The private practitioner in hospital quality assurance

External forces continue to dictate the necessity of delivering high-quality health care along with methods of proving that the claimed quality is attained. Gone are the days when both the institution and its practitioners could answer quality questions simply by stating that they were delivering excellent health care to their patient population. The federal government, via the Health Care Financing Administration, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are mandating that institutions prove, without question, that they are delivering health care of the highest quality. The essential key to attaining these goals is cooperative private practitioners.     

Correlates of honor ratings in a clinical clerkship employing a faculty forum evaluation system

5he purpose of this study was to determine whether or not suspected variables affected a surgery clerk's chances of being awarded an honor rating. Findings indicated a significant relationship between a student receiving an honor rating and his or her preceptor's predetermined level of student advocacy, the number of completed patient interview and physical examination write-ups, and final examination scores. There was no significant relationship found between honor ratings and the preceptor's status, the sequence in which the student was discussed or the length of time spent discussing the student at the final evaluation meeting, or the number of clinical faculty present at the meeting. These results lend support to the faculty forum evaluation approach, but suggest a need for further scrutiny of some influencing variables to ensure all students are fairly considered and honor ratings judiciously awarded.     

Geographic distribution of undocumented immigrants: estimates of undocumented aliens counted in the 1980 census by state

"This article presents estimates of the number of undocumented aliens counted in the 1980 [U.S.] census for each state and the District of Columbia. The estimates, which indicate that 2.06 million undocumented aliens were counted in the 1980 census, are not based on individual records, but are aggregate estimates derived by a residual technique. The census count of aliens (modified somewhat to account for deficiencies in the data) is compared with estimates of the legally resident alien population based on data collected by the Immigration and Naturalization Service in January 1980." Estimates are provided "for each of the states for selected countries of birth and for age, sex, and period of entry categories.... The origins of the undocumented alien population [are described], as well as some of their demographic characteristics. Some of the implications of the numbers and distribution of undocumented aliens are also discussed." This paper was originally presented at the 1984 Annual Meeting of the Population Association of America (see Population Index, Vol. 50, No. 3, Fall 1984, p. 435).     

Mental health services for Chinese in a community health center

Serious mental health problems exist within the Chinese population of the United States. This article describes one center's attempt to meet the psychiatric needs of both nonpsychotic and psychotic Chinese patients through bilingual, culturally relevant treatments.     

Declining world fertility: trends,causes, implications

This Bulletin examines the evidence that the world's fertility has declined in recent years, the factors that appear to have accounted for the decline, and the implications for fertility and population growth rates to the end of the century. On the basis of a compilation of estimates available for all nations of the world, the authors derive estimates which indicate that the world's total fertility rate dropped from 4.6 to 4.1 births per woman between 1968 and 1975, thanks largely to an earlier and more rapid and universal decline in the fertility of less developed countries (LDCs) than had been anticipated. Statistical analysis of available data suggests that the socioeconomic progress made by LDCs in this period was not great enough to account for more than a proportion of the fertility decline and that organized family planning programs were a major contributing factor. The authors' projections, which are compared to similar projections from the World Bank, the United Nations, and the U.S. Bureau of the Census, indicate that, by the year 2000, less than 1/5 of the world's population will be in the "red danger" circle of explosive population growth (2.1% or more annually); most LDCs will be in a phase of fertility decline; and many of them -- along with most now developed countries -- will be at or near replacement level of fertility. The authors warn that "our optimistic prediction is premised upon a big IF -- if (organized) family planning (in LDCs) continues. It remains imperative that all of the developed nations of the world continue their contribution to this program undiminished."     

Mental health program evaluation: Where you start?

Seduced by the elegance, sophistication and jargon characteristic of new developments in applied research, practicing evaluators are in danger of becoming distracted from achievement of their evaluative goal: that of providing timely, reliable and useful data to program management to facilitate rational data-based decision-making. To avoid such seduction, the author advocates adaptation of simple, inexpensive and efficient evaluative methods tailored to organizational needs and presentation of findings in language readily understood by constituent groups. Likewise, insistance by evaluators upon maintenance of a strict role boundary — that is, limiting role functioning exclusively to those tasks considered evaluation — may be dysfunctional. Rather than detract from accomplishment of his goals, the author maintains that such participation allows development of skills, insights and staff relationships which enhance the evaluator's effective functioning within the organizational context and contribute to organizational acceptance and use of his evaluative results.     

Program analysis using the client oriented cost outcome system.

The client oriented cost outcome system has been under development in Pennsylvania community and hospital programs since 1972. The system builds upon the behavioral and decision data generated with or on behalf of consumers. Flexibility for local program system design is permitted if the procedures of consumer intake, review, and termination document each consumer's (a) problems, resources, and goals, (b) overall functioning level in their ordinary community, and (c) services intended and rendered as related to (a), above. While the system's primary application is in providing feedback for local program quality assurance and evaluation procedures, aggregation of data permits program planning and evaluation at county, state, and federal levels in terms of (a) client demographic or diagnostic characteristics, and (b) program service characteristics and objectives.