Effects of managed care contracting on physician labor supply.

We examine the effect of managed care contracting on physician labor supply for office-based medical practices. We extend the standard labor supply model to incorporate choices regarding the patient base. Empirical tests use data from the 1985 and 1988 national HCFA Physician Practice Costs and Income Surveys and InterStudy Managed Care Surveys. We use physician-level information on participation in managed care contracting to estimate changes in work hours. Managed care contracting is generally associated with lower physician work hours. However, accounting for motivations to participate in contracts and the extent of contracting, the effect on hours is reduced in magnitude and significance. We conclude that relying on broad aggregate measures for policy analysis will likely be misleading as underlying motivations and contracting incentives change over time.

The future of orthopaedics in the United States: an analysis of the effects of managed care in the face of an excess supply of orthopaedic surgeons.

Recent technological advances in orthopaedic surgery have propelled both the volume of surgical cases and their complexity, resulting in increased costs, which should naturally result in higher incomes for surgeons. However, the transition from a fee-for-service model of physician compensation to a managed care model has resulted in major shifts in economic resource allocation. An economic model of this market based on imperfect competition shows that these changes have shifted market power from surgeons to the managed care organizations. Our model predicts that practicing surgeons will retire earlier, medical students will begin to select other specialties, and innovation will be slowed. Antitrust laws limit surgeons' ability to combat this trend through meaningful collective bargaining, creating the potential for future shortages as the baby boom generation reaches retirement age and the demand for orthopaedic services increases dramatically.

Research utilization: development of a central venous catheter procedure.

The Nursing Research Committee in a large, tertiary care teaching hospital used Horn model for research use to develop research bases practice guidelines for the care of patients with central venous catheters. Development of these guidelines was the outcome of a process for planned change including a critique of relevant literature consultation with clinical experts, involvement and commitment of stakeholders, and the development of an educational plan. The recommendations focus on the technique for the central venous catheter procedure, cleansing of the site, use of ointments, and application of dressings. Used as clinical practice guidelines, they offer nurses a scientific basis for their practice.

Emotional responses of hospitalized patients with burns to debridement during the acute phase.

The objectives of this descriptive study were to investigate anxiety and depressed mood of patients with burns associated with debridement and their preferences for and perceptions of control during the debridement procedure. Measurements began within 48 hours of hospital admission, continuing every 3 days over 2 weeks for subjects with small burn injuries (less than 30% of total body surface area). Data suggested the possibility of a mildly depressed mood for some subjects during the first week in the hospital and high levels of association between depressed mood and anxiety based on the large number of significant correlations (p < .05). Over time, the amount of control that patients preferred and the amount of choice they perceived during debridement increased. These findings about responses of patients with burns to debridement suggest that their emotional responses were well managed for the most part and support their involvement in the debridement procedure.

The RN and LPN skill mix.

Until a few years ago, patient care in most acute care areas at our tertiary care hospital in Alberta was delivered almost exclusively by registered nurses (RNs). Many believed their workload included tasks that did not require an RN's knowledge and skill levels. Around the same time, the hospital was faced with budget constraints. The staffing mix changed in 1991 with the introduction of another level of caregiver in the active treatment areas--licensed practical nurses (LPNs). The new mix caused problems: many RNs were unaccustomed to supervising and delegating to other workers and the primary nursing method for delivering patient care no longer worked.

Walking the talk: one hospital's experience in implementing a conceptual framework for nursing practice.

There has been considerable impetus to use conceptual frameworks to guide nursing practice, yet many nursing theories are not supported by research or understood by nurses. At Foothills Hospital, a Committee developed and implemented a conceptual framework based on self-care. Concepts within the framework are grounded in current nursing practice, consistent with consumer expectations and supported by philosophical statements about patient, society/environment, health and nursing.

Research or quality improvement?. Making the decision.

Deciding if a project is one of research or quality improvement is a dilemma frequently faced by nursing administrators. Guidelines have been established to help administrators and practitioners overcome this dilemma and, at the same time, consider the rights and responsibilities of the patient, the hospital, and the investigator.

Clinical nursing research and quality assurance: integration for improved patient care.

Understanding how nursing quality assurance and research programs are similar, yet different, is the first step towards enabling nurse managers to integrate the two programs. Blending research findings and research methods into the quality assurance process is one method of accomplishing integration. Other strategies include setting standards for nursing research and including instruments with known validity and reliability in patient care planning and patient assessment. Improving the scientific basis of nursing practice and the quality of patient care are viable outcomes.

Nursing research in Canadian hospitals.

This article describes a 1986 survey of Canadian teaching hospitals to determine the status and stage of nursing research studies, thereby providing comparative data for examining current nursing research endeavours. Most numerous were studies of patient care responses whereas quality assurance and nursing education projects were fewer in number. The majority of studies were in the beginning stages of the nursing research process, and only one-third had received external funding. The number of studies reported, and the involvement of several categories of nursing staff and nursing units in these studies confirms that clinically based nursing research activities are a reality for more than half of Canadian teaching hospitals.

Body temperature in elderly surgical patients.

Body temperatures of 37 elderly surgical patients with fractured hips were measured using tympanic membrane probes. Comparisons were made between patients having the usual body coverings, eight were hypothermic as compared with one of 16 patients with extra body coverings. Temperatures were significantly different between groups intraoperatively (p less than .001) and in the recovery room p less than .002) where the lowest temperatures were recorded. Anxiolytics given preoperatively had a significant negative relationship with lower body temperatures. Careful monitoring of temperatures and extra coverings are recommended for elderly hip fractured patients perioperatively.

Thermographic evaluation of the painful shoulder in the hemiplegic patient.

In this study, we investigated the applicability of thermography as a technique for evaluating the painful postcerebrovascular accident (CVA) shoulder in hemiplegic patients. A thermographic series was taken of the upper extremities and upper trunk of 27 female subjects. The four groups we evaluated were nonhemiplegic subjects (n = 9), post-CVA subjects with recovered function (n = 6), hemiplegic subjects with upper extremity motor impairment (n = 6), and hemiplegic subjects with both motor impairment and ipsilateral shoulder pain (n = 6). The data revealed a normal thermographic series in 8 of the 9 nonhemiplegic subjects, but only in 1 of the 18 post-CVA subjects. The majority of the abnormal thermographic series of post-CVA subjects showed a 1 degree to 5 degree C coolness on the involved side. No consistent thermographic patterns emerged that could be related to the severity or location of pain. Further studies are needed to evaluate the efficacy of thermography as a means of determining the relationship between ipsilateral post-CVA coolness and hemiplegic shoulder pain.