Variations in functional status among different groups of elderly people.

BACKGROUND: Functional status differs among populations of elderly, although the extent of differences in types of functions among groups has not been closely examined. This study identifies and compares characteristics among different populations of elderly, using a screening test that measures self-assessment of multiple areas of function. The screening tool used was the Dartmouth COOP Charts, developed for and primarily tested in office medical practices. It has not been used to systematically compare office patients with other groups of elderly. METHODS: Dartmouth COOP Charts were administered to five groups of elderly drawn from convenience samples of individuals age 65 and older, including elderly living in senior apartments, those attending community activities, mentally oriented nursing home patients, office patients, and elderly patients not visiting the doctor within the past 6 months. Demographic data, as well as COOP chart results, were obtained. RESULTS: There were multiple differences in COOP chart scores among the samples of elderly individuals. The greatest differences were in self-reported physical fitness and in the level of difficulty in performing daily activities. Medical office patients not visiting in 6 months had the highest fitness levels. On the other hand, the "social support" availability scale showed no differences among groups. Results from other scales were intermediate among these extremes. CONCLUSIONS: Different samples of elderly yield varying results on several measures of reported physical and emotional health. All convenience samples of the elderly may have somewhat poorer health than the average person age 65 and older. Of the groups studied, those with the poorest function were either older adults in nursing homes or those visiting the doctor's office for treatment.

Gender and the educational experience in a primary care training setting.

As the number of women entering medical school increases, patient contacts with female physicians will similarly increase. As a result, educators have begun to consider the relationship between gender and both performance and career preference. The current study explores the relationship between a student's gender and the educational experience of the student. In the setting of established primary care teaching physicians' offices at the University of Illinois College of Medicine at Rockford, gender and diagnosis data were collected on all patient encounters over the course of one year for the 129 students enrolled in the program. Women medical students were 29% less likely than chance to see male patients, and male students were 5% less likely than chance to see female patients in this setting. This finding was especially marked for encounters with younger adult patients and for sexually sensitive examinations, but was noted with all groups of adult patients. The qualitative effect of this on both educational experiences and health care delivery needs to be addressed.

Diagnosis clusters adapted for ICD-9-CM and ICHPPC-2.

An ad hoc committee of the North American Primary Care Research Group (NAPCRG) was appointed to adapt the diagnosis clusters instrument for use with the International Classification of Diseases (ICD-9-CM) and the International Classification of Health Problems in Primary Care (ICHPPC-2). This article describes the development and testing of the final roster of 110 diagnosis clusters for family physicians. Almost 90 percent of all diagnoses recorded by family physicians in a variety of settings were included in the clusters. The diagnosis clusters can be used in the analysis of large databases and facilitate comparisons between different providers and practices.

Resource requirements for teaching continuity in primary care: contrasts between a graduate and an undergraduate program.

Two similar primary care training programs for family practice residents and for medical students are compared to find differences and similarities in costs and the use of certain nonmonetary resources. Both programs emphasize long-term continuity, and trainees in both programs average two half-days per week at ambulatory care practice sites. Comparisons of the resource requirements of teaching high-continuity primary care curriculum segments between graduate and undergraduate programs will help determine where scarce medical teaching resources can be most beneficially used. It is hypothesized that there would be lower faculty costs, higher auxiliary staff and space requirements, and larger patient panel requirements for the residency program than for the undergraduate program. Extent of these differences could not be predicted. In the residency program, faculty costs were one quarter of total expenses and in the undergraduate program they were half of the program expenses. The residency recouped 81 percent of expenses from practice revenues while the undergraduate program recouped only 59 percent. The residency program averaged 814 visits per trainee during one year; the undergraduate program had only 268 visits per student.

Case mix in a primary care teaching practice for two clerkship schedules.

Student-physicians saw patients from assigned families at primary care training sites either one or two half-days a week. These practice conditions caused a skewing of diagnoses away from seeing acute conditions. Students who saw patients two half-days a week made 21 percent fewer acute care diagnoses than were made in the practice. Those students at the clinical site one half-day a week saw 28 percent fewer acute disease diagnoses. Accordingly, there was an increase in the percentage of chronic disease and health supervision diagnoses in the case mix of these student-physicians. This part-time scheduling of students at the training sites was related to a disruption in continuity of care for the patient. While a little less than half of acute illness care was performed by student-physicians, over two thirds of chronic disease diagnoses were made by these once-or-twice-a-week trainees. Almost nine tenths of health care supervision was accomplished within the trainees' twice-a-week schedule.

The Rockford School of Medicine undergraduate quality assurance program.

An undergraduate program of ambulatory care quality assurance has been operational at the Rockford School of Medicine for three years. The original intent of the program was to increase the acceptance of quality assurance activities among student physicians, inculcating in them the importance of peer review at an early stage in professional development. The program experience is described, results of preliminary evaluation reported, and generalizations offered. Activities in the first year of a hospital care quality assurance program are described.