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General Medical Care and the Education of Internists in University Hospitals
An Evaluation of the Teaching Hospital General Medicine Group Practice Program
- JACQUELINE KOSECOFF, Ph. D.;
- ARLENE FINK, Ph.D.;
- ROBERT H. BROOK, M.D., Sc.D.;
- ALLYSON ROSS DAVIES, Ph.D.;
- GEORGE GOLDBERG, M.D.;
- LAWRENCE S. LINN, Ph.D.;
- VIRGINIA A. CLARK, Ph.D.;
- PAMELA C. SALISBURY;
- GROUP PRACTICE PROJECT DIRECTORS; and
- NATIONAL PROGRAM STAFF*
Abstract
Fifteen general internal medicine group practices in university teaching hospitals were studied to evaluate their primary care services and education. Data were collected over 9 months from physicians, patients, and medical records, and by observation. All institutions had closed their general medical clinics. Many patients being treated in group practices were very sick; 57% had hypertension; 21% were diabetic; and 45% could not work. Most were satisfied with their care. Care for acute problems from a health care provider in the practice was available quickly; regular physicians were harder to see. House staff and faculty spent little time in the practices. Few practices used teams; most used traditional attending and house staff models. Practice physicians could not easily determine when patients were seen in the institution's emergency department or were hospitalized. Quality of care standards were not uniformly met. Finally, the structure of academic centers appeared to inhibit the practices' performance, suggesting a need for further appraisal of relationships between university hospitals and their ambulatory care units.
Article and Author Information
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↵* The Group Practice Project Directors include Susan H. Bane, M.D.; Richard L. Byyny, M.D.; Dennis W. Cope, M.D.; Robert D'Allessandri, M.D.; Thomas Delbanco, M.D.; William S. Dunn, M.D.; Jerry M. Earll, M.D.; Suzanne Fletcher, M.D.; Paul Gilbert, M.D.; John T. Harrington, M.D.; Jack Hughes, M.D.; Carter L. Marshall, M.D., M.P.H.; Steven A. Schroeder, M.D.; W. Anderson Spickard, M.D.; Raymond W. Turner, M.D., Roy T. Young, M.D.; and John M. Witherspoon, M.D., M.P.H. The National Program Staff includes Reisa Kahn, M.S.; H. Richard Nesson, M.D.; and Wendy Everett Watson, Sc.D.
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▸From the Departments of Medicine and Public Health, UCLA Center for the Health Sciences, Los Angeles, California; and Fink & Kosecoff, Santa Monica, California.
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Grant support: in part by grant #5318 from The Robert Wood Johnson Foundation.
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The views expressed herein do not necessarily represent those of The Robert Wood Johnson Foundation.
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▸Requests for reprints should be addressed to Robert H. Brook, M.D.; Department of Medicine, UCLA Center for Health Sciences; Los Angeles, CA 90024.
- © 1985 American College of Physicians
