Low cost ambulatory medical information system

A simple, low-cost computerized minirecord system (minimal essential record) has been in operation at the Johns Hopkins Medical Clinic since mid-1975. The system has three primary components: (a) the Minirecord which contains a listing of problems and medications, plus information about visits to other clinics, (b) an appointment system used to organize materials prior to clinic encounters and assist in the follow-up of high risk special patients, and (c) an encounter data system to prepare reports used for management, quality assurance and training. This paper describes the system's operation, and reports on its utility and cost.

Measuring provider continuity in ambulatory care: an assessment of alternative approaches

A comparison is made of existing measures of provider continuity in ambulatory care to assess differences and limitations. New measures are proposed that complement and improve upon certain limitations of existing measures. These measures are applied to a pilot study of hypertensive patients being seen in a medical outpatient clinic of a teaching hospital. The need for further development and refinement of continuity measures is indicated, and a unifying framework for measuring provider continuity is suggested.

Variations in utilization of health services by children

In this longitudinal study in two prepaid group practices, many more children stayed at the same level of use of services over a six- to ten-year period than would be expected if use of services had distributed randomly. Overall, about 13% remained consistently in the highest third of the distribution of use, and another 13% remained consistently in the middle or lowest third. If use of services had distributed randomly, 4% and 7%, respectively, would have been in these groups. Conversely, many fewer children (25%) showed fluctuating patterns of use over time than would be expected by chance alone (37%). Although the reasons for this phenomenon are unknown (and may be multiple), the findings have implications both for clinical care and for development of policy regarding the organization and financing of health services for children.

Assessing the timeliness of ambulatory medical care

The extent to which individuals receive necessary and timely care (timeliness) is one dimension of the process of care that has received little attention. Timeliness can be viewed as the interaction between patient care-seeking behavior and system accessibility,both of which are expected to influence the effectiveness of medical care. This study examines the provider's assessment of the timeliness of care received in the department of medicine of a prepaid program. Provider judgments are found to be significantly related to the provider's perception of problem severity and to the patient's prognosis. Anaylsis of patient-reported problem status one week later are also found to be related to the timeliness of care. Implications of timeliness assessments for monitoring and improving access and care-seeking behavior are discussed.

The Johns Hopkins ambulatory-care coding scheme

A classification and coding system for ambulatory-care problems has been developed at the Johns Hopkins Medical Institutions and three affiliated institutions. The provider's statement of the patient's problem, as recorded on an encounter from, is kept in a computer file. Codes from the classification scheme, based on those used in four existing schemes, are automatically assigned to diagnoses, symptoms, well-care services, and treatment procedures categorized by physiological system and subsystem. About 85 percent of recorded problems are machine-codable; the remainder are alphabetized for efficient manual coding. The coding system is integrated with an overall information system that allows linkage of coded problem data to diverse data on patient and provider characteristics. Examples are given of the uses and limitations of the linked data for care evaluation, management, and clinical research.

The role of new health practitioners in a prepaid group practice: changes in the distribution of ambulatory care between physician and nonphysician providers of care

Changes in the distribution of ambulatory care between physicians and new health practitioners (NHP) are examined in the pediatric and adult medicine departments of a prepaid group practice program. The study covers a three-year period during which NHP were extensively introduced to provide a broad range of ambulatory care. The source of data is a routine data information system that utilizes an encounter form to capture a minimal data set on every patient visit, including the provider's statement of diagnosis. Based on these data, changes in staffing are related to changes in workload and content of practice of both physicians and NHP.