Limits to the safety net: teaching hospital faculty report on their patients' access to care.

Many major teaching hospitals might not be able to offer adequate access to specialty care for uninsured patients. This study found that medical school faculty were more likely to have difficulty obtaining specialty services for uninsured than for privately insured patients. These gaps in access were similar in magnitude for public and private institutions.

Characteristics of medical school faculty members serving on institutional review boards: results of a national survey.

Purpose: To understand the characteristics of medical school faculty members who serve on institutional review boards (IRBs) in U.S. academic health centers.

Market competition and patient-oriented research: the results of a national survey of medical school faculty.

Purpose: To understand the effect of market competition on patient-oriented research at U.S. medical schools and teaching hospitals.

Switching to gatekeeping: changes in expenditures and utilization for children.

Background: Gatekeeping has been a central strategy in the cost-containment initiatives of managed care organizations. Little empirical research describes the impact of switching into a gatekeeping plan on health care expenditures and utilization for children.

Objective: To determine the likelihood of a parent with a chronically ill child enrolling in a health plan with gatekeeping, as well as the effects of gatekeeping on health care expenditures and utilization for children, especially those with chronic conditions.

The duration of ambulatory visits to physicians.

Background: The objective of our study was to determine the typical length of ambulatory visits to a nationally representative sample of primary care physicians, and the patient, physician, practice, and visit characteristics affecting duration of visit.

Methods: We used an analysis of cross-sectional survey data to determine duration of visit and the characteristics associated with it. The data sources were a random sample of the 19,192 visits by adults to 686 primary care physicians contained in the 1991-1992 National Ambulatory Medical Care Survey, and the results of the Physician Induction Interview conducted by the National Center for Health Statistics.

Market forces and unsponsored research in academic health centers.

Context: Increased competitive pressures on academic health centers may result in reduced discretionary funds from patient care revenues to support the performance of unsponsored research, including institutionally funded and faculty-supported activities.

Objective: To measure the amount and distribution of unsponsored research activities and their outcomes.

Design And Setting: Survey conducted in academic year 1996-1997 of 2336 research faculty in 117 medical schools.

Trends in adult visits to primary care physicians in the United States.

Background: Although numerous changes are apparent in the US health care system, little is known about how these changes have altered the work of primary care physicians.

Methods: We analyzed a nationally representative sample of 136,233 adult office visits to general internists, general practitioners, and family physicians contained in the 1978 through 1981, 1985, and 1989 through 1994 National Ambulatory Medical Care Surveys. Annual sample sizes varied between 5662 and 19,977 visits.

The declining impact of race and insurance status on hormone replacement therapy.

Objective: Socioeconomic barriers may limit the adoption of hormone replacement therapy, but little is known about recent trends in their influence. We evaluated trends in the impact of race and insurance status on national rates of hormone replacement therapy.

Design: We analyzed 32,608 physician office visits by nonpregnant women 40 years of age and older available from the 1989 through 1996 National Ambulatory Medical Care Surveys.

Changes in the daily practice of primary care for children.

Background: The environment in which medicine is practiced has changed in the past 2 decades, but little information has been available on how the day-to-day practice of primary care for children has changed during this period.

Objective: To identify aspects of primary care practices for children that are undergoing substantial changes.

Design: Analysis of National Ambulatory Medical Care Surveys from 1979 to 1981, 1985, and 1989 to 1994.

Is gatekeeping better than traditional care? A survey of physicians' attitudes.

Context: Nearly all managed care plans rely on a physician "gatekeeper" to control use of specialty, hospital, and other expensive services. Gatekeeping is intended to reduce costs while maintaining or improving quality of care by increasing coordination and prevention and reducing duplicative or inappropriate care. Whether gatekeeping achieves these goals remains largely unproven.

Low rates of hormone replacement in visits to United States primary care physicians.

Our objective was to determine national rates and predictors of hormone replacement therapy. We analyzed a nationally representative sample of 6341 office visits by women aged > or = 40 years to primary care physicians in the 1993 and 1994 National Ambulatory Medical Care Surveys. Independent predictors of estrogen use were determined by logistic regression.

Academic-industry research relationships in genetics: a field apart.

Academic-industry research relationships (AIRRS) have become widely accepted and increasingly common in the life sciences. Using nationwide surveys from the United States, we found significant differences between the AIRRs of genetics firms and faculty and those of other firms and faculty. Significantly more genetics than non-genetics firms funded AIRRs, and genetics firms' AIRRs were larger and longer.

Withholding research results in academic life science. Evidence from a national survey of faculty.

Objectives: To identify the prevalence and determinants of data-withholding behaviors among academic life scientists.

Design: Mailed survey of 3394 life science faculty in the 50 universities that received the most funding from the National Institutes of Health in 1993.

Participants: A total of 2167 faculty responded to the survey, a 64% response rate.

Participation of life-science faculty in research relationships with industry.

Background: Recent research on academic-industrial research relationships in the life sciences has examined their frequency, benefits, risks, and evolution from the standpoint of industrial sponsors of research. We collected information on the extent and effects of academic-industrial research relationships from the standpoint of faculty members who participate in them.

Methods: We used a mailed questionnaire to collect data between October 1994 and April 1995 from 2052 faculty members (of 3169 eligible respondents; response rate, 65 percent) in the life sciences at the 50 U.

Relationships between academic institutions and industry in the life sciences--an industry survey.

Background: Despite growing acceptance of relationships between academia and industry in the life sciences, systematic, up-to-date information about their extent and the consequences for the parties involved remains scarce. We attempted to collect information about the prevalence, magnitude, commercial benefits, and potential risks of such relationships by surveying a representative sample of life-science companies in the United States to determine their relationships with academic institutions.

Methods: We collected data by telephone from May through September 1994 from senior executives of 210 life-science companies (of 306 companies surveyed; response rate, 69 percent).

Results and impacts of the Resource-Based Relative Value Scale.

On January 1, 1992, the Health Care Financing Administration implemented the 1989 legislation reforming the Medicare payment system for physicians' services. The cornerstone of the new payment reform is the Medicare Fee Schedule (MFS), which is based on the Resource-Based Relative Value Scale (RBRVS). In this article, the major findings of the RBRVS study and its impacts on physician payment are summarized.

Physician and practice characteristics, frequency of performance, and the Resource-Based Relative Value Scale.

The Resource-Based Relative Value Scale is based in part on the ratings of the work of services obtained from a random sample of physicians in a specialty. Ratings are used without regard to board-certification or other characteristics of the physician, or to the physician's experience with the service. Critics have suggested that all physicians may not be equally qualified to rate the work of services.

Resource-based relative values for invasive procedures performed by eight surgical specialties.

We surveyed approximately 850 physicians in eight surgical specialties to investigate physicians' work in performing invasive services. Building on our analysis of physician work, we developed a relative value scale of physicians' services based on resource costs. First, we found that physician charges are not set in proportion to the resources required to perform a given procedure: there is a threefold variation, across hospital-based invasive procedures, in the ratio of charges to resource-based relative values.