ABSTRACT
In the Vermont study of experimental obesity, heterogeneity of the response to overfeeding was a striking finding in normal subjects. There is also poorly defined heterogeneity within the areas of obesity, noninsulin-dependent diabetes, hyperlipidemias, and so-called essential hypertension. These disorders may occur in the same individual and have important mechanisms in common. Thus it is logical to strive for an integrated approach to nutritional and medical management rather than an approach fragmented between medical specialties. The rapidly developing computer programs now adapted to microcomputers hold promise of facilitating an integrated approach both in the clinical and in the investigative field.
Subject(s)
Diabetes Mellitus, Type 2/physiopathology , Hyperlipidemias/physiopathology , Hypertension/physiopathology , Obesity/physiopathology , Software , Diabetes Mellitus, Type 2/classification , Diabetes Mellitus, Type 2/therapy , Diagnosis, Computer-Assisted , Forecasting , Humans , Hyperlipidemias/classification , Hyperlipidemias/therapy , Hypertension/classification , Hypertension/therapy , Microcomputers , Obesity/classification , Obesity/therapyABSTRACT
The problem-oriented system provides a unique management tool for medical practice. It follows basic management principles for any complex human endeavor (ie, define goals, set standards, audit performance to those standards, and assess results). The basic tool is the problem-oriented record, which demands that statements of medical action be explicit to permit audit. This concept can be extended to provide and assess care for an entire practice. Five years of cumulative data were assessed. The following changes were noted: (1) The ratio of patients to physicians doubled. (2) The total hospitalization rate fell by more than 20% and general medical portion by 60%. (3) Ambulatory use and cost decreased by approximately 20%. (4) Expenditures for services fell by 22%, while national expenditures for physician services increased by 28%.
