RESUMEN
The implications for medical education of a declining average length of stay (ALOS) and changes in numbers of hospital admissions have been the subject of considerable discussion. The changing hospital reimbursement schedules and the rise of managed-care systems have altered patterns of hospital use and consequently posed new problems for the education of medical students and residents. Between 1980 and 1986 in one university-affiliated hospital, the ALOS for patients with any of the most frequent discharge diagnoses for either of those years had declined 34% since 1980, despite a 59% increase in the number of patients with those diagnoses. Patients with any one of 21 of the 88 most frequent discharge diagnoses for 1986 were hospitalized for less than one day. Those patients with another eight of the disorders had an ALOSs of between one and two days; some of these patients had serious and common gastrointestinal disorders. Discharge diagnoses were categorized by the hospital service in which students and residents would have rotations and were analyzed for changes in case mix. This study showed that for the hospital's medical students and residents to be exposed to the same case mix of clinical disorders that were seen in-hospital in 1980, it is now necessary for them to have experience in the ambulatory setting.
Asunto(s)
Grupos Diagnósticos Relacionados , Hospitales de Enseñanza/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Atención Ambulatoria/educación , Educación Médica , Hospitales con 300 a 499 Camas , Humanos , New JerseyRESUMEN
This article summarizes the practice content and continuity for 35 senior residents in six family medicine residency model teaching units utilizing a computerized information management system. Comparisons are drawn with the content of family practices in the National Ambulatory Medical Care Survey (NAMCS), showing that family medicine third-year residents provide a large proportion of pregnancy care and general medical examinations and treat a smaller number of chronic illness patients compared with family physicians in practice. Third-year residents performed few surgical procedures in the model teaching units. Continuity of care, though espoused by family medicine residencies in principle, was deficient in the model teaching units studied. Intensive training to compensate for these deficiencies is recommended.
Asunto(s)
Atención Ambulatoria/educación , Continuidad de la Atención al Paciente , Medicina Familiar y Comunitaria/educación , Internado y Residencia , Atención Primaria de Salud , Enseñanza/métodos , Sistemas de Administración de Bases de DatosRESUMEN
The effectiveness of sharing medical records in improving physician-older patient communication was evaluated in 203 ambulatory chronically ill older patients (mean age, 70.1 years) by a randomized controlled trial. Ninety-five experimental group patients received copies of their physicians' progress notes 1 week after their last office visit, and 108 control patients did not. After 1-2 weeks, knowledge of health problems, medication, and nonmedication treatments was assessed by interview. Experimental group patients knew 74.1% of their health problems, compared with 64.1% in the control groups (P less than 0.05). There was no difference in knowledge of medications or adherence to medication regimens. Experimental group patients displayed higher treatment knowledge scores than control group patients (P less than 0.01). Less-educated patients showed greater adherence to nonmedication treatments. Shared medical records can enhance physician-older patient communication about health problems and nonmedication treatments, but they do little to enhance medication knowledge or adherence to medication regimens.