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Educating Physicians and Treating Patients in the Ambulatory Setting
Where Are We Going and How Will We Know When We Arrive?
- ROBERT H. BROOK, M.D., Sc.D.;
- ARLENE FINK, Ph.D.;
- JACQUELINE KOSECOFF, Ph.D.;
- LAWRENCE S. LINN, Ph.D.;
- WENDY EVERETT WATSON, Sc.D.;
- ALLYSON ROSS DAVIES, Ph.D.;
- VIRGINIA A. CLARK, Ph.D.;
- CAREN KAMBERG, M.S.P.H.; and
- THOMAS L. DELBANCO, M.D.
- the GROUP PRACTICE PROJECT DIRECTORS *
- the NATIONAL PROGRAM STAFF†; Los Angeles and Santa Monica, California; and all of the program sites
Abstract
We evaluated 15 group practices in general internal medicine in university hospitals with regard to access to and quality of care, patients' satisfaction with that care, and quality of residency education provided. We used these data to speculate about potential changes in ambulatory care programs in university teaching hospitals. All 15 practices participated for 4 years. One third of their patient population had no medical insurance. Practice patients had twice as many chronic illnesses as did the general population, and two fifths of patients stayed at least 2 years in the practice. Few faculty members spent more than 14 hours weekly in the practices, and housestaff worked an average of 4 hours per week. Patient waiting times did not meet ideal standards, but patient satisfaction was higher than in a general population. Compliance with quality of care criteria was not exceptional; for example, 10% of eligible patients received an annual influenza vaccination. Housestaff assigned a relatively low ranking to their educational experience in the practices. We recommend the institution of additional experimental programs in ambulatory care and housestaff education to improve the quality of care in the ambulatory setting.
- activities of daily living
- ambulatory care
- chronic disease
- continuity of patient care
- delivery of health care
- diabetes mellitus
- group practice
- health services accessibility
- hospitals, university
- hypertension
- internal medicine
- internship and residency
- obesity
- physicians
- quality of health care
Article and Author Information
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▸From the Departments of Medicine and Public Health, Center for Health Sciences, University of California, Los Angeles, and The Rand Corporation, Santa Monica; California.
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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'Allesandri, 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.; Dennis Quinlan, M.D.; Steven A. Schroeder, M.D.; W. Anderson Spickard, M.D.; Raymond W. Turner, M.D.; Roy T. Young; and John A. Witherspoon, MD., M.P.H.
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↵† The National Program Staff includes Reisa Kahn, M.S., and H. Richard Nesson, M.D.
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Grant support: 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.
- © 1987 American College of Physicians
