A study in a medical center investigated the feasibility of primary care practices combining internal medicine and pediatrics residencies. Equally divided among children and adults, the patients had sought specialists and were highly satisfied. The physicians had appeal particularly to young upper-middle class patients. (Author/MSE)

This article defines the concepts of medical technology and technology assessment and offers a five-level assessment scheme for the evaluation of medical technologies, including (1) biologic plausibility; (2) technical feasibility; (3) intermediate outcomes; (4) patient outcomes; and (5) societal outcomes. This scheme is applied to the use of…

Strong Memorial Hospital, Rochester, New York, initiated a hospital-funded applied-research program linking patient care and academic interests of clinicians with hospital management to improve patient outcomes while lowering costs. The program is projected to produce substantial cost savings while improving patient care quality. (GLR)

Compared the interviewing skills of first-year medical students at the University of Oklahoma receiving feedback primarily from standardized patients (SPs) with those of students receiving feedback primarily from faculty. Skills ratings using the Arizona Clinical Interview Rating Scale were significantly higher for the "types of questions…

A review of 136 malpractice cases involving residents and resident programs 1950-83 found a substantial increase in cases after 1975. Most concerned vicarious liability, applicable standard of care, and resident supervision. Residents were on the side of the prevailing party in 44 percent of cases. (Author/MSE)

At Case Western University (Ohio), medical students critically analyze the quality and cost of asthma care in the community by studying patients in primary care practices. Each writes a case report, listing all medical charges and comparing them with guidelines for asthma care. Several recommendations for improved care have emerged. (MSE)

A Medical University of South Carolina study assessed the appropriateness of care provided by medical residents by comparing written protocols with student compliance. Results show moonlighting residents were considerably less consistent than staff physicians in compliance. Intervention improved resident performance. (MSE)

A study investigated the usefulness of a small-group management process to involve physicians and nurses in analysis of patient mix, practice patterns, and care outcomes and improvement of practice strategies. Eight studies, each on one clinical topic, were undertaken at three hospitals. Significant positive changes were observed in five of them.…

A study assessed the usefulness of unannounced standardized patients to assess the skills of 284 physicians enrolled in a continuing medical education program in control of sexually transmitted diseases and human immunodeficiency virus. Significant discrepancies were found between physician-reported performance and actual performance, as found in…

This paper proposes structural reforms in the U.S. health care system based on the need for (1) workable, affordable solutions; (2) preserving and strengthening the biomedical research enterprise; (3) increased minority participation in science and the health professions; and (4) a culture of character emphasizing health promotion and disease…

A study evaluated the impact of the reorganization of the academic Sepulveda (California) Veterans' Administration medical center toward primary and ambulatory care. Surveys of several thousand patients were linked to computerized utilization and mortality data and related to the center's strategic plan and goals. Substantial improvement in…

The process of change at the academic Sepulveda (California) Veterans' Administration hospital during implementation of a new ambulatory primary care program was examined through individual or focus group interviews with 63 managers, house officers, and patients. Major problems included administrative integration of in- and outpatient services;…