Problem-oriented approach to practice. I. Economic impact
H. M. Tufo, R. E. Bouchard, A. S. Rubin, J. C. Twitchell, H. C. VanBuren, L. B. Weed and M. Rothwell
The problem-oriented system provides a unique management tool for medical
practice. It follows basic management principles for any complex human
endeavor (ie, define goals, set standards, audit performance to those
standards, and assess results). The basic tool is the problem-oriented
record, which demands that statements of medical action be explicit to
permit audit. This concept can be extended to provide and assess care for
an entire practice. Five years of cumulative data were assessed. The
following changes were noted: (1) The ratio of patients to physicians
doubled. (2) The total hospitalization rate fell by more than 20% and
general medical portion by 60%. (3) Ambulatory use and cost decreased by
approximately 20%. (4) Expenditures for services fell by 22%, while
national expenditures for physician services increased by 28%.
