After nearly two decades of Federal, State and local incentives, primary medical services in rural areas remain far short of target. Numerous demonstration projects supported by public and private funds have had some ...
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After nearly two decades of Federal, State and local incentives, primary medical services in rural areas remain far short of target. Numerous demonstration projects supported by public and private funds have had some success but models with both broad replicability and independence of external start-up and/or maintenance support are rare. The Department of Family Medicine at the State University of New York at Buffalo has established a novel collaborative network of public and private organizations to emplace a four-physician rural group practice concurrently accomplishing three major goals: high quality primary and specialty medical services to two medically underserved populations;enriched training opportunities for students, residents, and fellows;and financial viability. Beyond meeting regional needs, however, the components and nature of the collaborative effort indicate reproducibility in many communities thoughout the country. To emphasize exportable features we will focus on: opportunities, operational strategies, financial feasibility, training advantages, and impact.
To successfully purchase, commission and manage health services at the primary care level requires accurate, reliable, up-to-date and appropriate information for use by trusts, health authorities, and by the soon to b...
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To successfully purchase, commission and manage health services at the primary care level requires accurate, reliable, up-to-date and appropriate information for use by trusts, health authorities, and by the soon to be operational primary care groups. The national total purchasing evaluation has provided evidence which will be relevant to primary care groups, particularly in the areas of information technology (IT) and access to information. Progress in developing independent purchasing by total purchasers was slower than anticipated because of the large number of factors which had to be taken into account, of which IT and information were just two. Accurate and timely information will be crucial for primary care groups if they are to move from level 1 to level 4 without undue delay.
In-home care has grown rapidly in the past decade and has become increasingly complex. Accompanying these changes has been a resurgence of what was once thought to be an endangered if not extinct species, the physicia...
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This article describes an intervention that employed sociotechnical systems (STS) analysis in the laboratory of a major health care institution in the Midwest. The analysis was performed on two departments of the labo...
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This article describes an intervention that employed sociotechnical systems (STS) analysis in the laboratory of a major health care institution in the Midwest. The analysis was performed on two departments of the laboratory to determine opportunities for improving effectiveness, facilitating the introduction of new technology, and enhancing the work experience of technologists. The authors measured the results of the intervention by conducting a survey of technologists before and after the change effort and through follow-up interviews with a sample of physicians, supervisors, and technologists. The intervention did not achieve the results intended, and the authors present their explanation for why this occurred and suggest implications and recommendations for future STS applications to health care settings.
Hospital internal medicine and family practice care were redesigned in July 1995 at Kaiser Permanente of Colorado. The objectives were to provide for a full time dedicated inpatient team, improve continuity of care, a...
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Hospital internal medicine and family practice care were redesigned in July 1995 at Kaiser Permanente of Colorado. The objectives were to provide for a full time dedicated inpatient team, improve continuity of care, and establish a two-tiered process of admission. Physicians were divided into four tracks that marked varying degrees of time in the hospital. A position of triage physician was created that screened all potential admissions to internal medicine. Hospital inpatient days per thousand members, unadjusted lengths of stay, patient readmission rates, and satisfaction questionnaires were obtained both before and after the change. The change achieved significant reductions in unadjusted average lengths of stay and days per thousand without diminishing quality of care, as reflected by hospital readmission rates and by patient satisfaction surveys.
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