Knowledge-assisted visualization and segmentation of geologic features.

A 3D visualization environment contains domain information about geologic features in seismic data and lets users interactively steer segmentations on the basis of visual sources of information and knowledge. A user study demonstrates this approach's ability to transfer domain knowledge to non experts.

Establishing a quality improvement process for identification of psychosocial problems in a primary care practice.

OBJECTIVES: A quality improvement process that will significantly increase the rate of identification of psychosocial problems through routine use of case-finding instruments can be established in a general medicine practice. DESIGN: Two groups of patient examination reports written by physicians were retrospectively compared with the patients' responses on the case-finding database instrument. The samples were obtained by sequential selection in four time periods. SETTING AND PATIENTS: The study occurred in a university general internal medicine practice that utilizes the problem-oriented record. The patients studied were seen for first-time comprehensive examinations designed to identify all important health problems, including psychosocial problems. INTERVENTION: The authors compared performances of the physicians in identification of psychosocial problems before and after the intervention, which consisted of a pilot study audit of psychosocial problem identification, establishment of standards for interpretation of the case-finding instrument, design of a flow sheet to make case-finding data clearly available to the physician at each comprehensive examination, and feedback of physician performance according to practice-adopted standards for identification of psychosocial problems. MEASUREMENT: The result of the intervention was an increase in psychosocial problem identification from 67% to 90% of problems present, p less than 0.05 by chi-square distribution; or a decrease from 33% to 10% in psychosocial problems missed by the physicians. CONCLUSION: The quality improvement process for identification of psychosocial problems described in this report significantly increased the rate of identification of psychosocial problems by general internists.

Using medical records for older patient education in ambulatory practice.

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.

The impact of a quality assurance program on postgraduate training in internal medicine.

The development of a quality assurance program as part of residency training in internal medicine is described. In addition to ensuring quality, the program allows both the faculty and the resident to assess individual performance more precisely than previously possible. The residents become increasingly thorough and improve problem-solving skills over the three-year program. They are provided the tools to manage quality in their own practice.

Problem-oriented approach to practice. I. Economic impact.

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%.

A dynamic primary care curriculum based on the problem-oriented system.

The audit of behaviors of health care providers is a valuable tool for learning the essentials of primary care and health care delivery. At the University of Vermont a dynamic curriculum has evolved from the student audits of the practice sites where the training takes place. Evaluation studies to date indicate a positive effect on career goals leading to primary care specialties and a desire to practice in rural settings in underserved areas. This approach to teaching primary care has proven to be effective and has gained high acceptance with the students. They learn that audit is a valuable means of self-education as well as method for providing quality assurance to the patient.