The early diagnosis project: a collaborative approach to risk management.

Diagnostic errors account for one-fifth of lawsuits against hospitals and physicians. Virtually all medical specialties are at risk for these lawsuits. To this point, risk managers have done little to assist physicians to reduce their risk of failure-to-diagnose (FTD) lawsuits. This article describes a collaborative effort to reduce FTD lawsuits in the primary care setting.

Reducing malpractice risk and increasing quality in managed care.

The Early Diagnosis Project was established in an effort to improve quality and reduce malpractice risk in managed care practice environments. The first project, which addressed breast cancer, utilized practice guidelines, patient handouts, and follow-up forms in an integrated attempt to improve the quality of care and reduce litigation involving "failure-to-diagnose" claims.

Early diagnosis of breast changes. Risk management and quality of care approach.

Breast cancer is the leading cancer diagnosis among women. Systematic use of mammography and other screening modalities can reduce mortality. The gap between potential benefit and clinical reality appears to be widening, however, as suggested by the fact that failure to diagnose is now the number one cause of malpractice lawsuits against physicians.

Patient-centered computing: can it curb malpractice risk?

The threat of a medical malpractice suit represents a major cause of career dissatisfaction for American physicians. Patient-centered computing may improve physician-patient communications, thereby reducing liability risk. This review describes programs that have sought to enhance patient education and involvement pertaining to 5 major categories of malpractice lawsuits: Diagnosis, medications, obstetrics, surgery, and treatment errors.

The effectiveness of a worksite self-help smoking cessation program: a randomized trial.

A 2 x 2 randomized, factorial pretest/posttest group design was used to evaluate the effectiveness of self-help smoking cessation methods at the worksite. The study investigated the effect of a multicomponent health education and skill intervention versus the effect of a monetary incentive to the employee for quitting. All employees received, in addition, a standardized self-help smoking cessation manual and maintenance manual. Following agreement to participate and a baseline smoking history, all participants were followed for 6 weeks, 6 months, and 12 months. Saliva was obtained for thiocyanate (SCN) analysis of smoking status. Of the estimated 2000 smokers at the site, 387 smokers were recruited. Employees were randomly assigned to one of four groups. Results of this random trial indicate that those employees receiving a multicomponent program were most successful in quitting and remaining abstinent. The monetary incentive appears to have no effect on quit rate.

The effectiveness of smoking cessation methods for smokers in public health maternity clinics: a randomized trial.

Little insight is available in the literature on how best to assist the pregnant smoker in public health maternity clinics to quit during pregnancy. A randomized pretest/posttest experiment was used to evaluate the effectiveness of two different self-help cessation methods. Three hundred and nine pregnant women from three public health maternity clinics were assigned randomly to one of three groups with one-third assigned to each: a control group; a group receiving the American Lung Association's Freedom From Smoking Manual; and those receiving A Pregnant Woman's Self-Help Guide to Quit Smoking. Using a saliva thiocyanate (SCN) and behavioral report at mid-pregnancy and end of pregnancy to confirm cessation or reduction, 2 per cent in the control group quit and 7 per cent reduced their SCN levels substantially. Of the women assigned to the ALA method, 6 per cent quit and 14 per cent reduced their SCN levels substantially. Of the women who used the Guide, 14 per cent quit and 17 per cent reduced their SCN levels substantially. Results of this trial indicate that health education methods tailored to the pregnant smoker are more effective in changing smoking behavior than the standard clinic information and advice to quit and/or the use of smoking cessation methods not tailored to the needs of the pregnant smoker.

Employee self-help smoking cessation programs: a review of the literature.

The purpose of this article is to present a review of the literature on employee self-help smoking cessation programs. Included in this discussion are: (1) a rationale for self-help smoking cessation interventions; (2) a synopsis of their applicability to occupational settings; (3) a rational and description of the self-help smoking cessation interventions selected for a large group of employees; and (4) several methodological issues faced in conducting evaluations of smoking cessation programs.

Health hazard appraisal in a family practice center: an exploratory study.

Health Hazard Appraisal (HHA), a tool of primary prevention, has been advocated for use in family practice. Yet little evidence exists regarding its effectiveness in clinical settings or its acceptability to practitioners or patients. In this study, 69 family practice patients completed a HHA questionnaire. Their responses were computer-analyzed and returned in two to three weeks. The patients were telephoned three to five months later to assess the effectiveness of HHA in terms of desired behavioral changes. Of the patients who were recommended to undertake specified behavioral changes, 41.3% reported that they had begun an exercise program, 27.8% had stopped smoking cigarettes, 20.0% had limited their alcohol intake, 23.5% had reduced their driving mileage to under 10,000 miles, and 75.0% of the women started breast self examinations. Although the patients' self-reports may have been exaggerated, they nonetheless represent encouraging results. Evaluations by patients revealed little objection to the personal questions, length of time to complete, or cost of the HHA form. Physician evaluations expressed the consensus that HHA was beneficial to the doctor-patient relationship, but a few indicated they did not feel comfortable discussing the HHA results with the patient.

The contribution of school health education to community health promotion: what can we reasonably expect?

Evaluative studies of outcomes of traditional school health education programs have shown that they are very effective in increasing knowledge, somewhat effective in improving attitudes, and, with few notable exceptions, generally ineffective in changing health practices. This paper discusses the previous reviews of the literature of outcomes of school health education programs, and discusses the constraints inherent in school-based activities; an emphasis on cognitive learning, lecture-oriented teaching methods, inadequate pupil assessment procedures, a captive audience, competing subject areas, competing behavioral influences, behavior change attempts directed at ingrained health habits, inadequate coordination with community resources, and lack of consensus regarding educational goals. The paper then examines several recent successful school health education programs emphasizing non-traditional approaches in self-initiated care, pregnancy prevention, smoking prevention, and nutrition. It is concluded that school-based health education programs have three important roles in community health promotion: 1. the provision of a fundamental understanding of health and disease concepts to large segments of the population; 2. the reinforcement of positive health attitudes; and 3. the alteration of concurrent health behaviors for significant health problems. Although school health education may be helpful in enhancing decision-making and social interaction skills, little empirical evidence exists at this time to support this conclusion.