Systematic Utilization of Data for Analysis of a Pediatric Emergency-Room Experience

PEDIATRICS ◽  
1975 ◽  
Vol 55 (2) ◽  
pp. 266-274
Author(s):  
George A. Lamb ◽  
Howard L. Weinberger ◽  
Herbert Schneiderman ◽  
Bruce Goldstein
Keyword(s):  
Primary Care ◽  
Emergency Room ◽  
Systematic Approach ◽  
Care Setting ◽  
Health Maintenance Organizations ◽  
Pediatric Emergency ◽  
Health Centers ◽  
Health Maintenance ◽  
Cost Of Health Care ◽  
Neighborhood Health Centers

This report describes the systematic use of emergency-room data to (1) define the experiences of a group of pediatric interns in their emergency-room rotation (especially as they relate to their role as future pediatric practitioners), (2) evaluate, supervise, and learn from their performance in this primary care setting, and (3) provide an ongoing weekly list of illnesses diagnosed in the emergency room as an epidemiological sentinel for the larger community. The future applications of this type of systematic approach, perhaps with computer technology, offer the opportunity for comparison of delivery, quality, and cost of health care between various sources of primary care (emergency-room facilities, private physicians' offices, neighborhood health centers, and health maintenance organizations).

Ethics Case Consultation in Primary Care: Contextual Challenges for Clinical Ethicists

2009 ◽  
Vol 18 (4) ◽  
pp. 397-405 ◽  
Author(s):  
ANNE SLOWTHER
Keyword(s):  
Primary Care ◽  
Clinical Ethics ◽  
Western Europe ◽  
Ethics Consultation ◽  
Ethics Committees ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Ethics Committee ◽  
Health Maintenance ◽  
Case Consultation

The development of ethics case consultation over the past 30 years, initially in North America and recently in Western Europe, has primarily taken place in the secondary or tertiary healthcare settings. The predominant model for ethics consultation, in some countries overwhelmingly so, is a hospital-based clinical ethics committee. In the United States, accreditation boards suggest the ethics committee model as a way of meeting the ethics component of the accreditation requirement for payment by Health Maintenance Organizations (HMOs), and in some European countries, there are legislatory requirements or government recommendations for hospitals to have clinical ethics committees. There is no corresponding pressure for primary care services to have ethics committees or ethics consultants to advise clinicians, patients, and families on the difficult ethical decisions that arise in clinical practice.

Practicality of Screening Urinalyses in Asymptomatic Children in a Primary Care Setting

PEDIATRICS ◽  
1978 ◽  
Vol 62 (1) ◽  
pp. 103-105 ◽  
Author(s):  
Margaret Gutgesell
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Urine Samples ◽  
Systematic Evaluation ◽  
Current Debate ◽  
Health Maintenance ◽  
Hospital District ◽  
Asymptomatic Children ◽  
Strip Testing

The value of screening for proteinuria in the pediatric age group is a subject of current debate. Previous studies have1,2 reported proteinuria prevalence rates of 5.4% to 14.8% when random urine samples were tested. Since the test for proteinuria is simple and inexpensive, Bailey et al.3 recommended that indicator strip testing for proteinuria be done by the primary physician in preschool, preadolescent, and adolescent children. The Committee on Standards of Child Health Care4 suggests at least dipstick urinalyses as part of a regular health maintenance program. Haggerty5 recommends using only the dipstick tests for protein and glucose since these tests are simple and adequate. However, Bailey et al.3 and North6 do not recommend glucose screening since there is a low probability of finding new cases of diabetes mellitus. Dodge et al.7 are reluctant to recommend widespread screening in schoolchildren for proteinuria and hematuria because the significance of these two conditions is unknown in asymptomatic children. For those found to have proteinuria and/or hematuria, West8 proposes a systematic evaluation including determination of certain serum chemical values, radiographic studies, and even renal biopsy. To study the practicality of such a screening test in a primary care setting, we have reviewed 2,309 random dipstick urinalyses collected over a 26-month period. METHODS Indicator strip testing (Labstix) was performed on random urine samples of all eligible patients on their first visit for whatever reason to the pediatric clinic of West End Health Center, Houston. The center is one of a network of seven neighborhood clinics of the Harris County Hospital District and serves a low to moderate socioeconomic group.

Israel—start-up nation

2019 ◽  
pp. 28-33
Author(s):  
Mark Britnell
Keyword(s):  
Primary Care ◽  
Health System ◽  
Patient Information ◽  
Health Maintenance Organizations ◽  
Healthcare Organization ◽  
Immigrant Workers ◽  
Mutual Aid ◽  
Health Maintenance ◽  
Non Profit ◽  
Start Up

In this chapter, Mark Britnell focuses on Israel’s healthcare system, one of the best-kept secrets in healthcare. He looks at how Israel has achieved a primary care-led health system with four health maintenance organizations (HMOs) providing citizens with both choice and comprehensive cover. Primary and community care spend first exceeded that of secondary and acute care 20 years ago, but it has taken time. Its origins can be traced back to 1911 when an orchard worker had his arm severed and 150 immigrant workers joined together to form a mutual aid healthcare organization called Clalit, a non-governmental, non-profit entity. They knew that to help themselves they had to help each other, and Clalit is now the largest HMO in Israel with 14 hospitals and more than 1,200 primary and specialized clinics. The health system of Israel is not perfect but is highly innovative—not least in its use of patient information—and deserves attention.

Is Continuity of Care Preserved in Children Who Utilize the Pediatric Emergency Department?

PEDIATRICS ◽  
1995 ◽  
Vol 95 (1) ◽  
pp. 37-41
Author(s):  
Patrick M. Vivier ◽  
William J. Lewander ◽  
Stanley H. Block ◽  
Peter R. Simon ◽  
Anthony J. Alario ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Inner City ◽  
Health Center ◽  
Continuity Of Care ◽  
Pediatric Emergency ◽  
Health Centers ◽  
Pediatric Emergency Department ◽  
Primary Care Site

Objective. Inner city families often use multiple sites for nonemergent medical care, including the pediatric emergency department. This practice raises concerns about continuity of care. The present study examined one aspect of continuity of care: Do children who receive care in a pediatric emergency department return to their primary care site so that appropriate follow up may be obtained? Methods. Over a 4-week period two groups of neighborhood health center children were studied: Those who sought care at the pediatric emergency department and those who were "walk-ins" at the health centers. All visits during the 4-week study period which resulted in a recommendation for the child to be seen within 6 weeks at the health centers were included in the analysis. Results. During the study period there were 87 patient visits to the pediatric emergency department with a documented physician instruction to be seen at their health center within 6 weeks. In 66 (76%) of the cases, the patient was seen at one of the health centers during the 6 weeks following the pediatric emergency department visit. There were 146 "walk-in" visits to the health centers with a documented physician instruction to be seen again at the health centers during the 6 weeks following the walk-in visit. In 111 (76%) of the cases, the patient was seen during the 6-week period. Conclusion. Our study shows that revisit rates were comparable for the two groups. We conclude that the rate of compliance with follow-up recommendations is similar for those who utilized the pediatric emergency department versus those who used the primary care site.

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