Hi Ben.
Another way to get at something like the same construct as question 3 seems to be getting at would be to ask something like "For how many patients a day could a physician give full attention to their significant problems--if all the administrative details and any clinical details (e.g., reminding a patient of the need for a retinal exam or reporting to the patient the normal results of a screening mammogram) that could be transacted without the direct involvement of the physician were transacted in that way (e.g., by the patient using a networked PHR, by an automatic distribution of normal mammograms to patients, or by a care manager interviewing the patient over the phone)?
Or to put it differently, "Do physicians who see fewer patients per day because they work in dysfunctional work systems address more patients' problems with full attention?"
Best regards.
Jim
James M. Walker, MD, FACP
Chief Medical Information Officer
Geisinger Health System
The best way to predict the future is to invent it.
- Alan Kay
>>> "Djulbegovic, Benjamin" 01/14/12 5:27 PM >>>
Dear all,
I am hoping that proven wisdom of this group can provide me with some useful information/inputs even if these three questions which I am about to ask are probably the US-specific ones:
1) When people know that they will switch health insurance, do requests for health services increase?
(In the US there are number of health insurance companies; as a rule, the employers negotiate every year coverage rate for their employees. Very often, the negotiated terms and contracts change and the employers switch from one insurance carrier to another. The employees are typically given 3-4 months advance notice about this switch. The new coverage may be better or worse than the previous but in recent years in order to decrease costs, the coverage has typically been less generous. As a result, some people may decide to use the existing services- until the terms of contract expire- such as decide to have elective surgery earlier rather later etc).
2) When people switch their insurance (and doctors) does quality of care decrease?
3) Do physicians who see more patients per day solve fewer patients' problems?
(In the US at least, fragmentation of care has been tremendously increasing. As a result, a typical older patient may see 4-8 subspecialists at any time. One reason for this is that in order to see more patients, physicians have less and less time. The consequence of this is that the physicians increasingly refer patients to other specialists. This also implies that physicians are solving fewer patients' problems than if they had more time to spend with the patients. Is there any data on this? Or, is there any data on costs associated with increasing referrals and quality of care?
I would appreciate any thoughts on any of these questions even if direct evidence may be lacking.
Thanks
ben
Benjamin Djulbegovic, MD, PhD
Distinguished Professor
University of South Florida & H. Lee Moffitt Cancer Center & Research Institute
Associate Dean for Clinical Research, USF
Director of USF Clinical Translation Science Institute, USF
Mailing Address:
USF Health Clinical Research
12901 Bruce B. Downs Boulevard, MDC02
Tampa, FL 33612
Phone # 813-396-9178
Fax # 813-974-5411
e-mail: [log in to unmask]
______________________
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-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Catherine Voutier
Sent: Thursday, January 12, 2012 7:39 PM
To: [log in to unmask]
Subject: Re: Systematic reviews - searching Scopus
Hi Jane
Dean Guistini from UBC Biomedical Branch Library, Vancouver Hospital has a useful section on HLWiki comparing Scopus and Web of Science. http://hlwiki.slais.ubc.ca/index.php/Web_of_Science_vs._Scopus Because each indexes unique journals, you should search both if you have access to them (though this depends on what your topic is as Jim points out). However, these databases are primarily used for bibliometrics and citation tracking and so have different search interfaces compared to databases like PubMed Medline. Scopus uses multiple thesauri http://www.jisc-adat.com/adat/adat_db_details.pl?ns_ADAT:DB=Scopus. Web of Science is different in that they use extensive authority files and keyword tagging. I am not sure about the thesaurus - I think it is in-house. http://www.jisc-adat.com/adat/adat_db_details.pl?ns_ADAT:DB=Web%20of%20Science
Regards
Catherine Voutier
Clinical Librarian
Melbourne Health
email: [log in to unmask]
Chair, HTAi Information Resources Group
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