that of recent residency graduates. The role testing can play in enhancing expertise is described.

  14. Managing Performance to Change Behavior

    ERIC Educational Resources Information Center

    Denisi, Angelo S.

    2011-01-01

    Performance appraisal systems are often considered primarily in their role as criterion measures for validation studies. Even when they are considered in other organizational roles, there has traditionally been a strong focus on improving the accuracy of the appraisals. The present article argues that the proper focus of performance appraisal is…

  15. Managing Performance to Change Behavior

    ERIC Educational Resources Information Center

    Denisi, Angelo S.

    2011-01-01

    Performance appraisal systems are often considered primarily in their role as criterion measures for validation studies. Even when they are considered in other organizational roles, there has traditionally been a strong focus on improving the accuracy of the appraisals. The present article argues that the proper focus of performance appraisal is…

  16. Perceived intellectual performance change over seven years.

    PubMed

    Schaie, K W; Willis, S L; O'Hanlon, A M

    1994-05-01

    Actual and perceived change in intellectual performance over seven years was examined in a sample of 837 participants in the Seattle Longitudinal Study who took five subtests of Thurstone's Primary Mental Abilities (PMA) test in 1977 and 1984. In 1984 participants rated perceived change in intellectual performance from 1977 to 1984. Participants were categorized, based on their actual performance, into those who maintained earlier performance level, significantly increased their performance, or declined in performance. A typology linking actual and perceived change in performance was created: Realists (those who accurately estimated change in their performance); Optimists (those who oveestimated positive change); and Pessimists (those who overestimated negative change). Classification of participants varied across abilities. Women were more likely to be pessimists on Spatial Orientation than men. Older individuals were more likely to be pessimists on Verbal Meaning and Inductive Reasoning Abilities and to be realists on Number ability compared to younger participants.

  17. The diagnosis and reporting of occupational diseases: the performance of physicians in Thailand.

    PubMed

    Aekplakorn, Wichai; Suriyawongpaisal, Paibul; Methawikul, Thanaporn

    2002-03-01

    The diagnosis and reporting of occupational diseases are important components of any occupational disease surveillance system. These two factors were assessed in 222 Thai physicians by using a self-administered questionnaire. Study results show that a proper diagnosis of occupational disease is hampered by the following: lack of knowledge about occupational medicine; a shortage of environmental data; a lack of consultation services and laboratory facilities. Concern about possible legal implications also prevents physicians from making a diagnosis of occupational disease. Evidence shows that financial incentive seems to play a crucial role in physicians' compliance with the reporting system. A number of remedial approaches are proposed, including the improvement of professional training, the development of standard practice guidelines, and novel financial measures for healthcare providers. Improvement calls for the collaborative effort of all responsible agencies and warrants further research that will guide policy and practice.

  18. Perceived performance and impact of a non-physician-led interprofessional team in a trauma clinic setting.

    PubMed

    Driessen, Julia; Bellon, Johanna E; Stevans, Joel; Forsythe, Raquel M; Reynolds, Benjamin R; James, A Everette

    2017-01-01

    Faced with the challenge of meeting the wide degree of post-discharge needs in their trauma population, the University of Pittsburgh Medical Center (UPMC) developed a non-physician-led interprofessional team to provide follow-up care at its UPMC Falk Trauma Clinic. We assessed this model of care using a survey to gauge team member perceptions of this model, and used clinic visit documentation to apply a novel approach to assessing how this model improves the care received by clinic patients. The high level of perceived team performance and cohesion suggests that this model has been successful thus far from a provider perspective. Patients are seen most frequently by audiologists, while approximately half of physical therapy and speech language therapy consults generate a new therapy referral, which is interpreted as a potential change in the patient's care trajectory. The broader message of this analysis is that a collaborative, non-hierarchical team model incorporating rehabilitative specialists, who often operate independently of one another, can be successful in this setting, where patients appear to have a strong and previously under-attended need for rehabilitative intervention.

  19. What makes a top research medical school? A call for a new model to evaluate academic physicians and medical school performance.

    PubMed

    Goldstein, Matthew J; Lunn, Mitchell R; Peng, Lily

    2015-05-01

    Since the publication of the Flexner Report in 1910, the medical education enterprise has undergone many changes to ensure that medical schools meet a minimum standard for the curricula and clinical training they offer students. Although the efforts of the licensing and accrediting bodies have raised the quality of medical education, the educational processes that produce the physicians who provide the best patient care and conduct the best biomedical research have not been identified. Comparative analyses are powerful tools to understand the differences between institutions, but they are challenging to carry out. As a result, the analysis performed by U.S. News & World Report (USN&WR) has become the default tool to compare U.S. medical schools. Medical educators must explore more rigorous and equitable approaches to analyze and understand the performance of medical schools. In particular, a better understanding and more thorough evaluation of the most successful institutions in producing academic physicians with biomedical research careers are needed. In this Perspective, the authors present a new model to evaluate medical schools' production of academic physicians who advance medicine through basic, clinical, translational, and implementation science research. This model is based on relevant and accessible objective criteria that should replace the subjective criteria used in the current USN&WR rankings system. By fostering a national discussion about the most meaningful criteria that should be measured and reported, the authors hope to increase transparency of assessment standards and ultimately improve educational quality.

  20. Mixed results in the safety performance of computerized physician order entry.

    PubMed

    Metzger, Jane; Welebob, Emily; Bates, David W; Lipsitz, Stuart; Classen, David C

    2010-04-01

    Computerized physician order entry is a required feature for hospitals seeking to demonstrate meaningful use of electronic medical record systems and qualify for federal financial incentives. A national sample of sixty-two hospitals voluntarily used a simulation tool designed to assess how well safety decision support worked when applied to medication orders in computerized order entry. The simulation detected only 53 percent of the medication orders that would have resulted in fatalities and 10-82 percent of the test orders that would have caused serious adverse drug events. It is important to ascertain whether actual implementations of computerized physician order entry are achieving goals such as improved patient safety.

  1. Physician recruitment: understanding what physicians want.

    PubMed

    McCullough, T; Dodge, H R; Moeller, S

    1999-01-01

    One of the more dramatic changes in the healthcare industry has been the movement of physicians, particularly younger professionals, from private practice to some type of healthcare organization. In this study we examine the importance attached to specific incentives by physicians in making an affiliation decision and healthcare administrators. Our results suggest significant differences between the importance placed on certain recruiting incentives by physicians and healthcare administrators. Further, they suggest distinct differences in importance ratings by different types of physicians. Implications of this study argue for developing different compensation packages to appeal to different segments of physicians.

  2. Oncology house physician model: a response to changes in pediatric resident coverage.

    PubMed

    Rapson, Alicia; Kersun, Leslie

    2014-10-01

    Given decreasing resident duty hours, subspecialty hospitalist models have emerged to help compensate for the restructured presence of residents. We sought to examine the impact of our pediatric oncology hospitalist model on the oncology unit staff. The survey was developed after a literature review of subspecialty hospitalist models. The final surveys were designed using a 5-point Likert scale. Descriptive statistics were used to compile baseline demographic characteristics of respondents and overall responses to survey questions. Respondents agreed that house physicians provide better continuity of care (96.8%), are more comfortable with the experience level of the physician (98.4%), and are better able to answer questions (92%). Respondents also agreed that house physicians serve as backup for system-related and patient-related questions and found security knowing an experienced provider was on the floor (87.5%). Responses to open-ended questions indicated that the house physician model has impacted fellow education. Our oncology house physician model helps account for decreased residency duty hours. This can serve as a model for other institutions requiring subspecialty inpatient coverage, given resident work hour restrictions. Adjustments in the clinical education of hematology/oncology fellows need to be considered in the setting of competent, consistent, and experienced front-line providers.

  3. English-based Pediatric Emergency Medicine Software Improves Physician Test Performance on Common Pediatric Emergencies: A Multicenter Study in Vietnam

    PubMed Central

    Lin, Michelle; Brooks, Trevor N.; Miller, Alex C.; Sharp, Jamie L.; Hai, Le Thanh; Nguyen, Tu; Kievlan, Daniel R.; Rodriguez, Robert M.; Dieckmann, Ronald A.

    2013-01-01

    Introduction: Global health agencies and the Vietnam Ministry of Health have identified pediatric emergency care and health information technology as high priority goals. Clinical decision support (CDS) software provides physicians with access to current literature to answer clinical queries, but there is limited impact data in developing countries. We hypothesized that Vietnamese physicians will demonstrate improved test performance on common pediatric emergencies using CDS technologies despite being in English. Methods: This multicenter, prospective, pretest-posttest study was conducted in 11 Vietnamese hospitals enrolled a convenience sample of physicians who attended an 80-minute software training on a pediatric CDS software (PEMSoft). Two multiple-choice exams (A, B) were administered before and after the session. Participants, who received Test A as a pretest, received Test B as a posttest, and vice versa. Participants used the CDS software for the posttest. The primary outcome measure was the mean percentage difference in physician scores between the pretest and posttest, as calculated by a paired, two-tailed t-test. Results: For the 203 participants, the mean pretest, posttest, and improvement scores were 37% (95% CI: 35–38%), 70% (95% CI: 68–72%), and 33% (95% CI: 30–36%), respectively, with p<0.0001. This represents an 89% improvement over baseline. Subgroup analysis of practice setting, clinical experience, and comfort level with written English and computers showed that all subgroups equivalently improved their test scores. Conclusion: After brief training, Vietnamese physicians can effectively use an English-based CDS software based on improved performance on a written clinical exam. Given this rapid improvement, CDS technologies may serve as a transformative tool in resource-poor environments. PMID:24106545

  4. English-based Pediatric Emergency Medicine Software Improves Physician Test Performance on Common Pediatric Emergencies: A Multicenter Study in Vietnam.

    PubMed

    Lin, Michelle; Brooks, Trevor N; Miller, Alex C; Sharp, Jamie L; Hai, Le Thanh; Nguyen, Tu; Kievlan, Daniel R; Rodriguez, Robert M; Dieckmann, Ronald A

    2013-09-01

    Global health agencies and the Vietnam Ministry of Health have identified pediatric emergency care and health information technology as high priority goals. Clinical decision support (CDS) software provides physicians with access to current literature to answer clinical queries, but there is limited impact data in developing countries. We hypothesized that Vietnamese physicians will demonstrate improved test performance on common pediatric emergencies using CDS technologies despite being in English. This multicenter, prospective, pretest-posttest study was conducted in 11 Vietnamese hospitals enrolled a convenience sample of physicians who attended an 80-minute software training on a pediatric CDS software (PEMSoft). Two multiple-choice exams (A, B) were administered before and after the session. Participants, who received Test A as a pretest, received Test B as a posttest, and vice versa. Participants used the CDS software for the posttest. The primary outcome measure was the mean percentage difference in physician scores between the pretest and posttest, as calculated by a paired, two-tailed t-test. For the 203 participants, the mean pretest, posttest, and improvement scores were 37% (95% CI: 35-38%), 70% (95% CI: 68-72%), and 33% (95% CI: 30-36%), respectively, with p<0.0001. This represents an 89% improvement over baseline. Subgroup analysis of practice setting, clinical experience, and comfort level with written English and computers showed that all subgroups equivalently improved their test scores. After brief training, Vietnamese physicians can effectively use an English-based CDS software based on improved performance on a written clinical exam. Given this rapid improvement, CDS technologies may serve as a transformative tool in resource-poor environments.

  5. Feasibility of Hospital-Based Use of Peer Ratings to Evaluate the Performances of Practicing Physicians.

    ERIC Educational Resources Information Center

    Ramsey, Paul G.; And Others

    1996-01-01

    A study of 187 internists, evaluated by peers they recommended, found the highest rating was for integrity, and lowest was for psychosocial aspects of patient care. Peer raters' response rate and analysis of the ratings suggest this rating process is acceptable to physicians and that it is feasible to obtain reliable, multidimensional peer…

  6. [Change in the job description of physicians. Consequences for medical education].

    PubMed

    Gross, M; Pelz, J

    2009-08-01

    After receiving the final degree at the age of about 25 years, physicians are going to practice a minimum of 40 years. Therefore, one can assume that after graduation physicians are confronted with many occupational challenges which were not and could not be covered during their studies. This implies that medical education does not only have to provide intensive knowledge about established methods but above all about potential future techniques. Throughout the educational period and continuing during professional life, physicians have first to learn and then to be able to seek information and to conduct a critical appraisal - systematically examining research evidence, assessing its validity and the relevance of the results. The increasing velocity of innovation in the realm of medicine requires students to be prepared for life-long learning and continuous, autonomous professional development.

  7. A Two-Step Method to Identify Positive Deviant Physician Organizations of Accountable Care Organizations with Robust Performance Management Systems.

    PubMed

    Pimperl, Alexander F; Rodriguez, Hector P; Schmittdiel, Julie A; Shortell, Stephen M

    2017-04-06

    To identify positive deviant (PD) physician organizations of Accountable Care Organizations (ACOs) with robust performance management systems (PMSYS). Third National Survey of Physician Organizations (NSPO3, n = 1,398). Organizational and external factors from NSPO3 were analyzed. Linear regression estimated the association of internal and contextual factors on PMSYS. Two cutpoints (75th/90th percentiles) identified PDs with the largest residuals and highest PMSYS scores. A total of 65 and 41 PDs were identified using 75th and 90th percentiles cutpoints, respectively. The 90th percentile more strongly differentiated PDs from non-PDs. Having a high proportion of vulnerable patients appears to constrain PMSYS development. Our PD identification method increases the likelihood that PD organizations selected for in-depth inquiry are high-performing organizations that exceed expectations. © Health Research and Educational Trust.

  8. Preparing Physicians for the 21st Century: Targeting Communication Skills and the Promotion of Health Behavior Change

    PubMed Central

    Sibille, Kimberly; Greene, Anthony; Bush, Joseph P.

    2011-01-01

    The prevalence of behavior-related diseases is a predominant concern in the health care profession. Further complicating matters, the biomedical disease model has demonstrated limited effectiveness in treating the consequential array of chronic health conditions. Medical educators have been tasked with developing curricula to better prepare physicians to address the complex health issues of the 21st century. A review of empirically supported educational endeavors is essential in planning for future interventions. Prior efforts specific to physician-patient communication and the promotion of health behavior change will be reviewed. Opportunities to enhance medical education by targeting patient-centered care, attitudinal measures, individualized training, and an empirically supported, theoretically based model of change will be presented. PMID:22187518

  9. 360-degree Evaluations on Physician Performance as an Effective Tool for Interprofessional Teams: A critical analysis of physician self-assessment as compared to nursing staff and patient evaluations of providers.

    PubMed

    Kamangar, Faranak; Davari, Parastoo; Parsi, Kory K; Li, Chin-Shang; Wang, Qinlu; Mathis, Stephen; Fazel, Nasim

    2016-07-15

    ImportanceThe dynamics of the medical care team, including interactions between physicians and nursing staff, has a large role to play in patient care, patient satisfaction, and future possible reimbursement determination. In order to implement changes to improve this dynamic within the medical team, it is imperative that appropriate assessments are completed to determine baseline satisfaction of our patients and nursing staff in addition to provider self-assessment.ObjectiveWe aimed to investigate patient and nursing staff satisfaction with regards to provider quality of care in an outpatient academic dermatology clinic setting. We also sought out to determine provider insight in regards to satisfaction of patient and nursing staff.MethodsOur nursing staff, patients, and providers completed a questionnaire. We then compared nursing satisfaction data and patient satisfaction data with provider self-assessment to determine provider self-awareness.ResultsA total of 23 provider and nurse surveys and 562 patient satisfaction surveys were completed. Paired comparison and descriptive statistics were utilized to compare patient satisfaction, nursing satisfaction, and provider self-assessments.ConclusionsOverall, the results of the surveys demonstrated that the nursing staff and patients had high satisfaction in their interactions with the dermatology physicians. The physicians had appropriate insight into how they were perceived by the nursing staff and patients. Attending physicians as compared to resident physicians and male physicians as compared to female physicians tended to underrate themselves.

  10. Effects of performance-based reimbursement on the professional autonomy and power of physicians and the quality of care.

    PubMed

    Forsberg, E; Axelsson, R; Arnetz, B

    2001-01-01

    The key question addressed in this study is whether performance-based reimbursement in health care affects the professional power and autonomy of physicians, and if so, whether this has any consequences for the quality of care. This cohort study examines the period 1994-98 in 11 Swedish county councils. Four hundred and eighteen physicians were studied in Stockholm County Council, which has a performance-based reimbursement system, and in ten councils without such a system. The results show that professional power and autonomy are considered to be very limited in all councils, and that they have decreased during the period studied. Professional autonomy is, however, more limited in Stockholm. The limitations in Stockholm are more related to financial considerations, whereas the limitations in the other councils are more due to guidelines and lists of recommended drugs. Professional autonomy and power were found to be important determinants for quality of care, and the physicians in Stockholm estimated the quality of care lower than their colleagues in the ten other councils. Thus, our study suggests that the performance-based reimbursement system might fail to reach the desired results due to its negative impact on professional power and autonomy.

  11. Do Major League Baseball Team Physicians Harvest the Semitendinosus From the Drive Leg or Landing Leg When Performing Ulnar Collateral Ligament Reconstruction on Elite Baseball Pitchers?

    PubMed Central

    Erickson, Brandon J.; Chalmers, Peter N.; Dugas, Jeffrey R.; Bach, Bernard R.; Nicholson, Gregory P.; Verma, Nikhil N.; Ahmad, Christopher S.; Romeo, Anthony A.

    2017-01-01

    Background: Hamstring autograft is a common graft choice when performing ulnar collateral ligament reconstruction (UCLR). Purpose/Hypothesis: The purpose of this study was to survey Major League Baseball (MLB) team physicians and determine whether these physicians harvest the hamstring (semitendinosus or gracilis) from the drive leg (ipsilateral to surgical site) or landing leg (contralateral to surgical site) when performing UCLR on elite-level pitchers. The hypothesis was that the majority of surgeons harvest the hamstring from the drive leg when performing a UCLR. Study Design: Descriptive epidemiology study. Methods: Overall, 52 MLB team orthopaedic surgeons were sent the 5-question online survey. The survey assessed surgeon UCLR volume, surgical technique, which leg the hamstring graft was harvested from, the reasoning for choosing that particular leg, and whether the surgeon would change their practice if evidence showed the hamstring from one of the legs was more important than the other. The survey was sent out 5 separate times to maximize the response rate. Results: Forty (77%) MLB team physicians completed the survey. The largest number of surgeons (n = 16; 40%) performed between 5 and 14 UCLRs annually, while 6 (15%) performed more than 50 UCLRs annually. Most surgeons (n = 23; 57.5%) used the docking technique. Significantly more surgeons harvested the hamstring from the landing leg (n = 29; 72.5%) compared with the drive leg (n = 11; 27.5%) (P = .007). More surgeons cited the reason for their choice of leg as a belief that the hamstring they harvested plays less of a role in the ability of a pitcher to generate a forceful pitch (n = 25; 62.5%) than for logistical reasons in the operating room (n = 15; 37.5%); this difference was not statistically significant. Significantly more surgeons would change their practice (n = 35; 87.5%) if evidence showed the hamstrings from a specific (drive or landing) leg to be more active in the throwing motion compared

  12. Topic Transitions in Physician-Patient Interviews: Power; Gender, and Discourse Change.

    ERIC Educational Resources Information Center

    Ainsworth-Vaughn, Nancy

    1992-01-01

    The explicit theoretical frame in which topic transitions have been described and the types of transitions are discussed, based on a study of 12 physician-patient encounters. Reciprocal and unilateral activities are identified that relate to allocation of power. (34 references) (Author/LB)

  13. Adapting, Resisting, and Negotiating. How Physicians Cope with Organizational and Economic Change.

    ERIC Educational Resources Information Center

    Hoff, Timothy J.; McCaffrey, David P.

    1996-01-01

    Interviews with 25 primary care physicians found that (1) self-employed and salaried doctors view important practice issues identically; (2) they have different views of professional role and image; (3) self-employed doctors were concerned with protecting economic autonomy; and (4) salaried doctors' technical autonomy was threatened by the…

  14. Changing roles for primary-care physicians: addressing challenges and opportunities.

    PubMed

    McLaughlin, C P; Kaluzny, A D; Kibbe, D C; Tredway, R

    2005-01-01

    Direct-to-consumer advertising is but one example of a process called disintermediation that is directly affecting primary-care physicians and their patients. This paper examines the trends and the actors involved in disintermediation, which threatens the traditional patient-physician relationship. The paper outlines the social forces behind these threats and illustrates the resulting challenges and opportunities. A rationale and strategies are presented to rebuild, maintain and strengthen the patient-physician relationship in an era of growing disintermediation and anticipated advancements in cost-effective office-based information systems. Primary care--as we know it--is under siege from a number of trends in healthcare delivery, resulting in loss of physician autonomy, disrupted continuity of care and potential erosion of professional values (Rastegar 2004; Future of Family Medicine Project Leadership Committee 2004). The halcyon days of medicine as a craft guild with a monopoly on (1) technical knowledge and (2) the means of implementation, reached its zenith in the mid-twentieth century and has been under pressure ever since (Starr 1982; Schlesinger 2002). While this is a trend within the US health system, it is likely to affect other delivery systems in the years ahead.

  15. Changing Physicians' Behavior: What Works and Thoughts on Getting More Things to Work.

    ERIC Educational Resources Information Center

    Grimshaw, Jeremy M.; Eccles, Martin P.; Walker, Anne E.; Thomas, Ruth E.

    2002-01-01

    Efforts to address the information management problems of physicians include the Cochran reviews of the effectiveness of health care interventions and international clinical practice guidelines. A better theoretical base is needed to guide the choice of effective dissemination strategies. (Contains 18 references.) (SK)

  16. The supply of physicians' services.

    PubMed

    Brown, D M; Lapan, H E

    1979-04-01

    This paper presents a model of the supply of physicians' services based upon the assumption that physicians are price-taking utility maximizers. Assuming physicians' services are produced using physicians' labor and purchased inputs, the paper shows that the impact of changes in final product or input prices on the supply of physicians' services depends on the physicians' labor-leisure choice and on the degree of substitutability between physicians' labor and purchased inputs. The empirical results presented indicate that the physicians' labor supply curve is backward-bending, but that the supply curve of physicians' services is positively sloped.

  17. Changing interactions between physician trainees and the pharmaceutical industry: a national survey.

    PubMed

    Austad, Kirsten E; Avorn, Jerry; Franklin, Jessica M; Kowal, Mary K; Campbell, Eric G; Kesselheim, Aaron S

    2013-08-01

    Increasingly, medical school policies limit pharmaceutical representatives' access to students and gifts from drugmakers, but little is known about how these policies affect student attitudes toward industry. To assess interactions between trainees and the pharmaceutical industry, and to determine whether learning environment characteristics influence students' practices and attitudes. We conducted a cross-sectional survey with a nationally-representative sample of first- and fourth-year medical students and third-year residents, stratified by medical school, including ≥ 14 randomly selected trainees at each level per school. We measured frequency of industry interactions and attitudes regarding how such interactions affect medical training and the profession. Chi-squared tests assessed bivariate linear trend, and hierarchical logistic regression models were fitted to assess associations between trainees' attitudes and their schools' National Institutes of Health (NIH) funding levels and American Medical Student Association (AMSA) PharmFree Scorecard grades reflecting industry-related conflict of interest policies. Among 1,610 student (49.3 % response rate) and 739 resident (43.1 %) respondents, industry-sponsored gifts were common, rising from 33.0 % (first-year students) to 56.8 % (fourth-year students) and 54 % (residents) (p < 0.001). These gifts included meals outside the hospital (reported by 5 % first-year students, 13.4 % fourth-year students, 27.5 % residents (p < 0.001)) and free drug samples (reported by 7.4 % first-year students, 14.1 % fourth-year students, 14.3 % residents (p < 0.001)). The perception that industry interactions lead to bias was prevalent, but the belief that physicians receive valuable education through these interactions increased (64.1 % to 67.5 % to 79.8 %, p < 0.001). Students in schools receiving more NIH funding reported industry gifts less often (OR = 0.51, 95 % CI: 0.38-0.68, p < 0.001), but the

  18. Changing physician knowledge, attitudes, and beliefs about migraine: evaluation of a new educational intervention.

    PubMed

    Patwardhan, Meenal B; Samsa, Gregory P; Lipton, Richard B; Matchar, David B

    2006-05-01

    Use a presurvey of primary care providers (PCPs) enrolled in a continuing medical education (CME) program on headache management to ascertain their existing knowledge, attitudes, and beliefs regarding migraine and use a postsurvey to determine the extent to which the CME program has brought participant knowledge, attitudes, and skills closer to conformance with best evidence. Migraine is a common and debilitating condition, which PCPs may not always manage satisfactorily. In an effort to improve management, the American Headache Society has developed a CME program called BRAINSTORM that encourages PCPs to adopt the US Headache Consortium Guidelines for headache care. A 20-item questionnaire was developed that covered the essential elements of migraine care. The questionnaire was administered before and after a BRAINSTORM presentation to 254 consenting primary care clinicians attending a medical meeting at 1 of 6 sites. A control group of 112 comparable physicians who did not attend the presentation completed the same questionnaire. Prepresentation scores of attendees were compared to scores of nonattendees to assess the generalizability of results. Prepresentation scores on selected questions were used to assess participant baseline knowledge, attitudes, and beliefs. Pre- and postpresentation scores for attendees at all sites were compared using the Mantel-Haenszel statistic to assess the effectiveness of the BRAINSTORM CME. Pre- and postpresentation scores were compared by site using the Breslow-Day test to evaluate any differential impact based on CME location. Prepresentation scores of attendees and nonattendees were found to be similar. No significant difference in performance was noted across sites. A chi-square analysis revealed a statistically significant difference between pre- and postpresentation scores for 16 of the test's 20 questions. In the pretest, all participants scored <66% on 2 questions related to prevalence, impact, and pathophysiology of

  19. Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators.

    PubMed

    Von Pressentin, Klaus B; Mash, Bob J; Esterhuizen, Tonya M

    2017-04-28

    The supply of appropriate health workers is a key building block in the World Health Organization's model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS) from 2011. This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population) on key health indicators. All 52 South African health districts were included as units of analysis. An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015. Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district. The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician's circle of control may be better positioned to demonstrate a measurable impact in the short term.

  20. An analysis of candidate ethical justifications for allowing inexperienced physicians-in-training to perform invasive procedures.

    PubMed

    Mercurio, Mark R

    2008-02-01

    Allowing relatively inexperienced physicians-in-training to perform invasive medical procedures is a widely accepted practice, generally felt to be justified by the need to train future generations of physicians. The ethical justification of this practice, however, is rarely if ever explored in any depth. This essay examines the moral issues associated with this practice, in the setting of a specific clinical scenario involving the emergency intubation of a critically ill newborn. The practice is ultimately shown to be justified based not only on the needs of society and future patients but also on the best interests of the patient being treated. However, several important qualifications need to be satisfied in order for this practice to be ethically permissible. The arguments and qualifications presented can be extended to clinical situations beyond the specific scenario discussed and are relevant to a wide range of medical and surgical settings.

  1. Heavy physician workloads: impact on physician attitudes and outcomes.

    PubMed

    Williams, Eric S; Rondeau, Kent V; Xiao, Qian; Francescutti, Louis H

    2007-11-01

    The intensity of physician workload has been increasing with the well-documented changes in the financing, organization and delivery of care. It is possible that these stressors have reached a point where they pose a serious policy issue for the entire healthcare system through their diminution of physician's ability to effectively interact with patients as they are burned out, stressed and dissatisfied. This policy question is framed in a conceptual model linking workloads with five key outcomes (patient care quality, individual performance, absenteeism, turnover and organizational performance) mediated by physician stress and satisfaction. This model showed a good fit to the data in a structural equation analysis. Ten of the 12 hypothesized pathways between variables were significant and supported the mediating role of stress and satisfaction. These results suggest that workloads, stress and satisfaction have significant and material impacts on patient care quality, individual performance, absenteeism, turnover and organizational performance. Implications of these results and directions for future research are discussed.

  2. Is it primary neuropsychiatric systemic lupus erythematosus? Performance of existing attribution models using physician judgment as the gold standard.

    PubMed

    Fanouriakis, Antonis; Pamfil, Cristina; Rednic, Simona; Sidiropoulos, Prodromos; Bertsias, George; Boumpas, Dimitrios T

    2016-01-01

    Models for the attribution of neuropsychiatric manifestations to systemic lupus erythematosus (NPSLE) that incorporate timing and type of manifestation, exclusion/confounding or favouring factors have been proposed. We tested their diagnostic performance against expert physician judgment. SLE patients with neuropsychiatric manifestations were identified through retrospective chart review. Manifestations were classified according to physician judgment as attributed to SLE, not attributed or uncertain. Results were compared against the Systemic Lupus International Collaborating Clinics (SLICC) attribution models A and B, and one introduced by the Italian Study Group on NPSLE. 191 patients experienced a total 242 neuropsychiatric manifestations, 136 of which were attributed to SLE according to physician. Both SLICC models showed high specificity (96.2% and 79.2% for model A and B, respectively) but low sensitivity (22.8% and 34.6%, respectively) against physician judgment. Exclusion of cases of headache, anxiety disorders, mild mood and cognitive disorders and polyneuropathy without electrophysiologic confirmation led to modest increases in sensitivity (27.7% and 42.0% for SLICC models A and B, respectively) and reductions in specificity (94.8% and 65.5%, respectively). The Italian Group model showed good accuracy in NPSLE attribution with an area under the curve of the receiver operating characteristics analysis of 0.862; values ≥7 showed the best combination of sensitivity and specificity (82.4% and 82.9%, respectively). Attribution models can be useful in NPSLE diagnosis in routine clinical practice and their performance is superior in major neuropsychiatric manifestations. The Italian Study Group model is accurate, with values ≥7 showing the best combination of sensitivity and specificity.

  3. Physicians' and nurses' attitudes towards performance-based financial incentives in Burundi: a qualitative study in the province of Gitega.

    PubMed

    Rudasingwa, Martin; Uwizeye, Marie Rose

    2017-01-01

    Performance-based financing (PBF) was first implemented in Burundi in 2006 as a pilot programme in three provinces and was rolled out nationwide in 2010. PBF is a reform approach to improve the quality, quantity, and equity of health services and aims at achieving universal health coverage. It focuses on how to best motivate health practitioners. To elicit physicians' and nurses' experiences and views on how PBF influenced and helped them in healthcare delivery. A qualitative cross-sectional study was carried out among frontline health workers such as physicians and nurses. The data was gathered through individual face-to-face, in-depth, semi-structured interviews with 6 physicians and 30 nurses from February to March 2011 in three hospitals in Gitega Province. A simple framework approach and thematic analysis using a combination of manual technique and MAXQDA software guided the analysis of the interview data. Overall, the interviewees felt that the PBF scheme had provided positive motivation to improve the quality of care, mainly in the structures and process of care. The utilization of health services and the relationship between health practitioners and patients also improved. The salary top-ups were recognized as the most significant impetus to increase effort in improving the quality of care. The small and sometimes delayed financial incentives paid to physicians and nurses were criticized. The findings of this study also indicate that the positive interaction between performance-based incentive schemes and other health policies is crucial in achieving comprehensive improvement in healthcare delivery. PBF has the potential to motivate medical staff to improve healthcare provision. The views of medical staff and the context of the area of implementation have to be taken into consideration when designing and implementing PBF schemes.

  4. Disciplined doctors: the electronic medical record and physicians' changing relationship to medical knowledge.

    PubMed

    Reich, Adam

    2012-04-01

    This study explores the effects of the electronic medical record (EMR) on the power of the medical profession. It is based on twenty-five in-depth interviews with administrators and physicians across three departments of a large, U.S. integrated health system, as well as ethnographic observation, all of which took place between September of 2009 and December of 2010. While scholarship on professional power has tended toward the opposite poles of professional dominance and deprofessionalization or proletarianization, I find that doctors' interactions with the EMR reconcile these perspectives by making physicians' professional identities consistent with their subordination to bureaucratic authority. After examining the electronic medical record as a disciplinary technology, the paper analyzes variation in the extent to which practitioners' professional identities are reconciled with bureaucratic subordination across the different departments studies.

  5. Secure e-mailing between physicians and patients: transformational change in ambulatory care.

    PubMed

    Garrido, Terhilda; Meng, Di; Wang, Jian J; Palen, Ted E; Kanter, Michael H

    2014-01-01

    Secure e-mailing between Kaiser Permanente physicians and patients is widespread; primary care providers receive an average of 5 e-mails from patients each workday. However, on average, secure e-mailing with patients has not substantially impacted primary care provider workloads. Secure e-mail has been associated with increased member retention and improved quality of care. Separate studies associated patient portal and secure e-mail use with both decreased and increased use of other health care services, such as office visits, telephone encounters, emergency department visits, and hospitalizations. Directions for future research include more granular analysis of associations between patient-physician secure e-mail and health care utilization.

  6. Strategic alliance between the infectious diseases specialist and intensive care unit physician for change in antibiotic use.

    PubMed

    Curcio, D; Belloni, R

    2005-02-01

    There is a general consensus that antimicrobial use in intensive care units (ICU) is greater than that in general wards. By implementing a strategy of systematic infectious disease consultations in agreement with the ICU chief, we have modified the antibiotic prescription habits of the ICU physician. A reduction was observed in the use of selected antibiotics (third-generation cephalosporins, vancomycin, carbapenems and piperacillin-tazobactam), with a significant reduction in the length of hospital stay for ICU patients and lower antibiotic costs without negative impact on patient mortality. Leadership by the infectious diseases consultant in combination with commitment by ICU physicians is a simple and effective method to change antibiotic prescription habits in the ICU.

  7. Forgiven but not Relieved: US Physician Workforce Consequences of Changes to Public Service Loan Forgiveness.

    PubMed

    Friedman, Ari B; Grischkan, Justin A; Dorsey, E Ray; George, Benjamin P

    2016-10-01

    Public Service Loan Forgiveness (PSLF) was established in 2007 for public sector and nonprofit enterprise employees to pursue educational loan forgiveness. Under PSLF, graduates are offered complete loan forgiveness after 120 qualifying monthly payments while employed at public or nonprofit institutions, including payments made during residency for physicians. In response to concerns that PSLF will heavily subsidize lawyers, doctors, and other professionals, the President's 2017 budget proposes limiting maximum forgiveness. Using data from the Association of American Medical Colleges Graduation Questionnaire (n = 55,905; response rate of 80 %), we found that intended participation in PSLF among medical school graduates grew 20 % per year since 2010. Future primary care physicians intend to use PSLF more than programs that were historically designed to promote primary care, such as the National Health Service Corp (NHSC). The federal government's projected cost of PSLF will reach over $316 million for 2014 graduates (net present value), approximately seven times the annual contributions from the NHSC. The proposed cap will reduce the total anticipated forgiveness by nearly two-thirds and substantially reduce subsidies for physicians. More targeted measures of loan forgiveness could be considered, such as making forgiveness contingent on pursuing specialties that society needs or practicing in shortage areas.

  8. Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators

    PubMed Central

    Mash, Robert J.

    2017-01-01

    Background The supply of appropriate health workers is a key building block in the World Health Organization’s model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS) from 2011. Aim This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population) on key health indicators. Setting All 52 South African health districts were included as units of analysis. Methods An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015. Results Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district. Conclusion The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician’s circle of control may be better positioned to demonstrate a measurable impact in the short term. PMID:28470076

  9. Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study.

    PubMed

    Frajzyngier, Vera; Odingo, George; Barone, Mark; Perchal, Paul; Pavin, Melinda

    2014-02-01

    Male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. The Government of Kenya is rolling out voluntary medical male circumcision (VMMC) services, but struggles with health worker shortages, particularly with physician shortages. To evaluate the safety of male circumcision performed by non-physician clinicians in Kenya. Between December 2009 and December 2010, we conducted a prospective study of VMMC procedures performed by 15 nurses and 11 clinical officers, all trained to competence, in 11 public health facilities in Nyanza Province, Kenya. Providers reported surgical complications and adverse events (AEs), based on standardized definitions, immediately after the procedure and at 7 days and 60 days post-circumcision. We also assessed clients' satisfaction with the circumcision at 60 days. We recruited 2,244 men and boys, ages 13-54. The retention rate was high, with 2,192 participants (98%) returning for the 7-day follow-up visit and 1,845 (82%) for the 60-day visit. There was no difference in rates of moderate and severe AEs between participants whose circumcision was performed by a nurse (2.1%) or a clinical officer (1.9%) at 7 days post-circumcision. The most common AE was excess swelling (1.1%). Risk factors associated with an AE at 7 days post-circumcision included being employed and participant age ≥ 18 years. Participants circumcised by a provider with ≥ 6 years of professional experience were less likely to have an AE. Nearly all participants reported being satisfied with their circumcision at the 60-day follow-up visit. Trained nurses and clinical officers provided safe VMMC in Nyanza Province, Kenya. AE rates in this study were similar to those reported in typical service-delivery settings. These results add to the current body of evidence suggesting that trained non-physicians can provide safe medical male circumcision, thereby facilitating increased availability and access to circumcision services.

  10. A prospective survey of critical care procedures performed by physicians in helicopter emergency medical service: is clinical exposure enough to stay proficient?

    PubMed

    Sollid, Stephen J M; Bredmose, Per P; Nakstad, Anders R; Sandberg, Mårten

    2015-06-11

    Physicians in prehospital care must be proficient in critical care procedures. Procedure proficiency requires a combination of training, experience and continuous clinical exposure. Most physicians in helicopter emergency medical service (HEMS) in Norway are well-trained and experienced anaesthesiologists, but we know little about their exposure to critical care procedures in the prehospital arena. This knowledge is required to plan clinical training and in-hospital practice to maintain core competences for a HEMS physician. We collected survey data on critical care procedures performed by physicians at three HEMS bases in Norway for a one-year period. To correct for differences in duty time between physicians, the expected number of procedures performed in a full time engagement at each HEMS base was calculated. Data was analysed using descriptive statistics and expected procedure volume at each base was compared using one-way between group analysis of variance. We received data from 82.7 % of the duty hours in the study period. Physicians at Oslo University Hospital HEMS had the highest volume of procedures in most categories and were expected to perform a majority of the procedures at least once a year. There were significant differences in procedure volume between the bases in 25 procedures. Physicians in Norwegian HEMS perform critical care procedures with variable frequencies. The low procedure volume in some cases and variance between bases indicate the need for a tailored procedure maintenance training and relevant in-hospital clinical practice.

  11. Management training of physician executives, their leadership style, and care management performance: an empirical study.

    PubMed

    Xirasagar, Sudha; Samuels, Michael E; Curtin, Thomas F

    2006-02-01

    To examine associations between management training of physician executives and their leadership styles, as well as effectiveness in achieving disease management goals. Cross-sectional national survey. Executive directors of community health centers (269 respondents; response rate = 40.9%) were surveyed regarding their perceptions of the medical director's leadership, and for quantitative information on the center's achievement of clinical (mostly disease management) goals. The dependent variables were the medical director's scores (as perceived by the executive director) on transformational, transactional, and laissez-faire leadership, effectiveness, satisfaction with the leader, and subordinate extra effort, using an adapted Multifactor Leadership Questionnaire (43 items; 5-point Likert scale). The independent variable was the medical director's management training status. Compared with medical directors with < 30 days of inservice training, medical directors with an MHA, MPH, or MBA, or > or =30 days of in-service training, had 0.32, 0.35, 0.30, 0.36, and 0.37 higher scores on transformational leadership, transactional leadership, rated effectiveness, satisfaction, and subordinate extra effort, respectively, and 0.31 lower score on laissez-faire leadership (all P < .001). Medical directors without management degrees but with > or =30 days of in-service training had 0.34, 0.36, 0.50, and 0.47 higher scores on transformational leadership, transactional leadership, rated effectiveness, and satisfaction with the leader (all P < .02). Our data previously had demonstrated that medical directors' transformational leadership significantly influences achievement of disease management goals. Training may enable physician executives to develop leadership styles that are effective in influencing clinical providers' adoption of disease management guidelines under managed care.

  12. Changes in physicians' attitudes toward AIDS during residency training: a longitudinal study of medical school graduates.

    PubMed

    Yedidia, M J; Berry, C A; Barr, J K

    1996-06-01

    Understanding the impact of training on the development of physicians' attitudes toward AIDS is important to furthering our knowledge of the mechanisms through which socialization affects professional outlook, as well as promoting an adequate supply of providers to treat people with AIDS (PWAs). This prospective panel study collected data on 383 physicians at two critical stages: as fourth-year medical students and as third-year residents. Aspects of residency training (e.g., residents' morale and positive faculty role models) were the most powerful predictors of increase in willingness to treat PWAs. Decline in willingness was primarily a product of negative social attitudes-homophobia and IVDU-phobia (aversion to intravenous drug users). Cynicism toward patient care acted as a trigger, activating the negative effects of IVDU-phobia; having an acquaintance who is HIV positive mediated the negative impact of homophobia. Notably, cynicism was associated with basic aspects of training (specific characteristics of the faculty and of the educational milieu). The findings support a view of socialization as a pervasive process implicating intrinsic aspects of training and having an impact on a broad spectrum of outlooks. Accordingly, interventions must address structural characteristics that transcend AIDS-specific concerns.

  13. Cooperation within physician-nurse team in occupational medicine service in Poland - Knowledge about professional activities performed by the team-partner.

    PubMed

    Sakowski, Piotr

    2015-01-01

    The goal of the study has been to learn about physicians' and nurses' awareness of the professional activities that are being performed by their colleague in the physician-nurse team. Postal questionnaires were sent out to occupational physicians and nurses in Poland. The analysis includes responses from 232 pairs of physician-nurse teams. The knowledge among occupational professionals about tasks performed by their colleagues in the physician-nurse team seems to be poor. Respondents were asked about who performs tasks from each of 21 groups mentioned in the Occupational Medicine Service Act. In the case of only 3 out of 21 groups of tasks, the rate of non-consistence in answers was lower than 30%. A specified number of professionals performed their tasks on the individual basis. Although in many cases their team colleagues knew about those activities, there was a major proportion of those who had no awareness of such actions. Polish occupational physicians and nurses perform a variety of tasks. Occupational nurses, besides medical role, also play important organizational roles in their units. The cooperation between the two professional groups is, however, slightly disturbed by the deficits in communication. This issue needs to be improved for the betterment of operations within the whole system. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  14. The effects of noise on the cognitive performance of physicians in a hospital emergency department

    NASA Astrophysics Data System (ADS)

    Dodds, Peter

    In this research, the acoustic environment of a contemporary urban hospital emergency department has been characterized. Perceptive and cognitive tests relating to the acoustic environment were conducted on both medical professionals and lay people and a methodology for developing augmentable acoustic simulations from field recordings was developed. While research of healthcare environments remains a popular area of investigation for the acoustics community, a lack of communication between medical and acoustics researchers as well as a lack of sophistication in the methods implemented to evaluate hospital environments and their occupants has led to stagnation. This research attempted to replicate traditional methods for the evaluation of hospital acoustic environments including impulse response based room acoustics measurements as well as psychoacoustic evaluations. This thesis also demonstrates some of the issues associated with conducting such research and provides an outline and implementation for alternative advanced methods of re- search. Advancements include the use of the n-Back test to evaluate the effects of the acoustic environment on cognitive function as well as the outline of a new methodology for implementing realistic immersive simulations for cognitive and perceptual testing using field recordings and signal processing techniques. Additionally, this research utilizes feedback from working emergency medicine physicians to determine the subjective degree of distraction subjects felt in response to a simulated acoustic environment. Results of the room acoustics measurements and all experiments will be presented and analyzed and possible directions for future research will be presented.

  15. Ultrasound Detection of Soft Tissue Abscesses Performed by Non-Physician U.S. Army Medical Providers Naïve to Diagnostic Sonography.

    PubMed

    LaDuke, Mike; Monti, Jon; Cronin, Aaron; Gillum, Bart

    2017-03-01

    Patients commonly present to emergency rooms and primary care clinics with cellulitic skin infections with or without abscess formation. In military operational units, non-physician medical personnel provide most primary and initial emergency medical care. The objective of this study was to determine if, after minimal training, Army physician assistants and medics could use portable ultrasound (US) machines to detect superficial soft tissue abscesses. This was a single-blinded, randomized, prospective observational study conducted over the course of 2 days at a military installation. Active duty military physician assistants and medics with little or no US experience were recruited as participants. They received a short block of training on abscess detection using both clinical examination skills (inspection/palpation) and US examination. The participants were then asked to provide a yes/no answer regarding abscess presence in a chicken tissue model. Results were analyzed to assess the participants' abilities to detect abscesses, compare the diagnostic accuracy of their clinical examinations with their US examinations, and assess how often US results changed treatment plans initially on the basis of clinical examination findings alone. 22 participants performed a total of 220 clinical examinations and 220 US scans on 10 chicken tissue abscess models. Clinical examination for abscess detection yielded a sensitivity of 73.5% (95% confidence interval [CI], 65.3-80.3%) and a specificity of 77.2% (95% CI, 67.4-84.9%), although US examination for abscess detection yielded a sensitivity of 99.2% (95% CI, 95.4-99.9%) and a specificity of 95.5% (95% CI, 88.5-98.6%). Clinical examination yielded a diagnostic accuracy of 75.0% (95% CI, 68.9-80.3) although US examination yielded a diagnostic accuracy of 97.7% (95% CI, 94.6-99.2%), a difference in accuracy of 22.7% favoring US (p < 0.01). US changed the diagnosis in 56 of 220 cases (25.4% of all cases, p = 0.02). Of these 56

  16. Age-related changes in triathlon performances.

    PubMed

    Lepers, R; Sultana, F; Bernard, T; Hausswirth, C; Brisswalter, J

    2010-04-01

    The aim of this study was two-fold: i) to analyse age-related declines in swimming, cycling, and running performances for Olympic and Ironman triathlons, and ii) to compare age-related changes in these three disciplines between the Olympic and Ironman triathlons. Swimming, cycling, running and total time performances of the top 10 males between 20 and 70 years of age (in 5 years intervals) were analysed for two consecutive world championships (2006 and 2007) for Olympic and Ironman distances. There was a lesser age-related decline in cycling performance (p<0.01) compared with running and swimming after 55 years of age for Olympic distance and after 50 years of age for Ironman distance. With advancing age, the performance decline was less pronounced (p<0.01) for Olympic than for Ironman triathlon in cycling (>55 years) and running (>50 years), respectively. In contrast, an age-related decline in swimming performance seemed independent of triathlon distance. The age-related decline in triathlon performance is specific to the discipline, with cycling showing less declines in performance with age than swimming and running. The magnitude of the declines in cycling and running performance at Ironman distance is greater than at Olympic distance, suggesting that task duration exerts an important influence on the magnitude of the age-associated changes in triathlon performance.

  17. Impact of a change in physician reimbursement on bone mineral density testing in Ontario, Canada: a population-based study

    PubMed Central

    Hawker, Gillian; Croxford, Ruth; Cameron, Cathy; Schott, Anne-Marie; Munce, Sarah; Allin, Sonya

    2014-01-01

    Background On Apr. 1, 2008, a revision was made to the fee schedule for bone mineral density testing with dual-energy x-ray absorptiometry (DXA) in the province of Ontario, Canada, reducing the frequency of repeat screening in individuals at low risk of osteoporosis. We evaluated whether the change in physician reimbursement successfully promoted appropriate bone mineral density testing, with reduced use among women at low risk and increased use among women and men at higher risk of osteoporosis-related fracture. Methods We analyzed data from administrative databases on physician billings, hospital discharges and emergency department visits. We included all physician claims for DXA in the province to assess patterns in bone mineral density testing from Apr. 1, 2002, to Mar. 31, 2011. People at risk of an osteoporosis-related fracture were defined as women and men aged 65 years or more and those who had a recent (< 6 mo) fracture after age 40 years. Joinpoint regression analysis was used to examine trends in DXA testing. Results Before the policy change, the overall number of DXA tests increased from 433 419 in 2002/03 to 507 658 in 2007/08; after revision of the fee schedule, the number decreased to 422 915 by 2010/11. Most of this reduction was due to a decrease in the age-standardized rate of DXA testing among women deemed to be at low risk, from 5.7 per 100 population in 2008/09 to 1.8 per 100 in 2010/11. In the high-risk group of people aged 65 or more, the age-standardized rate of testing increased after the policy change among men but decreased among women. Among those at high risk because of a recent clinical fracture, the age-standardized rate of DXA testing increased for both sexes and then decreased after the policy change. Interpretation A change in reimbursement designed to restrict access to bone mineral density testing among low-risk women was associated with an overall reduction in testing. Efforts to communicate guidelines for bone mineral

  18. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014.

    PubMed

    Shanafelt, Tait D; Hasan, Omar; Dyrbye, Lotte N; Sinsky, Christine; Satele, Daniel; Sloan, Jeff; West, Colin P

    2015-12-01

    To evaluate the prevalence of burnout and satisfaction with work-life balance in physicians and US workers in 2014 relative to 2011. From August 28, 2014, to October 6, 2014, we surveyed both US physicians and a probability-based sample of the general US population using the methods and measures used in our 2011 study. Burnout was measured using validated metrics, and satisfaction with work-life balance was assessed using standard tools. Of the 35,922 physicians who received an invitation to participate, 6880 (19.2%) completed surveys. When assessed using the Maslach Burnout Inventory, 54.4% (n=3680) of the physicians reported at least 1 symptom of burnout in 2014 compared with 45.5% (n=3310) in 2011 (P<.001). Satisfaction with work-life balance also declined in physicians between 2011 and 2014 (48.5% vs 40.9%; P<.001). Substantial differences in rates of burnout and satisfaction with work-life balance were observed by specialty. In contrast to the trends in physicians, minimal changes in burnout or satisfaction with work-life balance were observed between 2011 and 2014 in probability-based samples of working US adults, resulting in an increasing disparity in burnout and satisfaction with work-life balance in physicians relative to the general US working population. After pooled multivariate analysis adjusting for age, sex, relationship status, and hours worked per week, physicians remained at an increased risk of burnout (odds ratio, 1.97; 95% CI, 1.80-2.16; P<.001) and were less likely to be satisfied with work-life balance (odds ratio, 0.68; 95% CI, 0.62-0.75; P<.001). Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  19. Attitudes of Slovenian family practice patients toward changing unhealthy lifestyle and the role of family physicians: a cross-sectional study

    PubMed Central

    Klemenc-Ketis, Zalika; Bulc, Mateja; Kersnik, Janko

    2011-01-01

    Aim To assess patients’ attitudes toward changing unhealthy lifestyle, confidence in the success, and desired involvement of their family physicians in facilitating this change. Methods We conducted a cross-sectional study in 15 family physicians’ practices on a consecutive sample of 472 patients (44.9% men, mean age  [± standard deviation] 49.3 ± 10.9 years) from October 2007 to May 2008. Patients were given a self-administered questionnaire on attitudes toward changing unhealthy diet, increasing physical activity, and reducing body weight. It also included questions on confidence in the success, planning lifestyle changes, and advice from family physicians. Results Nearly 20% of patients planned to change their eating habits, increase physical activity, and reach normal body weight. Approximately 30% of patients (more men than women) said that they wanted to receive advice on this issue from their family physicians. Younger patients and patients with higher education were more confident that they could improve their lifestyle. Patients who planned to change their lifestyle and were more confident in the success wanted to receive advice from their family physicians. Conclusion Family physicians should regularly ask the patients about the intention of changing their lifestyle and offer them help in carrying out this intention. PMID:21495204

  20. Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study

    PubMed Central

    Frajzyngier, Vera; Odingo, George; Barone, Mark; Perchal, Paul; Pavin, Melinda

    2014-01-01

    Background: Male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. The Government of Kenya is rolling out voluntary medical male circumcision (VMMC) services, but struggles with health worker shortages, particularly with physician shortages. Objective: To evaluate the safety of male circumcision performed by non-physician clinicians in Kenya. Methods: Between December 2009 and December 2010, we conducted a prospective study of VMMC procedures performed by 15 nurses and 11 clinical officers, all trained to competence, in 11 public health facilities in Nyanza Province, Kenya. Providers reported surgical complications and adverse events (AEs), based on standardized definitions, immediately after the procedure and at 7 days and 60 days post-circumcision. We also assessed clients' satisfaction with the circumcision at 60 days. Results: We recruited 2,244 men and boys, ages 13–54. The retention rate was high, with 2,192 participants (98%) returning for the 7-day follow-up visit and 1,845 (82%) for the 60-day visit. There was no difference in rates of moderate and severe AEs between participants whose circumcision was performed by a nurse (2.1%) or a clinical officer (1.9%) at 7 days post-circumcision. The most common AE was excess swelling (1.1%). Risk factors associated with an AE at 7 days post-circumcision included being employed and participant age ≥ 18 years. Participants circumcised by a provider with ≥ 6 years of professional experience were less likely to have an AE. Nearly all participants reported being satisfied with their circumcision at the 60-day follow-up visit. Conclusions: Trained nurses and clinical officers provided safe VMMC in Nyanza Province, Kenya. AE rates in this study were similar to those reported in typical service-delivery settings. These results add to the current body of evidence suggesting that trained non-physicians can provide safe medical male circumcision, thereby facilitating

  1. Reliability and Practicality of the Core Score: Four Dynamic Core Stability Tests Performed in a Physician Office Setting.

    PubMed

    Friedrich, Jason; Brakke, Rachel; Akuthota, Venu; Sullivan, William

    2017-07-01

    Pilot study to determine the practicality and inter-rater reliability of the "Core Score," a composite measure of 4 clinical core stability tests. Repeated measures. Academic hospital physician clinic. 23 healthy volunteers with mean age of 32 years (12 females, 11 males). All subjects performed 4 core stability maneuvers under direct observation from 3 independent physicians in sequence. Inter-rater reliability and time necessary to perform examination. The Core Score scale is 0 to 12, with 12 reflecting the best core stability. The mean composite score of all 4 tests for all subjects was 9.54 (SD, 1.897; range, 4-12). The intraclass correlation coefficients (ICC 1,1) for inter-rater reliability for the composite Core Score and 4 individual tests were 0.68 (Core Score), 0.14 (single-leg squat), 0.40 (supine bridge), 0.69 (side bridge), and 0.46 (prone bridge). The time required for a single examiner to assess a given subject's core stability in all 4 maneuvers averaged 4 minutes (range, 2-6 minutes). Even without specialized equipment, a clinically practical and moderately reliable measure of core stability may be possible. Further research is necessary to optimize this measure for clinical application. Despite the known value of core stability to athletes and patients with low back pain, there is currently no reliable and practical means for rating core stability in a typical office-based practice. This pilot study provides a starting point for future reliability research on clinical core stability assessments.

  2. Intratester and Intertester Reliability of Toe Pressure Measurements in People with and Without Diabetes Performed by Podiatric Physicians.

    PubMed

    Sonter, Jennifer A; Chuter, Vivienne; Casey, Sarah

    2015-05-01

    Toe pressures and the toe brachial index (TBI) represent possible screening tools for peripheral arterial disease; however, limited evidence is available regarding their reliability. The aim of this study was to determine intratester and intertester reliability of toe systolic pressure and the TBI in participants with and without diabetes performed by podiatric physicians. Two podiatric physicians performed toe and brachial pressure measurements on 80 participants, 40 with and 40 without diabetes, during two testing sessions using photoplethysmography and Doppler probe. Intraclass correlation coefficients (ICCs) and 95% limits of agreement were determined. In people with diabetes, intratester reliability of toe pressure measurement was excellent for both testers (ICCs, 0.84 and 0.82). Reliability of the TBI was good (ICCs, 0.72 and 0.75) and brachial pressure fair (ICCs, 0.43 and 0.55). The intertester reliability of toe pressure (ICC, 0.82) and the TBI (ICC, 0.80) was excellent. Intertester reliability of brachial pressure was reduced in people with diabetes (ICC, 0.49). In age-matched participants, intratester reliability of toe pressure measurement was excellent for both testers (ICCs, 0.83 and 0.87), and reliability of the TBI (ICCs, 0.74 and 0.80) and brachial pressure (ICCs, 0.73 and 0.78) was good to excellent. Intertester reliability of toe pressure (ICC, 0.84), the TBI (ICC, 0.81), and brachial pressure (ICC, 0.77) was excellent. Toe pressures and the TBI demonstrated excellent reliability in people with and without diabetes and can be an effective component of lower-extremity vascular screening. However, wide limits of agreement relative to blood pressure values for both cohorts indicate that results should be interpreted with caution.

  3. Effects of medication reviews performed by a physician on treatment with fracture-preventing and fall-risk-increasing drugs in older adults with hip fracture-a randomized controlled study.

    PubMed

    Sjöberg, Christina; Wallerstedt, Susanna M

    2013-09-01

    To investigate whether medication reviews increase treatment with fracture-preventing drugs and decrease treatment with fall-risk-increasing drugs. Randomized controlled trial (1:1). Departments of orthopedics, geriatrics, and medicine at Sahlgrenska University Hospital, Gothenburg, Sweden. One hundred ninety-nine consecutive individuals with hip fracture aged 65 and older. Medication reviews, based on assessments of risks of falls and fractures, regarding fracture-preventing and fall-risk-increasing drugs, performed by a physician, conveyed orally and in written form to hospital physicians during the hospital stay, and to general practitioners after discharge. Primary outcomes were changes in treatment with fracture-preventing and fall-risk-increasing drugs 12 months after discharge. Secondary outcomes were falls, fractures, deaths, and physicians' attitudes toward the intervention. At admission, 26% of intervention and 29% of control participants were taking fracture-preventing drugs, and 12% and 11%, respectively, were taking bone-active drugs, predominantly bisphosphonates. After 12 months, 77% of intervention and 58% of control participants were taking fracture-preventing drugs (P = .01), and 29% and 15%, respectively, were taking bone-active drugs (P = .04). Mean number of fall-risk-increasing drugs per participants was 3.1 (intervention) and 3.1 (control) at admission and 2.9 (intervention) and 3.1 (control) at 12 months (P = .62). No significant differences in hard endpoints were found. The responding physicians (n = 65) appreciated the intervention; on a scale from 1 (very bad) to 6 (very good), the median rating was 5 (interquartile range (IQR) 4-6) for the oral part and 5 (IQR 4-5.5) for the text part. Medication reviews performed and conveyed by a physician increased treatment with fracture-preventing drugs but did not significantly decrease treatment with fall-risk-increasing drugs in older adults with hip fracture. Prescribing physicians appreciated

  4. Confronting the disruptive physician.

    PubMed

    Linney, B J

    1997-01-01

    Ignoring disruptive behavior is no longer an option in today's changing health care environment. Competition and managed care have caused more organizations to deal with the disruptive physician, rather than look the other way as many did in years past. But it's not an easy task, possibly the toughest of your management career. How should you confront a disruptive physician? By having clearly stated expectations for physician behavior and policies in place for dealing with problem physicians, organizations have a context from which to address the situation.

  5. Physician-scientist, heal thyself . . .

    PubMed

    Marks, Andrew R

    2007-01-01

    Historically, physician-scientists have had dual roles in caring for patients and in performing investigative research that could potentially lead to new diagnostics and therapeutics. Physician-scientists conducted teaching rounds in the hospital, surrounded by eager house staff and medical students, and were often avidly pursued as the most important sources of new knowledge for trainees. But alas, times have changed. Now physician-scientists are rarely seen in the hospital; they are most often spotted at their desks tapping out yet another grant application. Most struggle to find the time to mentor students and clinical trainees, let alone to care for patients in the hospital, even though these interactions are often the motivating forces for scientific creativity.

  6. The role physicians play throughout the birthing process.

    PubMed

    Peltier, J W; Cochran, C R; Schibrowsky, J A

    2001-01-01

    The second of a series, this study examines the effect of physician service performance on women's perceptions of physician quality before, during, and after delivery. We also examine changing physician-patient relationships throughout the birthing experience and compare our findings to those reported in a previous study that focused on nurse-patient relationships. Our findings show that physicians can have a profound impact on patient quality assessments and that these perceptions are prone to change as patients progress through the three birthing stages.

  7. Factors Associated with Behavior Change in Family Physicians After CME Presentation.

    ERIC Educational Resources Information Center

    Ferguson, Kristi J.; And Others

    1984-01-01

    Registrants of a four-day family practice refresher course responded to a survey assessing their reaction to a brief presentation recommending the use of penile anesthesia in newborn circumcision. The results suggest that evaluation of behavior change should consider attitudinal variables. (Author/MLW)

  8. Factors Associated with Behavior Change in Family Physicians After CME Presentation.

    ERIC Educational Resources Information Center

    Ferguson, Kristi J.; And Others

    1984-01-01

    Registrants of a four-day family practice refresher course responded to a survey assessing their reaction to a brief presentation recommending the use of penile anesthesia in newborn circumcision. The results suggest that evaluation of behavior change should consider attitudinal variables. (Author/MLW)

  9. Community pediatric hospitalists providing care in the emergency department: an analysis of physician productivity and financial performance.

    PubMed

    Dudas, Robert A; Monroe, David; McColligan Borger, Melissa

    2011-11-01

    Community hospital pediatric inpatient programs are being threatened by current financial and demographic trends. We describe a model of care and report on the financial implications associated with combining emergency department (ED) and inpatient care of pediatric patients. We determine whether this type of model could generate sufficient revenue to support physician salaries for continuous in-house coverage in community hospitals. Financial productivity and selected performance indicators were obtained from a retrospective review of registration and billing records. Data were obtained from 2 community-based pediatric hospitalist programs, which are part of a single health system and included care delivered in the ED and inpatient settings during a 1-year period from July 1, 2008, to July 1, 2009. Together, the combined programs were able to generate 6079 total relative value units and collections of $244,828 annually per full-time equivalent (FTE). Salary, benefits, and practice expenses totaled $235,674 per FTE. Thus, combined daily revenues exceeded expenses and provided 104% of physician salary, benefits, and practice expenses. However, 1 program generated a net profit of $329,715 ($40,706 per FTE), whereas the other recorded a loss of $207,969 ($39,994 per FTE). Emergency department throughput times and left-without-being-seen rates at both programs were comparable to national benchmarks. Incorporating ED care into a pediatric hospitalist program can be an effective strategy to maintain the financial viability of pediatric services at community hospitals with low inpatient volumes that seek to provide 24-hour pediatric staffing.

  10. Task shifting in Mozambique: cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care

    PubMed Central

    2010-01-01

    Background Many resource-constrained countries now train non-physician clinicians in HIV/AIDS care, a strategy known as 'task-shifting.' There is as yet no evidence-based international standard for training these cadres. In 2007, the Mozambican Ministry of Health (MOH) conducted a nationwide evaluation of the quality of care delivered by non-physician clinicians (técnicos de medicina, or TMs), after a two-week in-service training course emphasizing antiretroviral therapy (ART). Methods Forty-four randomly selected TMs were directly observed by expert clinicians as they cared for HIV-infected patients in their usual worksites. Observed clinical performance was compared to national norms as taught in the course. Results In 127 directly observed patient encounters, TMs assigned the correct WHO clinical stage in 37.6%, and correctly managed co-trimoxazole prophylaxis in 71.6% and ART in 75.5% (adjusted estimates). Correct management of all 5 main aspects of patient care (staging, co-trimoxazole, ART, opportunistic infections, and adverse drug reactions) was observed in 10.6% of encounters. The observed clinical errors were heterogeneous. Common errors included assignment of clinical stage before completing the relevant patient evaluation, and initiation or continuation of co-trimoxazole or ART without indications or when contraindicated. Conclusions In Mozambique, the in-service ART training was suspended. MOH subsequently revised the TMs' scope of work in HIV/AIDS care, defined new clinical guidelines, and initiated a nationwide re-training and clinical mentoring program for these health professionals. Further research is required to define clinically effective methods of health-worker training to support HIV/AIDS care in Mozambique and similarly resource-constrained environments. PMID:20939909

  11. General physicians graduated from a PBL undergraduate medical curriculum: how well do they perform as PBL tutors?

    PubMed

    Kim, Kyong-Jee; Lee, Joo Heung; Kee, Changwon

    2009-06-01

    A study was conducted on the effectiveness of general physicians recently graduated from a medical school with Problem-Based Learning (PBL) curriculum as PBL tutors to expand the school's tutor pool. This study aims to investigate these non-staff tutors' effectiveness in terms of student satisfaction and learning outcomes. An experimental study was conducted of 12 PBL groups of second-year medical students (n = 40). Four PBL groups were led by non-staff tutors; the other eight groups were led by staff tutors during the two PBL units. Tutor evaluation and student satisfaction questionnaires were administered and student performance scores were analysed to compare between groups led by staff tutors and non-staff tutors. The students' overall satisfaction with the non-staff tutors on a five-point Likert-scale was high (M = 4.5 +/-.638). Additionally, the student scores on written tests were comparable between groups. Yet, in one unit, the groups led by staff tutors received significantly higher scores on the group evaluation than those led by non-staff tutors. The results of this study show that the non-staff tutors performed as effectively as the staff tutors did with regard to student achievement in written exams. Still, the findings of this study suggest that different tutor backgrounds and experiences might affect student performance beyond the written exam scores.

  12. Consideration of environmental change in performance assessments.

    PubMed

    Pinedo, P; Thorne, M; Egan, M; Calvez, M; Kautsky, U

    2005-01-01

    Depending on the particular circumstances in which a post-closure performance assessment of a radioactive waste repository is made, it may be appropriate to follow simple or more complex approaches in characterising the biosphere. Several different Example Reference Biospheres were explored in BIOMASS Theme 1 to address a range of issues that arise. Here, consideration is given to Example Reference Biospheres relevant to representing the implications of changes that may occur within the biosphere system during the period over which releases of radionuclides from a disposal facility might take place. Mechanisms of change considered include those extrinsic and intrinsic to the system of interest. An overall methodology for incorporating environmental change into assessments is proposed. This includes screening of primary mechanisms of change; identification of possible time sequences of change; development of a coherent description of the regional landscape response for each time sequence; integration of source term and geosphere-biosphere interface information; identification and description of one or more time series of assessment biospheres; and evaluation of the advantages and disadvantages of simulating the effects of sequences of biosphere systems and the transitions between them, or of defining a set of biosphere systems to be represented individually in a non-sequential analysis. The usefulness of the methodology is explored in two site-specific examples and one generic example.

  13. The true impact of the French pay-for-performance program on physicians' benzodiazepines prescription behavior.

    PubMed

    Michel-Lepage, Audrey; Ventelou, Bruno

    2016-07-01

    The French pay-for-performance (P4P) contract CAPI implemented by the national health insurance included a target-goal which aims at reducing benzodiazepines prescriptions. In this investigation, we would like to assess whether: (1) the general practitioners (GPs) having signed P4P contract obtain better results regarding the target-goal than non-signatories; (2) (part of) this progression is due to the CAPI contract itself (tentative measurement of a "causal effect"); (3) (part of) the money spent on this P4P incentive can be self-financed with the amount of pharmaceuticals saved. We matched cross-sectional and longitudinal data including 4622 French GPs from June 2011 to December 2012. A treatment effect model using instrumental variables was performed to take into account potential self-selection issue in signing. After having identified the NET impact of the P4P, we calculate the cost of an avoided benzodiazepines treatment. In our study, GPs who have signed the CAPI contract (36 % of the sample) are more numerous in achieving benzodiazepines target goal than non-signatories: 90.7 vs. 85.5 %. After controlling for the self-selection bias, the propensity of GPs to achieve the benzodiazepines target is only 0.31 % higher for signatories than for their non-signing counterparts-estimate for June 2012, which yields a statistically significant gap. Our economic analysis demonstrates that the CAPI contract does not allow savings, but presents in 2012 a NET cost of 93.6€ per avoided benzodiazepines treatment (291€ in 2011). The P4P contract has a positive but modest impact on the achievement of GPs regarding benzodiazepines indicator.

  14. Prevalence and impact of body physical changes in HIV patients treated with highly active antiretroviral therapy: results from a study on patient and physician perceptions.

    PubMed

    Cabrero, Esther; Griffa, Laura; Burgos, Angel

    2010-01-01

    Patients infected with HIV treated with highly active antiretroviral therapy (HAART) frequently develop body physical changes (BPC) that have an important psychosocial burden. The purpose of this study was to determine the prevalence of BPC observed by HIV-infected patients and their attending physicians and to assess the impact BPC had on daily life. In this epidemiologic multicenter study, patients with HIV infection and their treating physicians filled out parallel questionnaires about their perceptions of specific BPC and their impact on daily activities. A total of 965 patient-physician questionnaires were collected across 98 health centers. Patient's mean age was 43.7 +/- 8.5 years and 72.6% were men. Adjusted prevalence of perceived BPC by patients and physicians was 55.1% (95% confidence interval [CI]: 52.0-58.1) and 55.2% (95% CI: 52.1-58.2), respectively (p = 1.000). Overall patient-physician agreement concerning perception of BPC was 83% (p < 0.0005). The most common BPC was lipoatrophy, described by 46.8% (95% CI: 43.7-49.8) of patients and 49.4% (95% CI: 46.3-52.5) of physicians (p = 0.033) followed by lipohypertrophy. No gender differences were observed in the global prevalence of BPC (p = 0.649). However, significantly more women reported lipoatrophy of the lower limbs (p = 0.009) and buttocks (p = 0.007), as well as lipohypertrophy (p = 0.007), than men; 58.2% (95% CI: 54.0-62.4) patients noted that BPC negatively affected their daily activities. This study reflects the high prevalence of patient and physician-perceived BPC in the HIV population, and the adverse impact on daily life. Physicians should be aware of the psychosocial consequences of BPC in HIV patients in order to improve patient well-being.

  15. Changes in Physician Practice Patterns after Implementation of a Communication-and-Resolution Program.

    PubMed

    Helmchen, Lorens A; Lambert, Bruce L; McDonald, Timothy B

    2016-12-01

    To test if a 2006 communication-and-resolution program to address unexpected adverse outcomes was associated with changes in cost and use trajectories. Records of patients discharged with a principal diagnosis of chest pain from 44 nonfederal general hospitals in Cook County, Illinois, between January 2002 and December 2009. Propensity-score matched discharges from the intervention and comparison hospitals before computing difference-in-differences estimates of quarterly growth rates. We used discharge records submitted to a central statewide repository. Relative to the comparison hospitals and to pre-implementation trends, and consistent with reduced testing at presentation, the intervention hospital recorded an increase in the number of patients with a principal diagnosis of chest pain. Among admitted patients, quarterly growth rates of clinical laboratory and radiology charges at the intervention hospital declined by 3.8 and 6.9 percentage points. Among patients with chest pain, the implementation of a comprehensive communication-and-resolution program was associated with substantially reduced growth rates in the use of diagnostic testing and imaging services. Further research is needed to establish to what extent these changes were attributable to the program and clinically appropriate. © Health Research and Educational Trust.

  16. Ecological Change and the Future of the Human Species: Can Physicians Make a Difference?

    PubMed Central

    Rosenblatt, Roger A.

    2005-01-01

    Global environmental change is occurring so rapidly that it is affecting the health and threatening the future of many of Earth’s inhabitants, including human beings. Global warming; contamination of the air, water, and soil; and rampant deforestation have led to a collapse in biodiversity that threatens the integrity of the biophysical systems upon which all organisms depend. A basic cause of environmental degradation is human overpopulation and the nonsustainable consumption of natural resources by the human community. Everything that we have accomplished in the fields of medicine and public health could be undermined if we do not pay attention to these rapid environmental changes. As healers, human beings, and members of the biological community, we need to broaden our perspective on health and disease. Unless we devote our attention to stabilizing and repairing the ecosystem, our professional and personal accomplishments as health professionals may be swept away. Health care providers—particularly physicians—can play a role by adopting an ecosystem health perspective as we ply our trade. By helping people avoid unwanted pregnancies, by using resources parsimoniously, and by staying engaged in the natural world, we can help to prevent the collapse of the biological systems upon which we all depend. PMID:15798046

  17. The physician quality reporting initiative--a gateway to pay for performance: what every health care professional should know.

    PubMed

    Stulberg, Jonah

    2008-01-01

    The Physician Quality Reporting Initiative (PQRI) is a pay-for-reporting (P4R) program sponsored by the Centers for Medicare & Medicaid Services open to all health care providers that treat Medicare patients. This P4R initiative provides financial incentives for participation and unlike most pay-for-performance (P4P) programs, there are no penalties for poor performance. PQRI therefore offers Medicare providers nationwide a low-risk opportunity to gain experience with reporting procedures likely to be incorporated into P4P reimbursement schemes. The 74 measures used during the first reporting period are applicable to both generalist and specialist providers and open participation in PQRI to a much broader audience compared with previous federal initiatives. Also in contrast to programs that measure hospital or group quality and reimburse for services at the health system level, measurement and reimbursement in PQRI directly affects individual Medicare providers. The combination of provider-level measurement and reimbursement and efforts to assess care delivered by both generalist and specialist Medicare providers highlights how this P4R initiative is truly a gateway to a P4P reimbursement system. Participation in the PQRI program provides useful experience to Medicare providers and their staff in preparing for future initiatives that try to tie quality to reimbursement.

  18. Jet lag and travel fatigue: a comprehensive management plan for sport medicine physicians and high-performance support teams.

    PubMed

    Samuels, Charles H

    2012-05-01

    The impact of transcontinental travel and high-volume travel on athletes can result in physiologic disturbances and a complicated set of physical symptoms. Jet lag and travel fatigue have been identified by athletes, athletic trainers, coaches, and physicians as important but challenging problems that could benefit from practical solutions. Currently, there is a culture of disregard and lack of knowledge regarding the negative effects of jet lag and travel fatigue on the athlete's well-being and performance. In addition, the key physiologic metric (determination of the human circadian phase) that guides jet lag treatment interventions is elusive and thus limits evidence-based therapeutic advice. A better understanding of preflight, in-flight, and postflight management options, such as use of melatonin or the judicious application of sedatives, is important for the sports clinician to help athletes limit fatigue symptoms and maintain optimal performance. The purpose of this article was to provide a practical applied method of implementing a travel management program for athletic teams.

  19. Nodule performance within a changing environmental context.

    PubMed

    Aranjuelo, Iker; Arrese-Igor, Cesar; Molero, Gemma

    2014-07-15

    Global climate models predict that future environmental conditions will see alterations in temperature, water availability and CO2 concentration ([CO2]) in the atmosphere. Climate change will reinforce the need to develop highly productive crops. For this purpose it is essential to identify target traits conditioning plant performance in changing environments. N2 fixing plants represent the second major crop of agricultural importance worldwide. The current review provides a compilation of results from existing literature on the effects of several abiotic stress conditions on nodule performance and N2 fixation. The environmental factors analysed include water stress, salinity, temperature, and elevated [CO2]. Despite the large number of studies analysing [CO2] effects in plants, frequently they have been conducted under optimal growth conditions that are difficult to find in natural conditions where different stresses often occur simultaneously. This is why we have also included a section describing the current state of knowledge of interacting environmental conditions in nodule functioning. Regardless of the environmental factor considered, it is evident that some general patterns of nodule response are observed. Nodule carbohydrate and N compound availability, together with the presence of oxygen reactive species (ROS) have proven to be the key factors modulating N2 fixation at the physiological/biochemical levels. However, with the exception of water availability and [CO2], it should also be considered that nodule performance has not been characterised in detail under other limiting growth conditions. This highlights the necessity to conduct further studies considering these factors. Finally, we also observe that a better understanding of these metabolic effects of changing environment in nodule functioning would require an integrated and synergistic investigation based on widely used and novel protocols such as transcriptomics, proteomics, metabolomics and

  20. What makes a physician revenue cycle tick.

    PubMed

    Freeman, Thomas; Stephen, Stan

    2011-09-01

    Hospitals should boost the revenue cycle performance of acquired physician practices by: Effectively assimilating the physician practice into the overall organization. Standardizing revenue cycle processes, policies, and tools between the hospital and physician practice. Enhancing physician/patient scheduling policies and procedures. Regularly auditing physician documentation and periodically comparing hospital charges against practice charges. Improving procedures for responding to denials.

  1. Knowledge and attitude change in physician assistant students after an interprofessional geriatric care experience: a mixed methods study.

    PubMed

    Segal-Gidan, Freddi; Walsh, Anne; Lie, Désirée; Fung, Cha Chi; Lohenry, Kevin

    2014-01-01

    To examine changes in physician assistant (PA) student attitudes and knowledge about interprofessional education (IPE) after participation in a longitudinal community-based curriculum. Second-year PA students participated in an interprofessional geriatrics curriculum. Faculty-facilitated IPE teams met three times and assessed one adult patient longitudinally over 8 months. Attitudes of student participants and their nonparticipating peers (comparison group) were assessed pre- and postcurriculum using the validated Readiness for Interprofessional Learning Scale (RIPLS). Reflections submitted by participants after each session were analyzed thematically. No significant differences in RIPLS scores were found compared with baseline for either group; participating students had significantly higher baseline scores compared with nonparticipating students. Qualitative analysis of participant reflections revealed two major themes: "roles and scope of practice of other health professions"; and "applicability of team-based care to practice" with a temporal change in theme pattern over one year. Volunteer student participants had a more positive attitude toward interprofessional learning than nonparticipants. Primary learning occurred about roles of other professions and the value of team-based care. The mixed evaluation methodology allowed examination of attitudes, knowledge, and underlying ("informal" or "hidden") learning.

  2. Physician Information Seeking Behaviors: Are Physicians Successful Searchers?

    ERIC Educational Resources Information Center

    Swiatek-Kelley, Janice

    2010-01-01

    In the recent past, physicians found answers to questions by consulting colleagues, textbooks, and professional journals. Now, the availability of medical information through electronic resources has changed physician information-seeking behaviors. Evidence-based medicine is now the accepted decision-making paradigm, and a physician's ability to…

  3. Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan.

    PubMed

    Hsu, Min-Huei; Yeh, Yu-Ting; Chen, Chien-Yuan; Liu, Chien-Hsiang; Liu, Chien-Tsai

    2011-03-01

    Doctor shopping (or hospital shopping), which means changing doctors (or hospitals) without professional referral for the same or similar illness conditions, is common in Hong Kong, Taiwan and Japan. Due to the lack of infrastructure for sharing health information and medication history among hospitals, doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions. The Bureau of National Health Insurance (BNHI) adopted smart cards (or NHI-IC cards) as health cards in Taiwan. With their NHI-IC cards, patients can freely access different medical institutions. Because an NHI-IC card carries information about a patient's prescribed medications received from different hospitals nationwide, we used this system to address the problem of duplicate medications for outpatients visiting multiple hospitals. A computerized physician order entry (CPOE) system was enhanced with the capability of accessing NHI-IC cards and providing alerts to physicians when the system detects potential duplicate medications at the time of prescribing. Physician responses to the alerts were also collected to analyze changes in physicians' behavior. Chi-square tests and two-sided z-tests with Bonferroni adjustments for multiple comparisons were used to assess statistical significance of differences in actions taken by physicians over the three months. The enhanced CPOE system for outpatient services was implemented and installed at the Pediatric and Urology Departments of Taipei Medical University Wan-Fang Hospital in March 2007. The "Change Log" that recorded physician behavior was activated during a 3-month study period from April to June 2007. In 67.93% of patient visits, the physicians read patient NHI-IC cards, and in 16.76% of the reads, the NHI-IC card contained at least one prescribed medication that was taken by the patient. Among the prescriptions issued by physicians, on average, there were 2.36% prescriptions containing at least one

  4. Variation of availability and frequency of emergency physician-performed ultrasonography between adult and pediatric patients in the academic emergency department in Korea

    PubMed Central

    Ahn, Chiwon; Kim, Changsun; Kang, Bo Seung; Choi, Hyuk Joong; Cho, Jun Hwi

    2015-01-01

    Objective This study investigates the availability and frequency of emergency physician-performed ultrasonography (USG) in the emergency department (ED) and the status of USG training programs in emergency medicine residencies in academic EDs in Korea. Methods In spring 2014, a link to a 16-question, multiple-choice, and rating scale web-based survey was e-mailed to all 97 academic ED residency training directors in Korea. Results The response rate was 83.5% (81/97). All respondents had their own USG machines in the ED. In total, 82.7% of respondents reported that emergency physician-performed adult USGs were usually conducted daily, whereas only 23.6% performed pediatric USGs daily. Moreover, 55.5% performed pediatric USG fewer than once a week. 74.1% of respondents had education programs for adult USG in residency training, but only 21.0% had programs for pediatric USG. There was a high association between the presence of education programs and the use of USG in both groups. The faculty members who most commonly participated in teaching ED residents how to perform USG were emergency physicians (67.9%). Only 17.3% of respondents reported that they always supported a quality assurance process. The training directors generally agreed with the advantages in emergency physician-performed USGs. Conclusion The availability of ultrasound machines was high both for adult and pediatric EDs. Nevertheless, the frequency of Emergency physician-performed USG for pediatric patients was low, which was related to the lack of the training programs for treating pediatric patients. PMID:27752568

  5. Variation of availability and frequency of emergency physician-performed ultrasonography between adult and pediatric patients in the academic emergency department in Korea.

    PubMed

    Ahn, Chiwon; Kim, Changsun; Kang, Bo Seung; Choi, Hyuk Joong; Cho, Jun Hwi

    2015-03-01

    This study investigates the availability and frequency of emergency physician-performed ultrasonography (USG) in the emergency department (ED) and the status of USG training programs in emergency medicine residencies in academic EDs in Korea. In spring 2014, a link to a 16-question, multiple-choice, and rating scale web-based survey was e-mailed to all 97 academic ED residency training directors in Korea. The response rate was 83.5% (81/97). All respondents had their own USG machines in the ED. In total, 82.7% of respondents reported that emergency physician-performed adult USGs were usually conducted daily, whereas only 23.6% performed pediatric USGs daily. Moreover, 55.5% performed pediatric USG fewer than once a week. 74.1% of respondents had education programs for adult USG in residency training, but only 21.0% had programs for pediatric USG. There was a high association between the presence of education programs and the use of USG in both groups. The faculty members who most commonly participated in teaching ED residents how to perform USG were emergency physicians (67.9%). Only 17.3% of respondents reported that they always supported a quality assurance process. The training directors generally agreed with the advantages in emergency physician-performed USGs. The availability of ultrasound machines was high both for adult and pediatric EDs. Nevertheless, the frequency of Emergency physician-performed USG for pediatric patients was low, which was related to the lack of the training programs for treating pediatric patients.

  6. Diagnosis and disposition are changed when board-certified emergency physicians use CT for non-traumatic abdominal pain.

    PubMed

    Barksdale, Aaron Nathan; Hackman, Jeff Lee; Gaddis, Monica; Gratton, Matt Christopher

    2015-11-01

    To determine the effect of abdominal computed tomographic (CT) scan results on diagnosis and disposition of patients with non-traumatic abdominal pain who were evaluated by board-certified emergency physicians (EPs). Prospective, observational study conducted at a safety-net facility with an emergency medicine residency and 65000 annual adult visits. Patients with non-traumatic abdominal pain who underwent an abdominal CT from 3/2011 through 8/2011 were included. Decision to obtain CT was made by the EP. The computer order entry system required the EP to report the most likely diagnosis, and the management and disposition plan. After CT results, the same EP electronically again entered the most likely diagnosis and the planned management and disposition. CTs were interpreted by an attending radiologist. Descriptive statistics and χ(2) tests were used. Six hundred twenty-nine patients were entered and 547 remained after exclusions; 298 (54%) subjects had a change in diagnosis. In 6 categories, there was a statistically significant change, with non-specific abdominal pain the most common(P < .001); followed by renal colic (P < .001), appendicitis (P < .001), diverticulitis (P < .001), small bowel obstruction (P < .029), and gynecologic process (P < .001). The most common disposition plan was "admit for observation," which was reported in 262 patients and remained in only 122 post CT (47%); 301 (54%) patients whose initial plan was admission were ultimately managed otherwise. Abdominal CT use by board certified EPs for nontraumatic abdominal pain changed diagnosis and disposition, with more sent home in lieu of admission. Diagnostic accuracy did not appear to be related to years of clinical experience. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Psychosocial challenges facing physicians of today.

    PubMed

    Arnetz, B B

    2001-01-01

    leadership and the physician team impact on the overall work atmosphere. Physicians unaware of the goals of the department as well as the hospital, that do not receive management performance feedback, and who do not get annual performance appraisals and career guidance, rate their psychosocial environment as more adverse than their colleagues. There is also a great need to offer personally targeted competence development plans. Heads of department and senior physicians rate their work environment as of higher quality than more junior and mid-career physicians. More specifically, less senior physicians perceive similar work demands as their senior colleagues but rate influence over work, skills utilization, and intellectual stimulation at work as significantly worse. In order to combat negative stressors in the physicians' work environment, enhancement initiatives should be considered both at the individual, group, and structural level. Successful resources used by physicians to manage the stress of everyday medicine should be identified. Physicians are a key group to ensure a well-functioning health care system. In order to be able to change and adapt to the ongoing evolution of the Western health care system, more focus needs to be put on the psychosocial aspects of physicians' work.

  8. GPs' views on changing the law on physician-assisted suicide and euthanasia, and willingness to prescribe or inject lethal drugs: a survey from Wales.

    PubMed

    Pasterfield, Diana; Wilkinson, Clare; Finlay, Ilora G; Neal, Richard D; Hulbert, Nicholas J

    2006-06-01

    If physician-assisted suicide/euthanasia is legalised in the UK, this may be the work of GPs. In the absence of recent or comprehensive evidence about GPs' views on either legalisation or willingness to take part, a questionnaire survey of all Welsh GPs was conducted of whom 1202 (65%) responded. Seven hundred and fifty (62.4% of responders) and 671 (55.8% of responders) said that they did not favour a change in the law to allow physician-assisted suicide/voluntary euthanasia respectively. These data provide a rational basis for determining the position of primary care on this contentious issue.

  9. GPs' views on changing the law on physician-assisted suicide and euthanasia, and willingness to prescribe or inject lethal drugs: a survey from Wales

    PubMed Central

    Pasterfield, Diana; Wilkinson, Clare; Finlay, Ilora G; Neal, Richard D; Hulbert, Nicholas J

    2006-01-01

    If physician-assisted suicide/euthanasia is legalised in the UK, this may be the work of GPs. In the absence of recent or comprehensive evidence about GPs' views on either legalisation or willingness to take part, a questionnaire survey of all Welsh GPs was conducted of whom 1202 (65%) responded. Seven hundred and fifty (62.4% of responders) and 671 (55.8% of responders) said that they did not favour a change in the law to allow physician-assisted suicide/voluntary euthanasia respectively. These data provide a rational basis for determining the position of primary care on this contentious issue. PMID:16762127

  10. Applying principles from "Scientific Foundations for Future Physicians" to teaching chemistry in the department of medicine at Chang Gung University.

    PubMed

    Lou, Bih-Show

    2012-02-01

    Similar to the current trends in America that were recognized by the Association of American Medical College and the Howard Hughes Medical Institute in their 2009 report titled "Scientific Foundations for Future Physicians," Taiwanese medical students are lacking in their ability to apply their knowledge of basic sciences to real-life situations. The report recommended developing a competency-based approach to learning and also called for an increase in integrated and interdisciplinary courses in the education of medical students. Such a class, which would encourage students to look at biological concepts through chemical and physical principles, has been developed at Chang Gung University, and it strives to develop the medical student's ability to work in groups, think critically, and clearly and convincingly present ideas. The course requires students to present biological topics in groups after working closely with a teacher, and it trains the students to identify useful and trustworthy sources, to constructively criticize each other, and work together to present a cohesive and informative presentation for their peers. From my teaching experience, classes such as this have led me to conclude that the teacher's role does not simply encompass that of the informant, but also the facilitator of the academic success of the students, and this has led me to create certain class policies for teachers that help students of any field success in class. Copyright © 2011. Published by Elsevier B.V.

  11. Determinants of Cervical Cancer Screening Accuracy for Visual Inspection with Acetic Acid (VIA) and Lugol's Iodine (VILI) Performed by Nurse and Physician.

    PubMed

    Raifu, Amidu O; El-Zein, Mariam; Sangwa-Lugoma, Ghislain; Ramanakumar, Agnihotram; Walter, Stephen D; Franco, Eduardo L

    2017-01-01

    Visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) are used to screen women for cervical cancer in low-resource settings. Little is known about correlates of their diagnostic accuracy by healthcare provider. We examined determinants of VIA and VILI screening accuracy by examiner in a cross-sectional screening study of 1528 women aged 30 years or older in a suburb of Kinshasa, Democratic Republic of Congo. We used a logistic regression model for sensitivity and specificity to estimate the diagnostic accuracy of VIA and VILI, independently performed by nurse and physician, as a function of sociodemographic and reproductive health characteristics. Nurses rated tests as positive more often than physicians (36.3% vs 30.2% for VIA, 26.2% vs 25.2% for VILI). Women's age was the most important determinant of performance. It was inversely associated with sensitivity (nurse's VIA: p<0.001, nurse's VILI: p = 0.018, physician's VIA: p = 0.005, physician's VILI: p = 0.006) but positively associated with specificity (all four combinations: p<0.001). Increasing parity adversely affected sensitivity and specificity, but the effects on sensitivity were significant for nurses only. The screening performance of physician's assessment was significantly better than the nurse's (difference in sensitivity: VIA = 13%, VILI = 16%; difference in specificity: VIA = 6%, VILI = 1%). Age and parity influence the performance of visual tests for cervical cancer screening. Proper training of local healthcare providers in the conduct of these tests should take into account these factors for improved performance of VIA and VILI in detecting cervical precancerous lesions among women in limited-resource settings.

  12. Downsizing the physician workforce.

    PubMed Central

    McClendon, B J; Politzer, R M; Christian, E; Fernandez, E S

    1997-01-01

    OBJECTIVE: To estimate the need for downsizing the physician workforce in a changing health care environment. METHODS: First assuming that 1993 physician-to-population ratios would be maintained, the authors derived downsizing estimates by determining the annual growth in the supply of specialists necessary to maintain these ratios (sum of losses from death and retirement plus increase necessary to parallel population growth) and compared them with an estimate of the number of new physicians being produced (average annual number of board certificates issued between 1990 and 1994). Then, assuming that workforce needs would change in a system increasingly dominated by managed care, the authors estimated specialty-specific downsizing needs for a managed care dominated environment using data from several sources. RESULTS: To maintain the 1993 199.6 active physicians per 100,000 population ratio, 14,644 new physicians would be needed each year. Given that an average of 20,655 physicians were certified each year between 1990 and 1994, at least 6011 fewer new physicians were needed annually to maintain 1993 levels. To maintain the 132.2 ratio of active non-primary care physicians per 100,000 population, the system needed to produce 9698 non-primary care physicians per year, because an average of 14,527 new non-primary care physicians entered the workforce between 1990 and 1994, downsizing by 4829, or 33%, was needed. To maintain the 66.8 active primary care physicians per 100,000 population ratio, 4946 new primary care physicians were needed per year, since primary care averaged 6128 new certifications per year, a downsizing of 1182, or 20% was indicated. Only family practice, neurosurgery, otolaryngology, and urology did not require downsizing. Seventeen medical and hospital-based specialties, including 7 of 10 internal medicine subspecialties, needed downsizing by at least 40%. Less downsizing in general was needed in the surgical specialties and in psychiatry. A

  13. A tale of loss of privilege, resilience and change: the impact of the economic crisis on physicians and medical services in Portugal.

    PubMed

    Russo, Giuliano; Rego, Inês; Perelman, Julian; Barros, Pedro Pita

    2016-09-01

    That the current economic crisis is having an impact on population health and healthcare utilisation across Europe is fairly established; how national health systems and markets are reacting is however still poorly understood. Drawing from the economic literature we conducted 21 interviews with physicians, policy-makers and healthcare managers in Portugal, to explore their perceptions on the impact of the crisis on the country's market medical services, on physicians' motivation, and the ensuing coping strategies. Interviews were recorded, transcribed and analysed using NVivo software. We show that despite the crisis, few physicians reported considering leaving the public sector and the country, and very diverse coping strategies are emerging, depending on the respective employment institutions and seniority. In spite of the changes in patient case-mix, demand for medical services may not have necessarily increased, having shifted from public to private, with many highlighting the contribution of the current crisis in consolidating the private sector. In order to maintain their pre-crisis living standards amidst deteriorating salaries and increasing controls, hospital physicians have resorted to strategies such as shifting hours to the private, and primary care ones to anticipating their retirement. Migration was reported to be an option only for the younger and older doctors. Our study suggests the existence of resilience among Portuguese physicians and in the country's market for medical services, which, if corroborated by further research, will need to be taken into account by national health policies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. The role of audience characteristics and external factors in continuing medical education and physician change: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

    PubMed

    Lowe, Mary Martin; Bennett, Nancy; Aparicio, Alejandro

    2009-03-01

    The Agency for Healthcare Research and Quality (AHRQ) Evidence Report identified and assessed audience characteristics (internal factors) and external factors that influence the effectiveness of continuing medical education (CME) in changing physician behavior. Thirteen studies examined a series of CME audience characteristics (internal factors), and six studies looked at external factors to reinforce the effects of CME in changing behavior. With regard to CME audience characteristics, the 13 studies examined age, gender, practice setting, years in practice, specialty, foreign vs US medical graduate, country of practice, personal motivation, nonmonetary rewards and motivations, learning satisfaction, and knowledge enhancement. With regard to the external characteristics, the six studies looked at the role of regulation, state licensing boards, professional boards, hospital credentialing, external audits, monetary and financial rewards, academic advancement, provision of tools, public demand and expectations, and CME credit. No consistent findings were identified. The AHRQ Evidence Report provides no conclusions about the ways that internal or external factors influence CME effectiveness in changing physician behavior. However, given what is known about how individuals approach learning, it is likely that internal factors play an important role in the design of effective CME. Regulatory and professional organizations are providing new structures, mandates, and recommendations for CME activities that influence the way CME providers design and present activities, supporting a role that is not yet clear for external factors. More research is needed to understand the impact of these factors in enhancing the effectiveness of CME.

  15. Mortality in U.S. Physicians Likely to Perform Fluoroscopy-guided Interventional Procedures Compared with Psychiatrists, 1979 to 2008.

    PubMed

    Linet, Martha S; Kitahara, Cari M; Ntowe, Estelle; Kleinerman, Ruth A; Gilbert, Ethel S; Naito, Neal; Lipner, Rebecca S; Miller, Donald L; Berrington de Gonzalez, Amy

    2017-02-23

    Purpose To compare total and cause-specific mortality rates between physicians likely to have performed fluoroscopy-guided interventional (FGI) procedures (referred to as FGI MDs) and psychiatrists to determine if any differences are consistent with known radiation risks. Materials and Methods Mortality risks were compared in nationwide cohorts of 45 634 FGI MDs and 64 401 psychiatrists. Cause of death was ascertained from the National Death Index. Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for FGI MDs versus psychiatrists, with adjustment (via stratification) for year of birth and attained age. Results During follow-up (1979-2008), 3506 FGI MDs (86 women) and 7814 psychiatrists (507 women) died. Compared with psychiatrists, FGI MDs had lower total (men: RR, 0.80 [95% CI: 0.77, 0.83]; women: RR, 0.80 [95% CI: 0.63, 1.00]) and cancer (men: RR, 0.92 [95% CI: 0.85, 0.99]; women: RR, 0.83 [95% CI: 0.58, 1.18]) mortality. Mortality because of specific types of cancer, total and specific types of circulatory diseases, and other causes were not elevated in FGI MDs compared with psychiatrists. On the basis of small numbers, leukemia mortality was elevated among male FGI MDs who graduated from medical school before 1940 (RR, 3.86; 95% CI: 1.21, 12.3). Conclusion Overall, total deaths and deaths from specific causes were not elevated in FGI MDs compared with psychiatrists. These findings require confirmation in large cohort studies with individual doses, detailed work histories, and extended follow-up of the subjects to substantially older median age at exit. (©) RSNA, 2017 Online supplemental material is available for this article.

  16. Physician wellness: a missing quality indicator.

    PubMed

    Wallace, Jean E; Lemaire, Jane B; Ghali, William A

    2009-11-14

    When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

  17. Performance of e-ASPECTS software in comparison to that of stroke physicians on assessing CT scans of acute ischemic stroke patients.

    PubMed

    Herweh, Christian; Ringleb, Peter A; Rauch, Geraldine; Gerry, Steven; Behrens, Lars; Möhlenbruch, Markus; Gottorf, Rebecca; Richter, Daniel; Schieber, Simon; Nagel, Simon

    2016-06-01

    The Alberta Stroke Program Early CT score (ASPECTS) is an established 10-point quantitative topographic computed tomography scan score to assess early ischemic changes. We compared the performance of the e-ASPECTS software with those of stroke physicians at different professional levels. The baseline computed tomography scans of acute stroke patients, in whom computed tomography and diffusion-weighted imaging scans were obtained less than two hours apart, were retrospectively scored by e-ASPECTS as well as by three stroke experts and three neurology trainees blinded to any clinical information. The ground truth was defined as the ASPECTS on diffusion-weighted imaging scored by another two non-blinded independent experts on consensus basis. Sensitivity and specificity in an ASPECTS region-based and an ASPECTS score-based analysis as well as receiver-operating characteristic curves, Bland-Altman plots with mean score error, and Matthews correlation coefficients were calculated. Comparisons were made between the human scorers and e-ASPECTS with diffusion-weighted imaging being the ground truth. Two methods for clustered data were used to estimate sensitivity and specificity in the region-based analysis. In total, 34 patients were included and 680 (34 × 20) ASPECTS regions were scored. Mean time from onset to computed tomography was 172 ± 135 min and mean time difference between computed tomographyand magnetic resonance imaging was 41 ± 31 min. The region-based sensitivity (46.46% [CI: 30.8;62.1]) of e-ASPECTS was better than three trainees and one expert (p ≤ 0.01) and not statistically different from another two experts. Specificity (94.15% [CI: 91.7;96.6]) was lower than one expert and one trainee (p < 0.01) and not statistically different to the other four physicians. e-ASPECTS had the best Matthews correlation coefficient of 0.44 (experts: 0.38 ± 0.08 and trainees: 0.19 ± 0.05) and the lowest mean score error of 0.56 (experts

  18. Evidence to action: a tailored multifaceted approach to changing family physician practice patterns and improving preventive care.

    PubMed

    Lemelin, J; Hogg, W; Baskerville, N

    2001-03-20

    Although there is much room for improvement in the performance of recommended preventive manoeuvres, many inappropriate preventive interventions are being done. We evaluated a multifaceted intervention, delivered by nurses trained in prevention facilitation, to improve prevention in primary care. Forty-six health service organizations (HSOs) were recruited from 100 sites in Ontario. After baseline data were collected, we randomly assigned the practices to either an 18-month (July 1997 to December 1998) multifaceted intervention delivered by 1 of 3 nurse facilitators (23 practices) or no intervention (23 practices). The unit of intervention and analysis was the medical practice. The outcome measure was an overall index of preventive performance, which was calculated as the proportion of eligible patients who received 8 recommended preventive manoeuvres less the proportion of eligible patients who received 5 inappropriate preventive manoeuvres. One HSO, in the intervention group, was lost to follow-up. Before the intervention, the index of preventive performance was similar for the intervention and control groups (31.9% [95% confidence interval (CI) 27.3%-36.5%] and 32.1% [95% CI 27.2%-37.0%] respectively). At follow-up the corresponding values were 43.2% (95% CI 38.4%-48.0%) and 31.9% (95% CI 26.8%-37.0%), for an absolute improvement in the intervention group of 11.5% (p < 0.001). The mean proportion of eligible patients who received the recommended manoeuvres was 62.3% (95% CI 58.2%-66.4%) in the intervention group, as compared with 57.4% (95% CI 54.1%-60.7%) in the control group, for an absolute improvement of 7.2% (p = 0.008). The corresponding values for the inappropriate manoeuvres were 19.1% (95% CI 15.6%-22.6%) and 25.5% (95% CI 20.0%-31.0%), for an absolute improvement of 4.4% (p = 0.019). The tailored multifaceted intervention delivered by nurse facilitators was effective in modifying physician practice patterns and significantly improved preventive care

  19. Delivery of Operative Pediatric Surgical Care by Physicians and Non-Physician Clinicians in Malawi

    PubMed Central

    Tyson, Anna F; Msiska, Nelson; Kiser, Michelle; Samuel, Jonathan C; Mclean, Sean; Varela, Carlos; Charles, Anthony G

    2014-01-01

    Background Specialized pediatric surgeons are unavailable in much of sub-Saharan Africa. Delegating some surgical tasks to non-physician clinical officers can mitigate the dependence of a health system on highly skilled clinicians for specific services. Methods We performed a case-control study examining pediatric surgical cases over a 12 month period. Operating surgeon was categorized as physician or clinical officer. Operative acuity, surgical subspecialty, and outcome were then compared between the two groups, using physicians as the control. Results A total of 1186 operations were performed on 1004 pediatric patients. Mean age was 6 years (±5) and 64% of patients were male. Clinical officers performed 40% of the cases. Most general surgery, urology and congenital cases were performed by physicians, while most ENT, neurosurgery, and burn surgery cases were performed by clinical officers. Reoperation rate was higher for patients treated by clinical officers (17%) compared to physicians (7.1%), although this was attributable to multiple burn surgical procedures. Physician and clinical officer cohorts had similar complication rates (4.5% and 4.0%, respectively) and mortality rates (2.5% and 2.1%, respectively). Discussion Fundamental changes in health policy in Africa are imperative as a significant increase in the number of surgeons available in the near future is unlikely. Task-shifting from surgeons to clinical officers may be useful to provide coverage of basic surgical care. PMID:24560846

  20. Delivery of operative pediatric surgical care by physicians and non-physician clinicians in Malawi.

    PubMed

    Tyson, Anna F; Msiska, Nelson; Kiser, Michelle; Samuel, Jonathan C; Mclean, Sean; Varela, Carlos; Charles, Anthony G

    2014-01-01

    Specialized pediatric surgeons are unavailable in much of sub-Saharan Africa. Delegating some surgical tasks to non-physician clinical officers can mitigate the dependence of a health system on highly skilled clinicians for specific services. We performed a case-control study examining pediatric surgical cases over a 12 month period. Operating surgeon was categorized as physician or clinical officer. Operative acuity, surgical subspecialty, and outcome were then compared between the two groups, using physicians as the control. A total of 1186 operations were performed on 1004 pediatric patients. Mean age was 6 years (±5) and 64% of patients were male. Clinical officers performed 40% of the cases. Most general surgery, urology and congenital cases were performed by physicians, while most ENT, neurosurgery, and burn surgery cases were performed by clinical officers. Reoperation rate was higher for patients treated by clinical officers (17%) compared to physicians (7.1%), although this was attributable to multiple burn surgical procedures. Physician and clinical officer cohorts had similar complication rates (4.5% and 4.0%, respectively) and mortality rates (2.5% and 2.1%, respectively). Fundamental changes in health policy in Africa are imperative as a significant increase in the number of surgeons available in the near future is unlikely. Task-shifting from surgeons to clinical officers may be useful to provide coverage of basic surgical care. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  1. WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction.

    PubMed

    Quinn, Charlene C; Clough, Suzanne Sysko; Minor, James M; Lender, Dan; Okafor, Maria C; Gruber-Baldini, Ann

    2008-06-01

    Less than 63% of individuals with diabetes meet professional guidelines target of hemoglobin A1c <7.0%, and only 7% meet combined glycemic, lipid, and blood pressure goals. The primary study aim was to assess the impact on A1c of a cell phone-based diabetes management software system used with web-based data analytics and therapy optimization tools. Secondary aims examined health care provider (HCP) adherence to prescribing guidelines and assessed HCPs' adoption of the technology. Thirty patients with type 2 diabetes were recruited from three community physician practices for a 3-month study and evenly randomized. The intervention group received cell phone-based software designed by endocrinologists and CDEs (WellDoc Communications, Inc., Baltimore, MD). The software provided real-time feedback on patients' blood glucose levels, displayed patients' medication regimens, incorporated hypo- and hyperglycemia treatment algorithms, and requested additional data needed to evaluate diabetes management. Patient data captured and transferred to secure servers were analyzed by proprietary statistical algorithms. The system sent computer-generated logbooks (with suggested treatment plans) to intervention patients' HCPs. The average decrease in A1c for intervention patients was 2.03%, compared to 0.68% (P < 0.02, one-tailed) for control patients. Of the intervention patients, 84% had medications titrated or changed by their HCP compared to controls (23%, P = 0.002). Intervention patients' HCPs reported the system facilitated treatment decisions, provided organized data, and reduced logbook review time. Adults with type 2 diabetes using WellDoc's software achieved statistically significant improvements in A1c. HCP and patient satisfaction with the system was clinically and statistically significant.

  2. Leadership Attributes of Physician Assistant Program Directors

    ERIC Educational Resources Information Center

    Eifel, Raymond Leo

    2014-01-01

    Physician assistant (PA) program directors perform an essential role in the initiation, continuation, and development of PA education programs in the rapidly changing environments of both health care and higher education. However, only limited research exists on this academic leader. This study examined the leadership roles of PA program directors…

  3. Procedural Portfolio Planning in Plastic Surgery, Part 1: Strategic Changes in Clinical Practice to Increase Physician Revenue, Improve Operative Throughput, and Maintain Patient Satisfaction.

    PubMed

    Hultman, Charles Scott

    2016-06-01

    Portfolio planning in health care represents the strategic prioritization of services that permits an organization to better achieve its goals of margin and mission. Because of recent volatility in the economy, declining reimbursement, and rising costs of providing care, such strategic planning has become increasingly important if physicians want to remain leaders in health care. This project assesses the financial impact of procedural portfolio planning on an academic plastic surgery practice from the physician's perspective. We tracked the top 50 procedures, defined as total charges per CPT code, that were performed in our baseline year, for 6 providers in a stable plastic surgery practice. At the end of the first year, we implemented 3 types of strategic changes: growth of areas with high contribution margin (laser resurfacing of burn scars), curtailment of high-risk procedures with negative contribution margin (panniculectomy in smokers), and improved efficiency of mission-critical services with high resource consumption (free-flap breast reconstruction). During the 2-year study period, we had no turnover in faculty, did not pursue any formal marketing, did not change our surgical fees or billing system, provided care independent of payer mix, and maintained our commitment to indigent care. Outcome measures included procedural charges and revenue, collection rates, work relative value units, operating room times, idle times (room time less case time), receipts/minute in operating room, uncompensated charity care, and patient satisfaction (Press-Gainey scores). Before the study period, annual incremental growth in our practice was 1% to 2%, in terms of charges and receipts. After implementation of the portfolio planning project, the financial position of our division improved significantly, with patient satisfaction rates increasing from 85.5% to 94.1% and charity care remaining constant at US $400,000 per year. Encounters, work relative value units, charges

  4. Survey of inspection and palpation rates among spine providers: evaluation of physician performance of the physical examination for patients with low back pain.

    PubMed

    Press, Joel; Liem, Brian; Walega, David; Garfin, Steven

    2013-09-15

    Survey from July 2011 to April 2012 of adult patients with primary complaint of low back pain (LBP). To determine the frequency of physical examination being performed by various providers, as measured by frequency of inspection and palpation, of patients with LBP and to describe patient ratings of these examinations. The physical examination is a cornerstone of any evaluation of patients with LBP. With increasing reliance on diagnostic imaging, there is concern that patients are not being examined comprehensively, but to our knowledge, no studies have ever investigated how often the physical examination is performed in patients with LBP. Survey participants were asked to list the types of physicians that they had seen for LBP within the past 1 year and for each physician encounter to answer 2 "yes/no" questions: (1) whether they had removed their clothes or put on a gown or shorts during the examination (our proxy for inspection) and (2) whether the provider had placed his or her hands on the patient (our proxy for palpation). Subjects also provided quality ratings for each provider's physical examination. Main outcome measures included frequency of inspection and palpation and subjects' ratings of each physical examination. A total of 295 surveys were collected reflecting 696 prior physician encounters. Inspection was done in 57% of physician encounters. Across specialties, orthopedic surgeons had the highest reported rate of inspection at 72%. The worst was among chiropractors at 40%. Palpation occurred in 80% of physician encounters. Chiropractors had the highest rate of palpation at 94%. The lowest rate was among neurosurgeons at 58%. Our data suggest that approximately 43% of patient visits for LBP involved no inspection and nearly 20% without palpation. These numbers reflect a need for improvement among providers who treat patients with LBP. N/A.

  5. Comparing the Performance of Allopathically and Osteopathically Trained Physicians on the American Board of Family Medicine's Certification Examination

    ERIC Educational Resources Information Center

    O'Neill, Thomas R.; Royal, Kenneth D.; Schulte, Bradley M.; Leigh, Terrence

    2009-01-01

    Background: Two medical specialty boards offer certification in family medicine: the American Board of Family Medicine (ABFM) and the American Osteopathic Board of Family Physicians (AOBFP). The AOBFP certification is offered only to graduates of osteopathic colleges; however, graduates of both osteopathic and allopathic medical schools who have…

  6. Profit-seeking, corporate control, and the trustworthiness of health care organizations: assessments of health plan performance by their affiliated physicians.

    PubMed

    Schlesinger, Mark; Quon, Nicole; Wynia, Matthew; Cummins, Deborah; Gray, Bradford

    2005-06-01

    To compare the relative trustworthiness of nonprofit and for-profit health plans, using physician assessments to measure dimensions of plan performance that are difficult for consumers to evaluate. A nationally representative sample of 1,621 physicians who responded to a special topics module of the 1998 Socioeconomic Monitoring System Survey (SMS), fielded by the American Medical Association. Physicians assessed various aspects of their primary managed care plan, defined as the plan in which they had the largest number of patients. Plan ownership was measured as the interaction of tax-exempt status (nonprofit versus for-profit) and corporate control (single state versus multistate health plans). Two sets of regression models are estimated. The dependent variables in the regressions are five measures of performance related to plan trustworthiness: two related to deceptive practices and three to dimensions of quality that are largely hidden from enrollees. The first set (baseline) models relate plan ownership to trustworthy practices, controlling for other characteristics of the plan, the marketplace for health insurance, and the physician respondents. The second (interactive) set of models examines how the magnitude of ownership-related differences in trustworthiness varies with the market share of nonprofit plans in each community. The 1998 SMS was fielded between April and September of 1998 by Westat Inc. The average time required for a completed interview was approximately 30 minutes. The overall response rate was 52.2 percent. Compared with more local nonprofit plans, for-profit plans affiliated with multistate corporations are consistently reported by their affiliated physicians to engage in practices associated with reduced trustworthiness. Nonprofit plans affiliated with multistate corporations have more physician-reported practices associated with trustworthiness than do for-profit corporate plans on four of five outcomes, but appear less trustworthy than

  7. Profit-Seeking, Corporate Control, and the Trustworthiness of Health Care Organizations: Assessments of Health Plan Performance by Their Affiliated Physicians

    PubMed Central

    Schlesinger, Mark; Quon, Nicole; Wynia, Matthew; Cummins, Deborah; Gray, Bradford

    2005-01-01

    Objective To compare the relative trustworthiness of nonprofit and for-profit health plans, using physician assessments to measure dimensions of plan performance that are difficult for consumers to evaluate. Data Source A nationally representative sample of 1,621 physicians who responded to a special topics module of the 1998 Socioeconomic Monitoring System Survey (SMS), fielded by the American Medical Association. Physicians assessed various aspects of their primary managed care plan, defined as the plan in which they had the largest number of patients. Study Design Plan ownership was measured as the interaction of tax-exempt status (nonprofit versus for-profit) and corporate control (single state versus multistate health plans). Two sets of regression models are estimated. The dependent variables in the regressions are five measures of performance related to plan trustworthiness: two related to deceptive practices and three to dimensions of quality that are largely hidden from enrollees. The first set (baseline) models relate plan ownership to trustworthy practices, controlling for other characteristics of the plan, the marketplace for health insurance, and the physician respondents. The second (interactive) set of models examines how the magnitude of ownership-related differences in trustworthiness varies with the market share of nonprofit plans in each community. Data Collection The 1998 SMS was fielded between April and September of 1998 by Westat Inc. The average time required for a completed interview was approximately 30 minutes. The overall response rate was 52.2 percent. Principal Findings Compared with more local nonprofit plans, for-profit plans affiliated with multistate corporations are consistently reported by their affiliated physicians to engage in practices associated with reduced trustworthiness. Nonprofit plans affiliated with multistate corporations have more physician-reported practices associated with trustworthiness than do for

  8. Physician collective bargaining.

    PubMed

    Schiff, Anthony Hunter

    2009-11-01

    Current antitrust enforcement policy unduly restricts physician collaboration, especially among small physician practices. Among other matters, current enforcement policy has hindered the ability of physicians to implement efficient healthcare delivery innovations, such as the acquisition and implementation of health information technology (HIT). Furthermore, the Federal Trade Commission and Department of Justice have unevenly enforced the antitrust laws, thereby fostering an increasingly severe imbalance in the healthcare market in which dominant health insurers enjoy the benefit of largely unfettered consolidation at the cost of both consumers and providers. This article traces the history of antitrust enforcement in healthcare, describe the current marketplace, and suggest the problems that must be addressed to restore balance to the healthcare market and help to ensure an innovative and efficient healthcare system capable of meeting the demands of the 21st century. Specifically, the writer explains how innovative physician collaborations have been improperly stifled by the policies of the federal antitrust enforcement agencies, and recommend that these policies be relaxed to permit physicians more latitude to bargain collectively with health insurers in conjunction with procompetitive clinical integration efforts. The article also explains how the unbridled consolidation of the health insurance industry has resulted in higher premiums to consumers and lower compensation to physicians, and recommends that further consolidation be prohibited. Finally, the writer discusses how health insurers with market power are improperly undermining the physician-patient relationship, and recommend federal antitrust enforcement agencies take appropriate steps to protect patients and their physicians from this anticompetitive conduct. The article also suggests such steps will require changes in three areas: (1) health insurers must be prohibited from engaging in anticompetitive

  9. Family physicians' ability to perform population management is associated with adoption of other aspects of the patient-centered medical home.

    PubMed

    Ottmar, Jessica; Blackburn, Brenna; Phillips, Robert L; Peterson, Lars E; Jaén, Carlos Roberto

    2015-04-01

    The patient-centered medical home (PCMH) model is considered a promising approach to improving population health, but how elements of these advanced practice models relate to population health capability is unknown. To measure associations between family physicians' performance of population management with PCMH components, a cross-sectional survey was conducted with physicians accessing the American Board of Family Medicine Web site in 2011. Bivariate analysis and logistic regression tested associations between physician and practice demographics and specific PCMH features. The primary outcome was performance of population management. The final sample included 3855 physicians, 37.3% of whom reported performing population management. Demographic characteristics significantly associated with greater use of population management were female sex and graduation from an international medical school. PCMH components that remained associated with population management after adjustment were access to clinical case managers (odds ratio [OR]=2.01, 95% confidence interval [95% CI]: 1.69, 2.39), behavioral health collaboration (OR=1.49, 95% CI: 1.26, 1.77), having an electronic health record that supports meaningful use (OR=1.47, 95% CI: 1.25, 1.74), recent participation in a quality improvement project (OR=2.47, 95% CI: 2.12, 2.89), and routine measurement of patient difficulty securing an appointment (OR=2.87, 95% CI: 2.45, 3.37). Performance of population management was associated with several PCMH elements and resources not present in traditional primary care offices. Attention to these elements likely will enhance delivery of population management services in primary care.

  10. Physician resource databank: numbers, distribution and activities of Canada's physicians

    PubMed Central

    Woodward, Christel; Adams, Orvill

    1985-01-01

    The physician resource databank, compiled and maintained by the Canadian Medical Association (CMA), contains functional information from 41 599 of Canada's licensed physicians. The information was gathered from a 20-item questionnaire sent to 47 162 physicians. Of the total, 38 653 responses came from physicians who had completed their training and these were included in the analysis to produce a profile of the supply of physicians in Canada. The data from physicians younger than 35 years indicate some changes in the structure of the supply: 27% are women (compared with only about 9% of physicians older than 45 years). The implications of these statistics are not yet clear, but within the next decade the numbers in some specialties—surgery, anesthesia, obstetrics and gynecology, and radiology—may be too few to meet the demand as more than 20% of the current practitioners reach retirement age. Other findings are that [List: see text] PMID:3995440

  11. Linking Competence Change and Organization Performance

    ERIC Educational Resources Information Center

    Boulay, David

    2007-01-01

    The notion of long term sustainable competitive advantage assumes that environment changes are engrained into organizations. Yet, the principles of continuous improvement suggest a shorter and shorter lifecycle of skills and knowledge that provides the sustainable advantage. Continuous change resulting from new ideas, practices, and technologies…

  12. The Challenges for Physicians of Demonstrating Continuing Competence in the Changing World of Medical Regulation: Osteopathic Pediatrician Case Report

    ERIC Educational Resources Information Center

    Langenau, Erik E.; Gimpel, John R.

    2012-01-01

    The current system of continuing medical education, maintenance of certification, and renewal of medical licenses can be quite burdensome and inefficient for all practicing physicians: medical doctors (M.D.s) and doctors of osteopathic medicine (D.O.s). D.O.s have opportunities for residency training and specialty certification which are not…

  13. Strategy Changes After Errors Improve Performance

    PubMed Central

    Van der Borght, Liesbet; Desmet, Charlotte; Notebaert, Wim

    2016-01-01

    The observation that performance does not improve following errors contradicts the traditional view on error monitoring (Fiehler et al., 2005; Núñez Castellar et al., 2010; Notebaert and Verguts, 2011). However, recent findings suggest that typical laboratory tasks provided us with a narrow window on error monitoring (Jentzsch and Dudschig, 2009; Desmet et al., 2012). In this study we investigated strategy-use after errors in a mental arithmetic task. In line with our hypothesis, this more complex task did show increased performance after errors. More specifically, switching to a different strategy after an error resulted in improved performance, while repeating the same strategy resulted in worse performance. These results show that in more ecological valid tasks, post-error behavioral improvement can be observed. PMID:26793159

  14. Orthopedic board certification and physician performance: an analysis of medical malpractice, hospital disciplinary action, and state medical board disciplinary action rates.

    PubMed

    Kocher, Mininder S; Dichtel, Laura; Kasser, James R; Gebhardt, Mark C; Katz, Jeffery N

    2008-02-01

    Specialty board certification status has become the de facto standard of competency by which the profession and the public recognize physician specialists. However, the relationship between orthopedic board certification and physician performance has not been established. Rates of medical malpractice claims, hospital disciplinary actions, and state medical board disciplinary actions were compared between 1309 board-certified (BC) and 154 non-board-certified (NBC) orthopedic surgeons in 3 states. There was no significant difference between BC and NBC surgeons in medical malpractice claim proportions (BC, 19.1% NBC, 16.9% P = .586) or in hospital disciplinary action proportions (BC, 0.9% NBC, 0.8% P = 1.000). There was a significantly higher proportion of state medical board disciplinary action for NBC surgeons (BC, 7.6% NBC, 13.0% P = .028). An association between board certification status and physician performance is necessary to validate its status as the de facto standard of competency. In this study, BC surgeons had lower rates of state medical board disciplinary action.

  15. Training non-physician mid-level providers of care (associate clinicians) to perform caesarean sections in low-income countries.

    PubMed

    Bergström, Staffan

    2015-11-01

    Comprehensive emergency obstetric care including major surgery such as caesarean section is a major health system problem in rural areas of poor countries, where there are no doctors. Innovative trainings of mid-level workforce have now demonstrated viable, scientifically valid solutions. Delegation of major surgery to duly trained 'non-physician clinicians' - 'task shifting' - should be seriously considered to address the human resources crisis in poor countries to cope with current challenges to enhance maternal and neonatal survival. Nationwide, non-physician clinicians in Mozambique perform approximately 90% of caesarean sections at the district hospital level. A comparison between the outcomes of caesarean sections provided by this category and medical doctors, respectively, demonstrates no clinically significant differences. These mid-level providers have a remarkably high retention rate in rural areas (close to 90%). They are cost-effective, as their training and deployment is three times more cost-effective than that of medical doctors.

  16. Beneath the calm surface: the changing face of physician-service use in British Columbia, 1985/86 versus 1996/97.

    PubMed

    Barer, Morris L; Evans, Robert G; McGrail, Kimberlyn M; Green, Bo; Hertzman, Clyde; Sheps, Samuel B

    2004-03-02

    Although expenditures on health care are continually increasing and often said to be unsustainable, few studies have examined these trends at the level of services delivered to individual patients. We analyzed trends in the various components that contributed to changes in overall expenditures for physician services in British Columbia from 1985/86 to 1996/97. We obtained data on all fee-for-service payments to physicians in each study year using the British Columbia Linked Health Data set and analyzed these at the level of individual patients. We disaggregated overall billing levels by year into the following components: number of physicians seen by each patient, number of visits per physician, number of services rendered on each visit and average price of those services. We removed the effect of inflation on fees by adjusting to those in 1988. We used direct age-standardization to isolate and measure the effect of demographic changes. We used the Consumer Price Index to determine the effects of inflation. Total payments to fee-for-service physicians in British Columbia rose 86.3% over the study period. The increase was entirely accounted for by the combined effects of population growth (28.9%), aging (2.1%) and general inflation (41.4%). Service use per capita rose 10.5%; this increase was offset by a decline of 9.4% in inflation-adjusted fees. The average cost of age-adjusted per-capita services rendered by general or family practitioners (GP/FPs) increased very little (3.3%) over the 11-year period, compared with a nearly one-third (31.8%) increase for medical specialists. Although there was a dramatic increase in the number of GP/FPs seen on average by each patient (32.9%), this increase was offset by the combination of decreases in the number of visits per physician (-14.9%), the number of services provided per visit (-8.0%) and the "real cost" of each service provided (-3.5%). Visits to medical specialists increased by about 20% over the study period in all

  17. The application of change management principles to facilitate the introduction of nurse practitioners and physician assistants into six Ontario emergency departments.

    PubMed

    Ducharme, James; Buckley, Jenny; Alder, Robert; Pelletier, Cindy

    2009-01-01

    In a project funded by the Ontario Ministry of Health and Long-Term Care, MedEmerg facilitated the introduction of three new providers into six emergency departments. A managed change process that included team development was carried out. Increased team awareness and a higher acceptance of the provider roles were some of the key successes. Challenges included role confusion and the learning curve for the new providers. While overall the project was a success, lessons learned included the need for physician buy-in, communication, planning for unintended consequences and management of expectations. The project emphasized the importance of a managed process, including team development, in the implementation of change.

  18. Safety study of 38,503 intravitreal ranibizumab injections performed mainly by physicians in training and nurses in a hospital setting.

    PubMed

    Hasler, Pascal W; Bloch, Sara Brandi; Villumsen, Jørgen; Fuchs, Josefine; Lund-Andersen, Henrik; Larsen, Michael

    2015-03-01

    To evaluate and to compare the safety of intravitreal ranibizumab injections performed by physicians and nurses at a single large hospital clinic in Denmark during 5 years. Retrospective, interventional, non-comparative study. All eyes that underwent a protocolized ranibizumab injection procedure performed in an operating room mainly by nurses and physicians in their first year of ophthalmology training. A total of 4623 eyes in 3679 patients with subretinal neovascularization secondary to a variety of retinal diseases, mainly neovascular AMD treated with intravitreal therapy (IVT) at the Glostrup Hospital from January 1, 2007 to December 31, 2011 with a mean follow-up of 12.2 months (95% confidence interval: 11.9-12.6). Frequency of endophthalmitis, traumatic cataract, intraocular haemorrhage and retinal detachment from 2007 to 2012. Overall, 38,503 intravitreal ranibizumab injections were performed in 4623 eyes. Injections were performed by nurses (32.5%), ophthalmology residents (61.3%) and vitreoretinal surgeons (6.2%). Severe complications to treatment were observed in 17 eyes: Endophthalmitis (14 eyes, 0.36 ‰ of injections whereof seven cases were culture-positive), anterior uveitis (one eye, 0.026 ‰), traumatic cataract (one eye, 0.026 ‰) and rhegmatogenous retinal detachment (one eye, 0.026 ‰). Retinal pigment epithelial tears were registered in 14 eyes in 14 subjects within the first year of treatment with ranibizumab. Of the 14 cases of endophthalmitis, seven occurred within a period of 5 weeks in 2010 when occasionally abnormal needle outflow resistance prompted the needle replacement in the operating room. No drug-related adverse events were recorded. Intravitreal ranibizumab injection performed by nurses and physicians without preinjection topical antibiotics was associated with a rate of injection-related adverse events of 0.44 ‰. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  19. Changes of Working Responsibilities and Intentions of Industrial Physicians (Graduates of University of Occupational and Environmental Health, Japan) in a Comparison Between 2001, 2008 and 2015 Questionnaire Analyses.

    PubMed

    Nakamura, Hayato; Isse, Toyohi; Sakai, Akinori

    For the purpose of understanding the current conditions of the duties of industrial physicians and the consciousness of graduates of the University of Occupational and Environmental Health, Japan (UOEH) engaged in industry, we performed a questionnaire survey in July, 2001 and July, 2008 and reported the results (J UOEH 2009 31: 281-91). A similar survey was carried out in July, 2015. We dispatched the questionnaire to industrial physicians and physicians in occupational health organizations who had graduated from UOEH and got the replies. The investigation asked about their career, their activities, and how they thought about their duties. We compared the three years and got the following results: 1) The ratio of respondents who were satisfied with the salary or official post was 38.3, 48.1, 65.4% in each investigation, respectively. 2) The ratio of the respondents whose official post and rank would not be promoted in the future was 25.3, 28.4, 32.3%, respectively. 3) The ratio of respondents satisfied with the relationship with the superior and the industrial health staff was 70.8, 80.3, 86.1%, respectively. The investigation performed every seven years since July, 2001 showed that the ratio of the graduates of UOEH whose official post and rank would not be promoted in the future had gradually increased, while the ratio of graduates who were satisfied with the relationship with the superior and the industrial health staff had also gradually increased.

  20. Disenfranchised Grief and Physician Burnout.

    PubMed

    Lathrop, Deborah

    2017-07-01

    Over the span of their career, physicians experience changes to their professional role and professional identity. The process of continual adaptation in their work setting incurs losses. These losses can be ambiguous, cumulative, and may require grieving. Grief in the workplace is unsanctioned, and may contribute to physicians' experience of burnout (emotional exhaustion, depersonalization, low sense of achievement). Acknowledging loss, validating grief, and being prescient in dealing with physician burnout is essential. © 2017 Annals of Family Medicine, Inc.

  1. Changes in Memory Prediction Accuracy: Age and Performance Effects

    ERIC Educational Resources Information Center

    Pearman, Ann; Trujillo, Amanda

    2013-01-01

    Memory performance predictions are subjective estimates of possible memory task performance. The purpose of this study was to examine possible factors related to changes in word list performance predictions made by younger and older adults. Factors included memory self-efficacy, actual performance, and perceptions of performance. The current study…

  2. Changes in Memory Prediction Accuracy: Age and Performance Effects

    ERIC Educational Resources Information Center

    Pearman, Ann; Trujillo, Amanda

    2013-01-01

    Memory performance predictions are subjective estimates of possible memory task performance. The purpose of this study was to examine possible factors related to changes in word list performance predictions made by younger and older adults. Factors included memory self-efficacy, actual performance, and perceptions of performance. The current study…

  3. Association of Practice-Level Social and Medical Risk With Performance in the Medicare Physician Value-Based Payment Modifier Program.

    PubMed

    Chen, Lena M; Epstein, Arnold M; Orav, E John; Filice, Clara E; Samson, Lok Wong; Joynt Maddox, Karen E

    2017-08-01

    Medicare recently launched the Physician Value-Based Payment Modifier (PVBM) Program, a mandatory pay-for-performance program for physician practices. Little is known about performance by practices that serve socially or medically high-risk patients. To compare performance in the PVBM Program by practice characteristics. Cross-sectional observational study using PVBM Program data for payments made in 2015 based on performance of large US physician practices caring for fee-for-service Medicare beneficiaries in 2013. High social risk (defined as practices in the top quartile of proportion of patients dually eligible for Medicare and Medicaid) and high medical risk (defined as practices in the top quartile of mean Hierarchical Condition Category risk score among fee-for-service beneficiaries). Quality and cost z scores based on a composite of individual measures. Higher z scores reflect better performance on quality; lower scores, better performance on costs. Among 899 physician practices with 5 189 880 beneficiaries, 547 practices were categorized as low risk (neither high social nor high medical risk) (mean, 7909 beneficiaries; mean, 320 clinicians), 128 were high medical risk only (mean, 3675 beneficiaries; mean, 370 clinicians), 102 were high social risk only (mean, 1635 beneficiaries; mean, 284 clinicians), and 122 were high medical and social risk (mean, 1858 beneficiaries; mean, 269 clinicians). Practices categorized as low risk performed the best on the composite quality score (z score, 0.18 [95% CI, 0.09 to 0.28]) compared with each of the practices categorized as high risk (high medical risk only: z score, -0.55 [95% CI, -0.77 to -0.32]; high social risk only: z score, -0.86 [95% CI, -1.17 to -0.54]; and high medical and social risk: -0.78 [95% CI, -1.04 to -0.51]) (P < .001 across groups). Practices categorized as high social risk only performed the best on the composite cost score (z score, -0.52 [95% CI, -0.71 to -0.33]), low risk had the next

  4. Managing the negatives of experience in physician teams.

    PubMed

    Hoff, Timothy

    2010-01-01

    Experience is a key shaper of thought and action in the health care workplace and a fundamental component of management and professional policies dealing with improving quality of care. Physicians rely on experience to structure social interaction, to determine authority relations, and to resist organizational encroachments on their work and autonomy. However, an overreliance on experience within physician teams may paradoxically undermine learning, participation, and entrepreneurship, affecting organizational performance. Approximately 100 hours of direct observation of normal workdays for physician teams (n = 17 physicians) in two different work settings in a single academic medical center located in the Northeastern part of the United States. Qualitative data were collected from physician teams in the medical intensive care unit and trauma/general surgery settings. Data were transcribed and computer analyzed through an interactive process of open coding, theoretical sampling, and pattern recognition that proceeded longitudinally. Three particular experience-based schemas were identified that physician teams used to structure social relations and perform work. These schemas involved using experience as a commodity, trump card, and liberator. Each of these schemas consisted of strongly held norms, beliefs, and values that produced team dynamics with the potential for undermining learning, participation, and entrepreneurship in the group. Organizations may move to mitigate the negative impact of an overreliance on experience among physicians by promoting bureaucratic forms of control that enable physicians to engage learning, participation, and entrepreneurship in their work while not usurping existing and difficult-to-change cultural drivers of team behavior.

  5. Female Physicians and the Future of Endocrinology.

    PubMed

    Pelley, Elaine; Danoff, Ann; Cooper, David S; Becker, Carolyn

    2016-01-01

    Given that approximately 70% of current endocrinology fellows are women, female physicians will compose the majority of the future endocrinology workforce. This gender shift partly reflects an apparent waning of interest in endocrinology among male trainees. It also coincides with a projected shortage of endocrinologists overall. Female physicians face unique challenges in the workplace. To continue to attract trainees to the specialty and support their success, it is imperative that these challenges be recognized, understood, and addressed. A PubMed search using the terms "female physician" and "physician gender" covering the years 2000-2015 was performed. Additional references were identified through review of the citations of the retrieved articles. The following topics were identified as key to understanding the impact of this gender shift: professional satisfaction, work-life balance, income, parenthood, academic success, and patient satisfaction. Several changes can be predicted to occur as endocrinology becomes a female-predominant specialty. Although professional satisfaction should remain stable, increased burnout rates are likely. Work-life balance challenges will likely be magnified. The combined effects of occupational gender segregation and a gender pay gap are predicted to negatively impact salaries of endocrinologists of both genders. The underrepresentation of women in academic leadership may mean a lesser voice for endocrinology in this arena. Finally, gender biases evident in patient satisfaction measures--commonly used as proxies for quality of care--may disproportionately impact endocrinology. Endocrinology is predicted to become the most female-predominant subspecialty of internal medicine. The specialty of endocrinology should take a lead role in advocating for changes that support the success of female physicians. Strengthening and supporting the physician workforce can only serve to attract talented physicians of both genders to the

  6. Effects of Gain Changes on RPM Performance

    SciTech Connect

    Lousteau, Angela L; York, Robbie Lynn; Livesay, Jake

    2012-03-01

    gains are less than 5% (Fig. 6). ORNL does not consider this slight increase in sensitivity to be a worthwhile pursuit. Second, increasing the ULD will increase sensitivity a few percent (Fig. 7); however, it is not clear that the slight increase in sensitivity is worth the effort required to make the change (e.g., reliability, cost, etc.). Additionally, while the monitor would be more sensitive to HEU, it would also be more sensitive to NORM. Third, the sensitivity of the system remains approximately the same whether it is calibrated to a small source on contact or a large source far away (Fig. 6). This affirms that no changes to the existing calibration procedure are necessary.

  7. How French physicians manage with a future change in the primary vaccination of infants against diphtheria, tetanus, pertussis and poliomyelitis? A qualitative study with focus groups

    PubMed Central

    2013-01-01

    Background As in other European countries, the French vaccination schedule changes according to epidemiological and socio-economic situations. Further changes are planned for 2013, including the withdrawal of one dose for primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. A partnership between the French Technical Vaccination Committee and the French Institute for Health and Medical Research designed a study to assess primary care physicians’ agreement about this modification. Methods Qualitative study with focus groups and semi-structured interviews in France. Four focus groups were conducted with physicians, supplemented by four individual interviews. Results The physicians of the survey had accepted the suggested vaccination schedule well. A few concerns had been underlined: fear of less follow-up care for infants resulting from the removal of one visit driven by the primary vaccination; fear of loss of vaccine efficacy; suspicion of the existence of financial arguments at the origin of this change; and adjustment to current vaccination schedule. Several suggestions were made: providing strong support from health authorities; developing stable and simple recommendations; providing effective tools for monitoring patient’s vaccination status. Conclusions Physicians’ opinions suggested a good acceptance of a possible change about primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. Physicians’ suggestions resulted from this qualitative study on a new vaccination schedule. It showed how that their involvement was feasible for preparing the implementation of a new vaccination schedule. PMID:23782853

  8. The physician leader as logotherapist.

    PubMed

    Washburn, E R

    1998-01-01

    Today's physicians feel helpless and angry about changing conditions in the medical landscape. This is due, in large part, to our postmodernist world view and the influence of corporations on medical practice. The life and work of existentialist psychiatrist Viktor Frankl is proposed as a role model for physicians to take back control of their profession. Physician leaders are in the best position to bring the teachings and insight of Frankl's logotherapy to rank-and-file physicians in all practice settings, as well as into the board rooms of large medical corporations. This article considers the spiritual and moral troubles of American medicine, Frankl's answer to that affliction, and the implications of logotherapy for physician organizations and leadership. Physician executives are challenged to take up this task.

  9. Measuring input prices for physicians: The revised Medicare Economic Index

    PubMed Central

    Freeland, Mark S.; Chulis, George S.; Arnett, Ross H.; Brown, Aaron P.

    1991-01-01

    Medicare payments for physician services under Part B were historically restrained by capping prevailing charges using the Medicare Economic Index (MEI). The MEI, an input price index for physician services that incorporates an adjustment for economywide labor productivity, has not undergone a major revision since 1975. The MEI is an important determinant of the annual volume performance standard that will be used to set aggregate increases in the revised system for paying physicians under Medicare beginning in 1992. The MEI will also be used in establishing the annual changes to the payment conversion factors under the new payment system. PMID:10170807

  10. Community volunteerism of US physicians.

    PubMed

    Grande, David; Armstrong, Katrina

    2008-12-01

    Many physicians and professional leaders agree that community participation is an important professional role for physicians. Volunteerism has also received increasing attention in the national agenda for social change. Yet little is known about physicians' community volunteer activities. To measure levels of community volunteerism among US physicians. Analysis of the 2003 Current Population Survey (CPS) Volunteer Supplement, a cross-sectional, nationally-representative, in-person and telephone survey of 84,077 adult citizens, including 316 physicians. The primary outcome was whether the respondent had volunteered in the prior 12 months and if so the total number of hours. The level of community volunteer activity was compared between physicians, lawyers and the general public. In addition, predictors of physician volunteerism were identified. According to the survey, 39% of physicians had volunteered in their community in the past 12 months compared to 30% of the general public (p = 0.002) and 57% of lawyers (p < 0.001). After multivariate adjustment, physicians were half as likely as the general public (OR = 0.52, p < 0.001) or lawyers (OR = 0.44, p < 0.001) to have volunteered. Physicians were more likely to have volunteered if they worked part-time (OR = 3.35, p = 0.03), variable hours (OR = 3.16, p = 0.03), or between 45-54 hours per week (OR = 3.15, p = 0.02) compared to a 35-44 hour work week. Despite highly favorable physician attitudes toward volunteerism in prior surveys, less than half of US physicians have volunteered with community organizations in the past year. Renewed attention to understanding and increasing physician engagement in community volunteer work is needed.

  11. Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey.

    PubMed

    Lampi, Maria; Vikström, Tore; Jonson, Carl-Oscar

    2013-12-20

    In a mass casualty situation, medical personnel must rapidly assess and prioritize patients for treatment and transport. Triage is an important tool for medical management in disaster situations. Lack of common international and Swedish triage guidelines could lead to confusion. Attending the Advanced Trauma Life Support (ATLS) provider course is becoming compulsory in the northern part of Europe. The aim of the ATLS guidelines is provision of effective management of single critically injured patients, not mass casualties incidents. However, the use of the ABCDE algorithms from ATLS, has been proposed to be valuable, even in a disaster environment. The objective for this study was to determine whether the mnemonic ABCDE as instructed in the ATLS provider course, affects the ability of Swedish physician's to correctly triage patients in a simulated mass casualty incident. The study group included 169 ATLS provider students from 10 courses and course sites in Sweden; 153 students filled in an anonymous test just before the course and just after the course. The tests contained 3 questions based on overall priority. The assignment was to triage 15 hypothetical patients who had been involved in a bus crash. Triage was performed according to the ABCDE algorithm. In the triage, the ATLS students used a colour-coded algorithm with red for priority 1, yellow for priority 2, green for priority 3 and black for dead. The students were instructed to identify and prioritize 3 of the most critically injured patients, who should be the first to leave the scene. The same test was used before and after the course. The triage section of the test was completed by 142 of the 169 participants both before and after the course. The results indicate that there was no significant difference in triage knowledge among Swedish physicians who attended the ATLS provider course. The results also showed that Swedish physicians have little experience of real mass casualty incidents and exercises

  12. The Teacher, the Physician and the Person: Exploring Causal Connections between Teaching Performance and Role Model Types Using Directed Acyclic Graphs

    PubMed Central

    Boerebach, Benjamin C. M.; Lombarts, Kiki M. J. M. H.; Scherpbier, Albert J. J.; Arah, Onyebuchi A.

    2013-01-01

    Background In fledgling areas of research, evidence supporting causal assumptions is often scarce due to the small number of empirical studies conducted. In many studies it remains unclear what impact explicit and implicit causal assumptions have on the research findings; only the primary assumptions of the researchers are often presented. This is particularly true for research on the effect of faculty’s teaching performance on their role modeling. Therefore, there is a need for robust frameworks and methods for transparent formal presentation of the underlying causal assumptions used in assessing the causal effects of teaching performance on role modeling. This study explores the effects of different (plausible) causal assumptions on research outcomes. Methods This study revisits a previously published study about the influence of faculty’s teaching performance on their role modeling (as teacher-supervisor, physician and person). We drew eight directed acyclic graphs (DAGs) to visually represent different plausible causal relationships between the variables under study. These DAGs were subsequently translated into corresponding statistical models, and regression analyses were performed to estimate the associations between teaching performance and role modeling. Results The different causal models were compatible with major differences in the magnitude of the relationship between faculty’s teaching performance and their role modeling. Odds ratios for the associations between teaching performance and the three role model types ranged from 31.1 to 73.6 for the teacher-supervisor role, from 3.7 to 15.5 for the physician role, and from 2.8 to 13.8 for the person role. Conclusions Different sets of assumptions about causal relationships in role modeling research can be visually depicted using DAGs, which are then used to guide both statistical analysis and interpretation of results. Since study conclusions can be sensitive to different causal assumptions, results

  13. The teacher, the physician and the person: exploring causal connections between teaching performance and role model types using directed acyclic graphs.

    PubMed

    Boerebach, Benjamin C M; Lombarts, Kiki M J M H; Scherpbier, Albert J J; Arah, Onyebuchi A

    2013-01-01

    In fledgling areas of research, evidence supporting causal assumptions is often scarce due to the small number of empirical studies conducted. In many studies it remains unclear what impact explicit and implicit causal assumptions have on the research findings; only the primary assumptions of the researchers are often presented. This is particularly true for research on the effect of faculty's teaching performance on their role modeling. Therefore, there is a need for robust frameworks and methods for transparent formal presentation of the underlying causal assumptions used in assessing the causal effects of teaching performance on role modeling. This study explores the effects of different (plausible) causal assumptions on research outcomes. This study revisits a previously published study about the influence of faculty's teaching performance on their role modeling (as teacher-supervisor, physician and person). We drew eight directed acyclic graphs (DAGs) to visually represent different plausible causal relationships between the variables under study. These DAGs were subsequently translated into corresponding statistical models, and regression analyses were performed to estimate the associations between teaching performance and role modeling. The different causal models were compatible with major differences in the magnitude of the relationship between faculty's teaching performance and their role modeling. Odds ratios for the associations between teaching performance and the three role model types ranged from 31.1 to 73.6 for the teacher-supervisor role, from 3.7 to 15.5 for the physician role, and from 2.8 to 13.8 for the person role. Different sets of assumptions about causal relationships in role modeling research can be visually depicted using DAGs, which are then used to guide both statistical analysis and interpretation of results. Since study conclusions can be sensitive to different causal assumptions, results should be interpreted in the light of causal

  14. Family physician pathway and medical student career choice. Ten years after curriculum change at the University of Washington.

    PubMed

    Phillips, T J; Gordon, M J; Leversee, J H; Smith, C K

    1978-10-13

    In 1968 the University of Washington School of Medicine initiated a new curriculum that included a family physician pathway. Six of these classes have now graduated. Two thirds of the planned strategies for the pathway were actually implemented. Approximately half of the students in each second-year class now choose this pathway. Ninety percent of those graduating have done so in the traditional four years. Seventy-three percent of those in the pathway actually pursued family practice training on graduation. Approximately one third of all University of Washington graduates now enter training for family practice, one third enter internal medicine, 10% enter surgical fields, and 8% enter pediatrics. These rates represent significant increases in the proportion of students entering directly into family practice, internal medicine, and pediatrics training.

  15. Evaluation of the effectiveness of peer pressure to change disposition decisions and patient throughput by emergency physician.

    PubMed

    Wu, Kuan-Han; Cheng, Fu-Jen; Li, Chao-Jui; Cheng, Hsien-Hung; Lee, Wen-Huei; Lee, Chi-Wei

    2013-03-01

    The aim of this study was to develop a strategy for imposing peer pressure on emergency physicians to discharge patients and to evaluate patient throughput before and after intervention. A before-and-after study was conducted in a medical center with more than 120 000 annual emergency department (ED) visits. All nontraumatic adult patients who presented to the ED between 7:30 and 11:30 am Wednesday to Sunday were reviewed. We created a "team norm" imposed peer-pressure effect by announcing the patient discharge rate of each emergency physician through monthly e-mail reminders. Emergency department length of stay (LOS) and 8-hour (the end of shift) and final disposition of patients before (June 1, 2011-September 30, 2011) and after (October 1, 2011-January 30, 2012) intervention were compared. Patients enrolled before and after intervention totaled 3305 and 2945. No differences existed for age, sex, or average number of patient visits per shift. The 8-hour discharge rate increased significantly for all patients (53.5% vs 48.2%, P < .001), particularly for triage level III patients (odds ratio, 1.3; 95% confidence interval, 1.09-1.38) after intervention and without corresponding differences in the final disposition (P = .165) or admission rate (33.7% vs 31.6%, P = .079). Patients with a final discharge disposition had a shorter LOS (median, 140.4 min vs 158.3 min; P < .001) after intervention. The intervention strategy used peer pressure to enhance patient flow and throughput. More patients were discharged at the end of shifts, particularly triage level III patients. The ED LOS for patients whose final disposition was discharge decreased significantly. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Physicians' Use of Compliance Gaining.

    PubMed

    Pochop, Kayla; Tyler, Jill

    2016-07-01

    A qualitative analysis was conducted exploring physicians' use of compliance gaining strategies used in attempts to change patient behaviors. Analysis revealed six sets of perceptions that describe the ways physicians manage the difficult task of compliance gaining - recognition of failure, tolerance of outside credibility, labeling the "art of medicine," assigning patient responsibility, placing patients on "their journey," and acknowledging "the event." Analysis also identified three key sets of strategies that physicians use in compliance gaining: 1) message strategies (which include direct and strategic attempts to manage interactions about behavior change); 2) relational strategies (which emerge from the relationship shared by the physician and the patient); and 3) personal strategies (which include the individual physician's approaches to compliance gaining). Eight message strategies, three relational strategies, and two personal strategies are identified and described. Copyright© South Dakota State Medical Association.

  17. Estimating head and neck tissue dose from x-ray scatter to physicians performing x-ray guided cardiovascular procedures: a phantom study.

    PubMed

    Fetterly, Kenneth A; Schueler, Beth A; Grams, Michael P; Sturchio, Glenn M

    2017-03-20

    Physicians performing x-ray guided interventional procedures have a keen interest in radiation safety. Radiation dose to tissues and organs of the head and neck are of particular interest because they are not routinely protected by wearable radiation safety devices. This study was conducted to facilitate estimation of radiation dose to tissues of the head and neck of interventional physicians based on the dose recorded by a personal dosimeter worn on the left collar. Scatter beam qualities maximum energy and HVL were measured for 40 scatter beams emitting from an anthropomorphic patient phantom. Variables of the scatter beams included scatter angle (35° and 90°), primary beam peak tube potential (60, 80, 100, and 120 kVp), and 5 Cu spectral filter thicknesses (0-0.9 mm). Four reference scatter beam qualities were selected to represent the range of scatter beams realized in a typical practice. A general radiographic x-ray tube was tuned to produce scatter-equivalent radiographic beams and used to simultaneously expose the head and neck of an anthropomorphic operator phantom and radiochromic film. The geometric relationship between the x-ray source of the scatter-equivalent beams and the operator phantom was set to mimic that between a patient and physician performing an invasive cardiovascular procedure. Dose to the exterior surface of the operator phantom was measured with both 3 × 3 cm(2) pieces of film and personal dosimeters positioned at the location of the left collar. All films were scanned with a calibrated flatbed scanner, which converted the film's reflective density to dose. Films from the transverse planes of the operator phantom provided 2D maps of the dose distribution within the phantom. These dose maps were normalized by the dose at the left collar, providing 2D percent of left collar dose (LCD) maps. The percent LCD maps were overlain with bony anatomy CT images of the operator phantom and estimates of percent LCD to the left, right and whole

  18. Editorial Changes and Item Performance: Implications for Calibration and Pretesting

    ERIC Educational Resources Information Center

    Stoffel, Heather; Raymond, Mark R.; Bucak, S. Deniz; Haist, Steven A.

    2014-01-01

    Previous research on the impact of text and formatting changes on test-item performance has produced mixed results. This matter is important because it is generally acknowledged that "any" change to an item requires that it be recalibrated. The present study investigated the effects of seven classes of stylistic changes on item…

  19. Editorial Changes and Item Performance: Implications for Calibration and Pretesting

    ERIC Educational Resources Information Center

    Stoffel, Heather; Raymond, Mark R.; Bucak, S. Deniz; Haist, Steven A.

    2014-01-01

    Previous research on the impact of text and formatting changes on test-item performance has produced mixed results. This matter is important because it is generally acknowledged that "any" change to an item requires that it be recalibrated. The present study investigated the effects of seven classes of stylistic changes on item…

  20. Physician ownership of medical equipment.

    PubMed

    Reschovsky, James; Cassil, Alwyn; Pham, Hoangmai H

    2010-12-01

    This Data Bulletin presents findings from the Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey, a nationally rep­resentative mail survey of U.S. physicians providing at least 20 hours per week of direct patient care. The sample of physicians was drawn from the American Medical Association master file and included active, nonfederal, office- and hospital-based physicians. Residents and fellows were excluded, as well as radiologists, anesthesiologists and pathologists. The survey includes responses from more than 4,700 phy­sicians, and the response rate was 62 percent. Since this Data Bulletin examines the extent of physician practice ownership or leasing of medical equipment, the sample was limited to 2,750 physicians practic­ing in community-based, physician-owned practices, who represent 58 percent of all physicians surveyed. Physicians employed by hospitals, who practiced in hospital-based settings or who worked in hospital-owned practices were excluded.

  1. Work-arounds and artifacts during transition to a computer physician order entry: what they are and what they mean.

    PubMed

    Schoville, Rhonda R

    2009-01-01

    This study examined work-arounds and artifacts in the work performed by nurses and other healthcare providers when physicians transitioned to a computer physician order entry system. There were 5 types of work-arounds and artifacts identified: (1) workflow timing of events, (2) communication changes, (3) system problems, (4) learning curve, and (5) patient safety. Benefits of this study include the ability to understand how nursing work changes in the transition to a computer physician order entry system.

  2. Community Volunteerism of US Physicians

    PubMed Central

    Armstrong, Katrina

    2008-01-01

    Background Many physicians and professional leaders agree that community participation is an important professional role for physicians. Volunteerism has also received increasing attention in the national agenda for social change. Yet little is known about physicians’ community volunteer activities. Objective To measure levels of community volunteerism among US physicians. Design and Participants Analysis of the 2003 Current Population Survey (CPS) Volunteer Supplement, a cross-sectional, nationally-representative, in-person and telephone survey of 84,077 adult citizens, including 316 physicians. Measurements The primary outcome was whether the respondent had volunteered in the prior 12 months and if so the total number of hours. The level of community volunteer activity was compared between physicians, lawyers and the general public. In addition, predictors of physician volunteerism were identified. Results According to the survey, 39% of physicians had volunteered in their community in the past 12 months compared to 30% of the general public ( = 0.002) and 57% of lawyers ( < 0.001). After multivariate adjustment, physicians were half as likely as the general public (OR = 0.52,  < 0.001) or lawyers (OR = 0.44,  < 0.001) to have volunteered. Physicians were more likely to have volunteered if they worked part-time (OR = 3.35,  = 0.03), variable hours (OR = 3.16,  = 0.03), or between 45–54 hours per week (OR = 3.15,  = 0.02) compared to a 35–44 hour work week. Conclusions Despite highly favorable physician attitudes toward volunteerism in prior surveys, less than half of US physicians have volunteered with community organizations in the past year. Renewed attention to understanding and increasing physician engagement in community volunteer work is needed. PMID:18839260

  3. Determinants of Cervical Cancer Screening Accuracy for Visual Inspection with Acetic Acid (VIA) and Lugol’s Iodine (VILI) Performed by Nurse and Physician

    PubMed Central

    Raifu, Amidu O.; El-Zein, Mariam; Sangwa-Lugoma, Ghislain; Ramanakumar, Agnihotram; Walter, Stephen D.

    2017-01-01

    Background Visual inspection with acetic acid (VIA) and Lugol’s iodine (VILI) are used to screen women for cervical cancer in low-resource settings. Little is known about correlates of their diagnostic accuracy by healthcare provider. We examined determinants of VIA and VILI screening accuracy by examiner in a cross-sectional screening study of 1528 women aged 30 years or older in a suburb of Kinshasa, Democratic Republic of Congo. Methods We used a logistic regression model for sensitivity and specificity to estimate the diagnostic accuracy of VIA and VILI, independently performed by nurse and physician, as a function of sociodemographic and reproductive health characteristics. Results Nurses rated tests as positive more often than physicians (36.3% vs 30.2% for VIA, 26.2% vs 25.2% for VILI). Women’s age was the most important determinant of performance. It was inversely associated with sensitivity (nurse’s VIA: p<0.001, nurse’s VILI: p = 0.018, physician’s VIA: p = 0.005, physician’s VILI: p = 0.006) but positively associated with specificity (all four combinations: p<0.001). Increasing parity adversely affected sensitivity and specificity, but the effects on sensitivity were significant for nurses only. The screening performance of physician’s assessment was significantly better than the nurse’s (difference in sensitivity: VIA = 13%, VILI = 16%; difference in specificity: VIA = 6%, VILI = 1%). Conclusions Age and parity influence the performance of visual tests for cervical cancer screening. Proper training of local healthcare providers in the conduct of these tests should take into account these factors for improved performance of VIA and VILI in detecting cervical precancerous lesions among women in limited-resource settings. PMID:28107486

  4. Prehospital anaesthesia performed by physician/critical care paramedic teams in a major trauma network in the UK: a 12 month review of practice.

    PubMed

    McQueen, Carl; Crombie, Nicholas; Hulme, Jonathan; Cormack, Stef; Hussain, Nageena; Ludwig, Frank; Wheaton, Steve

    2015-01-01

    In the West Midlands region of the UK, delivery of pre-hospital care has been remodelled through introduction of a 24 h Medical Emergency Response Incident Team (MERIT). Teams including physicians and critical care paramedics (CCP) are deployed to incidents on land-based and helicopter-based platforms. Clinical practice, including delivery of rapid sequence induction of anaesthesia (RSI), is underpinned by standard operating procedures (SOP). This study describes the first 12 months experience of prehospital RSI in the MERIT scheme in the West Midlands. Retrospective review of the MERIT clinical database for the 12 months following the launch of the scheme. Data was collected relating to the number of RSIs performed; indication for RSI; number of intubation attempts; grade of view on laryngoscopy and the base speciality/grade of the operator performing intubation. MERIT teams were activated 1619 times, attending scene in 1029 cases. RSI was performed 142 times (13.80% of scene attendances). There was one recorded case of failure to intubate requiring insertion of a supraglottic airway device (0.70%). In over a third of RSI cases, CCPs performed laryngoscopy and intubation (n=53, 37.32%). Proficiency of obtaining Grade I view at laryngoscopy was similar for physicians (74.70%) and CCPs (77.36%). Intubation was successful at the first attempt in over 90% of cases. This study demonstrates that operation within a system that provides high levels of exposure, underpinned by comprehensive and robust training and governance frameworks, promotes levels of performance in successful prehospital RSI regardless of base speciality or profession. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Chemical Dependency and the Physician

    PubMed Central

    Berge, Keith H.; Seppala, Marvin D.; Schipper, Agnes M.

    2009-01-01

    Although the nature and scope of addictive disease are commonly reported in the lay press, the problem of physician addiction has largely escaped the public's attention. This is not due to physician immunity from the problem, because physicians have been shown to have addiction at a rate similar to or higher than that of the general population. Additionally, physicians' addictive disease (when compared with the general public) is typically advanced before identification and intervention. This delay in diagnosis relates to physicians' tendency to protect their workplace performance and image well beyond the time when their life outside of work has deteriorated and become chaotic. We provide an overview of the scope and risks of physician addiction, the challenges of recognition and intervention, the treatment of the addicted physician, the ethical and legal implications of an addicted physician returning to the workplace, and their monitored aftercare. It is critical that written policies for dealing with workplace addiction are in place at every employment venue and that they are followed to minimize risk of an adverse medical or legal outcome and to provide appropriate care to the addicted physician. PMID:19567716

  6. The Impact of Expressions of Treatment Efficacy and Out-of-pocket Expenses on Patient and Physician Interest in Osteoporosis Treatment: Implications for Pay-for-performance Programs

    PubMed Central

    Foreman-Hoffman, Valerie; Cram, Peter

    2007-01-01

    BACKGROUND Clinical practice guidelines (CPGs) are increasingly used as the basis for pay-for-performance (P4P) programs. It is unclear how support for guidelines varies when treatment efficacy is expressed in varying mathematically equivalent ways. OBJECTIVES To assess: (1) how patient and provider compliance with osteoporosis CPGs varies when pharmacotherapy efficacy is presented as relative risk reduction (RRR) versus absolute risk reduction (ARR) and (2) the impact of increasing out-of-pocket drug expenditures on acceptance of guideline concordant therapy. DESIGN Cross-sectional survey of patients and physicians. SUBJECTS AND SETTING Female patients age >50 years and providers drawn from academic and community outpatient clinics. MEASUREMENTS Patient and provider acceptance of pharmacotherapy when treatment efficacy (reduction in hip fractures) was expressed alternatively in relative terms (35% RRR) versus absolute terms (1% ARR); acceptance of pharmacotherapy as patient drug copayment increased from 0% to 100% of the total drug costs. RESULTS Compliance with CPGs fell significantly when the expression of treatment benefit was switched from RRR to ARR for both patients (86% vs 57% compliance; P < .001) and physicians (97% vs 56% compliance; P < .001). Increasing drug copayment from 0% to 10% of total drug cost decreased patient compliance with CPGs from 80% to 57% (P < .001) but did not impact physician compliance. With increasing levels of copay, both patient and provider interest in treatment decreased. LIMITATIONS Respondents may not have fully understood the risks and benefits associated with osteoporosis and its treatment. CONCLUSION Patient and provider interest in CPG-recommended treatment for osteoporosis is reduced when treatment benefit is expressed as ARR rather than RRR. In addition, minimal increases in drug copayment significantly decreased patient, but not provider, interest in osteoporosis treatment. Designers of P4P programs should

  7. Ethical principles for physician rating sites.

    PubMed

    Strech, Daniel

    2011-12-06

    During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites' effects on physicians' performance, patient outcomes, or the public's trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians' performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician-patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial harms for

  8. Today's Physicians Seek Career Direction.

    ERIC Educational Resources Information Center

    Morgan-Haker, Veronica R.

    1998-01-01

    Changes in the role of the physician in today's society have made their career choices risky. Career specialists have an opportunity to assist those who do not normally seek career advice outside their own profession. (JOW)

  9. Social media: physicians-to-physicians education and communication.

    PubMed

    Fehring, Keith A; De Martino, Ivan; McLawhorn, Alexander S; Sculco, Peter K

    2017-06-01

    Physician to physician communication is essential for the transfer of ideas, surgical experience, and education. Social networks and online video educational contents have grown exponentially in recent years changing the interaction among physicians. Social media platforms can improve physician-to-physician communication mostly through video education and social networking. There are several online video platforms for orthopedic surgery with educational content on diagnosis, treatment, outcomes, and surgical technique. Social networking instead is mostly centered on sharing of data, discussion of confidential topics, and job seeking. Quality of educational contents and data confidentiality represent the major drawbacks of these platforms. Orthopedic surgeons must be aware that the quality of the videos should be better controlled and regulated to avoid inaccurate information that may have a significant impact especially on trainees that are more prone to use this type of resources. Sharing of data and discussion of confidential topics should be extremely secure according the HIPAA regulations in order to protect patients' confidentiality.

  10. Physician groups' use of data from patient experience surveys.

    PubMed

    Friedberg, Mark W; SteelFisher, Gillian K; Karp, Melinda; Schneider, Eric C

    2011-05-01

    In Massachusetts, physician groups' performance on validated surveys of patient experience has been publicly reported since 2006. Groups also receive detailed reports of their own performance, but little is known about how physician groups have responded to these reports. To examine whether and how physician groups are using patient experience data to improve patient care. During 2008, we conducted semi-structured interviews with the leaders of 72 participating physician groups (out of 117 groups receiving patient experience reports). Based on leaders' responses, we identified three levels of engagement with patient experience reporting: no efforts to improve (level 1), efforts to improve only the performance of low-scoring physicians or practice sites (level 2), and efforts to improve group-wide performance (level 3). Groups' level of engagement and specific efforts to improve patient care. Forty-four group leaders (61%) reported group-wide improvement efforts (level 3), 16 (22%) reported efforts to improve only the performance of low-scoring physicians or practice sites (level 2), and 12 (17%) reported no performance improvement efforts (level 1). Level 3 groups were more likely than others to have an integrated medical group organizational model (84% vs. 31% at level 2 and 33% at level 1; P < 0.005) and to employ the majority of their physicians (69% vs. 25% and 20%; P < 0.05). Among level 3 groups, the most common targets for improvement were access, communication with patients, and customer service. The most commonly reported improvement initiatives were changing office workflow, providing additional training for nonclinical staff, and adopting or enhancing an electronic health record. Despite statewide public reporting, physician groups' use of patient experience data varied widely. Integrated organizational models were associated with greater engagement, and efforts to enhance clinicians' interpersonal skills were uncommon, with groups predominantly focusing

  11. Introduction of the patient-list system in general practice. Changes in Norwegian physicians' perception of their gatekeeper role.

    PubMed

    Carlsen, Benedicte; Norheim, Ole Frithjof

    2003-12-01

    To explore whether the patient-list system, recently introduced in general practice, has influenced general practitioners' (GPs') self-perception as gatekeepers. Structured focus group interviews with GPs and a short self-administered questionnaire. Primary care within the public health care system in Norway. Group interviews were conducted 6 months to 1 year after the patient-list system was introduced in June, 2001. 81 GPs attending tutorial groups or specialists' continuous education groups. GPs' experience with the reform as stated in 11 group discussions, recorded, transcribed and systematically analysed through coding and extracting of the informants' statements. The questionnaire provided background information about each participant. The doctors generally perceived themselves as less concerned with the gatekeeper role under the new system. They felt it more important to provide better services and keep patients satisfied. The practitioners explained this shift using three contextual factors: increased and more visible competition, higher expectations from the patients and more responsibility assigned to the GP. GPs in Norway have experienced a shift in power in the physician-patient relationship favouring the patient. The GP's consciousness of the gatekeeper role has diminished. We question whether the new system lessens the incentive to consider resource use in decision-making.

  12. Forecasting the absolute and relative shortage of physicians in Japan using a system dynamics model approach.

    PubMed

    Ishikawa, Tomoki; Ohba, Hisateru; Yokooka, Yuki; Nakamura, Kozo; Ogasawara, Katsuhiko

    2013-08-27

    In Japan, a shortage of physicians, who serve a key role in healthcare provision, has been pointed out as a major medical issue. The healthcare workforce policy planner should consider future dynamic changes in physician numbers. The purpose of this study was to propose a physician supply forecasting methodology by applying system dynamics modeling to estimate future absolute and relative numbers of physicians. We constructed a forecasting model using a system dynamics approach. Forecasting the number of physician was performed for all clinical physician and OB/GYN specialists. Moreover, we conducted evaluation of sufficiency for the number of physicians and sensitivity analysis. As a result, it was forecast that the number of physicians would increase during 2008-2030 and the shortage would resolve at 2026 for all clinical physicians. However, the shortage would not resolve for the period covered. This suggests a need for measures for reconsidering the allocation system of new entry physicians to resolve maldistribution between medical departments, in addition, for increasing the overall number of clinical physicians.

  13. Understanding the business of employed physician practices.

    PubMed

    Sanford, Kathleen D

    2013-09-01

    Health system leaders should understand issues related to finance, compliance, human resources, quality, and safety in their employed physician practices to better support the success of these practices. New business and payment models are driving operational changes in physician offices. Catholic Health Initiatives (CHI) has added new system roles and responsibilities to oversee physician practices.

  14. Application of the Theoretical Domains Framework and the Behaviour Change Wheel to Understand Physicians' Behaviors and Behavior Change in Using Temporary Work Modifications for Return to Work: A Qualitative Study.

    PubMed

    Horppu, Ritva; Martimo, K P; MacEachen, E; Lallukka, T; Viikari-Juntura, E

    2017-04-08

    Purpose Applying the theoretical domains framework (TDF) and the Behaviour Change Wheel (BCW) to understand physicians' behaviors and behavior change in using temporary work modifications (TWMs) for return to work (RTW). Methods Interviews and focus group discussions were conducted with 15 occupational physicians (OPs). Responses were coded using the TDF and the BCW. Results Key behaviors related to applying TWMs were initiating the process with the employee, making recommendations to the workplace, and following up the process. OP behaviors were influenced by several factors related to personal capability and motivation, and opportunities provided by the physical and social environment. Capability comprised relevant knowledge and skills related to applying TWMs, remembering to initiate TWMS and monitor the process, and being accustomed to reflective practice. Opportunity comprised physical resources (e.g., time, predefined procedures, and availability of modified work at companies), and social pressure from stakeholders. Motivation comprised conceptions of a proper OP role, confidence to carry out TWMs, personal RTW-related goals, beliefs about the outcomes of one's actions, feedback received from earlier cases, and feelings related to applying TWMs. OPs' perceived means to target these identified factors were linked to the following BCW intervention functions: education, training, persuasion, environmental restructuring, and enablement. The results suggest that at least these functions should be considered when designing future interventions. Conclusions Our study illustrates how theoretical frameworks TDF and BCW can be utilized in a RTW context to understand which determinants of physicians' behavior need to be targeted, and how, to promote desired behaviors.

  15. Medical interviewing by exemplary family physicians.

    PubMed

    Marvel, M K; Doherty, W J; Weiner, E

    1998-11-01

    Little is known about the extent to which models of ideal physician-patient interviews are actually practiced by physicians. This study examined physician-patient communication during medical interviews by exemplary family physicians. We performed a cross-sectional study of verbal exchanges using 300 transcripts of office visits made to two groups of family physicians: 9 exemplars and 20 controls. The exemplars were family physicians with fellowship training in family therapy; the control group consisted of a convenience sample of board-certified family physicians with no special training in communication skills or counseling. Data were collected from June 1995 to July 1996. Physician statements were rated according to the Level of Physician Involvement model, which measures physicians' abilities to collaborate with patients and address the psychosocial concerns of patients and their families. Patient satisfaction ratings were obtained by a research assistant immediately after the visit. Compared with the control physicians, the exemplars showed higher levels of psychosocial involvement with patients during routine office visits. In particular, they involved patients more in the medical interview, offered more emotional support, and showed more family involvement. Despite this greater depth of involvement, the length of office visits did not differ between the two physician groups. Our findings show that exemplars were more involved with their patients and provided more family-oriented care than community physicians. Exemplars routinely applied a biopsychosocial approach, collaborating with patients and addressing psychosocial topics without sacrificing efficiency, while community physicians focused on biomedical issues.

  16. Prerequisite Change and Its Effect on Intermediate Accounting Performance

    ERIC Educational Resources Information Center

    Huang, Jiunn; O'Shaughnessy, John; Wagner, Robin

    2005-01-01

    As of Fall 1996, San Francisco State University changed its introductory financial accounting course to focus on a "user's" perspective, de-emphasizing the accounting cycle. Anticipating that these changes could impair subsequent performance, the Department of Accounting instituted a new prerequisite for intermediate accounting: Students would…

  17. Prerequisite Change and Its Effect on Intermediate Accounting Performance

    ERIC Educational Resources Information Center

    Huang, Jiunn; O'Shaughnessy, John; Wagner, Robin

    2005-01-01

    As of Fall 1996, San Francisco State University changed its introductory financial accounting course to focus on a "user's" perspective, de-emphasizing the accounting cycle. Anticipating that these changes could impair subsequent performance, the Department of Accounting instituted a new prerequisite for intermediate accounting: Students would…

  18. Burnout among physicians

    PubMed Central

    Romani, Maya; Ashkar, Khalil

    2014-01-01

    Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to cognitive-behavioral and patient-centered therapy have been found to be of utmost significance when it comes to preventing and treating burnout. However, evidence is insufficient to support that stress management programs can help reducing job-related stress beyond the intervention period, and similarly mindfulness-based stress reduction interventions efficiently reduce psychological distress and negative vibes, and encourage empathy while significantly enhancing physicians’ quality of life. On the other hand, a few small studies have suggested that Balint sessions can have a promising positive effect in preventing burnout; moreover exercises can reduce anxiety levels and exhaustion symptoms while improving the mental and physical well-being of healthcare workers. Occupational interventions in the work settings can also improve the emotional and work-induced exhaustion. Combining both individual and organizational interventions can have a good impact in reducing burnout scores among physicians; therefore, multidisciplinary actions that include changes in the work environmental factors along with stress management programs that teach people how to cope better with stressful events showed promising solutions to manage burnout. However, until now there have been no rigorous studies to prove this. More interventional research targeting medical students, residents, and practicing physicians are needed in order to improve psychological well-being, professional careers, as well as

  19. Assessing a group of physicians' ethical sensitivity in Turkey.

    PubMed

    Cetin, M; Cimen, M

    2011-01-01

    The objective was to measure the sensitivity of a group of physicians regarding the ethics-related situations, which they faced during patient care and treatment. All of 306 physicians who joined the Turkish Army for compulsory military service in December 2008 were included in the study. A "Moral Sensitivity Questionnaire", formed by Kim Lutzen, was applied to all of them. From total, 95% of physicians performed their job willingly, 88% of physicians attended ethic lessons (n=265), 72.4% (n=218) followed ethic publications, 67.4% (n=203) stated that there was an ethic committee at their institutions, and 5% worked as a member of the ethic committee. There were statistically significant differences between autonomy, benevolence meaning, conflict, and total scores according to workplace of physicians, employment period, and being specialists. Points of autonomy were found lower in physicians working at private hospital and health center than those at public hospital. Ethical sensitivity of physicians changed due to work place. We conclude that organizational arrangements are of beneficial effects to increase ethical sensitivity.

  20. The Association between Medical Education Accreditation and Examination Performance of Internationally Educated Physicians Seeking Certification in the United States

    ERIC Educational Resources Information Center

    van Zanten, Marta; Boulet, John R.

    2013-01-01

    The purposes of this research were to examine medical education accreditation practices around the world, with special focus on the Caribbean, and to explore the association between medical school accreditation and graduates' examination performance. In addition to other requirements, graduates of international medical schools seeking to enter…

  1. The Association between Medical Education Accreditation and the Examination Performance of Internationally Educated Physicians Seeking Certification in the United States

    ERIC Educational Resources Information Center

    van Zanten, Marta

    2012-01-01

    Background: The purpose of the first phase of the present research was to examine medical education accreditation practices around the world, with special focus on the Caribbean region, to determine the association of accreditation of medical schools with student/graduate performance on examinations. The aim of the second phase of this research…

  2. The Association between Medical Education Accreditation and Examination Performance of Internationally Educated Physicians Seeking Certification in the United States

    ERIC Educational Resources Information Center

    van Zanten, Marta; Boulet, John R.

    2013-01-01

    The purposes of this research were to examine medical education accreditation practices around the world, with special focus on the Caribbean, and to explore the association between medical school accreditation and graduates' examination performance. In addition to other requirements, graduates of international medical schools seeking to enter…

  3. Performing Environmental Change: MED Theatre and the Changing Face of Community-Based Performance Research

    ERIC Educational Resources Information Center

    Schaefer, Kerrie

    2012-01-01

    This article examines a programme of work produced by community-based theatre company, Manaton and East Dartmoor (MED) Theatre, addressing issues of climate change as they impact on life in rural Devon, UK. After some discussion of MED Theatre's constitution as a community-based company and the group's long-term engagement with the place, history,…

  4. Performing Environmental Change: MED Theatre and the Changing Face of Community-Based Performance Research

    ERIC Educational Resources Information Center

    Schaefer, Kerrie

    2012-01-01

    This article examines a programme of work produced by community-based theatre company, Manaton and East Dartmoor (MED) Theatre, addressing issues of climate change as they impact on life in rural Devon, UK. After some discussion of MED Theatre's constitution as a community-based company and the group's long-term engagement with the place, history,…

  5. Academic Performance of Students in an Accelerated Baccalaureate/MD Program: Implications for Alternative Physician Education Pathways.

    PubMed

    Green, Marianne M; Welty, Leah; Thomas, John X; Curry, Raymond H

    2016-02-01

    Over one-third of U.S. medical schools offer combined baccalaureate/MD (BA/MD) degree programs. A subset of these truncate the premedical phase, reducing total time to the MD degree. Data comparing educational outcomes of these programs with those of conventional pathways are limited. The authors reviewed demographic characteristics and medical school performance of all 2,583 students entering Northwestern University Feinberg School of Medicine from 1999 to 2013, comparing students in the Honors Program in Medical Education (HPME), an accelerated seven-year program, versus non-HPME medical students. They evaluated Alpha Omega Alpha (AOA) selection, quintile performance distribution from the Medical Student Performance Evaluation, United States Medical Licensing Examination (USMLE) scores, and Match outcomes. A total of 560 students (21.7%) entered through the HPME. HPME students were on average 2.2 years younger and less likely (15/537 [2.8%] versus 285/1,833 [15.5%]) to belong to a racial/ethnic group underrepresented in medicine. There were no significant differences in AOA selection, quintile performance distribution, or USMLE scores. More HPME students entered internal medicine (161/450 [35.8%] versus 261/1,265 [20.6%]), and fewer chose emergency medicine (25/450 [5.6%] versus 110/1,265 [8.7%]) and obstetrics-gynecology (9/450 [2.0%] versus 67/1,265 [5.3%]). The academic performances of medical students in the two programs studied were equivalent. Accelerated BA/MD programs might play a role in ameliorating the length and cost of a medical education. The academic success of these students absent the usual emphasis on undergraduate GPA and Medical College Admission Test scores supports efforts to redefine medical student selection criteria.

  6. Changing surgical practice through feedback of performance data.

    PubMed

    Reilly, Jacqueline; McIntosh, Jean; Currie, Kay

    2002-06-01

    Changing health care practice is commonly attempted by feedback of performance data measured by clinical audit. However, empirical evidence of the effectiveness of clinical audit in changing practice is limited. Few studies have attempted to evaluate practice development or clinical outcomes within the conceptual framework of change theory. Several published studies have used passive feedback in an attempt to promote a change in practice. Sending information to health care workers on their performance is one of the simplest ways of attempting to change performance. To evaluate the impact on infection rates of the passive feedback of surgical wound infection rate data to nurses and surgeons within an empirical rational approach to change, and the active feedback of data within a normative re-educative approach to change. A prospective cohort study over a 3-year period of all surgical patients undergoing clean elective surgery (n = 2241). Patients were monitored whilst an inpatient and up to 30 days postoperatively by an independent observer to determine surgical wound infection rates. The method employed was 'gold standard' surveillance, whereby patients were followed up into the community setting. Interventions of feedback and withdrawal of feedback of infection rate data and introduction of guidelines for evidence-based surgical practice within a change theory framework were monitored by the incidence of infection during the periods of the particular intervention. Although the feedback of infection rate data impacted on the subsequent infection rates, the reduction was not statistically significant. However, a significant reduction in the infection rates was achieved following the introduction of guidelines for best surgical practice (P < 0.05). The findings indicate that if change in practice is to be achieved by the feedback of performance data, then the process of feedback should be active and within a normative re-educative approach to change.

  7. Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey

    PubMed Central

    2013-01-01

    Background In a mass casualty situation, medical personnel must rapidly assess and prioritize patients for treatment and transport. Triage is an important tool for medical management in disaster situations. Lack of common international and Swedish triage guidelines could lead to confusion. Attending the Advanced Trauma Life Support (ATLS) provider course is becoming compulsory in the northern part of Europe. The aim of the ATLS guidelines is provision of effective management of single critically injured patients, not mass casualties incidents. However, the use of the ABCDE algorithms from ATLS, has been proposed to be valuable, even in a disaster environment. The objective for this study was to determine whether the mnemonic ABCDE as instructed in the ATLS provider course, affects the ability of Swedish physician’s to correctly triage patients in a simulated mass casualty incident. Methods The study group included 169 ATLS provider students from 10 courses and course sites in Sweden; 153 students filled in an anonymous test just before the course and just after the course. The tests contained 3 questions based on overall priority. The assignment was to triage 15 hypothetical patients who had been involved in a bus crash. Triage was performed according to the ABCDE algorithm. In the triage, the ATLS students used a colour-coded algorithm with red for priority 1, yellow for priority 2, green for priority 3 and black for dead. The students were instructed to identify and prioritize 3 of the most critically injured patients, who should be the first to leave the scene. The same test was used before and after the course. Results The triage section of the test was completed by 142 of the 169 participants both before and after the course. The results indicate that there was no significant difference in triage knowledge among Swedish physicians who attended the ATLS provider course. The results also showed that Swedish physicians have little experience of real mass

  8. A Descriptive Analysis of Changes in Selected Drug Groups Available to Primary Care Physicians in Israel From 2000 to 2013.

    PubMed

    Treister-Goltzman, Yulia; Peleg, Roni

    Several medical and economic factors affect the process of development and introduction of new drugs and the disappearance of various medical agents from the drug market. There are no data in the existing literature on quantitative and qualitative changes in the drug market. We assessed changes in the drug market in Israel over 14 years, focusing on drug groups that, in our subjective opinion, are mainly used in primary care medicine: pain medications, lipid lowering agents, drugs for diabetes, and antihypertensives. We assessed volume of drugs and changes and trends in terms of therapeutic efficacy and safety in selected drugs in each of the groups over the study time period. We used the Medic Compendium for the analyses. Medic contains a listing of drugs that are approved and available for use in Israel. It is updated every 2 months. In 2000, there were 253 available drugs in the study groups that contained 124 active agents. In contrast, in 2013, there were 278 available drugs that contained 130 active agents. Over the study years, there was an increase in the number of drugs that are effective, "user friendly," and have a high safety profile. Our study provides the first data on quantitative and qualitative changes that have taken place in selected groups of drugs. Although the availability of the drugs in different countries is determined by multiple factors, we assumed that there are other countries with a similar situation in terms of their drug markets.

  9. Relation Between Physicians' Work Lives and Happiness.

    PubMed

    Eckleberry-Hunt, Jodie; Kirkpatrick, Heather; Taku, Kanako; Hunt, Ronald; Vasappa, Rashmi

    2016-04-01

    Although we know much about work-related physician burnout and the subsequent negative effects, we do not fully understand work-related physician wellness. Likewise, the relation of wellness and burnout to physician happiness is unclear. The purpose of this study was to examine how physician burnout and wellness contribute to happiness. We sampled 2000 full-time physician members of the American Academy of Family Physicians. Respondents completed a demographics questionnaire, questions about workload, the Physician Wellness Inventory, the Maslach Burnout Inventory, and the Subjective Happiness Scale. We performed a hierarchical regression analysis with the burnout and wellness subscales as predictor variables and physician happiness as the outcome variable. Our response rate was 22%. Career purpose, personal accomplishment, and perception of workload manageability had significant positive correlations with physician happiness. Distress had a significant negative correlation with physician happiness. A sense of career meaning and accomplishment, along with a lack of distress, are important factors in determining physician happiness. The number of hours a physician works is not related to happiness, but the perceived ability to manage workload was significantly related to happiness. Wellness-promotion efforts could focus on assisting physicians with skills to manage the workload by eliminating unnecessary tasks or sharing workload among team members, improving feelings of work accomplishment, improving career satisfaction and meaning, and managing distress related to patient care.

  10. Evaluating the effect of Japan's 2004 postgraduate training programme on the spatial distribution of physicians.

    PubMed

    Sakai, Rie; Tamura, Hiroshi; Goto, Rei; Kawachi, Ichiro

    2015-01-24

    In 2004, the Japanese government permitted medical graduates for the first time to choose their training location directly through a national matching system. While the reform has had a major impact on physicians' placement, research on the impact of the new system on physician distribution in Japan has been limited. In this study, we sought to examine the determinants of physicians' practice location choice, as well as factors influencing their geographic distribution before and after the launch of Japan's 2004 postgraduate medical training programme. We analyzed secondary data. The dependent variable was the change in physician supply at the secondary tier of medical care in Japan, a level which is roughly comparable to a Hospital Service Area in the US. Physicians were categorized into two groups according to the institutions where they practiced; specifically, hospitals and clinics. We considered the following predictors of physician supply: ratio of physicians per 1,000 population (physician density), age-adjusted mortality, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. Baseline physician density showed a positive association with the change in physician supply after the launch of the 2004 programme (P-value < .001), whereas no such effect was found before 2004. Urban locations were inversely associated with the change in physician supply before 2004 (P-value = .026), whereas a positive association was found after 2004 (P-value < .001). Urban location and area-level socioeconomic status were positively correlated with the change in hospital physician supply after 2004 (P-values < .001 for urban centre, and .025 for area-level socioeconomic status), even though in the period prior to the 2004 training scheme, urban location was inversely associated with the change in physician supply

  11. The migration of physicians and the local supply of practitioners: a five-year comparison.

    PubMed

    Ricketts, Thomas C

    2013-12-01

    The overall distribution of physicians in the United States is uneven, with concentrations in urban areas while some rural places have proportionately very few. This report examines the movement of physicians who have completed their training and choose to move from one location to another. The analysis linked the locations of practice of physicians practicing in the 50 U.S. states in 2006 and 2011 using data from the American Medical Association Physician Masterfile. Age, gender, location practice, activity status, and specialty were included in the data. Physicians who changed address in the five-year period were identified and were compared with nonmovers using descriptive statistics. A summary logistic regression of movers compared with nonmovers was performed to assess the most important correlates of migration. The overall rate of county-to-county relocation for physicians was 19.8% for the five-year period 2006-2011. Analyses indicated that older, male, and urban physicians were less likely to move; that physicians with osteopathic training were more likely to move; and that surgeons and primary care physicians were less likely to move compared with other specialists. The physician workforce in the United States migrates from place to place, and this movement determines the local supply of practitioners at any given time. Programs that intend to influence the local supply of doctors should account for this background tendency to relocate practice in order to achieve goals of more equal geographic distribution.

  12. Predictive value of preoperative digital templating in THA depends on the surgical experience of the performing physician.

    PubMed

    Mittag, Falk; Ipach, Ingmar; Schaefer, Ralf; Meisner, Christoph; Leichtle, Ulf

    2012-02-17

    Digital preoperative templating is increasingly used to predict the correct component size in total hip arthroplasty (THA). Experienced surgeons could avoid the new technique and rely on a digital template done by a younger colleague. We compared the accuracy of preoperative templating between orthopedic residents (group A) and an experienced orthopedic surgeon (group B). In 106 cases, the software-predicted component sizes of both groups were compared with component sizes placed surgically. An accurate prediction of the acetabular component was achieved in 63% of cases in group A compared with 88% of cases in group B (P=.001). Concerning the femoral component, accurate prediction was achieved in 89% in group A and 97% in group B (P=.021). If performed by an experienced orthopedic surgeon, digital templating is an accurate method to predict the prosthetic component size in THA. Copyright 2012, SLACK Incorporated.

  13. The feasibility of nurse practitioner-performed, telementored lung telesonography with remote physician guidance - ‘a remote virtual mentor’

    PubMed Central

    2013-01-01

    Background Point-of-care ultrasound (POC-US) use is increasingly common as equipment costs decrease and availability increases. Despite the utility of POC-US in trained hands, there are many situations wherein patients could benefit from the added safety of POC-US guidance, yet trained users are unavailable. We therefore hypothesized that currently available and economic ‘off-the-shelf’ technologies could facilitate remote mentoring of a nurse practitioner (NP) to assess for recurrent pneumothoraces (PTXs) after chest tube removal. Methods The simple remote telementored ultrasound system consisted of a handheld ultrasound machine, head-mounted video camera, microphone, and software on a laptop computer. The video output of the handheld ultrasound machine and a macroscopic view of the NP's hands were displayed to a remote trauma surgeon mentor. The mentor instructed the NP on probe position and US machine settings and provided real-time guidance and image interpretation via encrypted video conferencing software using an Internet service provider. Thirteen pleural exams after chest tube removal were conducted. Results Thirteen patients (26 lung fields) were examined. The remote exam was possible in all cases with good connectivity including one trans-Atlantic interpretation. Compared to the subsequent upright chest radiograph, there were 4 true-positive remotely diagnosed PTXs, 2 false-negative diagnoses, and 20 true-negative diagnoses for 66% sensitivity, 100% specificity, and 92% accuracy for remotely guided chest examination. Conclusions Remotely guiding a NP to perform thoracic ultrasound examinations after tube thoracostomy removal can be simply and effectively performed over encrypted commercial software using low-cost hardware. As informatics constantly improves, mentored remote examinations may further empower clinical care providers in austere settings. PMID:23805869

  14. Environmental context change affects memory for performed actions.

    PubMed

    Sahakyan, Lili

    2010-03-01

    The current study investigated the effect of environmental context change between the study and test on the recall of action phrases that either were performed during encoding (subject-performed tasks, SPTs) or were verbally encoded (verbal tasks, VTs). Both SPTs and VTs showed the same magnitude of impaired recall when the study and test contexts mismatched. Furthermore, changing the context between the two study lists reduced cross-list intrusion errors compared to encoding the lists in the same context. Both SPTs and VTs benefited from studying the lists in different contexts as evidenced by reduced intrusions. Taken together, the results suggest that SPTs are integrated with their context because they suffered when context changed between the study and test, and they also benefited when they were performed in two environments versus the same environment.

  15. Movement amplitude and tempo change in piano performance

    NASA Astrophysics Data System (ADS)

    Palmer, Caroline

    2004-05-01

    Music performance places stringent temporal and cognitive demands on individuals that should yield large speed/accuracy tradeoffs. Skilled piano performance, however, shows consistently high accuracy across a wide variety of rates. Movement amplitude may affect the speed/accuracy tradeoff, so that high accuracy can be obtained even at very fast tempi. The contribution of movement amplitude changes in rate (tempo) is investigated with motion capture. Cameras recorded pianists with passive markers on hands and fingers, who performed on an electronic (MIDI) keyboard. Pianists performed short melodies at faster and faster tempi until they made errors (altering the speed/accuracy function). Variability of finger movements in the three motion planes indicated most change in the plane perpendicular to the keyboard across tempi. Surprisingly, peak amplitudes of motion before striking the keys increased as tempo increased. Increased movement amplitudes at faster rates may reduce or compensate for speed/accuracy tradeoffs. [Work supported by Canada Research Chairs program, HIMH R01 45764.

  16. Managed care relationships from the physician's perspective.

    PubMed

    Mack, J M

    1993-01-01

    In response to health care reform proposals as well as health plans, hospitals and individual physicians are affiliating into models that will favorably position them in the evolving managed care marketplace. The development of integrated delivery vehicles requires a merging of physician and hospital cultures. To manage this process the relationship between hospitals and physicians must receive the greatest attention. This chapter describes physician perceptions of specific aspects in the evolving managed care marketplace. Understanding reactions to various initiatives will enable readers to overcome resistance to change and improve their managed care relationships with physicians.

  17. Doctors for the world: Indian physician emigration.

    PubMed

    Mullan, Fitzhugh

    2006-01-01

    Almost 60,000 Indian physicians practice in the United States, United Kingdom, Canada, and Australia--a workforce equal to 10 percent of the physicians in India and the largest émigré physician workforce in the world. I traveled to India to interview leaders in medical education, health policy, and public health, to better characterize and understand Indian physician emigration. A changing political and policy environment in India is raising new questions about what might be done to keep more of India's physicians at home.

  18. Ethical Principles for Physician Rating Sites

    PubMed Central

    2011-01-01

    During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites’ effects on physicians’ performance, patient outcomes, or the public’s trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians’ performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician–patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial

  19. Analysis of lawsuits filed against emergency physicians for point-of-care emergency ultrasound examination performance and interpretation over a 20-year period.

    PubMed

    Blaivas, Michael; Pawl, Richard

    2012-02-01

    The study aims to define extent of lawsuits filed against emergency physicians (EPs) over point-of-care emergency ultrasound (US) during the last 20 years. We performed a nationwide search of the WESTLAW legal database for filed lawsuits involving EPs and US. WESTLAW covers all state and federal lawsuits dating back to 1939. Using an electronic search feature, all states were searched using emergency and US as key words. The database automatically accounts for different variants on US such as sonography. An attorney who is also boarded in and practices emergency medicine, as well as an emergency US expert, reviewed returned cases. Descriptive statistics were used to evaluate the data. Using the search criteria and excluding obvious radiology suits, 659 cases were returned and reviewed. There were no cases of EPs being sued for performance or interpretation of point-of-care US. There was one case alleging EP failure to perform point-of-care US and diagnose an ectopic before it ruptured. This case was won by the defense. There were no cases against EPs for common causes of radiology and obstetric litigation including sexual assault during endovaginal US. Cases of missed testicular torsion on US were frequent in the emergency setting but none linked EP US. Only one case filed against EPs over the last 2 decades was identified, it was over failure to perform US. Most frequent litigations against radiologists and obstetricians are unlikely to be duplicated in the emergency department, and future litigations may also come from EP failure to perform point-of-care US. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Physicians' and Nurse Practitioners' Level of Pessimism About End-of-Life Care During Training: Does It Change Over Time?

    PubMed

    Long, Ann C; Downey, Lois; Engelberg, Ruth A; Ford, Dee W; Back, Anthony L; Curtis, J Randall

    2016-05-01

    An enhanced understanding of trainee attitudes about end-of-life care is needed to inform interventions to improve clinician communication about dying and death. To examine changes in trainee pessimism about end-of-life care over the course of one academic year and to explore predictors of pessimism among residents, fellows, and nurse practitioners. We used baseline and follow-up surveys completed by trainees during a randomized controlled trial of an intervention to improve clinician communication skills. Surveys addressed trainee feelings about end-of-life care. Latent variable modeling was used to identify indicators of trainee pessimism, and this pessimism construct was used to assess temporal changes in trainee attitudes about end-of-life care. We also examined predictors of trainee pessimism at baseline and follow-up. Data were available for 383 trainees from two training programs. There was a significant decrease in pessimism between baseline and follow-up assessments. Age had a significant inverse effect on baseline pessimism, with older trainees being less pessimistic. There was a direct association of race/ethnicity on pessimism at follow-up, with greater pessimism among minority trainees (P = 0.028). The model suggests that between baseline and follow-up, pessimism among younger white non-Hispanic trainees decreased, whereas pessimism among younger trainees in racial/ethnic minorities increased over the same period. Overall, trainee pessimism about end-of-life care decreases over time. Pessimism about end-of-life care among minority trainees may reflect the influence of culture on clinician attitudes about communication with seriously ill patients. Further research is needed to understand the evolution of trainee attitudes about end-of-life care during clinical training. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  1. Aligning physician compensation with strategic goals.

    PubMed

    Bunkers, Brian; Koch, Mark; McDonough, Becky; Whited, Brian

    2014-07-01

    In 2012, Mayo Clinic Health System (MCHS) had 13 different physician compensation models among its operating units, with most based on productivity metrics. MCHS aimed to transition all physicians to a single compensation model that would facilitate its integration with Mayo Clinic and promote physician engagement with emerging value-based payment models. The new model, which was implemented this past January, incorporates quality metrics, provides physicians with regular reports of their performance, and already has resulted in greater physician attention to outcomes, safety, and patient experience.

  2. Physiological Factors Contributing to Postflight Changes in Functional Performance

    NASA Technical Reports Server (NTRS)

    Bloomberg, J. J.; Feedback, D. L.; Feiverson, A. H.; Lee, S. M. C.; Mulavara, A. P.; Peters, B. T.; Platts, S. H.; Reschke, M. F.; Ryder, J.; Spiering, B. A.; Stenger, M. B.; Wood, S.; Lawrence, E.; Arzeno, N.

    2009-01-01

    Astronauts experience alterations in multiple physiological systems due to exposure to the microgravity conditions of space flight. These physiological changes include sensorimotor disturbances, cardiovascular deconditioning and loss of muscle mass and strength. These changes might affect the ability of crewmembers to perform critical mission tasks immediately after landing on lunar and Martian surfaces. To date, changes in functional performance have not been systematically studied or correlated with physiological changes. To understand how changes in physiological function impact functional performance an interdisciplinary pre/postflight testing regimen (Functional Task Test, FTT) has been developed that systematically evaluates both astronaut postflight functional performance and related physiological changes. The overall objectives of the FTT are to: Develop a set of functional tasks that represent critical mission tasks for Constellation. Determine the ability to perform these tasks after flight. Identify the key physiological factors that contribute to functional decrements. Use this information to develop targeted countermeasures. The functional test battery was designed to address high priority tasks identified by the Constellation program as critical for mission success. The set of functional tests making up the FTT include the: 1) Seat Egress and Walk Test, 2) Ladder Climb Test, 3) Recovery from Fall/Stand Test, 4) Rock Translation Test, 5) Jump Down Test, 6) Torque Generation Test, and 7) Construction Activity Board Test. Corresponding physiological measures include assessments of postural and gait control, dynamic visual acuity, fine motor control, plasma volume, orthostatic intolerance, upper and lower body muscle strength, power, fatigue, control and neuromuscular drive. Crewmembers will perform both functional and physiological tests before and after short (Shuttle) and long-duration (ISS) space flight. Data will be collected on R+0 (Shuttle only), R

  3. [Dangerous liaisons--physicians and pharmaceutical sales representatives].

    PubMed

    Granja, Mónica

    2005-01-01

    Interactions between physicians and detailers (even when legitimate ones) raise scientific and ethical questions. In Portugal little thinking and discussion has been done on the subject and the blames for bribery have monopolized the media. This work intended to review what has been said in medical literature about these interactions. How do physicians see themselves when interacting with pharmaceutical companies and their representatives? Do these companies in fact change their prescriptive behaviour, and, if so, how do they change it? How can physicians interact with detailers and still keep their best practice? A Medline research, from 1966 till 2002, was performed using the key-words as follows. A database similar to Medline but concerning medical journals published in Portugal, Index das Revistas Médicas Portuguesas, was also researched from 1992 to 2002. Pharmaceutical companies are profit bound and they allot promoting activities, and detailing in particular, huge amounts of money. Most physicians hold firmly to the belief that they are able to resist and not be influenced by drug companies promotion activities. Nevertheless, all previous works on literature tell us the opposite. Market research also indicates that detailers effectively promote drug sales. Various works also suggest that the information detailers provide to physicians may be largely incorrect, even comparing it to the written information provided by the pharmaceutical companies they work for. The frequency at which portuguese physicians (especially family physicians) contact with pharmaceutical sales representatives is higher than the frequency reported in countries where the available studies come from (namely, Canada and the United States of America). This may put portuguese physicians at a higher risk, making it imperative that work and wide debate are initiated among the class.

  4. Quantitative and Qualitative Change in Children's Mental Rotation Performance

    ERIC Educational Resources Information Center

    Geiser, Christian; Lehmann, Wolfgang; Corth, Martin; Eid, Michael

    2008-01-01

    This study investigated quantitative and qualitative changes in mental rotation performance and solution strategies with a focus on sex differences. German children (N = 519) completed the Mental Rotations Test (MRT) in the 5th and 6th grades (interval: one year; age range at time 1: 10-11 years). Boys on average outperformed girls on both…

  5. Physician transition plans: planning for physician slowdown.

    PubMed

    Walker Keegan, Deborah

    2008-01-01

    Transition is a natural progression for physicians in a medical practice. At some point, at least one physician will seek to deviate from the work norm of the group, either due to retirement, need for part-time status, or other reason. Medical practices that have a formal transition plan in place have a competitive advantage over other practices in terms of physician recruitment and retention. Not only do the formal transition plans permit physicians to proactively plan for work slowdown, but they also permit the medical practice to ensure its financial health and effectively position itself for the future. Key issues addressed in physician transition plans include governance, continuity of care, eligibility, time limits, on-call schedules, practice overhead, and physician compensation.

  6. Use of an outpatient medical record audit to achieve educational objectives: changes in residents' performances over six years.

    PubMed

    Kern, D E; Harris, W L; Boekeloo, B O; Barker, L R; Hogeland, P

    1990-01-01

    To evaluate the effectiveness of a process whereby a faculty-resident committee annually audits outpatient record keeping and preventive care practices and provides feedback to resident physicians. Pre- and postfeedback audits with interventions and observations repeated over six consecutive academic years. The adult primary care practice of housestaff in a university-affiliated hospital. All 139 physicians in an internal medicine residency program from 1981-82 through 1986-87, of whom 37 were present for three consecutive years. Each year, residents were given individualized, detailed, typewritten feedback based on audits of their outpatient records. Each resident physician had a minimum of four (mean 5.2) outpatient records per year audited against standards for record-keeping practices and the provision of preventive care. Overall performance scores for each resident audit improved from a mean of 39.7 +/- 12.3 (SD) in 1981-82 to a mean of 58.5 +/- 14.1 (SD) in 1986-87 (possible range 0 to 100, observed range 9.4 to 86.6). The overall performance scores of individual residents, who received two cycles of feedback, improved an average of 11.5 (95% confidence limits 7.6, 15.3), from a mean of 48.4 +/- 11.4 (SD) during their first year of residency to 59.8 +/- 13.9 (SD) during their third year. General (primary care) and traditional-track residents improved at similar rates, although mean performance scores were consistently higher for general than for traditional-track residents. Analysis of variance revealed that all changes and differences were statistically significant. An ongoing chart audit and feedback system can be associated with improvements both in the performance of individual residents and in the long-term performance of a residency program.

  7. Physicians' fees and public medical care programs.

    PubMed Central

    Lee, R H; Hadley, J

    1981-01-01

    In this article we develop and estimate a model of physicians' pricing that explicitly incorporates the effects of Medicare and Medicaid demand subsidies. Our analysis is based on a multiperiod model in which physicians are monopolistic competitors supplying services to several markets. The implications of the model are tested using data derived from claims submitted by a cohort of 1,200 California physicians during the years 1972-1975. We conclude that the demand for physician's services is relatively elastic; that increases in the local supply of physicians reduce prices somewhat; that physicians respond strategically to attempts to control prices through the customary-prevailing-reasonable system; and that price controls limit the rate of increase in physicians' prices. The analysis identifies a family of policies that recognize the monopsony power of public programs and may change the cost-access trade-off. PMID:7021479

  8. Multispecialty physician networks in Ontario

    PubMed Central

    Stukel, Therese A; Glazier, Richard H; Schultz, Susan E; Guan, Jun; Zagorski, Brandon M; Gozdyra, Peter; Henry, David A

    2013-01-01

    Background Large multispecialty physician group practices, with a central role for primary care practitioners, have been shown to achieve high-quality, low-cost care for patients with chronic disease. We assessed the extent to which informal multispecialty physician networks in Ontario could be identified by using health administrative data to exploit natural linkages among patients, physicians, and hospitals based on existing patient flow. Methods We linked each Ontario resident to his or her usual provider of primary care over the period from fiscal year 2008/2009 to fiscal year 2010/2011. We linked each specialist to the hospital where he or she performed the most inpatient services. We linked each primary care physician to the hospital where most of his or her ambulatory patients were admitted for non-maternal medical care. Each resident was then linked to the same hospital as his or her usual provider of primary care. We computed “loyalty” as the proportion of care to network residents provided by physicians and hospitals within their network. Smaller clusters were aggregated to create networks based on a minimum population size, distance, and loyalty. Networks were not constrained geographically. Results We identified 78 multispecialty physician networks, comprising 12 410 primary care physicians, 14 687 specialists, and 175 acute care hospitals serving a total of 12 917 178 people. Median network size was 134 723 residents, 125 primary care physicians, and 143 specialists. Virtually all eligible residents were linked to a usual provider of primary care and to a network. Most specialists (93.5%) and primary care physicians (98.2%) were linked to a hospital. Median network physician loyalty was 68.4% for all physician visits and 81.1% for primary care visits. Median non-maternal admission loyalty was 67.4%. Urban networks had lower loyalties and were less self-contained but had more health care resources. Interpretation We demonstrated the feasibility

  9. Multispecialty physician networks in Ontario.

    PubMed

    Stukel, Therese A; Glazier, Richard H; Schultz, Susan E; Guan, Jun; Zagorski, Brandon M; Gozdyra, Peter; Henry, David A

    2013-01-01

    Large multispecialty physician group practices, with a central role for primary care practitioners, have been shown to achieve high-quality, low-cost care for patients with chronic disease. We assessed the extent to which informal multispecialty physician networks in Ontario could be identified by using health administrative data to exploit natural linkages among patients, physicians, and hospitals based on existing patient flow. We linked each Ontario resident to his or her usual provider of primary care over the period from fiscal year 2008/2009 to fiscal year 2010/2011. We linked each specialist to the hospital where he or she performed the most inpatient services. We linked each primary care physician to the hospital where most of his or her ambulatory patients were admitted for non-maternal medical care. Each resident was then linked to the same hospital as his or her usual provider of primary care. We computed "loyalty" as the proportion of care to network residents provided by physicians and hospitals within their network. Smaller clusters were aggregated to create networks based on a minimum population size, distance, and loyalty. Networks were not constrained geographically. We identified 78 multispecialty physician networks, comprising 12,410 primary care physicians, 14,687 specialists, and 175 acute care hospitals serving a total of 12,917,178 people. Median network size was 134,723 residents, 125 primary care physicians, and 143 specialists. Virtually all eligible residents were linked to a usual provider of primary care and to a network. Most specialists (93.5%) and primary care physicians (98.2%) were linked to a hospital. Median network physician loyalty was 68.4% for all physician visits and 81.1% for primary care visits. Median non-maternal admission loyalty was 67.4%. Urban networks had lower loyalties and were less self-contained but had more health care resources. We demonstrated the feasibility of identifying informal multispecialty physician

  10. Physician Training for Hospital Information Systems.

    ERIC Educational Resources Information Center

    Shapiro, Jay R.; And Others

    1982-01-01

    Advantages and disadvantages discovered during introduction of computerized patient-care recordkeeping at the National Institute of Health's Clinical Center are discussed, including the needs for physicians to change some behaviors and for better records, changes in the relationship between nurse and physician, and adjustment problems in inputting…

  11. The Exnovation of Chronic Care Management Processes by Physician Organizations.

    PubMed

    Rodriguez, Hector P; Henke, Rachel Mosher; Bibi, Salma; Ramsay, Patricia P; Shortell, Stephen M

    2016-09-01

    Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care. Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population-level increases in practice use of CMPs over time. Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations. Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Over one-third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one-third of exnovators, while nurse

  12. The Exnovation of Chronic Care Management Processes by Physician Organizations

    PubMed Central

    HENKE, RACHEL MOSHER; BIBI, SALMA; RAMSAY, PATRICIA P.; SHORTELL, STEPHEN M.

    2016-01-01

    Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care.Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population‐level increases in practice use of CMPs over time.Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations. Context Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Methods Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Findings Over one‐third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one

  13. Determinants of physicians' communication behaviour in disability assessments.

    PubMed

    Van Rijssen, H Jolanda; Schellart, Antonius J M; Anema, Johannes R; Van der Beek, Allard J

    2011-01-01

    Knowledge about the determinants of communication behaviour of physicians during face-to-face consultations with patients might increase our understanding of communication behaviour, and provide insight into how training might be able to change their communication behaviour. For physicians who conduct work disability assessment interviews, referred to as 'social insurance physicians', communication with patients is their most important instrument. Therefore, the aim of this study was to understand the determinants of communication behaviour of social insurance physicians, by modelling the following constructs of the Theory of Planned Behaviour: attitudes, social influence, self-efficacy, skills, barriers and intentions concerning their communication with claimants in medical disability assessments. Cross-sectional data were collected by means of questionnaires. Analyses were performed with the LISREL maximum likelihood estimation procedure. The results showed a well-fitting model in which attitudes had a significant and substantial direct effect on two intentions. Self-efficacy had a significant, but smaller direct effect on one intention. Empirical support was found for a model that describes intentions of social insurance physicians, especially intentions to give information and to consider personal aspects. Attitudes were the main determinants of physicians' intentions and therefore these may be a promising focus of communication skills training.

  14. A change in opinion on surgeon's performance indicators.

    PubMed

    Maytham, Gary; Kessaris, Nicos

    2011-04-01

    Individual performance indicators for cardiac surgeons in the UK were published in 2004. A comprehensive update published in 2009 reported statistically significant decreases in mortality rates suggesting that the publication of this data may have contributed to this improvement in outcomes. In view of this, the authors present an assessment of the attitudes of cardiac surgeons to individual performance tables, having performed this by sending questionnaires exploring the surgeon's views on performance tables to UK cardiac surgeons in 2005 and 2009. The responses demonstrated that whilst the majority of cardiac surgeons (68.8%) were initially opposed to performance tables, the number welcoming their introduction increased significantly (22.9-48.5%) over the four-year period. The attitude of the consultants towards the possible effect of this data on the management of high-risk patients also changed, with fewer consultants believing they would (P=0.0001) or may (P=0.023) avoid these patients. The observed change in attitude of cardiac surgeons may be due to acclimatization to an established system of audit, improved mortality rates, a desire for more transparency following the Bristol Enquiry, or improved risk stratification. These findings may be of benefit to those tasked with initiating these indicators elsewhere.

  15. Effects of regenerator size change on Stirling engine performance

    NASA Astrophysics Data System (ADS)

    Hamaguchi, K.; Hiratsuka, Y.; Miyabe, H.

    A systematic approach to the regenerator shape design is developed. The basic data reported with respect to the flow loss and heat transfer characteristics of the stacked wire gauzes, which have often been used as a regenerator matrix, are put in order by using the fixed dimensionless parameters. The effect of the regenerator shape on the engine performance is studied theoretically and experimentally. In the theoretical study, an equivalent indicated thermal efficiency is defined and the effects of size change are investigated by using a simple analysis. The effects of regenerator shape are experimentally evaluated by the engine performance.

  16. Physician leadership.

    PubMed

    Woo, K T

    2007-12-01

    Doctors, because of the nature of their training and their profession, have to be leaders. Subsequently, when they specialise, leadership qualities are even more important if they are to be effective in leading the specialty team. It is common knowledge that doctors have become leaders in various sectors of society. One of the fundamental advantages a doctor has over others in leadership positions is his basic training in studying and understanding human nature. With years of practice and experience, the doctor, a student of human nature, has a good grasp of human behaviour which enables him to become a better leader. The six universal and timeless characteristics of great leaders are: ability to share a vision, surrounding oneself with great people, ability to coach other team members, ability to focus on perfection, developing emotional intelligence and ability to train effective leaders. I would like to see three essential qualities in a strong leader: ability to secure an "envisioned future", ability to sacrifice in order to cultivate loyalty, and courage to do the right thing and protect his people. An effective leader positions himself in a situation to ensure survival. Having secured the leadership position, one must take certain steps to strengthen one's leadership so that it will survive. Six strategies from the Art of War by Sun Tzu which are of great practical value are: walk the ground, have trusted lieutenants, information gathering, confuse the enemy, win most while doing nothing, and that which is too good will not last forever. Sometimes we have to change in order to survive. We need to get rid of outmoded practices and shed old burdens to take advantage of the present. The task of exiting from leadership is facilitated if one has groomed a successor. The longer one is in a leadership position, the more difficult it is for one to step down. Some organisations retain old leaders as advisors or mentors. They should be just seen and not heard and go

  17. Primary care physician supply, physician compensation, and Medicare fees: what is the connection?

    PubMed

    Dummit, Laura A

    2008-11-03

    Primary care, a cornerstone of several health reform efforts, is believed by many to be in a crisis because of inadequate supply to meet future demand. This belief has focused attention on the adequacy of primary care physician supply and ways to boost access to primary care. One suggested approach is to raise Medicare fees for primary care services. Whether higher Medicare fees would increase physician interest in primary care specialties by reducing compensation disparities between primary care and other specialties has not been established. Further, many questions remain about the assumptions underlying these policy concerns. Is there really a primary care physician crisis? Why does compensation across physician specialties vary so widely? Can Medicare physician fee changes affect access to primary care? These questions defy simple answers. This issue brief lays out the latest information on physician workforce, compensation differences across physician specialties, and Medicare's physician fee-setting process.

  18. Thermal Performance of Microencapsulated Phase Change Material Slurry

    DTIC Science & Technology

    2008-03-01

    tetradec- ane-containing microcapsules with an average size of 4.4 μm. Yamagishi et al. (1999) obtained empirical data for microencapsulated octadecane ob...MPCM slurry (90 – 150 μm). It should be noted that the mass of an average microcapsule is equal to the mass of microencapsulated PCM and the mass...ER D C TR -0 8 -4 Basic Research/Military Construction Thermal Performance of Microencapsulated Phase Change Material Slurry Jorge L

  19. Thermal Performance of Microencapsulated Phase Change Material Survey

    DTIC Science & Technology

    2008-03-01

    tetradec- ane-containing microcapsules with an average size of 4.4 μm. Yamagishi et al. (1999) obtained empirical data for microencapsulated octadecane ob...MPCM slurry (90 – 150 μm). It should be noted that the mass of an average microcapsule is equal to the mass of microencapsulated PCM and the mass...ER D C TR -0 8 -4 Basic Research/Military Construction Thermal Performance of Microencapsulated Phase Change Material Slurry Jorge L

  20. Diagnostic Accuracy of Point-of-Care Ultrasound Performed by Pulmonary Critical Care Physicians for Right Ventricle Assessment in Patients With Acute Pulmonary Embolism.

    PubMed

    Filopei, Jason; Acquah, Samuel O; Bondarsky, Eric E; Steiger, David J; Ramesh, Navitha; Ehrlich, Madeline; Patrawalla, Paru

    2017-09-26

    Medicine Fellows and intensivists made a timely and accurate assessment. Screening for right ventricular dysfunction using goal-directed echocardiography can and should be performed by pulmonary critical care physicians in patients with acute pulmonary embolism.

  1. Natural resource manager perceptions of agency performance on climate change.

    PubMed

    Lemieux, Christopher J; Thompson, Jessica L; Dawson, Jackie; Schuster, Rudy M

    2013-01-15

    An important precursor to the adoption of climate change adaptation strategies is to understand the perceived capacity to implement and operationalize such strategies. Utilizing an importance-performance analysis (IPA) evaluation framework, this article presents a comparative case study of federal and state land and natural resource manager perceptions of agency performance on factors influencing adaptive capacity in two U.S. regions (northern Colorado and southwestern South Dakota). Results revealed several important findings with substantial management implications. First, none of the managers ranked the adaptive capacity factors as a low priority. Second, managers held the perception that their agencies were performing either neutrally or poorly on most factors influencing adaptive capacity. Third, gap analysis revealed that significant improvements are required to facilitate optimal agency functioning when dealing with climate change-related management issues. Overall, results suggest that a host of institutional and policy-oriented (e.g., lack of clear mandate to adapt to climate change), financial and human resource (e.g., inadequate staff and financial resources), informational (e.g., inadequate research and monitoring programs) and contextual barriers (e.g., sufficient regional networks to mitigate potential transboundary impacts) currently challenge the efficient and effective integration of climate change into decision-making and management within agencies working in these regions. The IPA framework proved to be an effective tool to help managers identify and understand agency strengths, areas of concern, redundancies, and areas that warrant the use of limited funds and/or resource re-allocation in order to enhance adaptive capacity and maximize management effectiveness with respect to climate change. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. Physicians in transition: practice due diligence.

    PubMed

    Paterick, Timothy E

    2013-01-01

    The landscape of healthcare is changing rapidly. That landscape is now a business model of medicine. That rapid change resulting in a business model is affecting physicians professionally and personally. The new business model of medicine has led to large healthcare organizations hiring physicians as employees. The role of a physician as an employee has many limitations in terms of practice and personal autonomy. Employed physicians sign legally binding employment agreements that are written by the legal team working for the healthcare organization. Thus physicians should practice due diligence before signing the employment agreement. "Due diligence" refers to the care a reasonable person should take before entering into an agreement with another party. That reasonable person should seek expertise to represent his or her interests when searching a balanced agreement between the physician and organization.

  3. Leadership development programs for physicians: a systematic review.

    PubMed

    Frich, Jan C; Brewster, Amanda L; Cherlin, Emily J; Bradley, Elizabeth H

    2015-05-01

    Physician leadership development programs typically aim to strengthen physicians' leadership competencies and improve organizational performance. We conducted a systematic review of medical literature on physician leadership development programs in order to characterize the setting, educational content, teaching methods, and learning outcomes achieved. Articles were identified through a search in Ovid MEDLINE from 1950 through November 2013. We included articles that described programs designed to expose physicians to leadership concepts, outlined teaching methods, and reported evaluation outcomes. A thematic analysis was conducted using a structured data entry form with categories for setting/target group, educational content, format, type of evaluation and outcomes. We identified 45 studies that met eligibility criteria, of which 35 reported on programs exclusively targeting physicians. The majority of programs focused on skills training and technical and conceptual knowledge, while fewer programs focused on personal growth and awareness. Half of the studies used pre/post intervention designs, and four studies used a comparison group. Positive outcomes were reported in all studies, although the majority of studies relied on learner satisfaction scores and self-assessed knowledge or behavioral change. Only six studies documented favorable organizational outcomes, such as improvement in quality indicators for disease management. The leadership programs examined in these studies were characterized by the use of multiple learning methods, including lectures, seminars, group work, and action learning projects in multidisciplinary teams. Physician leadership development programs are associated with increased self-assessed knowledge and expertise; however, few studies have examined outcomes at a system level. Our synthesis of the literature suggests important gaps, including a lack of programs that integrate non-physician and physician professionals, limited use of more

  4. Physicians on board: an examination of physician financial interests in ASCs using longitudinal data.

    PubMed

    Yee, Christine A

    2011-09-01

    This paper investigates physician financial interests in ambulatory surgery centers (ASCs) using novel, longitudinal data that identify board members (directors) of ASCs in Florida. Improving on prior research, the estimated models in this paper disentangle physician director selection effects from the causal impact of these financial interests. The data suggest that even prior to their financial interest, physician directors had larger procedure volumes than non-directors. Physician directors also referred more lower-risk patients. On average, ASC board membership led to a 27% increase in a physician's procedure volume and a 16% increase in a physician's colonoscopy volume. Simulations suggest that 5% of the colonoscopies performed in Florida between 1997 and 2004 may have been due to physician ASC board membership. The evidence also suggests that physician directors steered patients from hospitals to their affiliate ASCs. In addition, they referred and/or treated more lower-risk patients as a result of board membership.

  5. Selection of the Family Physician

    PubMed Central

    Christ, L. W. A. C.; Harris, A. L.; Korchinski, E. D.

    1976-01-01

    This study was conducted to examine the characteristics of ‘initial visits’ by patients, contrasted with ‘average visits’, to discover what is needed to establish a satisfactory patient-physician relationship leading to long term continuous care. In the initial visit, the patient presents with a relatively simple problem which will enable the physician to demonstrate his ability without unduly taxing his skills. This suggests that patients create an opportunity for a thorough face-to-face contact to provide an opportunity for the physician to display his ability so that the patient's desire for a long term relationship can be achieved. The study also suggests that patients' expectations have changed in proportion to changes in the mode of medical practice. PMID:21308071

  6. Performance efficiency and its changes among aging municipal employees.

    PubMed

    Suvanto, S; Huuhtanen, P; Nygård, C H; Ilmarinen, J

    1991-01-01

    The aims of the study were to compare the performance efficiency of aging municipal workers in different work categories and to determine the changes that occurred in visual search, short-term memory, and fine motor performance over a four-year follow-up period beginning at about 51 years of age. The mental capacity of the workers in mental work was better than that of the workers in physical and mixed physical and mental work, and the results between the physical and mixed work groups did not differ significantly. In four years, the workers' complex short-term memory weakened 6-7% in all three work content groups. Fine motor speed decreased 2-7% in the physical and mental work groups. It was concluded that the mental capacity of older workers depends on the mental demands of their work tasks. The weakening of performance is 2-7% between the ages of 51 to 55 years.

  7. Perceived training intensity and performance changes quantification in judo.

    PubMed

    Agostinho, Marcus F; Philippe, Antony G; Marcolino, Gilvan S; Pereira, Ewerton R; Busso, Thierry; Candau, Robin B; Franchini, Emerson

    2015-06-01

    The objective of this study was to determine the methods of quantification for training and performance, which would be the most appropriate for modeling the responses to long-term training in cadet and junior judo athletes. For this, 10 young male judo athletes (15.9 ± 1.3 years, 64.9 ± 10.3 kg, and 170.8 ± 5.4 cm) competing at a regional/state level volunteered to take part in this study. Data were collected during a 2-year training period (i.e., 702 days) from January 2011 to December 2012. Their mean training volume was 6.52 ± 0.43 hours per week during the preparatory periods and 4.75 ± 0.49 hours per week during the competitive periods. They followed a training program prescribed by the same coach. The training load (TL) was quantified through the session rating of perceived exertion (RPE) and expressed in arbitrary unit (a.u.). Performance was quantified from 5 parameters and divided into 2 categories: performance in competition and performance in training. The evaluation of performance in competition was based on the number of points per level. Performance in training was assessed through 4 different tests. A physical test battery consisting of a standing long jump, 2 judo-specific tests that were the maximal number of dynamic chin-up holding the judogi, and the Special Judo Fitness Test was used. System modeling for describing training adaptations consisted of mathematically relating the TL of the training sessions (system input) to the change in performance (system output). The quality of the fit between TL and performance was similar, whether the TL was computed directly from RPE (R = 0.55 ± 0.18) or from the session RPE (R = 0.56 ± 0.18) and was significant in 8 athletes over 10, excluding the standing jump from the computation of the TL, leading to a simplest method. Thus, this study represents a first attempt to model TL effects on judo-specific performance and has shown that the best relationships between amounts of training and changes in

  8. Estimating endogenous changes in task performance from EEG

    PubMed Central

    Touryan, Jon; Apker, Gregory; Lance, Brent J.; Kerick, Scott E.; Ries, Anthony J.; McDowell, Kaleb

    2014-01-01

    Brain wave activity is known to correlate with decrements in behavioral performance as individuals enter states of fatigue, boredom, or low alertness.Many BCI technologies are adversely affected by these changes in user state, limiting their application and constraining their use to relatively short temporal epochs where behavioral performance is likely to be stable. Incorporating a passive BCI that detects when the user is performing poorly at a primary task, and adapts accordingly may prove to increase overall user performance. Here, we explore the potential for extending an established method to generate continuous estimates of behavioral performance from ongoing neural activity; evaluating the extended method by applying it to the original task domain, simulated driving; and generalizing the method by applying it to a BCI-relevant perceptual discrimination task. Specifically, we used EEG log power spectra and sequential forward floating selection (SFFS) to estimate endogenous changes in behavior in both a simulated driving task and a perceptual discrimination task. For the driving task the average correlation coefficient between the actual and estimated lane deviation was 0.37 ± 0.22 (μ ± σ). For the perceptual discrimination task we generated estimates of accuracy, reaction time, and button press duration for each participant. The correlation coefficients between the actual and estimated behavior were similar for these three metrics (accuracy = 0.25 ± 0.37, reaction time = 0.33 ± 0.23, button press duration = 0.36 ± 0.30). These findings illustrate the potential for modeling time-on-task decrements in performance from concurrent measures of neural activity. PMID:24994968

  9. [Collaboration between occupational physicians and other specialists including insurance physicians].

    PubMed

    Rijkenberg, A M; van Sprundel, M; Stassijns, G

    2013-09-01

    other stakeholders is essential and should be improved. In the future researchers should develop techniques, which help to improve collabora- tion. For example, Dutch investigators advocate the development of guidelines. There is agreement that collaboration between occupational physicians and some other specialists is important. In particular, collaboration between specialists in physical medicine has been investigated. Also, curative physicians and insurance physicians have an important role in disability management. So all stakeholders should work together more intensively. However, literature is difficult to find and not often part of international literature. This must change urgently.

  10. An intelligent assistant for physicians.

    PubMed

    Gavrilis, Dimitris; Georgoulas, George; Vasiloglou, Nikolaos; Nikolakopoulos, George

    2016-08-01

    This paper presents a software tool developed for assisting physicians during an examination process. The tool consists of a number of modules with the aim to make the examination process not only quicker but also fault proof moving from a simple electronic medical records management system towards an intelligent assistant for the physician. The intelligent component exploits users' inputs as well as well established standards to line up possible suggestions for filling in the examination report. As the physician continues using it, the tool keeps extracting new knowledge. The architecture of the tool is presented in brief while the intelligent component which builds upon the notion of multilabel learning is presented in more detail. Our preliminary results from a real test case indicate that the performance of the intelligent module can reach quite high performance without a large amount of data.

  11. Do State Continuing Medical Education Requirements for Physicians Improve Clinical Knowledge?

    PubMed

    Vandergrift, Jonathan L; Gray, Bradley M; Weng, Weifeng

    2017-04-16

    To evaluate the effect of state continuing medical education (CME) requirements on physician clinical knowledge. Secondary data for 19,563 general internists who took the Internal Medicine Maintenance of Certification (MOC) examination between 2006 and 2013. We took advantage of a natural experiment resulting from variations in CME requirements across states over time and applied a difference-in-differences methodology to measure associations between changes in CME requirements and physician clinical knowledge. We measured changes in clinical knowledge by comparing initial and MOC examination performance 10 years apart. We constructed difference-in-differences estimates by regressing examination performance changes against physician demographics, county and year fixed effects, trend-state indicators, and state CME change indicators. Physician data were compiled by the American Board of Internal Medicine. State CME policies were compiled from American Medical Association reports. More rigorous CME credit-hour requirements (mostly implementing a new requirement) were associated with an increase in examination performance equivalent to a shift in examination score from the 50th to 54th percentile. Among physicians required to engage in a summative assessment of their clinical knowledge, CME requirements were associated with an improvement in physician clinical knowledge. © Health Research and Educational Trust.

  12. Web-Based Physician Ratings for California Physicians on Probation.

    PubMed

    Murphy, Gregory P; Awad, Mohannad A; Osterberg, E Charles; Gaither, Thomas W; Chumnarnsongkhroh, Thanabhudee; Washington, Samuel L; Breyer, Benjamin N

    2017-08-22

     Web-based physician ratings systems are a popular tool to help patients evaluate physicians. Websites help patients find information regarding physician licensure, office hours, and disciplinary records along with ratings and reviews. Whether higher patient ratings are associated with higher quality of care is unclear.  The aim of this study was to characterize the impact of physician probation on consumer ratings by comparing website ratings between doctors on probation against matched controls.  A retrospective review of data from the Medical Board of California for physicians placed on probation from December 1989 to September 2015 was performed. Violations were categorized into nine types. Nonprobation controls were matched by zip code and specialty with probation cases in a 2:1 ratio using the California Department of Consumer Affairs website. Web-based reviews were recorded from vitals.com, healthgrades.com, and ratemds.com (ratings range from 1-5).  A total of 410 physicians were placed on probation for 866 violations. The mean (standard deviation [SD]) number of ratings per doctor was 5.2 (7.8) for cases and 4 (6.3) for controls (P=.003). The mean rating for physicians on probation was 3.7 (1.6) compared with 4.0 (1.0) for controls when all three rating websites were pooled (P<.001). Violations for medical documentation, incompetence, prescription negligence, and fraud were found to have statistically significant lower rating scores. Conversely, scores for professionalism, drugs or alcohol, crime, sexual misconduct, and personal illness were similar between cases and controls. In a univariate analysis, probation was found to be associated with lower rating, odds ratio=1.5 (95% CI 1.0-2.2). This association was not significant in a multivariate model when we included age and gender.  Web-based physician ratings were lower for doctors on probation indicating that patients may perceive a difference. Despite these statistical findings, the absolute

  13. Knowledge crystallization and clinical priorities: evaluating how physicians collect and synthesize patient-related data.

    PubMed

    Pollack, Ari H; Tweedy, Carolyn G; Blondon, Katherine; Pratt, Wanda

    2014-01-01

    Information seeking and synthesis are time consuming processes for physicians. Although systems have the potential to simplify these tasks, future improvements must be based on an understanding of how physicians perform these tasks during clinical prioritization. We enrolled 23 physicians in semi-structured focus groups discussing simulated inpatient populations. Participants documented and discussed their data gathering and prioritization processes. Transcripts were coded to identify themes and generalized process flows. Results indicate that data are collected to categorize and prioritize patients according to expected clinical course. When data do not support these expectations, or when categorization indicates potential for morbidity, physicians increase efforts to act or recategorize patients. Unexpected clinical changes have a significant impact on the decision-making and prioritization by clinicians. A modified version of the Knowledge Crystallization Framework helps to frame this work laying a foundation to advance information displays and facilitate information processing by physicians in clinical care environments.

  14. The Geographic Distribution of Physicians Revisited

    PubMed Central

    Rosenthal, Meredith B; Zaslavsky, Alan; Newhouse, Joseph P

    2005-01-01

    Context While there is debate over whether the U.S. is training too many physicians, many seem to agree that physicians are geographically maldistributed, with too few in rural areas. Objective Official definitions of shortage areas assume the market for physician services is based on county boundaries. We wished to ascertain how the picture of a possible shortage changes using alternative measures of geographic access. We measure geographic access by the number of full-time equivalent physicians serving a community divided by the expected number of patients (possibly both from within the community and outside) receiving care from those physicians. Moreover, we wished to determine how the geographic distribution of physicians had changed since previous studies, in light of the large increase in physician numbers. Design Cross-sectional data analyses of alternative measures of geographic access to physicians in 23 states with low physician–population ratios. Results Between 1979 and 1999, the number of physicians doubled in the sample states. Although most specialties experienced greater diffusion everywhere, smaller specialties had not yet diffused to the smallest towns. Multiple measures of geographic access, including physician-to-population ratios, average distance traveled to the nearest physician, and projected average caseload per physician, confirm that residents of metropolitan areas have better geographic access to physicians. Physician-to-population ratios exhibit the largest degree of geographic disparity, but ratios in rural counties adjacent to metropolitan areas are smaller than in those not adjacent to metropolitan areas. Distance-traveled and caseload models that allow patients to cross county lines show less disparity and indicate that residents of isolated rural counties have less access than those living in counties adjacent to metropolitan areas. Conclusion Geographic access to physicians has continued to improve over the past two decades

  15. Shifting Patterns of Physician Home Visits.

    PubMed

    Sairenji, Tomoko; Jetty, Anuradha; Peterson, Lars E

    2016-04-01

    Home visits have been shown to improve quality of care and lower medical costs for complex elderly patients. We investigated trends in physician home visits and domiciliary care visits as well as physician characteristics associated with providing these services. Longitudinal analysis of Medicare Part B claims data for a national sample of direct patient care physicians in 2006 and 2011. Descriptive statistics were used to characterize the physician sample and to determine numbers of home visits and domiciliary visits in total and by physician specialty. Patient homes, nursing homes, and domiciliary care facilities. Direct patient care physicians (n = 22,186). Physician demographics, specialty, practice characteristics (practice type, geographic location), number of home visits, and domiciliary visits in 2006 and 2011. We found a small increase (n = 63,501) in total number of home visits made to Medicare beneficiaries between 2006 and 2011 performed by a decreasing percentage of physicians (5.1%, n = 18,165 in 2006; 4.5%, n = 15,296 in 2011). There was substantial growth in domiciliary care visit numbers (n = 218,514) and a small increase in percentage of physicians delivering these services (2.0% in 2006, 2.3% in 2011). Physicians who performed home visits were more likely to be older, in rural locations, specialists in primary care, and more likely to provide nursing home and domiciliary care compared with physicians who did not make any home visits (P < .05). Home visits and domiciliary visits to Medicare beneficiaries are increasing. General internal medicine physicians provided the highest number of home and domiciliary care visits in 2006, and family physicians did so in 2011. Such delivery models show promise in lowering medical costs while providing high-quality patient care. © The Author(s) 2015.

  16. Physician-assisted death.

    PubMed Central

    1995-01-01

    Physician-assisted death includes both euthanasia and assistance in suicide. The CMA urges its members to adhere to the principles of palliative care. It does not support euthanasia and assisted suicide. The following policy summary includes definitions of euthanasia and assisted suicide, background information, basic ethical principles and physician concerns about legalization of physician-assisted death. PMID:7632208

  17. Reservoir performance under uncertainty in hydrologic impacts of climate change

    NASA Astrophysics Data System (ADS)

    Raje, Deepashree; Mujumdar, P. P.

    2010-03-01

    Relatively few studies have addressed water management and adaptation measures in the face of changing water balances due to climate change. The current work studies climate change impact on a multipurpose reservoir performance and derives adaptive policies for possible future scenarios. The method developed in this work is illustrated with a case study of Hirakud reservoir on the Mahanadi river in Orissa, India, which is a multipurpose reservoir serving flood control, irrigation and power generation. Climate change effects on annual hydropower generation and four performance indices (reliability with respect to three reservoir functions, viz. hydropower, irrigation and flood control, resiliency, vulnerability and deficit ratio with respect to hydropower) are studied. Outputs from three general circulation models (GCMs) for three scenarios each are downscaled to monsoon streamflow in the Mahanadi river for two future time slices, 2045-65 and 2075-95. Increased irrigation demands, rule curves dictated by increased need for flood storage and downscaled projections of streamflow from the ensemble of GCMs and scenarios are used for projecting future hydrologic scenarios. It is seen that hydropower generation and reliability with respect to hydropower and irrigation are likely to show a decrease in future in most scenarios, whereas the deficit ratio and vulnerability are likely to increase as a result of climate change if the standard operating policy (SOP) using current rule curves for flood protection is employed. An optimal monthly operating policy is then derived using stochastic dynamic programming (SDP) as an adaptive policy for mitigating impacts of climate change on reservoir operation. The objective of this policy is to maximize reliabilities with respect to multiple reservoir functions of hydropower, irrigation and flood control. In variations to this adaptive policy, increasingly more weightage is given to the purpose of maximizing reliability with respect to

  18. Evaluating physicians' probabilistic judgments.

    PubMed

    Poses, R M; Cebul, R D; Centor, R M

    1988-01-01

    Physicians increasingly are challenged to make probabilistic judgments quantitatively. Their ability to make such judgments may be directly linked to the quality of care they provide. Many methods are available to evaluate these judgments. Graphic means of assessment include the calibration curve, covariance graph, and receiver operating characteristic (ROC) curve. Statistical tools can measure the significance of departures from ideal calibration, and measure the area under ROC curve. Modeling the calibration curve using linear or logistic regression provides another method to assess probabilistic judgments, although these may be limited by failure of the data to meet the model's assumptions. Scoring rules provide indices of overall judgmental performance, although their reliability is difficult to gauge for small sample sizes. Decompositions of scoring rules separate judgmental performance into functional components. The authors provide preliminary guidelines for choosing methods for specific research in this area.

  19. Role of the Physician Anesthesiologist

    MedlinePlus

    ... of the Physician Anesthesiologist Role of the Physician Anesthesiologist When preparing for surgery, many patients think of the physician anesthesiologist as just the person behind the mask who ...

  20. How to perform a tracheostomy dressing and inner cannula change.

    PubMed

    Credland, Nicola

    2016-03-23

    RATIONALE AND KEY POINTS: Proactive tracheostomy management increases patient safety and reduces adverse events. ▶ A cleaning regimen performed every four hours reduces the risk of a blocked tracheostomy cannula, complete tube occlusion and respiratory arrest. ▶ Sterile tracheostomy dressings allow secretions from the stoma to be absorbed and prevent pressure damage from the tracheostomy tube. ▶ Regular dressing changes and skin inspection permit timely identification of inflammatory processes and skin excoriation, enabling prompt treatment to be instigated. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article will change your practice. 2. How you intend to develop your knowledge and skills regarding tracheostomy management.

  1. Physicians with the least experience have higher cost profiles than do physicians with the most experience.

    PubMed

    Mehrotra, Ateev; Reid, Rachel O; Adams, John L; Friedberg, Mark W; McGlynn, Elizabeth A; Hussey, Peter S

    2012-11-01

    Health plans and Medicare are using cost profiles to identify which physicians account for more health care spending than others. By identifying the costliest physicians, health plans and Medicare hope to craft policy interventions to reduce total health care spending. To identify which physician types, if any, might be costlier than others, we analyzed cost profiles created from health plan claims for physicians in Massachusetts. We found that physicians with fewer than ten years of experience had 13.2 percent higher overall costs than physicians with forty or more years of experience. We found no association between costs and other physician characteristics, such as having had malpractice claims or disciplinary actions, board certification status, and the size of the group in which the physician practices. Although winners and losers are inevitable in any cost-profiling effort, physicians with less experience are more likely to be negatively affected by policies that use cost profiles, unless they change their practice patterns. For example, these physicians could be excluded from high-value networks or receive lower payments under Medicare's planned value-based payment program. We cannot fully explain the mechanism by which more-experienced physicians have lower costs, but our results suggest that the more costly practice style of newly trained physicians may be a driver of rising health care costs overall.

  2. Developing Physician Migration Estimates for Workforce Models.

    PubMed

    Holmes, George M; Fraher, Erin P

    2017-02-01

    To understand factors affecting specialty heterogeneity in physician migration. Physicians in the 2009 American Medical Association Masterfile data were matched to those in the 2013 file. Office locations were geocoded in both years to one of 293 areas of the country. Estimated utilization, calculated for each specialty, was used as the primary predictor of migration. Physician characteristics (e.g., specialty, age, sex) were obtained from the 2009 file. Area characteristics and other factors influencing physician migration (e.g., rurality, presence of teaching hospital) were obtained from various sources. We modeled physician location decisions as a two-part process: First, the physician decides whether to move. Second, conditional on moving, a conditional logit model estimates the probability a physician moved to a particular area. Separate models were estimated by specialty and whether the physician was a resident. Results differed between specialties and according to whether the physician was a resident in 2009, indicating heterogeneity in responsiveness to policies. Physician migration was higher between geographically proximate states with higher utilization for that specialty. Models can be used to estimate specialty-specific migration patterns for more accurate workforce modeling, including simulations to model the effect of policy changes. © Health Research and Educational Trust.

  3. Physician professionalism for a new century.

    PubMed

    Holsinger, James W; Beaton, Benjamin

    2006-07-01

    During the past 50 years, physicians have become increasingly dissatisfied with certain aspects of their profession. Dissatisfaction has intensified with the advent of managed care in the late 20th century, the medical liability crisis, and the growing divergence between the professional and personal expectations placed upon physicians and their practical ability to meet these expectations. These and other factors have encroached on physician autonomy, the formerly ascendant professional value within medicine. As the underlying values and practical realities of the broader American health care system have changed, the professional values and practices of physicians have failed to adapt correspondingly, resulting in a "professionalism gap" that contributes to physician dissatisfaction. To improve the outlook and efficacy of modern American physicians, the profession must adopt a new values framework that conforms to today's health care system. This means foregoing the 20th century's preferred "independent physician" model in favor of a new professional structure based on teamwork and collaboration. Convincing established physicians to embrace such a model will be difficult, but opportunities exist for significant progress among a new generation of physicians accustomed to the realities of managed care, flexible practice models, and health information technology. The teaching of clinical anatomy, given its incorporation of student collaboration at the earliest stages of medical education, offers a prime opportunity to introduce this generation to a reinvigorated code of professionalism that should reduce physician dissatisfaction and benefit society.

  4. An MBA: the utility and effect on physicians' careers.

    PubMed

    Parekh, Selene G; Singh, Bikramjit

    2007-02-01

    Higher economic, legislative, legal, and administrative constraints in health-care services in the United States have led to an increase in physician dissatisfaction and a decrease in physician morale. In this study, we attempted to understand the motivation for a physician to enroll in a business school, and to discover the utility of the Master of Business Administration degree and how it changed the career path for the practicing clinician. We conducted a retrospective study in which a twenty-seven-question survey was distributed by the United States Postal Service and by e-mail to 161 physician graduates of three East Coast business schools. The results were evaluated, and a statistical analysis was performed. Eighty-seven physicians (54%) responded. Eight surveys were discarded because of incomplete data or stray marks, leaving seventy-nine surveys. The average age of the respondents was 41.4 years. The major motivations for going back to school included learning the business aspects of the health-care system (fifty-three respondents; 67%) and obtaining a more interesting job (forty-one respondents; 52%). The time that the respondents allocated for health-care-related activities before and after obtaining the degree was 58.3% and 31.8%, respectively, for patient care (p < 0.001); 8.5% and 3.68% for teaching (p < 0.001); 4.57% and 1.46% for basic-science research (p = 0.11); 4.23% and 4.55% for clinical research (p = 0.90); and 11.8% and 33.5% for administrative responsibilities (p < 0.001). The physicians stated that the most pertinent skills they had acquired were those related to evaluating systems operations and implementing improvements (thirty-nine respondents; 49%), learning how to be an effective leader (thirty-five; 44%), comprehending financial principles (thirty-three; 42%), working within a team (twenty-seven; 34%), and negotiating effectively (twenty-five; 32%). Sixty-four physicians (81%) believed that their business degree had been very useful or

  5. Effects of Changing Atmospheric Conditions on Wind Turbine Performance (Poster)

    SciTech Connect

    Clifton, A.

    2012-12-01

    Multi-megawatt, utility-scale wind turbines operate in turbulent and dynamic winds that impact turbine performance in ways that are gradually becoming better understood. This poster presents a study made using a turbulent flow field simulator (TurbSim) and a Turbine aeroelastic simulator (FAST) of the response of a generic 1.5 MW wind turbine to changing inflow. The turbine power output is found to be most sensitive to wind speed and turbulence intensity, but the relationship depends on the wind speed with respect to the turbine's rated wind speed. Shear is found to be poorly correlated to power. A machine learning method called 'regression trees' is used to create a simple model of turbine performance that could be used as part of the wind resource assessment process. This study has used simple flow fields and should be extended to more complex flows, and validated with field observations.

  6. Effect of Curriculum Changes on Student Performance During General Surgical Clerkship.

    PubMed

    Hagan, Elizabeth A; Jaffe, Bernard M

    2017-09-15

    Good clinical knowledge of anatomy, taught in medical school, is necessary for practicing physicians. It is a key feature of performance on the United States Medical Licensing Examination Step 1 score. Student performance on anatomy is also an early indicator of overall medical student performance. Unfortunately, curricular time provided for the teaching of anatomy has declined significantly over the last 30 years, leading to growing concerns that the anatomical knowledge of new medical graduates may not be adequate. Data regarding the impact of these changes to the medical school curriculum are lacking, with studies often being limited in number of medical students or time. This study examined the anatomy knowledge of students on third-year clinical rotations at Tulane University Medical School. Oral examinations were administered at the conclusion of the junior surgical clerkship. Data on performance were collected over a 5-year period from 690 medical students tested in their knowledge of anatomy, and the other basic sciences collectively considered as pathophysiology. Over the 5-year period, student total scores by year increased in all categories tested. However, during the course of the students' third-year clerkships, the later in the year the students rotated on surgery, the more their scores progressively declined. Unfortunately, this fall was most severe in the knowledge of anatomy. Although it is possible to teach anatomy in increasingly shorter periods of time, such that the students achieve high test scores in the standardized short answer examinations, it is clear that their knowledge, as applied to clinical care, rapidly declines the further they get away from Step 1 studying. Further study is necessary to elucidate the weaknesses in the current basic science curricula as they pertain to anatomy and to devise mechanisms to assure retention of this critical science during clinical rotations and beyond into practice. Copyright © 2017. Published by

  7. Sensorimotor changes and functional performance in patients with knee osteoarthritis

    PubMed Central

    Hurley, M.; Scott, D.; Rees, J.; Newham, D.

    1997-01-01

    OBJECTIVE—Muscles are essential components of our sensorimotor system that help maintain balance and perform a smooth gait, but it is unclear whether arthritic damage adversely affects muscle sensorimotor function. Quadriceps sensorimotor function in patients with knee osteoarthritis (OA) was investigated, and whether these changes were associated with impairment of functional performance.
METHODS—Quadriceps strength, voluntary activation, and proprioceptive acuity (joint position sense acuity) were assessed in 103 patients with knee OA and compared with 25 healthy control subjects. In addition, their postural stability, objective functional performance (the aggregate time for four activities of daily living), and disabilities (Lequesne index) were also investigated.
RESULTS—Compared with the control subjects, the patients with knee OA had weaker quadriceps (differences between group mean 100N, CI 136, 63N), poorer voluntary activation (20% CI 13, 25%) that was associated with quadriceps weakness, and impaired acuity of knee joint position sense (1.28°, CI 0.84, 1.73°). As a group the patients were more unstable (p=0.0017), disabled (10, CI 7, 11), and had poorer functional performance (19.6 seconds, CI 14.3, 24.9 seconds). The most important predictors of disability were objective functional performance and quadriceps strength.
CONCLUSIONS—In patients with knee OA, articular damage may reduce quadriceps motoneurone excitability, which decreases voluntary quadriceps activation thus contributing to quadriceps weakness, and diminishes proprioceptive acuity. The arthrogenic impairment in quadriceps sensorimotor function and decreased postural stability was associated with reduced functional performance of the patients.

 PMID:9462165

  8. Effects of changing airfoil aerodynamic characteristics on turning diffuser performances

    NASA Astrophysics Data System (ADS)

    Noh@Seth, Nur Hazirah; Isa, Norasikin Mat

    2017-04-01

    Combining both turning and diffusing activities by using 3-dimensional turning diffuser offer more advantages as compared to bend-diffuser systems. However, adverse pressure gradient and curvature design of turning diffuser itself will result in existence of secondary flow at the inner wall and both left and right wall region, which will disrupt turning diffuser performance. Introduction of baffle has successfully proven able to improve the performance of 3-dimensional turning diffuser in terms of both pressure recovery and flow uniformity using experimental approach. Preliminary design airfoil referred to previous study was used, and the results were used to validate present study simulation work. Aerodynamic characteristic of the airfoil were varied and series of simulation were conducted to study the effects of changing aerodynamic characteristics of an airfoil on turning diffuser performance. Optimum parameters proposed in this study have successfully improved 3-dimensional turning diffuser performance by 7.20% in terms of flow uniformity and 6.16% in terms of pressure recovery. Turning diffuser efficiency was also improved with increment of 6.12%. These parameters can be used in the future for reference in the design of airfoil baffle especially for usage involving 3-dimensional turning diffuser.

  9. Factors that influence changes in wheelchair cushion performance over time.

    PubMed

    Sprigle, Stephen; Delaune, William

    2014-01-01

    Wheelchair cushions can be used for many hours every day. Like all devices, cushions degrade over time, losing the ability to provide adequate support. Little is known about the changes that cushions undergo after typical everyday use. This project was designed to monitor cushion performance over time with the objective to identify the most important factors that predict cushion degradation. Wheelchair users and their cushions were evaluated multiple times. Information was collected about participants' posture and activities, their cushions, and use of their cushions. Cushion performance was determined by measuring interface pressure using a buttock model. Data analysis proceeded in two steps. First, principal component analysis was run to reduce the number of variables. Second, multiple regression determined which variables influenced the interface pressure performance variables. Results indicated that user characteristics and the manner in which the cushion is used have a greater influence on cushion performance than the chronological age of the cushion. This result can be useful to clinicians who should query users about cushion use when investigating the need to replace a cushion. Finally, this information is applicable to policies that govern cushion replacement and indicted that wear on a cushion is not equivocal across users.

  10. Detecting future performance of the reservoirs under the changing climate

    NASA Astrophysics Data System (ADS)

    Biglarbeigi, Pardis; Strong, W. Alan; Griffiths, Philip

    2017-04-01

    hand, are defined based on the target of COP21, Paris which proposed to keep "the global temperature increase well below 2 degrees Celsius, while urging efforts to limit the increase to 1.5 degrees", as well as temperatures higher than this limit to better address the effects of climate change. Numerical results of the proposed model are anticipated to represent the performance of the system by the year 2100 through RRV indices. RRV metrices are effective means of quantitative estimation of climate change impacts on reservoir system in order to obtain the potential policies to solve the future water supply issues.

  11. Physicians' "right of conscience"- beyond politics.

    PubMed

    Gold, Azgad

    2010-01-01

    During the past few months, the discussion over the physicians' "Right of Conscience" (ROC) has been on the rise. The intervention of politics in this issue shifts the discussion to a very specific and narrow area, namely the "reproductive health laws" which bear well-known predisposing attitudes. In this article, the physician's ROC is discussed in the context in which it naturally belongs: the Patient Physician Relationship (PPR). I suggest that the physicians' rights demand is a comprehensible, predictable, and even inevitable step as part of the "evolution" of the PPR. Thus, the most appropriate way to comprehend and tackle the demand for physicians' ROC is within the context of medical professionalism. While searching for practical solutions to the "reproductive health" problems, there is a need to recognize the ethical and practical implications of the change in the PPR and balance between patient and physician rights.

  12. Health information technology and physician career satisfaction.

    PubMed

    Elder, Keith T; Wiltshire, Jacqueline C; Rooks, Ronica N; Belue, Rhonda; Gary, Lisa C

    2010-09-01

    Health information technology (HIT) and physician career satisfaction are associated with higher-quality medical care. However, the link between HIT and physician career satisfaction, which could potentially reduce provider burnout and attrition, has not been fully examined. This study uses a nationally representative survey to assess the association between key forms of HIT and career satisfaction among primary care physicians (PCPs) and specialty physicians. We performed a retrospective, cross-sectional analysis of physician career satisfaction using the Community Tracking Study Physician Survey, 2004-2005. Nine specific types of HIT as well as the overall adoption of HIT in the practice were examined using multivariate logistic regression. Physicians who used five to six (odds ratio [OR] = 1.46) or seven to nine (OR = 1.47) types of HIT were more likely than physicians who used zero to two types of HIT to be "very satisfied" with their careers. Information technology usages for communicating with other physicians (OR = 1.31) and e-mailing patients (OR = 1.35) were positively associated with career satisfaction. PCPs who used technology to write prescriptions were less likely to report career satisfaction (OR = 0.67), while specialists who wrote notes using technology were less likely to report career satisfaction (OR = 0.75). Using more information technology was the strongest positive predictor of physicians being very satisfied with their careers. Toward that end, healthcare organizations working in conjunction with providers should consider exploring ways to integrate various forms of HIT into practice.

  13. "The Record is Our Work Tool!"-Physicians' Framing of a Patient Portal in Sweden.

    PubMed

    Grünloh, Christiane; Cajander, Åsa; Myreteg, Gunilla

    2016-06-27

    Uppsala County in Sweden launched an eHealth patient portal in 2012, which allows patients to access their medical records over the Internet. However, the launch of the portal was critically debated in the media. The professionals were strongly skeptical, and one reason was possible negative effects on their work environment. This study hence investigates the assumptions and perspectives of physicians to understand their framing of the patient portal in relation to their work environment. The study uses the concept of technological frames to examine how physicians in different specialties make sense of the patient portal in relation to their work environment. A total of 12 semistructured interviews were conducted with physicians from different specialties. Interviews were transcribed and translated. A theoretically informed thematic analysis was performed. The thematic analysis revealed 4 main themes: work tool, process, workload, and control. Physicians perceive medical records as their work tool, written for communication within health care only. Considering effects on work environment, the physicians held a negative attitude and expected changes, which would affect their work processes in a negative way. Especially the fact that patients might read their test results before the physician was seen as possibly harmful for patients and as an interference with their established work practices. They expected the occurrence of misunderstandings and needs for additional explanations, which would consequently increase their workload. Other perceptions were that the portal would increase controlling and monitoring of physicians and increase or create a feeling of mistrust from patients. Regarding benefits for the patients, most of the physicians believe there is only little value in the patient portal and that patients would mostly be worried and misunderstand the information provided. Supported by the study, we conclude: (1) The transfer of a paper-based health care

  14. [Drug dependence among physicians].

    PubMed

    Schifferdecker, M; Schmidt, R; Loevenich, A; Krahl, A

    1996-06-01

    Physicians are at higher risk of addiction compared with the general population. Worldwide about 15% of physicians may be addicted to drugs or alcohol. In Germany, accurate epidemiological data are not available. The underlying issues of this occupational risk are the dangers of "role strain", features of a "typical" personality and a high rate of burnout among physicians. Most important is therefore prevention, the need to persuade physicians to "cherish themselves" and reduce work stress as far as possible. An US-program is described regarding identification and therapy of drug users among physicians.

  15. Urban-Rural Flows of Physicians

    ERIC Educational Resources Information Center

    Ricketts, Thomas C.; Randolph, Randy

    2007-01-01

    Context: Physician supply is anticipated to fall short of national requirements over the next 20 years. Rural areas are likely to lose relatively more physicians. Policy makers must know how to anticipate what changes in distribution are likely to happen to better target policies. Purpose: To determine whether there was a significant flow of…

  16. Urban-Rural Flows of Physicians

    ERIC Educational Resources Information Center

    Ricketts, Thomas C.; Randolph, Randy

    2007-01-01

    Context: Physician supply is anticipated to fall short of national requirements over the next 20 years. Rural areas are likely to lose relatively more physicians. Policy makers must know how to anticipate what changes in distribution are likely to happen to better target policies. Purpose: To determine whether there was a significant flow of…

  17. Effects of changing atmospheric conditions on wind turbine performance

    NASA Astrophysics Data System (ADS)

    Clifton, A.; Fleming, P.; Kilcher, L.; Lundquist, J. K.

    2012-12-01

    The atmospheric boundary layer is well known as a dynamic, hard-to-predict environment. Some large scale trends are clear, for example a switch from stable nighttime stratification to convective conditions during the day. In comparison, other effects, such as changes in shear, turbulence and wind veer are less obvious and can be influenced by terrain and synoptic conditions as well as the diurnal cycle. Wind turbines are designed to operate almost continuously for 20 years or more, and so must work reliably and produce predictable amounts of power in very variable wind conditions. Using data from the observations on turbines at the National Wind Technology Center and other sites, together with simulations of turbine performance at different fidelities, we show some of the ways in which turbine performance and loads are affected by changes in the atmosphere. We compare and contrast our results with some of the methods frequently used in the wind industry to predict turbine power output, and discuss how the wind resource assessment process could be improved to account for variations in the atmosphere. Finally we highlight combinations of conditions that may be particularly advantageous or challenging for the wind turbines we have studied.

  18. Physician communication coaching effects on patient experience.

    PubMed

    Seiler, Adrianne; Knee, Alexander; Shaaban, Reham; Bryson, Christine; Paadam, Jasmine; Harvey, Rohini; Igarashi, Satoko; LaChance, Christopher; Benjamin, Evan; Lagu, Tara

    2017-01-01

    Excellent communication is a necessary component of high-quality health care. We aimed to determine whether a training module could improve patients' perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication. We designed a comprehensive physician-training module focused on improving specific "etiquette-based" physician communication skills through standardized simulations and physician coaching with structured feedback. We employed a quasi-experimental pre-post design, with an intervention group consisting of internal medicine hospitalists and residents and a control group consisting of surgeons. The outcome was percent "always" scores for questions related to patients' perceptions of physician communication using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and a Non-HCAHPS Physician-Specific Patient Experience Survey (NHPPES) administered to patients cared for by hospitalists. A total of 128 physicians participated in the simulation. Responses from 5020 patients were analyzed using HCAHPS survey data and 1990 patients using NHPPES survey data. The intercept shift, or the degree of change from pre-intervention percent "always" responses, for the HCAHPS questions of doctors "treating patients with courtesy" "explaining things in a way patients could understand," and "overall teamwork" showed no significant differences between surgical control and hospitalist intervention patients. Adjusted NHPPES percent excellent survey results increased significantly post-intervention for the questions of specified individual doctors "keeping patient informed" (adjusted intercept shift 9.9% P = 0.019), "overall teamwork" (adjusted intercept shift 11%, P = 0.037), and "using words the patient could understand" (adjusted intercept shift 14.8%, p = 0.001). A simulation based physician communication coaching method focused on specific "etiquette

  19. Patient outcomes and evidence-based medicine in a preferred provider organization setting: a six-year evaluation of a physician pay-for-performance program.

    PubMed

    Gilmore, Amanda S; Zhao, Yingxu; Kang, Ning; Ryskina, Kira L; Legorreta, Antonio P; Taira, Deborah A; Chung, Richard S

    2007-12-01

    To determine whether health plan members who saw physicians participating in a quality-based incentive program in a preferred provider organization (PPO) setting received recommended care over time compared with patients who saw physicians who did not participate in the incentive program, as per 11 evidence-based quality indicators. Administrative claims data for PPO members of a large nonprofit health plan in Hawaii collected over a 6-year period after the program was first implemented. An observational study allowing for multiple member records within and across years. Levels of recommended care received by members who visited physicians who did or did not participate in a quality incentive program were compared, after controlling for other member characteristics and the member's total number of annual office visits. Data for all PPO enrollees eligible for at least one of the 11 quality indicators in at least 1 year were collected. We found a consistent, positive association between having seen only program-participating providers and receiving recommended care for all 6 years with odds ratios ranging from 1.06 to 1.27 (95 percent confidence interval: 1.03-1.08, 1.09-1.40). Physician reimbursement models built upon evidence-based quality of care metrics may positively affect whether or not a patient receives high quality, recommended care.

  20. Patient Outcomes and Evidence-Based Medicine in a Preferred Provider Organization Setting: A Six-Year Evaluation of a Physician Pay-for-Performance Program

    PubMed Central

    Gilmore, Amanda S; Zhao, Yingxu; Kang, Ning; Ryskina, Kira L; Legorreta, Antonio P; Taira, Deborah A; Chung, Richard S

    2007-01-01

    Objective To determine whether health plan members who saw physicians participating in a quality-based incentive program in a preferred provider organization (PPO) setting received recommended care over time compared with patients who saw physicians who did not participate in the incentive program, as per 11 evidence-based quality indicators. Data Sources/Study Setting Administrative claims data for PPO members of a large nonprofit health plan in Hawaii collected over a 6-year period after the program was first implemented. Study Design An observational study allowing for multiple member records within and across years. Levels of recommended care received by members who visited physicians who did or did not participate in a quality incentive program were compared, after controlling for other member characteristics and the member's total number of annual office visits. Data Collection Data for all PPO enrollees eligible for at least one of the 11 quality indicators in at least 1 year were collected. Principal Findings We found a consistent, positive association between having seen only program-participating providers and receiving recommended care for all 6 years with odds ratios ranging from 1.06 to 1.27 (95 percent confidence interval: 1.03–1.08, 1.09–1.40). Conclusions Physician reimbursement models built upon evidence-based quality of care metrics may positively affect whether or not a patient receives high quality, recommended care. PMID:17995557

  1. Abrupt Strategy Change Underlies Gradual Performance Change: Bayesian Hierarchical Models of Component and Aggregate Strategy Use.

    PubMed

    Wynton, Sarah K A; Anglim, Jeromy

    2017-04-10

    While researchers have often sought to understand the learning curve in terms of multiple component processes, few studies have measured and mathematically modeled these processes on a complex task. In particular, there remains a need to reconcile how abrupt changes in strategy use can co-occur with gradual changes in task completion time. Thus, the current study aimed to assess the degree to which strategy change was abrupt or gradual, and whether strategy aggregation could partially explain gradual performance change. It also aimed to show how Bayesian methods could be used to model the effect of practice on strategy use. To achieve these aims, 162 participants completed 15 blocks of practice on a complex computer-based task-the Wynton-Anglim booking (WAB) task. The task allowed for multiple component strategies (i.e., memory retrieval, information reduction, and insight) that could also be aggregated to a global measure of strategy use. Bayesian hierarchical models were used to compare abrupt and gradual functions of component and aggregate strategy use. Task completion time was well-modeled by a power function, and global strategy use explained substantial variance in performance. Change in component strategy use tended to be abrupt, whereas change in global strategy use was gradual and well-modeled by a power function. Thus, differential timing of component strategy shifts leads to gradual changes in overall strategy efficiency, and this provides one reason for why smooth learning curves can co-occur with abrupt changes in strategy use. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  2. Who gets a family physician through centralized waiting lists?

    PubMed

    Breton, Mylaine; Brousselle, Astrid; Boivin, Antoine; Roberge, Danièle; Pineault, Raynald; Berbiche, Djamal

    2015-02-05

    North American patients are experiencing difficulties in securing affiliations with family physicians. Centralized waiting lists are increasingly being used in Organisation for Economic Co-operation and Development countries to improve access. In 2011, the Canadian province of Quebec introduced new financial incentives for family physicians' enrolment of orphan patients through centralized waiting lists, the Guichet d'accès aux clientèles orphelines, with higher payments for vulnerable patients. This study analyzed whether any significant changes were observed in the numbers of patient enrolments with family physicians' after the introduction of the new financial incentives. Prior to then, financial incentives had been offered for enrolment of vulnerable patients only and there were no incentives for enrolling non-vulnerable patients. After 2011, financial incentives were also offered for enrolment of non-vulnerable patients, while those for enrolment of vulnerable patients were doubled. A longitudinal quantitative analysis spanning a five-year period (2008-2013) was performed using administrative databases covering all patients enrolled with family physicians through centralized waiting lists in the province of Quebec (n = 494,697 patients). Mixed regression models for repeated-measures were used. The number of patients enrolled with a family physician through centralized waiting lists more than quadrupled after the changes in financial incentives. Most of this increase involved non-vulnerable patients. After the changes, 70% of patients enrolled with a family physician through centralized waiting lists were non-vulnerable patients, most of whom had been referred to the centralized waiting lists by the physician who enrolled them, without first being registered in those lists or having to wait because of their priority level. Centralized waiting lists linked to financial incentives increased the number of family physicians' patient enrolments. However, although

  3. [Sleep disorders among physicians on shift work].

    PubMed

    Schlafer, O; Wenzel, V; Högl, B

    2014-11-01

    Sleep disorders in physicians who perform shift work can result in increased risks of health problems that negatively impact performance and patient safety. Even those who cope well with shift work are likely to suffer from sleep disorders. The aim of this manuscript is to discuss possible causes, contributing factors and consequences of sleep disorders in physicians and to identify measures that can improve adaptation to shift work and treatment strategies for shift work-associated sleep disorders. The risk factors that influence the development of sleep disorders in physicians are numerous and include genetic factors (15 % of the population), age (> 50 years), undiagnosed sleep apnea,, alcohol abuse as well as multiple stress factors inherent in clinical duties (including shift work), research, teaching and family obligations. Several studies have reported an increased risk for medical errors in sleep-deprived physicians. Shift workers have an increased risk for psychiatric and cardiovascular diseases and shift work may also be a contributing factor to cancer. A relationship has been reported not only with sleep deprivation and changes in food intake but also with diabetes mellitus, obesity, hypertension and coronary heart disease. Nicotine and alcohol consumption are more frequent among shift workers. Increased sickness and accident rates among physicians when commuting (especially after night shifts) have a socioeconomic impact. In order to reduce fatigue and to improve performance, short naps during shiftwork or naps plus caffeine, have been proposed as coping strategies; however, napping during adverse circadian phases is less effective, if not impossible when unable to fall asleep. Bright and blue light supports alertness during a night shift. After shiftwork, direct sunlight exposure to the retina can be avoided by using dark sunglasses or glasses with orange lenses for commuting home. The home environment for daytime sleeping after a night shift should be

  4. Fractals for physicians.

    PubMed

    Thamrin, Cindy; Stern, Georgette; Frey, Urs

    2010-06-01

    There is increasing interest in the study of fractals in medicine. In this review, we provide an overview of fractals, of techniques available to describe fractals in physiological data, and we propose some reasons why a physician might benefit from an understanding of fractals and fractal analysis, with an emphasis on paediatric respiratory medicine where possible. Among these reasons are the ubiquity of fractal organisation in nature and in the body, and how changes in this organisation over the lifespan provide insight into development and senescence. Fractal properties have also been shown to be altered in disease and even to predict the risk of worsening of disease. Finally, implications of a fractal organisation include robustness to errors during development, ability to adapt to surroundings, and the restoration of such organisation as targets for intervention and treatment. Copyright 2010 Elsevier Ltd. All rights reserved.

  5. Physician self-directed learning and education.

    PubMed

    Tagawa, Masami

    2008-07-01

    Physicians are expected to be life-long learners because updated and effective patient care should be provided while medical and clinical knowledge and skills and social requirements for patient care are rapidly changing. Also, qualified clinical competence needs long periods of training and each physician has to continually learn as long as he/she works as a professional. Self-directed learning is an important factor in adult learning. Medical students' readiness for self-directed learning is not high, and should be improved by medical school and postgraduate training curricula. Garrison proposed a comprehensive model of self-directed learning, and it has dimensions of motivation (entering and task), self-monitoring (responsibility), and self-management (responsibility). To teach individual self-directed learning competencies, the following are important: (1) situate learners to experience "real" problems; (2) encourage learners to reflect on their own performance; (3) create an educational atmosphere in clinical training situations. In 2005, a 2-year mandatory residency program was implemented in Japan, and fewer medical school graduates took residency programs in medical school hospitals and advanced specialty programs provided by medical school departments. Medical school departments provide traditional, but life-long clinical training opportunities. Under the new residency program, an additional postgraduate and continuing medical training system has to be built up to maintain and confirm a physician's competencies. If physicians do clinical work using a scholarly way of thinking with critical analysis of their own competencies and improvement by reflection, they will become an excellent life-long learner.

  6. Construction of a Physician Skills Inventory

    ERIC Educational Resources Information Center

    Richard, George V.; Zarconi, Joseph; Savickas, Mark L.

    2012-01-01

    The current study applied Holland's RIASEC typology to develop a "Physician Skills Inventory". We identified the transferable skills and abilities that are critical to effective performance in medicine and had 140 physicians in 25 different specialties rate the importance of those skills. Principal component analysis of their responses produced…

  7. Construction of a Physician Skills Inventory

    ERIC Educational Resources Information Center

    Richard, George V.; Zarconi, Joseph; Savickas, Mark L.

    2012-01-01

    The current study applied Holland's RIASEC typology to develop a "Physician Skills Inventory". We identified the transferable skills and abilities that are critical to effective performance in medicine and had 140 physicians in 25 different specialties rate the importance of those skills. Principal component analysis of their responses produced…

  8. 20 CFR 725.703 - Physician defined.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Physician defined. 725.703 Section 725.703... AND HEALTH ACT, AS AMENDED Medical Benefits and Vocational Rehabilitation § 725.703 Physician defined... scope of their practices as defined by State law. No treatment or medical services performed by any...

  9. Evaluation of Physicians' Requests for Autopsies.

    ERIC Educational Resources Information Center

    Kesler, Richard W.; And Others

    1983-01-01

    Chaplains and seminary students enrolled in the University of Virginia Medical Center's Clinical Pastoral Program were asked to judge physicians' performances while requesting autopsies by completing a confidential evaluation form. The results of the evaluations were correlated with the physicians' success in obtaining autopsies. (MLW)

  10. Patterns in computed tomography utilization among emergency physicians in an urban, academic emergency department.

    PubMed

    Kirschner, Jonathan; Shah, Kaushal; Runde, Daniel; Newman, David; Godbout, Brandon; Wiener, Dan; Lee, Jarone

    2014-12-01

    We sought to determine if CT utilization rates varied by characteristics of the physician. A chart review was performed at an urban academic emergency department (ED) to identify all the CT scans ordered and patients seen for subjects 21 years of age and older by physicians between January 2001 and December 2008. "Years of experience" was defined as years of practice after residency. Various experience cutoffs were determined a priori. Physicians were labeled "academic" if they had reduced clinical hours for academic duties and "clinical" if they were physicians without "protected time." We categorized physicians as "high users" (top quartiles) and "low users" (bottom quartiles), and compared utilization rates from 2001 to 2003 to utilization rates from 2005 to 2007. There were 280 physician-years of practice, with an average experience of 6.1 years. When comparing groups of physicians with more or less than 3, 5, 10, and 15 years of experience, there were no statistically significant differences between the number of CT scans per 1,000 visits (p = 0.85; p = 0.21; p = 0.57; p = 0.08, respectively). Comparison between clinical and academic physicians yielded no differences (clinical = 98.4, academic = 104.2, p = 0.10). Low users ordered 78 CT scans per 1,000 patient visits (95 % CI 76.6-78.5), as compared to the high users that ordered 135 CT scans per 1,000 patient visits (95 % CI 131.8-139.0). We found that all of physicians stayed within their quartiles except one. While there was substantial variation among CT utilization rates by physicians at this urban emergency department, our data shows no differences between physicians with more or less clinical experience and no change in individual utilization patterns during the study period.

  11. Health care workplace discrimination and physician turnover.

    PubMed

    Nunez-Smith, Marcella; Pilgrim, Nanlesta; Wynia, Matthew; Desai, Mayur M; Bright, Cedric; Krumholz, Harlan M; Bradley, Elizabeth H

    2009-12-01

    To examine the association between physician race/ ethnicity, workplace discrimination, and physician job turnover. Cross-sectional, national survey conducted in 2006-2007 of practicing physicians (n = 529) randomly identified via the American Medical Association Masterfile and the National Medical Association membership roster. We assessed the relationships between career racial/ethnic discrimination at work and several career-related dependent variables, including 2 measures of physician turnover, career satisfaction, and contemplation of career change. We used standard frequency analyses, odds ratios and chi2 statistics, and multivariate logistic regression modeling to evaluate these associations. Physicians who self-identified as nonmajority were significantly more likely to have left at least 1 job because of workplace discrimination (black, 29%; Asian, 24%; other race, 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models, having experienced racial/ethnic discrimination at work was associated with high job turnover (adjusted odds ratio, 2.7; 95% CI, 1.4-4.9). Among physicians who experienced workplace discrimination, only 45% of physicians were satisfied with their careers (vs 88% among those who had not experienced workplace discrimination, p value < .01), and 40% were contemplating a career change (vs 10% among those who had not experienced workplace discrimination, p value < .001). Workplace discrimination is associated with physician job turnover, career dissatisfaction, and contemplation of career change. These findings underscore the importance of monitoring for workplace discrimination and responding when opportunities for intervention and retention still exist.

  12. Changing the precision of preschoolers’ approximate number system representations changes their symbolic math performance

    PubMed Central

    Wang, Jinjing (Jenny); Odic, Darko; Halberda, Justin; Feigenson, Lisa

    2016-01-01

    From early in life, humans have access to an Approximate Number System (ANS) that supports an intuitive sense of numerical quantity. Previous work in both children and adults suggests that individual differences in the precision of ANS representations correlate with symbolic math performance. However, this work has been almost entirely correlational in nature. Here we tested for a causal link between ANS precision and symbolic math performance by asking whether a temporary modulation of ANS precision changes symbolic math performance. First we replicated a recent finding that 5-year-old children make more precise ANS discriminations when starting with easier trials and gradually progressing to harder ones, compared to the reverse. Next, we show that this brief modulation of ANS precision influenced children’s performance on a subsequent symbolic math task, but not a vocabulary task. In a supplemental experiment we present evidence that children who performed ANS discriminations in a random trial order showed intermediate performance both on the ANS task and the symbolic math task, compared to the children who made ordered discriminations. Thus, our results point to a specific causal link from the ANS to symbolic math performance. PMID:27061668

  13. Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: A report from the CHANGES study☆

    PubMed Central

    van Ryn, Michelle; Hardeman, Rachel R.; Phelan, Sean M.; Burke, Sara E.; Przedworski, Julia; Allen, Michele L.; Burgess, Diana J.; Ridgeway, Jennifer; White, Richard O.; Dovidio, John F.

    2014-01-01

    Objective Medical school curricula intended to promote empathy varies widely. Even the most effective curricula leave a significant group of students untouched. Pre-existing student factors influence their response to learning experiences. We examined the individual predictors of first semester medical students’ attitudes toward the value of physician empathy in clinical encounters. Methods First year students (n = 4732) attending a stratified random sample of 49 US medical schools completed an online questionnaire that included measures of dispositional characteristics, attitudes and beliefs, self-concept and well-being. Results Discomfort with uncertainty, close-mindedness, dispositional empathy, elitism, medical authoritarianism, egalitarianism, self-concept and well-being all independently predicted first year medical students’ attitudes toward the benefit of physician empathy in clinical encounters. Conclusion Students vary on their attitude toward the value of physician empathy when they start medical school. The individual factors that predict their attitudes toward empathy may also influence their response to curricula promoting empathic care. Practice implications Curricula in medical school promoting empathic care may be more universally effective if students’ preexisting attitudes are taken into account. Messages about the importance of physician empathy may need to be framed in ways that are consistent with the beliefs and prior world-views of medical students. PMID:25065328

  14. Can a Free Wearable Activity Tracker Change Behavior? The Impact of Trackers on Adults in a Physician-Led Wellness Group

    PubMed Central

    Rosenbluth, Sandra; Phillips, Jeffrey

    2016-01-01

    Background Wearable activity trackers (trackers) are increasingly popular devices used to track step count and other health indicators. Trackers have the potential to benefit those in need of increased physical activity, such as adults who are older and face significant health challenges. These populations are least likely to purchase trackers and most likely to face challenges in using them, yet may derive educational, motivational, and health benefits from their use once these barriers are removed. Objective The aim of this pilot research is to investigate the use of trackers by adults with chronic medical conditions who have never used trackers previously. Specifically, we aim to determine (1) if participants would accept and use trackers to increase their physical activity; (2) if there were barriers to use besides cost and training; (3) if trackers would educate participants on their baseline and ongoing activity levels and support behavior change; and (4) if clinical outcomes would show improvements in participants’ health. Methods This study was conducted with patients (N=10) in a 12-week physician-led wellness group offered by Family Doctors, LLC. Patients were given trackers in the second week of The Wellness Group and were interviewed 2 to 4 weeks after it ended. The study investigators analyzed the interview notes to extract themes about the participants’ attitudes and behavior changes and collected and analyzed participants’ clinical data, including weight and low-density lipoprotein (LDL) cholesterol over the course of the study. Results Over the 12 to 14 weeks of tracker use, improvements were seen in clinical outcomes, attitudes towards the trackers, and physical activity behaviors. Participants lost an average of 0.5 lbs per week (SD 0.4), with a mean total weight loss of 5.97 lbs (P=.004). Other short-term clinical outcomes included a 9.2% decrease in LDL levels (P=.038). All participants reported an increase in well-being and confidence in

  15. Developmental Changes in Adolescents' Olfactory Performance and Significance of Olfaction

    PubMed Central

    Klötze, Paula; Gerber, Friederike; Croy, Ilona; Hummel, Thomas

    2016-01-01

    Aim of the current work was to examine developmental changes in adolescents’ olfactory performance and personal significance of olfaction. In the first study olfactory identification abilities of 76 participants (31 males and 45 females aged between 10 and 18 years; M = 13.8, SD = 2.3) was evaluated with the Sniffin Stick identification test, presented in a cued and in an uncued manner. Verbal fluency was additionally examined for control purpose. In the second study 131 participants (46 males and 85 females aged between 10 and 18 years; (M = 14.4, SD = 2.2) filled in the importance of olfaction questionnaire. Odor identification abilities increased significantly with age and were significantly higher in girls as compared to boys. These effects were especially pronounced in the uncued task and partly related to verbal fluency. In line, the personal significance of olfaction increased with age and was generally higher among female compared to male participants. PMID:27332887

  16. Multivoxel neurofeedback selectively modulates confidence without changing perceptual performance

    PubMed Central

    Cortese, Aurelio; Amano, Kaoru; Koizumi, Ai; Kawato, Mitsuo; Lau, Hakwan

    2016-01-01

    A central controversy in metacognition studies concerns whether subjective confidence directly reflects the reliability of perceptual or cognitive processes, as suggested by normative models based on the assumption that neural computations are generally optimal. This view enjoys popularity in the computational and animal literatures, but it has also been suggested that confidence may depend on a late-stage estimation dissociable from perceptual processes. Yet, at least in humans, experimental tools have lacked the power to resolve these issues convincingly. Here, we overcome this difficulty by using the recently developed method of decoded neurofeedback (DecNef) to systematically manipulate multivoxel correlates of confidence in a frontoparietal network. Here we report that bi-directional changes in confidence do not affect perceptual accuracy. Further psychophysical analyses rule out accounts based on simple shifts in reporting strategy. Our results provide clear neuroscientific evidence for the systematic dissociation between confidence and perceptual performance, and thereby challenge current theoretical thinking. PMID:27976739

  17. No exodus: physicians and managed care networks.

    PubMed

    O'Malley, Ann S; Reschovsky, James D

    2006-05-01

    After remaining stable since 1996-97, the percentage of U.S. physicians who do not contract with managed care plans rose from 9.2 percent in 2000-01 to 11.5 percent in 2004-05, according to a national study from the Center for Studying Health System Change (HSC). While physicians have not left managed care networks in large numbers, this small but statistically significant increase could signal a trend toward greater out-of-pocket costs for patients and a decline in patient access to physicians. The increase in physicians without managed care contracts was broad-based across specialties and other physician and practice characteristics. Compared with physicians who have one or more managed care contracts, physicians without managed care contracts are more likely to have practiced for more than 20 years, work part time, lack board certification, practice solo or in two-physician groups, and live in the western United States. The study also found substantial variation in the proportion of physicians without managed care contracts across communities, suggesting that local market conditions influence decisions to contract with managed care plans.

  18. Flow pattern changes improve roller cone bit performance

    SciTech Connect

    Huffstutler, A.D.

    1996-05-06

    Improving the flow pattern through and around roller cone bits has increased penetration rate and footage while dropping the cost per foot drilled. These changes to the flow area around the bit help clean the bit and borehole more efficiently. By eliminating the protruding nozzle bosses, increasing nozzle bore size, narrowing the width of the bit arm segments, and providing a convex spherical dome, flow trajectories have been improved. These altered flow trajectories have eliminated hydraulic dead spots commonly found around current roller cone rock bit configurations. Nozzles are directed significantly more inward, toward the well bore bottom and away from the edge of the borehole. The flow impacts the bottom of the hole where it is needed most. Further performance enhancement features include an angled ramp on the shirt-tail portion of the arm to aid in lifting the cuttings upward, away from the cones and the bearing seals. Changing contours of the bit arms in the nozzle and bearing areas also improves cleaning and prevents cuttings from packing off in the bearing seal area.

  19. Assessing changes in knowledge, attitude and practices on dengue diagnosis and management among primary care physicians after the largest dengue epidemic in Singapore.

    PubMed

    Pang, Junxiong; Hildon, Zoe Jane-Lara; Thein, Tun Linn; Jin, Jing; Leo, Yee Sin

    2017-06-15

    Dengue results in high morbidity and mortality globally. The knowledge, attitude and practices (KAP) of dengue management, including diagnosis, among primary care physicians (PCPs) are important to reduce dengue transmission and burden. However, there is a lack of understanding on the impact of dengue epidemic on dengue management. Hence, the aim of this study is to examine the changes in KAP on dengue management among PCPs before and after the largest dengue epidemic in 2013 in Singapore. Surveys were mailed to 2000 and 1514 PCPs registered under the Singapore Medical Council in March of year 2011 and 2014, respectively. Survey data were then collected between April and June of that year. Chi-square or Fisher's exact test was used for comparing categorical variables. A multivariate logistic regression model was implemented to determine independent factors for frequent use of dengue diagnostic tests (DDTs). All tests were conducted at 5% level of significance. Adjusted odds ratio and corresponding 95% confidence intervals were reported, where applicable. Qualitative data were descriptively coded for themes and analysis. Among PCPs surveyed in 2011 and 2014, 89.9% and 86% had good knowledge on dengue management respectively. The usage of DDTs had increased significantly in 2014 (N = 164;56%) as compared to 2011 (N = 107;29.5%) in both private and public clinics (p < 0.001). Dengue Duo point-of-care test (POCT) kits was independently associated with frequent use of DDTs (adjusted odds ratio = 2.15; 95% confidence interval = 1.25-3.69). There was a significant reduction in referral of dengue patients to hospital (31.4% in 2011; 13.3% in 2014; p < 0.001), and a significant increase in frequency of clinic follow-ups (18.4% in 2011; 28.5% in 2014; p = 0.003). One key theme highlighted was that dengue management can be improved with availability of POCT kit, better awareness of the disease and any revised clinical guidelines. The knowledge on dengue

  20. How does burnout affect physician productivity? A systematic literature review.

    PubMed

    Dewa, Carolyn S; Loong, Desmond; Bonato, Sarah; Thanh, Nguyen Xuan; Jacobs, Philip

    2014-07-28

    Interest in the well-being of physicians has increased because of their contributions to the healthcare system quality. There is growing recognition that physicians are exposed to workplace factors that increase the risk of work stress. Long-term exposure to high work stress can result in burnout. Reports from around the world suggest that about one-third to one-half of physicians experience burnout. Understanding the outcomes associated with burnout is critical to understanding its affects on the healthcare system. Productivity outcomes are among those that could have the most immediate effects on the healthcare system. This systematic literature review is one of the first to explore the evidence for the types of physician productivity outcomes associated with physician burnout. It answers the question, "How does burnout affect physician productivity?" A systematic search was performed of: Medline Current, Medline in process, PsycInfo, Embase and Web of Science. The search period covered 2002 to 2012. The searches identified articles about practicing physicians working in civilian settings. Articles that primarily looked only at residents or medical students were excluded. Productivity was captured by hours worked, patients seen, sick leave, leaving the profession, retirement, workload and presenteeism. Studies also were excluded if: (1) the study sample was not comprised of at least 50% physicians, (2) the study did not examine the relationship between burnout and productivity or (3) a validated measure of burnout was not used. The search identified 870 unique citations; 5 met the inclusion/exclusion criteria. This review indicates that globally there is recognition of the potential impact of physician burnout on productivity. Productivity was examined using: number of sick leave days, work ability, intent to either continue practicing or change jobs. The majority of the studies indicate there is a negative relationship between burnout and productivity. However

  1. X-ray exposure hazards for physicians performing ablation procedures and device implantation: results of the European Heart Rhythm Association survey.

    PubMed

    Marinskis, Germanas; Bongiorni, Maria Grazia; Dagres, Nikolaos; Lewalter, Thorsten; Pison, Laurent; Blomstrom-Lundqvist, Carina

    2013-03-01

    The purpose of the survey was to evaluate physician's and authorities policies and clinical practices when using occupational X-ray during ablation procedures and device implantation. This survey shows infrequent use of lead gloves, radiation absorbing pads, and lead glass cabins, but increasing use of three-dimensional mapping systems to decrease X-ray radiation hazards. Digital fluoroscopy with decreased frame rate is not used by approximately one-third of responding centres.

  2. Formation of homophily in academic performance: Students change their friends rather than performance

    PubMed Central

    Smirnov, Ivan

    2017-01-01

    Homophily, the tendency of individuals to associate with others who share similar traits, has been identified as a major driving force in the formation and evolution of social ties. In many cases, it is not clear if homophily is the result of a socialization process, where individuals change their traits according to the dominance of that trait in their local social networks, or if it results from a selection process, in which individuals reshape their social networks so that their traits match those in the new environment. Here we demonstrate the detailed temporal formation of strong homophily in academic achievements of high school and university students. We analyze a unique dataset that contains information about the detailed time evolution of a friendship network of 6,000 students across 42 months. Combining the evolving social network data with the time series of the academic performance (GPA) of individual students, we show that academic homophily is a result of selection: students prefer to gradually reorganize their social networks according to their performance levels, rather than adapting their performance to the level of their local group. We find no signs for a pull effect, where a social environment of good performers motivates bad students to improve their performance. We are able to understand the underlying dynamics of grades and networks with a simple model. The lack of a social pull effect in classical educational settings could have important implications for the understanding of the observed persistence of segregation, inequality and social immobility in societies. PMID:28854202

  3. Formation of homophily in academic performance: Students change their friends rather than performance.

    PubMed

    Smirnov, Ivan; Thurner, Stefan

    2017-01-01

    Homophily, the tendency of individuals to associate with others who share similar traits, has been identified as a major driving force in the formation and evolution of social ties. In many cases, it is not clear if homophily is the result of a socialization process, where individuals change their traits according to the dominance of that trait in their local social networks, or if it results from a selection process, in which individuals reshape their social networks so that their traits match those in the new environment. Here we demonstrate the detailed temporal formation of strong homophily in academic achievements of high school and university students. We analyze a unique dataset that contains information about the detailed time evolution of a friendship network of 6,000 students across 42 months. Combining the evolving social network data with the time series of the academic performance (GPA) of individual students, we show that academic homophily is a result of selection: students prefer to gradually reorganize their social networks according to their performance levels, rather than adapting their performance to the level of their local group. We find no signs for a pull effect, where a social environment of good performers motivates bad students to improve their performance. We are able to understand the underlying dynamics of grades and networks with a simple model. The lack of a social pull effect in classical educational settings could have important implications for the understanding of the observed persistence of segregation, inequality and social immobility in societies.

  4. Referral physician marketing.

    PubMed

    Lewis, A

    1993-01-01

    Marketing of specialist services to referring physicians can be highly effective at influencing referral patterns if the referring physician's needs are taken into account. Furthermore, it is possible to generate referrals from nonreferring physicians by approaching them correctly. The ideal approach is for a specialist to treat non-referring physicians as though they referred the patient, even when they didn't. This practice allows the specialist to demonstrate communications service quality in a non-aggressive, non-sales context. The United Weight Control case study summarizes the impact of a referral-generation strategy with "before" and "after" analyses of the strategy's cost and effectiveness.

  5. How does a lower predictability of lane changes affect performance in the Lane Change Task?

    PubMed

    Petzoldt, Tibor; Krems, Josef F

    2014-07-01

    The Lane Change Task (LCT) is an established method to assess driver distraction caused by secondary tasks. In the LCT ISO standard, "course following and maneuvering" and "event detection" are mentioned as central task properties. Especially event detection seems to be a reasonable feature, as research suggests that distraction has profound effects on drivers' reactions to sudden, unexpected events. However, closer inspection of the LCT reveals that the events to be detected (lane change signs) and the required response are highly predictable. To investigate how the LCT's distraction assessment of secondary tasks might change if lane change events and responses were less predictable, we implemented three different versions of the LCT - an "original" one, a second one with lowered predictability of event position, and a third one with lowered predictability of event position and response. We tested each of these implementations with the same set of visual and cognitive secondary tasks of varying demand. The results showed that a decrease in predictability resulted in overall degraded performance in the LCT when using the basic lane change model for analysis. However, all secondary task conditions suffered equally. No differential effects were found. We conclude that although an ISO conforming implementation of the LCT might not be excessively valid regarding its depiction of safety relevant events, the results obtained are nevertheless comparable to what would be found in settings of higher validity.

  6. A history of physician suicide in America.

    PubMed

    Legha, Rupinder K

    2012-12-01

    Over the course of the last century, physicians have written a number of articles about suicide among their own. These articles reveal how physicians have fundamentally conceived of themselves, how they have addressed vulnerability among their own, and how their self-identification has changed over time, due, in part, to larger historical changes in the profession, psychiatry, and suicidology. The suicidal physician of the Golden Age (1900-1970), an expendable deviant, represents the antithesis of that era's image of strength and invincibility. In contrast, the suicidal physician of the modern era (1970 onwards), a vulnerable human being deserving of support, reflects that era's frustration with bearing these unattainable ideals and its growing emphasis on physician health and well-being. Despite this key transition, specifically the acknowledgment of physicians' limitations, more recent articles about physician suicide indicate that Golden Age values have endured. These persistent emphases on perfection and discomfort with vulnerability have hindered a comprehensive consideration of physician suicide, despite one hundred years of dialogue in the medical literature.

  7. Assessing the implementation of physician-payment reform.

    PubMed

    Hsiao, W C; Dunn, D L; Verrilli, D K

    1993-04-01

    The Medicare program fundamentally changed its system of payment for physicians' services in 1992. Controversy over the new Medicare fee schedule has focused on three issues: the adequacy of the conversion factor used to translate resource-based relative-value units into fees; the ability of the new payment system to capture differences in work between surgeons and physicians in other specialties; and the allocation of practice expenses across services. Using a standard service in each specialty, we developed simulation methods to assess the implementation of physician-payment reform. With these methods we calculated the potential net income for each specialty, as generated by different payment scenarios, including the Medicare fee schedule. We found that Medicare's current monetary-conversion factor yields an unreasonably low level of income for most specialties. Furthermore, the Medicare fee schedule misallocates practice expenses; invasive services are reimbursed for more than actual expenses, and medical services are reimbursed for less. Thus, physicians continue to be paid more generously for invasive services. Finally, the Medicare fee schedule does recognize the wide differences in the intensity of work performed by physicians in various specialties. The misallocation of practice expenses in the Medicare fee schedule results in serious underpayment for medical services. We think it likely that physicians compensate by performing more lucrative services, such as diagnostic tests. Even if legislation is passed to deal with the misallocation of expenses, the current conversion factor still produces unreasonably low levels of payment overall, which could dissuade those considering a career in medicine from entering the field. Finally, the simulation method we developed can be used as a tool for fee negotiations.

  8. Designing a physician leadership development program based on effective models of physician education.

    PubMed

    Hopkins, Joseph; Fassiotto, Magali; Ku, Manwai Candy; Mammo, Dagem; Valantine, Hannah

    2017-02-02

    Because of modern challenges in quality, safety, patient centeredness, and cost, health care is evolving to adopt leadership practices of highly effective organizations. Traditional physician training includes little focus on developing leadership skills, which necessitates further training to achieve the potential of collaborative management. The aim of this study was to design a leadership program using established models for continuing medical education and to assess its impact on participants' knowledge, skills, attitudes, and performance. The program, delivered over 9 months, addressed leadership topics and was designed around a framework based on how physicians learn new clinical skills, using multiple experiential learning methods, including a leadership active learning project. The program was evaluated using Kirkpatrick's assessment levels: reaction to the program, learning, changes in behavior, and results. Four cohorts are evaluated (2008-2011). Reaction: The program was rated highly by participants (mean = 4.5 of 5). Learning: Significant improvements were reported in knowledge, skills, and attitudes surrounding leadership competencies. Behavior: The majority (80%-100%) of participants reported plans to use learned leadership skills in their work. Improved team leadership behaviors were shown by increased engagement of project team members. All participants completed a team project during the program, adding value to the institution. Results support the hypothesis that learning approaches known to be effective for other types of physician education are successful when applied to leadership development training. Across all four assessment levels, the program was effective in improving leadership competencies essential to meeting the complex needs of the changing health care system. Developing in-house programs that fit the framework established for continuing medical education can increase physician leadership competencies and add value to health care

  9. Facility evaluation of resigned hospital physicians:managerial implications for hospital physician manpower.

    PubMed

    Cheng, Kao-Chi; Lee, Tsung-Lin; Lin, Yen-Ju; Liu, Chiu-Shong; Lin, Cheng-Chieh; Lai, Shih-Wei

    2016-12-01

    Turnover of physicians might be responsible for reducing patients' trust and affecting hospital performance. This study aimed to understand physicians' psychological status regarding their hospital work environment and the resources of independent practitioners. This was a cross-sectional study with 774 physicians who had resigned from hospitals and were now practicing privately in clinics in Taichung City as its study population. A mail survey with a multidimensional questionnaire was sent to each subject. This study revealed that older physicians were less satisfied regarding the work environment in their respective former hospitals. Male physicians were found to be more satisfied with the tangible resources of their hospitals. Internal medicine physicians were found to be less satisfied overall with the intangible resources. Gynecologists and pediatricians were found to be more satisfied with their hospital environments. The physicians who worked long hours per week reported that they were less satisfied with their job content. The physicians who had opportunities to learn advanced skills and enhance their knowledge were more satisfied with their hospital environment, tangible resources, and intangible resources. In addition, physicians in private hospitals were found to be more satisfied with their job content, but they were less satisfied with work motivation and retention and intangible resources. In addition, physicians who worked in hospitals located in Taichung city reported that they were less satisfied with their tangible resources than the physicians working in hospitals outside of the city. This study focused on the satisfaction of physicians who had already left their respective hospitals instead of current retained physicians. From this study, it is our recommendation that hospital managers should pay closer attention to the real needs and expectations of the physicians they employ, and managers should consider adjusting their managerial perspectives

  10. Change in filter strip performance over ten years

    Treesearch

    M.G. Dosskey; K.D. Hoagland; J.R. Brandle

    2007-01-01

    Effectiveness of filter strips may change over a period of years because key soil and vegetation conditions change after conversion of cultivated farmland to permanent vegetation. the main objectives of this study were to : 1) determine if effectiveness of a filter strip changes over years since establishment, and 2) determine if temporal change depends on vegetation...

  11. Performance of Driver-Vehicle in Aborted Lane Change Maneuvers

    NASA Technical Reports Server (NTRS)

    Lee, Allan Y.

    1995-01-01

    A 'lane change crash' is defined as a family of collisions that occurred when a driver attempts to change lane and strikes or is struck by a vehicle in the adjacent lane. One type of maneuver that is commonly used to avert a lane change crash involved aborting the intended lane change, and returning the vehicle to the original lane of the subject vehicle.

  12. First and foremost, physicians: the clinical versus leadership identities of physician leaders.

    PubMed

    Quinn, Joann Farrell; Perelli, Sheri

    2016-06-20

    Purpose - Physicians are commonly promoted into administrative and managerial roles in US hospitals on the basis of clinical expertise and often lack the skills, training or inclination to lead. Several studies have sought to identify factors associated with effective physician leadership, yet we know little about how physician leaders themselves construe their roles. The paper aims to discuss these issues. Design/methodology/approach - Phenomenological interviews were performed with 25 physicians at three organizational levels with physicians affiliated or employed by four hospitals within one health care organization in the USA between August and September 2010. A rigorous comparative methodology of data collection and analysis was employed, including the construction of analytic codes for the data and its categorization based on emergent ideas and themes that are not preconceived and logically deduced hypotheses, which is characteristic of grounded theory. Findings - These interviews reveal differences in how part- vs full-time physician leaders understand and value leadership roles vs clinical roles, claim leadership status, and identify as physician leaders on individual, relational and organizational basis. Research limitations/implications - Although the physicians in the sample were affiliated with four community hospitals, all of them were part of a single not-for-profit health care system in one geographical locale. Practical implications - These findings may be of interest to hospital administrators and boards seeking deeper commitment and higher performance from physician leaders, as well as assist physicians in transitioning into a leadership role. Social implications - This work points to a broader and more fundamental need - a modified mindset about the nature and value of physician leadership. Originality/value - This study is unique in the exploration of the nature of physician leadership from the perspective of the physician on an individual, peer

  13. Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia.

    PubMed

    Wilckens, Kristine A; Hall, Martica H; Nebes, Robert D; Monk, Timothy H; Buysse, Daniel J

    2016-01-01

    The present study examined sleep features associated with cognition in older adults and examined whether sleep changes following insomnia treatment were associated with cognitive improvements. Polysomnography and cognition (recall, working memory, and reasoning) were assessed before and after an insomnia intervention (Brief Behavioral Treatment of Insomnia [BBTI] or information control [IC]) in 77 older adults with insomnia. Baseline wake-after-sleep-onset (WASO) was associated with recall. Greater NREM (nonrapid eye movement) delta power and lower NREM sigma power were associated with greater working memory and reasoning. The insomnia intervention did not improve performance. However, increased absolute delta power and decreased relative sigma power were associated with improved reasoning. Findings suggest that improvements in executive function may occur with changes in NREM architecture.

  14. Physician retention in community and migrant health centers: who stays and for how long?

    PubMed

    Singer, J D; Davidson, S M; Graham, S; Davidson, H S

    1998-08-01

    This study used discrete-time survival analysis to estimate the tenure of primary care physicians in Community Health Centers (CHCs), to identify the changing risk of leaving Community Health Center employment as time passes, and to identify factors associated with a physician's likelihood of remaining in a Community Health Center. Because of dramatic differences in physician career trajectories, much of the focus was on differences between physicians with and without National Health Service Corps obligations. Beginning with an administrative dataset at the Bureau of Primary Health Care that listed primary care physicians for each Community Health Center, the completeness and accuracy of the information provided were verified and an analytic database of all physicians working in those centers during a 21-month measurement window from January 1, 1990 through September 30, 1992 was constructed. The data included start and end dates, percent full-time equivalent status, and certain demographic characteristics. In addition, several data elements describing the Community Health Center were merged onto each physician record. These included urban or rural location, expenditure level, productivity, and federal grade. Through the use of discrete-time survival analysis, it was possible to include in the analytic sample all 2,654 physicians who worked during the period, even those who started working before January 1, 1990 and those who were still working on September 30, 1992. Survivor functions were estimated showing the proportion of physicians remaining after each quarter of their tenure (ie, after the fourth quarter of work, after the 12th quarter of work, etc). In addition, hazard functions were estimated showing the risk that a physician who had worked through the end of one quarter would leave during the following quarter. Finally, multivariate analysis demonstrated the relation of certain physician and center characteristics to the likelihood of the physician

  15. The Immediate Impact of the 2009 USPSTF Screening Guideline Change on Physician Recommendation of a Screening Mammogram: Findings from a National Ambulatory and Medical Care Survey-Based Study.

    PubMed

    Rajan, Suja S; Suryavanshi, Manasi S; Karanth, Siddharth; Lairson, David R

    2016-08-26

    Regular screening is considered the most effective method to reduce the mortality and morbidity associated with breast cancer. Nevertheless, contradictory evidence about screening mammograms has led to periodic changes and considerable variations among different screening guidelines. This study is the first to examine the immediate impact of the 2009 US Preventive Services Task Force (USPSTF) guideline modification on physician recommendation of mammograms. The study included visits by women aged 40 years and older without prior breast cancer from the National Ambulatory and Medical Care Survey 2008-2010. Bivariate and multiple logistic regressions were used to determine the factors associated with mammography recommendation. Approximately 29,395 visits were included and mammography was recommended during 1350 visits; 50-64-year-old women had 72% higher odds, and 65-74-year-old women had twice the odds of getting a mammogram recommendation compared with 40-49-year-old women in 2009. However, there was no difference in recommendation by age groups in 2008 and 2010. Obstetricians and gynecologists did not modify their recommendation behavior in 2009, unlike all other specialists who reduced their recommendation for 40-49-year-old women in 2009. Other characteristics associated with mammogram recommendations were certain patient comorbidities, physician specialty and primary care physician status, health maintenance organization status of the clinic, and certain visit characteristics. This study demonstrated a temporary effect of the USPSTF screening guideline change on mammogram recommendation. However, in light of conflicting recommendations by different guidelines, the physicians erred toward the more rigorous guidelines and did not permanently reduce their mammogram recommendation for women aged 40-49 years.

  16. Does the physician's emotional intelligence matter? Impacts of the physician's emotional intelligence on the trust, patient-physician relationship, and satisfaction.

    PubMed

    Weng, Hui-Ching

    2008-01-01

    Much of the literature pertinent to management indicates that service providers with high emotional intelligence (EI) receive higher customer satisfaction scores. Previous studies offer limited evidence regarding the impact of physician's EI on patient-physician relationship. Using a multilevel and multisource data approach, the current study aimed to build a model that demonstrated the impact of a physician's EI on the patient's trust and the patient-physician relationship. The survey sample included 983 outpatients and 39 physicians representing 11 specialties. Results of path analyses demonstrated that the ratio of patient's follow-up visits (p < .01) and the nurse-rated EI for physicians (p < .05) had positive effects on the patient's trust. The impact of patient's trust on patient's satisfaction was mediated by the patient-physician relationship at a significant level (p < .01). The patient-physician relationship had a significantly positive effect on patient's satisfaction (p < .001). The model accounted for 37% of the variance of patient's trust, 67% of the PDR, and 58% of patient's satisfaction on physician services. This study suggests that nurses had the sensitivity and intellectual skills in assessing the physician's performance and the patient's need. Our findings suggest that patient's trust is the cornerstone of the patient-physician relationship; however, mutual trust and professional respect between nurses and physicians play a critical role in reinforcing the patient-physician relationship to effect improvements in the provision of patient-centered care.

  17. Physician burnout: A neurologic crisis.

    PubMed

    Sigsbee, Bruce; Bernat, James L

    2014-12-09

    The prevalence of burnout is higher in physicians than in other professions and is especially high in neurologists. Physician burnout encompasses 3 domains: (1) emotional exhaustion: the loss of interest and enthusiasm for practice; (2) depersonalization: a poor attitude with cynicism and treating patients as objects; and (3) career dissatisfaction: a diminished sense of personal accomplishment and low self-value. Burnout results in reduced work hours, relocation, depression, and suicide. Burned-out physicians harm patients because they lack empathy and make errors. Studies of motivational factors in the workplace suggest several preventive interventions: (1) Provide counseling for physicians either individually or in groups with a goal of improving adaptive skills to the stress and rapid changes in the health care environment. (2) Identify and eliminate meaningless required hassle factors such as electronic health record "clicks" or insurance mandates. (3) Redesign practice to remove pressure to see patients in limited time slots and shift to team-based care. (4) Create a culture that promotes career advancement, mentoring, and recognition of accomplishments. © 2014 American Academy of Neurology.

  18. Physician-centered management guidelines.

    PubMed

    Pulde, M F

    1999-01-01

    The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.

  19. Hospital-physician relations: the recruitment perspective.

    PubMed

    Cejka, S A

    1994-01-01

    One of the biggest problems in the health care industry today is the supply and demand of physicians. As health care organizations scramble to recruit physicians for vital positions, they find themselves in a highly competitive and exhausting battle. As the health care industry changes, so do the needs and desires of physicians, especially young physicians. The heart and soul of a good recruitment program must include understanding who physicians are and what motivates them, selecting the right candidate, and most importantly, retaining them once you have gone to the time, expense, and heartache of recruiting them. Understanding how integrated systems can deal with these factors in the most effective and efficient way is key to surviving and thriving in an era of health care reform.

  20. Physician partnering: a provider network primer.

    PubMed

    Tortolani, A J; Cascardo-Weissman, D

    1999-01-01

    The face of health care is changing daily due to pressures brought about by dissatisfied consumers, physicians, and employers. The authors of this article believe that the only way to bring about a better health care system is for physicians to take back the administration of the medical profession from the insurers. Physicians must take the financial risks necessary to innovate a medical system that will benefit themselves, their patients, and their patients' employers. This article presents the basic business concepts needed to establish physician provider networks (PPNs) as well as the benefits and pitfalls of the various types of associations into which a PPN can enter. Clearly, the future will belong to those physicians who have the foresight to invest their talents and their finances in the business aspects of managed care.

  1. Negotiation for physicians.

    PubMed

    Hill, Micah J; DeCherney, Alan H

    2013-05-01

    Physicians are involved in negotiations on a daily basis. Interactions with patients, support staff, nurses, fellow physicians, administrators, lawyers, and third parties all can occur within the context of negotiation. This article reviews the basic principles of negotiation and negotiation styles, models, and practical tools. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Marketing specialty physician services.

    PubMed

    Olson, E A

    1993-01-01

    Physicians take into account many factors when making referral decisions, primarily provider expertise, good communication and good patient care. This professional paper will show that provider expertise and patient care are the most important factors in referral decisions, and that physicians rely primarily on direct experience for the information necessary to make a referral choice.

  3. The physician workforce in Kuwait to the year 2020.

    PubMed

    Al-Jarallah, Khaled; Moussa, Mohamed; Al-Khanfar, Khadija Figen

    2010-01-01

    The study addresses the supply of and demand for physicians in Kuwait in the light of the emerging variables such as increasing population, economic growth, changes in healthcare strategies, and expansion of healthcare facilities. The objective of the study was to project the future demand for physicians in Kuwait for the years 2007-2020 based on the period 1994-2006. Population projections were derived using the average annual natural increase rate of the 1994-2006 populations. The future demand for physicians was predicted using the average physician to population ratio for the years 1994-2006. The average annual growth rate of indigenous physicians during the period 1994-2006 was 4.08% compared to 2.83% for non-native expatriot physicians. There is a gap between the numbers of native and foreign physicians. In 2006, native physicians constituted 36.6% of the physician workforce in Kuwait. The disparity between the total number of physicians needed and the number of native physicians is expected to decline from 62.14% in 2007 to 48.1% in 2020. The supply of indigenous physicians should be increased. Without shared culture and language, it will be difficult to provide effective and efficient medical care to the people of Kuwait. This can be achieved through an improvement in recruitment and retention of indigenous physicians and medical students. There is also a need for establishment of a standing advisory committee for continuous monitoring of physician workforce planning and policy strategies in Kuwait.

  4. Business plan writing for physicians.

    PubMed

    Cohn, Kenneth H; Schwartz, Richard W

    2002-08-01

    Physicians are practicing in an era in which they are often expected to write business plans in order to acquire, develop, and implement new technology or programs. This task is yet another reminder of the importance of business principles in providing quality patient care amid allocation of increasingly scarce resources. Unfortunately, few physicians receive training during medical school, residencies, or fellowships in performing such tasks. The process of writing business plans follows an established format similar to writing a consultation, in which the risks, benefits, and alternatives to a treatment option are presented. Although administrative assistance may be available in compiling business plans, it is important for physicians to understand the rationale, process, and pitfalls of business planning. Writing a business plan will serve to focus, clarify, and justify a request for scarce resources, and thus, increase its chance of success, both in terms of funding and implementation. A well-written business plan offers a plausible, coherent story of an uncertain future. Therefore, a business plan is not merely an exercise to obtain funding but also a rationale for investment that can help physicians reestablish leadership in health care.

  5. Rural Idaho family physicians' scope of practice.

    PubMed

    Baker, Ed; Schmitz, David; Epperly, Ted; Nukui, Ayaka; Miller, Carissa Moffat

    2010-01-01

    Scope of practice is an important factor in both training and recruiting rural family physicians. To assess rural Idaho family physicians' scope of practice and to examine variations in scope of practice across variables such as gender, age and employment status. A survey instrument was developed based on a literature review and was validated by physician educators, practicing family physicians and executives at the state hospital association. This survey was mailed to rural family physicians practicing in Idaho counties with populations of less than 50,000. Descriptive, bivariate and multivariate analyses were employed to describe and compare scope of practice patterns. Responses were obtained from 92 of 248 physicians (37.1% response rate). Idaho rural family physicians reported providing obstetrical services in the areas of prenatal care (57.6%), vaginal delivery (52.2%) and C-sections (37.0%); other operating room services (43.5%); esophagogastroduodenoscopy (EGD) or colonoscopy services (22.5%); emergency room coverage (48.9%); inpatient admissions (88.9%); mental health services (90.1%); nursing home services (88.0%); and supervision to midlevel care providers (72.5%). Bivariate analyses showed differences in scope of practice patterns across gender, age group and employment status. Binomial logistic regression models indicated that younger physicians were roughly 3 times more likely to provide prenatal care and perform vaginal deliveries than older physicians in rural areas. Idaho practicing rural family physicians report a broad scope of practice. Younger, employed and female rural family medicine physicians are important subgroups for further study.

  6. Factors affecting the valuation of physician practices.

    PubMed

    Cleverley, W O

    1997-12-01

    Valuation of physician practices provides physicians with a benchmark of their business success and helps purchasers negotiate a purchase price. The Center for Healthcare Industry Performance Studies (CHIPS) recently conducted a survey of physician practice acquisitions. The survey collected data on salaries and benefits paid to physicians after practice acquisition, historical profitability of the acquired practice, and specific values assigned to both tangible and intangible assets in the practice. Some of the survey's critical conclusions include: hospitals tend to acquire unprofitable practices, value is based on historical revenues rather than historical profits, the importance of valuation methodology and payer mix is underestimated, tangible assets represent a large part of the purchase price, and hospitals tend to pay higher physician compensation than do other purchasers.

  7. Increasing physician engagement. Using norms of physician culture to improve relationships with medical staff.

    PubMed

    O'Hare, Dennis; Kudrle, Venetia

    2007-01-01

    Comments on the 2004 survey identified that physicians thought it was too early to judge whether the new structure itself was successful. This year, the survey will be repeated to measure the effectiveness of the new structure and to help administrators set goals to further improve physician engagement levels. Meanwhile, Mercy & Unity is using the tenets of the physician compact, elements of physician culture, and elements of administrative culture to inform new process-improvement activities. More study is needed to identify whether Mercy & Unity's techniques of reorganization contributed to the higher rates of physician satisfaction and engagement, but it is our belief that incorporating physician cultural norms into the process helped prevent the change process from turning the horse into the proverbial camel.

  8. Comanagement and Gainsharing Opportunities for Independent Physicians.

    PubMed

    McBride, Chris; Althausen, Peter L

    2016-12-01

    Gainsharing and comanagament programs are both successful means of achieving physician buy-in for all cost containment programs in Orthopaedic Trauma. Under comanagement agreements, physicians are reimbursed for their time and intellectual efforts in program and algorithm creation. The cost is minimal for the hospital in return for the millions of dollars in savings they achieve. Gainsharing models can incentivize physicians to quickly adopt cost-effective implant choices, care plans, and program development. Hospital systems keep the majority of the profits, patients, and insurance carriers benefit from the cost savings and physicians receive remuneration for their efforts. Careful attention must be paid to the legal issues surrounding the Federal Anti-Kickback Statute, the Civil Monetary Penalty Law, and the Physician Self-Referral Law when setting up these agreements. The keys to success for these programs are the presence of a physician champion, economic transparency for both physicians and hospitals, accurate data collection, and adequate economic incentive for physicians to drive change in practice patterns.

  9. Performance of Thermal Insulation Containing Microencapsulated Phase Change Material

    SciTech Connect

    Kosny, Jan; Yarbrough, David; Syed, Azam M

    2007-01-01

    The objective of this study is dynamic thermal performance microencapsulated phase change material (PCM) blended with loose-fill cellulose insulation. Dynamic hot-box testing and heat-flux measurements have been made for loose-fill cellulose insulation with and without uniformly distributed microencapsulated PCM. The heat flux measurements were made with a heat-flow-meter (HFM) apparatus built in accordance with ASTM C 518. Data were obtained for 1.6 lb{sub m}/ft{sup 3} cellulose insulation containing 0 to 40 wt% PCM. Heat-flux data resulting from a rapid increase in the temperature on one side of a test specimen initially at uniform temperature were analyzed to access the effect of PCM on total heat flow. The heat flux was affected by the PCM for about 100 minutes after the temperature increase. The total heat flow during this initial period decreased linearly with PCM content from 6.5 Btu/ft{sup 2} at 0% PCM to 0.89 Btu/ft{sup 2} for 40 wt% PCM. The cellulose insulation with PCM discharged heat faster than the untreated cellulose when the hot-side temperature of the test specimen was reduced. In addition, hot-box apparatus built in accordance with ASTM C 1363 was utilized for dynamic hot-box testing of a wood stud wall assembly containing PCM-enhanced cellulose insulation. Experimental data obtained for wood-frame wall cavities containing cellulose insulation with PCM was compared with results obtained from cavities containing only cellulose insulation.

  10. Ophidia: high performance data analytics for climate change

    NASA Astrophysics Data System (ADS)

    Fiore, S.; Williams, D. N.; Foster, I.; Aloisio, G.

    2013-12-01

    This work presents the most relevant results related to the Ophidia project, a big data analytics research effort applied to climate change. It combines together high perfomance computing and database management systems to provide users with an efficient and climate-oriented data analytics platform. Ophidia extends, in terms of both Structured Query Language (SQL) primitives and data types, current relational database systems to enable efficient data analysis tasks on scientific array-based data. It exploits a proprietary storage model jointly with a parallel software framework based on the Message Passing Interface (MPI) to run from single tasks to more complex dataflows. The current version of the Ophidia framework includes more than 60 array-based primitives and about 25 operators (16 parallel and 9 sequential). Among others, the available array-based functions allow to perform data sub-setting, data aggregation, array concatenation, algebraic expressions and predicate evaluation. Nesting is also supported. On the other hand, some relevant examples related to the parallel operators include (i) data sub-setting (slicing and dicing), (ii) data aggregation, (iii) array-based primitives, (iv) dataset duplication, (v) NetCDF-import and export. The Ophidia framework is being tested on NetCDF data produced in the context of the international Coupled Model Intercomparison Project Phase 5 (CMIP5) and available through the Earth System Grid Federation infrastructure. The current set of use cases includes: 1) data subsetting (e.g. slicing an dicing); 2) time series analysis (e.g. data summary and statistics); 3) data reduction (e.g. from daily to monthly, annual data); 4) data transformation (e.g. re-gridding); 5) data intercomparison (e.g. model and scenario intercomparison) 6) a composition of the aforementioned tasks. This work will highlight the most relevant architectural and infrastructural aspects of the Ophidia project, the parallel framework, the current set of

  11. User perspectives on an electronic decision-support tool performing comprehensive medication reviews - a focus group study with physicians and nurses.

    PubMed

    Koskela, Tuomas; Sandström, Saana; Mäkinen, Joonas; Liira, Helena

    2016-01-22

    Although a number of studies have evaluated the effectiveness of computerized decision-support systems (CDSS), there is lack of data on user perspectives, barriers, and facilitators to the implementation of CDSSs in real-life surroundings. The aim of this study was to assess individually perceived barriers, facilitators and ideas influencing the CDSS implementation and usability. In this qualitative study, five focus groups were carried out with physicians and nurses separately at the Tampere City Health Center, Finland. The participants were end-users of the EBMeDS computerized decision support system. An explorative data content analysis was applied. The most important barrier to benefitting from CDSS was the lack of structured and coded diagnosis documentation and outdated medication information in the electronic health records. This led to false alerts and distrust towards the system. Among the major facilitators found were e.g. the beneficial reminders that helped practitioners take into account matters otherwise ignored; automatic glomerular filtration rate (GFR) calculations; medication safety checks; and the summaries in the single medication review at a glance. Physicians' and nurses' are keen to use the CDSS and it may enhance their inter-professional collaboration. Documenting patient information in a structured, uniform and easy manner is the essential starting point for electronic decision support. When implementing CDSS, managers need to focus on common practices in documenting structured data in their organizations in order to prevent undermining trust in the system.

  12. Administrative competencies for physician organizations with capitation.

    PubMed

    Penner, M

    1999-01-01

    In California, it is common for HMOs to capitate physician organizations (e.g., independent practice organizations and multispecialty medical groups) for all professional and outpatient ancillary services (and to share risk for inpatient care) under professional risk capitation contracts. This arrangement exports most of the financial risk from the HMO to the physician organization. When HMOs and physician organizations contract under these arrangements, HMOs delegate many of their administrative functions to physician organizations--giving the physician organization authority to make the decisions needed to manage capitated risk. As a result, administrators of physician organizations must be competent in such areas as provider network development, financial forecasting, utilization and quality management, contract negotiation, and establishing systems for claims, reporting, authorizations, and the like. In this study four HMO and 22 physician organization administrators were interviewed concerning key administrative competencies for managing capitation contracts. The competencies were assessed as key administrative work activities that required specific knowledge, skill, or ability to perform. Identifying these competencies is important for physician organizations preparing for capitated risk and will be essential for organizations preparing for HMO or Medicare capitation.

  13. Associations between physician characteristics and quality of care.

    PubMed

    Reid, Rachel O; Friedberg, Mark W; Adams, John L; McGlynn, Elizabeth A; Mehrotra, Ateev

    2010-09-13

    Information on physicians' performance on measures of clinical quality is rarely available to patients. Instead, patients are encouraged to select physicians on the basis of characteristics such as education, board certification, and malpractice history. In a large sample of Massachusetts physicians, we examined the relationship between physician characteristics and performance on a broad range of quality measures. We calculated overall performance scores on 124 quality measures from RAND's Quality Assessment Tools for each of 10,408 Massachusetts physicians using claims generated by 1.13 million adult patients. The patients were continuously enrolled in 1 of 4 Massachusetts commercial health plans from 2004 to 2005. Physician characteristics were obtained from the Massachusetts Board of Registration in Medicine. Associations between physician characteristics and overall performance scores were assessed using multivariate linear regression. The mean overall performance score was 62.5% (5th to 95th percentile range, 48.2%-74.9%). Three physician characteristics were independently associated with significantly higher overall performance: female sex (1.6 percentage points higher than male sex; P < .001), board certification (3.3 percentage points higher than noncertified; P < .001), and graduation from a domestic medical school (1.0 percentage points higher than international; P < .001). There was no significant association between performance and malpractice claims (P = .26). Few characteristics of individual physicians were associated with higher performance on measures of quality, and observed associations were small in magnitude. Publicly available characteristics of individual physicians are poor proxies for performance on clinical quality measures.

  14. Retention rate of physicians in public health administration agencies and their career paths in Japan.

    PubMed

    Koike, Soichi; Kodama, Tomoko; Matsumoto, Shinya; Ide, Hiroo; Yasunaga, Hideo; Imamura, Tomoaki

    2010-04-23

    Physicians who serve as public health specialists at public health centers and health departments in local or central government have significant roles because of their public health expertise. The aim of this study is to analyze the retention and career paths of such specialists in Japan. We analyzed the data of seven consecutive surveys, spanning 1994 to 2006. We first analyzed the 2006 survey data by sex, age group, and facility type. We then examined the changes over time in the proportion of physicians working in public health administration agencies. We also examined the distribution of the facility types and specialties in which physicians worked both before beginning and after leaving their jobs. These analyses were performed by using physician registration numbers to cross-link data from two consecutive surveys. The proportion of physicians working in public health administration agencies was 0.7% in 2006. The actual numbers for each survey ranged between 1,800 and 1,900. The overall rate remaining in public health administration agencies during the two-year survey interval was 72.8% for 1994-1996. The ratio declined to 67.2% for 2004-2006. Among younger physicians with 1-10 years of experience, the retention rate showed a sharp decline, dropping from 72.6% to 50.0%. Many of these physicians came from or left for a hospital position, with the proportion entering academic hospital institutions increasing in recent years. In many cases, physicians left or entered internal medicine clinical practices. At present in Japan, the number of physicians who leave and the number who begin a position are almost the same; thus, some of the problems associated with physicians leaving are yet to become apparent. However, the fact that the retention period is shortening for younger physicians may represent a future problem for ensuring the quality of physicians in public health administration agencies. Possible strategies include: increasing the number of physicians

  15. Physician stress: is it inevitable?

    PubMed

    Orman, M C

    1989-01-01

    Early attempts to understand the causes of physician stress focused almost exclusively upon the role of external stressors and demands. Recent psychosocial and behavioral research, however, suggests that individual attitudes, beliefs, personality factors, and learned coping strategies probably play a more important role. In addition, such cognitive and behavioral tendencies are within the control of each individual, and clinical experience has shown that these factors can indeed be modified. Freudenberger noted that most health professionals who are experiencing high levels of stress fail to identify the role that they themselves play in generating such symptoms. Instead, they tend to blame others as the cause of their problems and tend to react cynically toward suggestions that they could benefit from help. A large-scale study of family physicians in North Carolina, conducted by May, Revicki, and Jones in 1983, confirmed the fact that most physicians who reported a high level of professional stress also tended to score high on measures of external locus of control--i.e. the perception that external or environmental factors are mainly responsible for one's problems or successes. My own experience in treating physicians and other people with stress tends to confirm these findings. More importantly, I have found that once individuals are helped to identify the role that their own cognitive and behavioral tendencies play in the origin of their stress, they can usually bring about impressive reductions in stress and tension without significant changes in environmental factors or demands. While many people advocate stress-releasing and other relaxation skills for physicians, I have found that such approaches are often counterproductive.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. The impact of health information technology and e-health on the future demand for physician services.

    PubMed

    Weiner, Jonathan P; Yeh, Susan; Blumenthal, David

    2013-11-01

    Arguably, few factors will change the future face of the American health care workforce as widely and dramatically as health information technology (IT) and electronic health (e-health) applications. We explore how such applications designed for providers and patients will affect the future demand for physicians. We performed what we believe to be the most comprehensive review of the literature to date, including previously published systematic reviews and relevant individual studies. We estimate that if health IT were fully implemented in 30 percent of community-based physicians' offices, the demand for physicians would be reduced by about 4-9 percent. Delegation of care to nurse practitioners and physician assistants supported by health IT could reduce the future demand for physicians by 4-7 percent. Similarly, IT-supported delegation from specialist physicians to generalists could reduce the demand for specialists by 2-5 percent. The use of health IT could also help address regional shortages of physicians by potentially enabling 12 percent of care to be delivered remotely or asynchronously. These estimated impacts could more than double if comprehensive health IT systems were adopted by 70 percent of US ambulatory care delivery settings. Future predictions of physician supply adequacy should take these likely changes into account.

  17. Physician retirement: a case for concern in Canadian hospitals.

    PubMed

    Gillies, J H; Ross, L C

    1984-08-15

    Mandatory retirement is being challenged on the basis of age discrimination, and physicians are not divorced from this social trend. In January 1982 legal precedent was set by the Manitoba Court of Appeal concerning the retirement policy for physicians in Canada. Currently, Canadian hospital bylaws include clauses that require a change in membership status once a physician reaches 65 years of age. The main arguments in favour of this change include easier physician manpower management, ensured public safety and, in some instances, greater productivity. The main arguments against this change include loss of income to physicians, loss of skilled manpower to the profession and adverse effects on the mental and physical health of retiring physicians. In an effort to resolve this conflict some Canadian hospitals are developing strategies for reviewing the specific privileges and responsibilities physicians will retain once they reach age 65. The medical staff of the Victoria General Hospital in Halifax, NS have addressed this issue through their annual reappointment process.

  18. The practice of physicians and nurses in the Brazilian Family Health Programme – evidences of change in the delivery health care model

    PubMed Central

    Peres, Ellen M; Andrade, Ana M; Dal Poz, Mario R; Grande, Nuno R

    2006-01-01

    The article analyzes the practice of physicians and nurses working on the Family Health Programme (Programa de Saúde da Família or PSF, in Portuguese). A questionnaire was used to assess the evidences of assimilation of the new values and care principles proposed by the programme. The results showed that a great number of professionals seem to have incorporated the practice of home visits, health education actions and planning of the teams' work agenda to their routine labour activities. PMID:17107622

  19. Measuring physicians' productivity: a three-year study to evaluate a new remuneration system.

    PubMed

    Filler, Guido; Burkoski, Vanessa; Tithecott, Gary

    2014-01-01

    To evaluate a new assessment tool measuring physicians' academic productivity and its use in a performance-based remuneration system. The authors developed an assessment tool based on existing tools to measure productivity. Yearly, from 2008 to 2011, physicians at the University of Western Ontario received a score of up to three points for each of four components (impact, application, scholarly activity, mentorship) in each of four domains (clinical practice, education, research, administration). Scores were weighted by the percentage of time physicians spent on tasks in each domain. Year 1 scores were a baseline. In Years 2 and 3, scores were tied to remuneration. The authors compared scores and associations, accounting for age and academic rank, across the three years. The 37 participating physicians included 11 assistant, 23 associate, and 4 full professors. The mean weighted total baseline score across all four domains was 7.44. Years 2 and 3 scores were highly correlated with Year 1 scores (r = 0.85, Years 1 and 2; r = 0.89, Years 1 and 3). Year 2 mean weighted scores did not differ significantly from Year 1 scores. Assistant professors' scores improved significantly between Years 1 and 2 (+1.08, P < .001). Lower Year 1 scores were correlated with a greater improvement in scores between Years 1 and 2, and age was negatively correlated with score changes between Years 2 and 3. Although the tool may be a robust measurement of physicians' productivity, performance-based remuneration had no effect on physicians' overall performance.

  20. Taking a new approach to reduce the incidence of physician disruptive behaviors.

    PubMed

    Rosenstein, Alan H

    2015-01-01

    Disruptive behaviors continue to play a disturbing role in today's healthcare environment, negatively affecting care relationships that can adversely impact outcomes of patient care. Many organizations have implemented a number of different strategies in an effort to address this important issue with varying degrees of success. New complexities and changing roles, responsibilities and accountabilities for the delivery of appropriate, high-value, high-quality, safe, satisfying care have added increasing pressures on healthcare organizations to better integrate and coordinate healthcare delivery across the entire spectrum of care. Physicians play a crucial role in this process. When disruptive behaviors occur, rather than taking the traditional more remedial punitive approach to behavioral management, organizations would do better to try to focus on strategies that address physician and staff needs and provide appropriate supportive services to help them better adjust to stress and pressures of today's healthcare environment. Increasing levels of stress and burnout are taking their toll on physician attitudes and behaviors resulting in increasing levels of disillusionment, dissatisfaction and frustration affecting physician well-being and performance. Physicians often won't act on their own and we need to look to the organizations they are affiliated with to take the initiative by providing appropriate administrative, clinical and emotional support services before the occurrence of an unwanted event. Allowing physicians' input, listening to their concerns and providing needed support will enhance physician satisfaction, engagement, compliant attitudes and behaviors that lead to less disruption and better patient care.

  1. Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.

    PubMed

    Emanuel, Ezekiel J; Ubel, Peter A; Kessler, Judd B; Meyer, Gregg; Muller, Ralph W; Navathe, Amol S; Patel, Pankaj; Pearl, Robert; Rosenthal, Meredith B; Sacks, Lee; Sen, Aditi P; Sherman, Paul; Volpp, Kevin G

    2016-01-19

    Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.

  2. Exemplary family physicians and consultants: empirical definition of contemporary medical practice.

    PubMed Central

    Langley, G R; Till, J E

    1989-01-01

    To identify the characteristics of exemplary family physicians and consultants, we interviewed 25 family physicians and 25 consultants (5 each in the specialties of internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery) selected by their peers as being exemplary in their own practice setting. The results indicated that the participants had well-formulated concepts of exemplary practitioners, defining five main categories of performance: clinical competence, relationship with patients, availability, family physician-consultant relationship and a fifth category that included organizational ability and personality attributes. The family physicians and the consultants placed different values on these categories and indicated that these values might change under different clinical circumstances. Their concepts appear to be compatible with, but not restricted to, a model of contemporary medical practice based on an ethic specific to medicine. PMID:2766165

  3. Exemplary family physicians and consultants: empirical definition of contemporary medical practice.

    PubMed

    Langley, G R; Till, J E

    1989-08-15

    To identify the characteristics of exemplary family physicians and consultants, we interviewed 25 family physicians and 25 consultants (5 each in the specialties of internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery) selected by their peers as being exemplary in their own practice setting. The results indicated that the participants had well-formulated concepts of exemplary practitioners, defining five main categories of performance: clinical competence, relationship with patients, availability, family physician-consultant relationship and a fifth category that included organizational ability and personality attributes. The family physicians and the consultants placed different values on these categories and indicated that these values might change under different clinical circumstances. Their concepts appear to be compatible with, but not restricted to, a model of contemporary medical practice based on an ethic specific to medicine.

  4. When Does Changing Representation Improve Problem-Solving Performance?

    NASA Technical Reports Server (NTRS)

    Holte, Robert; Zimmer, Robert; MacDonald, Alan

    1992-01-01

    The aim of changing representation is the improvement of problem-solving efficiency. For the most widely studied family of methods of change of representation it is shown that the value of a single parameter, called the expulsion factor, is critical in determining (1) whether the change of representation will improve or degrade problem-solving efficiency and (2) whether the solutions produced using the change of representation will or will not be exponentially longer than the shortest solution. A method of computing the expansion factor for a given change of representation is sketched in general and described in detail for homomorphic changes of representation. The results are illustrated with homomorphic decompositions of the Towers of Hanoi problem.

  5. Physician reimbursement perception for outpatient procedures and procedures among managed care patients with diabetes

    PubMed Central

    Kim, Catherine; Tierney, Edward F.; Herman, William H.; Mangione, Carol M.; Venkat Narayan, K.M.; Gerzoff, Robert B.; Bilik, Dori; Ettner, Susan L.

    2013-01-01

    OBJECTIVE To examine the association between physicians’ reimbursement perceptions and outpatient test performance. Previous studies have documented an association between reimbursement perceptions and electrocardiogram performance, but not for other common outpatient procedures. STUDY DESIGN Cross-sectional analysis. METHODS Participants were physicians (n = 766) and their managed care patients with diabetes mellitus (n = 2758) enrolled in 6 plans in 2003. Procedures measured included electrocardiograms, radiographs or x-rays, urine microalbumin measures, hemoglobin A1cs, and Pap smears for women. Hierarchical logistic regression models were adjusted for health plan and physician level clustering and for physician and patient covariates. To minimize confounding by unmeasured health plan variables, we adjusted for plan as a fixed effect. Thus, we estimated variation between physicians using only the variance within health plans. RESULTS Patients of physicians who reported reimbursement for electrocardiograms were more likely to receive electrocardiograms than patients of physicians who did not perceive reimbursement (unadjusted mean difference 4.9% (95% confidence interval, 1.1% to 8.9%)) and adjusted mean difference 3.9% (95% confidence interval, 0.21% to 7.8%)). For the other tests examined, no significant differences in procedure performance were found between patients of physicians who perceived rei