Paul A Nutting
Dados Biográficos
| ID | 3483149 |
|---|---|
| NOME | Paul A Nutting |
| PRENOMES | Paul A |
| SOBRENOME | Nutting |
| ASSINATURA | NUTTING P A |
| AFILIAÇÕES | Indian Health Service |
| VERIFICADO | Não |
| TOTAL DE OBRAS | 16 |
| TOTAL DE CITAÇÕES | 18 |
| TOTAL COMO AUTOR | 16 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1977 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2014 |
| ÍNDICE H | 3 |
A Typology of Primary Care Workforce Innovations in the United States Since 2000
PURPOSE: Innovative workforce models are being developed and implemented to meet the changing demands of primary care. A literature review was conducted to construct a typology of workforce models used by primary care practices. METHODS: Ovid Medline, CINAHL, and PsycInfo were used to identify published descriptions of the primary care workforce that deviated from what would be expected in the typical practice in the year 2000. Expert consultants…
Primary Care Practice Transformation is Hard Work
BACKGROUND: Serious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a patient-centered medical home present even greater challenges and require more effective approaches. METHODS: Our research team conducted a series of National Institutes of Health funded descript…
Evaluation of Patient Centered Medical Home Practice Transformation Initiatives
BACKGROUND: The patient-centered medical home (PCMH) has become a widely cited solution to the deficiencies in primary care delivery in the United States. To achieve the magnitude of change being called for in primary care, quality improvement interventions must focus on whole-system redesign, and not just isolated parts of medical practices. METHODS: Investigators participating in 9 different evaluations of Patient Centered Medical Home implemen…
A Fidelity Measure for Integrated Management of Depression in Primary Care
BACKGROUND: Integrated models of primary care depression management improve outcomes. Subsequent dissemination efforts and their evaluation need a fidelity measure. OBJECTIVES: We sought to develop and validate a fidelity measure using data gathered during routine clinical application of the clinical model. METHODS: Longitudinal outcome data on depression severity were obtained from 224 subjects experiencing major depression or dysthymia and assi…
Impact of Ongoing Primary Care Intervention on Long Term Outcomes In Uninsured and Insured Patients With Depression
BACKGROUND AND OBJECTIVES: To assess the differential impact of an ongoing primary care depression intervention on uninsured and insured patients' outcomes 12, 18, and 24 months following baseline. RESEARCH DESIGN: Quasi-experimental longitudinal study of insured and uninsured patients with depression receiving treatment from 12 practices randomized to enhanced (intervention) and usual care study conditions. SUBJECTS: In 1996 to 1997, 383 nonelde…
Resolving Disparities in Antidepressant Treatment and Quality-of-Life Outcomes Between Uninsured and Insured Primary Care Patients With Depression
BACKGROUND: Efforts to improve primary care depression treatment should penetrate to vulnerable uninsured populations. OBJECTIVE: To assess a primary care intervention's impact on treatment and quality-of-life outcomes in uninsured and insured depressed patients during the acute treatment phase. RESEARCH DESIGN: Twelve community primary care practices were randomized to 'enhanced' (intervention) and usual care conditions. Physicians, nurses and a…
A Primary Care Intervention for Depression
To assess a guideline‐based intervention's impact on depression care provided in rural vs. urban primary care settings, 12 community primary care practices (four rural, eight urban) were randomized to enhanced (i.e, intervention) and usual care study conditions. The study enrolled 479 depressed patients, with 432 (90.2 percent) completing telephone follow‐up at six months. Multilevel analytic models revealed that rural enhanced care patients had …
Defining Primary Care
OBJECTIVES: Efforts to contain health care costs have increased interest in defining which specialties provide primary care and in developing tools to assess the delivery of primary care services. METHODS: Using data from the 1985-1991 National Ambulatory Medical Care Surveys, the authors examined the activities of 29 physician specialty groups to determine whether the recent Institute of Medicine definition of primary care could be operationaliz…
The danger of applying uniform clinical policies across populations
OBJECTIVES. This study examined the implications of annual screening mammography for cost and mortality in American Indian populations with differing baseline breast cancer rates. METHODS. A decision tree compared annual screening mammography and screening clinical breast examination with referral for diagnostic mammography when appropriate. The decision tree was constructed to examine the effect of different base-line cancer rates, stage at diag…
Health insurance and subjective health status
OBJECTIVES. The relationship between health insurance and subjective health status was investigated. It was hypothesized that persons without health insurance would have lower levels of subjective health status than those with health insurance and that this relationship would hold for both poor and nonpoor persons. METHODS. Data from the 1987 National Medical Expenditure Survey were analyzed to examine the relationship between health insurance an…
Cancer incidence among American Indians and Alaska Natives, 1980 through 1987
OBJECTIVES. This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. METHODS. Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. RESULTS. Cancers of the gallbladd…
Where Do We Go From Here
Bergner, Marilyn PhD; Barry, Michael J. MD; Bowman, Marjorie A. MD, MPA; Doyle, M Anne; Guess, Harry A. MD, PhD; Nutting, Paul A. MD Author Information
Community-oriented primary care
Community-oriented primary care (COPC) represents a specific variation on the general primary care model. Seven case studies from vastly different health care settings were examined and this report describes the diversity of expression of the principles of COPC observed. The results suggest that COPC is not limited to publicly funded programs, but can find expression in the private sector as well. The organization of financing and the lack of fea…
Relationship of Size and Payment Mechanism to System Performance in 11 Medical Care Systems
The performance of 11 medical care systems of varying size and payment mechanisms (consisting of six government owned and operated Indian Health Service units, three fee-for-service private practices and two HMOs) was studied. Performance was defined as the percentage of consumers in need of care who received adequate care according to predetermined standards for the process of care for various functions (i.e., prevention, screening, treatment, f…
Assessing the Performance of Medical Care Systems
As health care becomes more differentiated, fewer people receive the majority of their care from a single source. Yet, most methods for assessing health care focus on the care provided by a single facility or group of practitioners. A method is described which tracks individuals through the diffuse medical care "system" and examines the process of care received for complete episodes of care. Through the use of tracer conditions the individual's p…
A Population-based Assessment of the Continuity of Ambulatory Care
A strategy is described in which explicit patient care criteria are used to measure the continuity of the health problem solving process. Prevalent diseases are selected to represent the work load of the health system. Continuity is defined in terms of rates of transition between the major clinical elements: screening, the definitive diagnostic evaluation, treatment, and follow-up evaluation. Results define critical dropout patterns and promote c…
Health insurance and subjective health status
OBJECTIVES. The relationship between health insurance and subjective health status was investigated. It was hypothesized that persons without health insurance would have lower levels of subjective health status than those with health insurance and that this relationship would hold for both poor and nonpoor persons. METHODS. Data from the 1987 National Medical Expenditure Survey were analyzed to examine the relationship between health insurance an…
Cancer incidence among American Indians and Alaska Natives, 1980 through 1987
OBJECTIVES. This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. METHODS. Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. RESULTS. Cancers of the gallbladd…
The danger of applying uniform clinical policies across populations
OBJECTIVES. This study examined the implications of annual screening mammography for cost and mortality in American Indian populations with differing baseline breast cancer rates. METHODS. A decision tree compared annual screening mammography and screening clinical breast examination with referral for diagnostic mammography when appropriate. The decision tree was constructed to examine the effect of different base-line cancer rates, stage at diag…
Community-oriented primary care
Community-oriented primary care (COPC) represents a specific variation on the general primary care model. Seven case studies from vastly different health care settings were examined and this report describes the diversity of expression of the principles of COPC observed. The results suggest that COPC is not limited to publicly funded programs, but can find expression in the private sector as well. The organization of financing and the lack of fea…
A Population-based Assessment of the Continuity of Ambulatory Care
A strategy is described in which explicit patient care criteria are used to measure the continuity of the health problem solving process. Prevalent diseases are selected to represent the work load of the health system. Continuity is defined in terms of rates of transition between the major clinical elements: screening, the definitive diagnostic evaluation, treatment, and follow-up evaluation. Results define critical dropout patterns and promote c…
Assessing the Performance of Medical Care Systems
As health care becomes more differentiated, fewer people receive the majority of their care from a single source. Yet, most methods for assessing health care focus on the care provided by a single facility or group of practitioners. A method is described which tracks individuals through the diffuse medical care "system" and examines the process of care received for complete episodes of care. Through the use of tracer conditions the individual's p…
Relationship of Size and Payment Mechanism to System Performance in 11 Medical Care Systems
The performance of 11 medical care systems of varying size and payment mechanisms (consisting of six government owned and operated Indian Health Service units, three fee-for-service private practices and two HMOs) was studied. Performance was defined as the percentage of consumers in need of care who received adequate care according to predetermined standards for the process of care for various functions (i.e., prevention, screening, treatment, f…
Community-oriented primary care
Community-oriented primary care (COPC) represents a specific variation on the general primary care model. Seven case studies from vastly different health care settings were examined and this report describes the diversity of expression of the principles of COPC observed. The results suggest that COPC is not limited to publicly funded programs, but can find expression in the private sector as well. The organization of financing and the lack of fea…
Where Do We Go From Here
Bergner, Marilyn PhD; Barry, Michael J. MD; Bowman, Marjorie A. MD, MPA; Doyle, M Anne; Guess, Harry A. MD, PhD; Nutting, Paul A. MD Author Information
Health insurance and subjective health status
OBJECTIVES. The relationship between health insurance and subjective health status was investigated. It was hypothesized that persons without health insurance would have lower levels of subjective health status than those with health insurance and that this relationship would hold for both poor and nonpoor persons. METHODS. Data from the 1987 National Medical Expenditure Survey were analyzed to examine the relationship between health insurance an…
Cancer incidence among American Indians and Alaska Natives, 1980 through 1987
OBJECTIVES. This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. METHODS. Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. RESULTS. Cancers of the gallbladd…
The danger of applying uniform clinical policies across populations
OBJECTIVES. This study examined the implications of annual screening mammography for cost and mortality in American Indian populations with differing baseline breast cancer rates. METHODS. A decision tree compared annual screening mammography and screening clinical breast examination with referral for diagnostic mammography when appropriate. The decision tree was constructed to examine the effect of different base-line cancer rates, stage at diag…
Defining Primary Care
OBJECTIVES: Efforts to contain health care costs have increased interest in defining which specialties provide primary care and in developing tools to assess the delivery of primary care services. METHODS: Using data from the 1985-1991 National Ambulatory Medical Care Surveys, the authors examined the activities of 29 physician specialty groups to determine whether the recent Institute of Medicine definition of primary care could be operationaliz…
A Primary Care Intervention for Depression
To assess a guideline‐based intervention's impact on depression care provided in rural vs. urban primary care settings, 12 community primary care practices (four rural, eight urban) were randomized to enhanced (i.e, intervention) and usual care study conditions. The study enrolled 479 depressed patients, with 432 (90.2 percent) completing telephone follow‐up at six months. Multilevel analytic models revealed that rural enhanced care patients had …
Resolving Disparities in Antidepressant Treatment and Quality-of-Life Outcomes Between Uninsured and Insured Primary Care Patients With Depression
BACKGROUND: Efforts to improve primary care depression treatment should penetrate to vulnerable uninsured populations. OBJECTIVE: To assess a primary care intervention's impact on treatment and quality-of-life outcomes in uninsured and insured depressed patients during the acute treatment phase. RESEARCH DESIGN: Twelve community primary care practices were randomized to 'enhanced' (intervention) and usual care conditions. Physicians, nurses and a…
Impact of Ongoing Primary Care Intervention on Long Term Outcomes In Uninsured and Insured Patients With Depression
BACKGROUND AND OBJECTIVES: To assess the differential impact of an ongoing primary care depression intervention on uninsured and insured patients' outcomes 12, 18, and 24 months following baseline. RESEARCH DESIGN: Quasi-experimental longitudinal study of insured and uninsured patients with depression receiving treatment from 12 practices randomized to enhanced (intervention) and usual care study conditions. SUBJECTS: In 1996 to 1997, 383 nonelde…
A Fidelity Measure for Integrated Management of Depression in Primary Care
BACKGROUND: Integrated models of primary care depression management improve outcomes. Subsequent dissemination efforts and their evaluation need a fidelity measure. OBJECTIVES: We sought to develop and validate a fidelity measure using data gathered during routine clinical application of the clinical model. METHODS: Longitudinal outcome data on depression severity were obtained from 224 subjects experiencing major depression or dysthymia and assi…
Primary Care Practice Transformation is Hard Work
BACKGROUND: Serious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a patient-centered medical home present even greater challenges and require more effective approaches. METHODS: Our research team conducted a series of National Institutes of Health funded descript…
Evaluation of Patient Centered Medical Home Practice Transformation Initiatives
BACKGROUND: The patient-centered medical home (PCMH) has become a widely cited solution to the deficiencies in primary care delivery in the United States. To achieve the magnitude of change being called for in primary care, quality improvement interventions must focus on whole-system redesign, and not just isolated parts of medical practices. METHODS: Investigators participating in 9 different evaluations of Patient Centered Medical Home implemen…
A Typology of Primary Care Workforce Innovations in the United States Since 2000
PURPOSE: Innovative workforce models are being developed and implemented to meet the changing demands of primary care. A literature review was conducted to construct a typology of workforce models used by primary care practices. METHODS: Ovid Medline, CINAHL, and PsycInfo were used to identify published descriptions of the primary care workforce that deviated from what would be expected in the typical practice in the year 2000. Expert consultants…
Medicine (16 obras) · Family medicine (9 obras) · Primary Care and Health Outcomes (9 obras) · Nursing (8 obras) · Health care (7 obras) · Computer Science (6 obras) · Environmental health (6 obras) · Healthcare Policy and Management (6 obras) · Primary care (6 obras) · Internal Medicine (5 obras)