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The training and utilization of New Health Practitioners (NHP's) has moved within a decade from a small tentative beginning in the mid-1960's to a major health manpower policy issue. Its discussion transcends a number of important and emotionally charged areas including the role of various professions in providing health care services, the renaissance of primary care, the geographic and economic maldistribution of medical services, and the cost of care. It is valuable to highlight what is known, what is professed and what needs to be studied further about this issue.

Faculty members from medicine, nursing, social work, and law, as well as a group of medical students, tested their own criteria for a good lecturer; each group focused on different aspects of the behaviors sought in the good lecture. The "Dr. Fox" paradigm was the lecture chosen; all groups failed to identify the deliberately incorporated failings. These results were then compared with the results obtained by using a standardized rating form in current use within a major university.

Terminally ill cancer patients at a Veterans Administration hospital were randomly assigned to receive hospice or conventional care. The hospice care was provided both in a special inpatient unit and at home. 137 hospice patients and 110 control patients and their familial care givers (FCGs) were followed until the patient's death. No significant differences were noted between the patient groups in measures of pain, symptoms, activities of daily living, or affect. Hospice patients expressed more satisfaction with the care they received; and hospice patients' FCGs showed somewhat more satisfaction and less anxiety than did those of controls. Hospice care was not associated with a reduced use of hospital inpatient days or therapeutic procedures and was at least as expensive as conventional care.

Some 1,700 acute care episodes were studied to assess the outcomes in terms of the extent to which patients regained their usual functional status. Involving active follow-up of each patient, the study serves as a prototype for measuring several components of quality of care including actual outcomes, patient expectation of outcome, physician expectation of outcome, and patient satisfaction with outcome and care. Because this study was conducted in a family practice residency training setting, we hope that it will serve as a model of how such information may be used to increase residents' sensitivity to the course of illness commonly seen in primary care, and to encourage the residents to set expectations for the care they give.

A system of chart review is presented which develops both auditing skills and patient care skills. The model suggested is a flexible one, applicable at various levels of training in both inpatient and outpatient settings. Its application to family practice resident training is shown by comparing the performances of residents at the beginning and end of a demonstration period.

The authors analyzed the USC/DRME Practice Study data to determine if the characteristics of physician patient encounters change with patient age. The only significant change observed was a decline in encounter time for patients 65 years of age and older compared with those 45 through 64 years of age. This decrease was significant for raw data and for data weighted for the number of physicians of various types and standardized for complexity of case mix in various age groups, also for both nonhospital and hospital encounters and for almost all classes of encounters. Three types of generalists and four types of medical subspecialists were studied; encounter times for all types were, for patients 65 and older, either the same as or less than those for patients 45 through 64. The observed phenomenon may reflect a conscious decision on the part of some physicians to allot less time to elderly patients.

This study was designed to compare the outcomes achieved in a series of acute care episodes by different levels of family practice providers working in the clinic setting. The study utilizes a method which depends upon the provider to estimate level of function expected and earliest date of recovery for each episode. When the patients are viewed as a single group, those patients treated by the medex appear to fare considerably better and those seen by a faculty member do worse; however, when each functional status group is examined separately, only the asymptomatic but clinically ill patients (45 cases) show a statistically significant difference in outcomes among the providers, with the medex having good results and the faculty poor results.

This study developed a practical method for determining the functional outcome status of patients in an ambulatory setting. Health status of 1,840 primary care patients in an ambulatory setting. Health status of 1,840 primary care patients was compared at three points in time: patient's usual status, status at the initial visit, and status at time of telephone follow-up. Follow-up status was also compared with the physician's expectation, which was estimated at the time of the initial visit. Of the patients, 62% showed improvement, 31% remained at the same level, and 7% deteriorated from the time of their initial clinic visit. Physicians tended to overestimate either the speed or degree with which patients return to their usual functional status; 32% of the patients studied reported themselves as being less well than usual at the time of follow-up.

Are walk time and grip strength measures of disease activity or functional ability? Ninety-two patients with rheumatoid arthritis were examined initially and 12 months later for clinical measures including joint deformity, and answered a functional status questionnaire. Walk time and grip strength were strongly related to joint deformity and functional questionnaire measures, and appeared insensitive in showing changes in disease activity over time. They could serve as objective functional measures in studies primarily directed towards changing functional ability, but appeared to be poor major outcome measures for trials aimed at altering disease activity.

This study examined the relationship between levels of medical training and direct costs for 1,700 episodes of acute illness treated in ambulatory-care clinics. Faculty, family practice residents, and physician assistants were included as the providers. Total cost and four component costs were examined. An outcome was defined as good if the patient returned to his usual level of functioning after an acute illness episode. Average total cost per episode was not related to type of provider, but there were significant (P less than .05) differences among providers in laboratory and medication costs. Faculty and physician assistants produced higher costs, especially for patients who experienced bad outcomes. Both costs and percentage of good outcomes achieved were similar in first-, second-, and third-year residents.

Data were collected on all persons within a sample of upper-and lower-income households who had seen physicians for illness episodes within a year prior to the interview. Forty-eight percent of upper-and 37 percent of lower-income families in the sample had changed doctors because of dissatisfaction with some aspect of the care. Factors related to tendency to shop for doctors in both upper-and lower-income groups were a lack of confidence in doctors' competence, unwillingness of doctors to spend time talking with patients, hostile feelings toward doctors, high cost of services, inconvenience of location and hours, and unfavorable attitudes toward doctors' personal qualities. Hypochondriasis was related to doctorshopping in the upper-income group. Results of this investigation suggest that patients may be becoming more discriminating in their choice of physicians.