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VOLUME 20, NUMBER 7
February 16, 1973
DURHAM, NORTH CAROLINA
^ Duke Receives $1 Million Johnson Grant
MAJOR GRANT FOR PATIENT Cy4/?f-Using a rolled up map as a pointer. Dr. E.
Harvey Estes indicates a section of northern Durham County that will figure in
projects being undertaken with a $1 million grant from the Robert Wood Johnson
Foundation. The grant was made to Estes' Department of Community Health
Sciences. (Photo by Thad Sparks)
Impact of Disease Elimination
On Elderly Population Studied
f
If one of the four major causes of
death in this country could be
eliminated today, the greatest impact on
the elderly population would come from
eliminating all deaths from heart and
kidney diseases.
The director of Duke's Center for
Demographic Studies, Dr. George C.
Myers, said the impact of eliminating
major cardiovascular-renal diseases would
greatly exceed the impact of the
elimination of influenza and pneumonia,
malignant tumors and motor vehicle
accidents.
The findings are part of the
preliminary results of an investigation
aimed at devising better methods of
forecasting mortality trends. Myers
discussed the findings during a seminar
here last "week sponsored by Duke's
Council on Aging and Human
Development.
Myers said planners and
policy-makers must have more
sophisticated methods of projecting the
future size and composition of the older
population if they are to plan for the
social, economic and health welfare of
the elderly.
Changes in mortality patterns become
increasingly important, he said, as the
fertility rate is lowered and the
population of the nation becomes more
stabilized.
Myers and his associates prepared a
set of projections which each assumed
the immediate elimination in 1973 of all
deaths from a single cause and
continuation of this condition through
the year 2000. He said although these
assumptions are not realistic, the
projections give some indication of the
relative effect reductions in each of
these major diseases would have on the
elderly population.
He found that the projected size of
the population age 65 and over in the
(Continued on page 3)
Under a new million-dollar grant, the medical center is launching a sweeping
research and education program aimed at giving the patient better and more
efficient health care—and giving him a voice in how it's done.
It also is aimed at giving medical students and young doctors a clearer picture of
some of the problems and frustrations people face when trying to see the doctor.
The $1,134,375 three-year grant to the Department of Community Health
Sciences is from the Robert Wood Johnson Foundation of Princeton, N.J.
"The practice of medicine and delivery of health care are not going to be the
same 10 years from now," Dr. E. Harvey Estes predicted. As chairman of
Community Health Sciences, Estes has overall responsibility for administering
projects under the grant.
"How health care will change, we don't know," Estes said. "But the Robert
Wood Johnson Foundation grant will help us look ahead, anticipate changes and
provide sound recommendations on what we think some of those changes ought to
be."
The Duke study will take place both
in the clinic—the doctor's office
setting—where the process of primary
health care will be examined very
closely, and out in the community
where the individual, family and other
group reactions to illness and health care
will be sought.
Both settings will provide a training
ground for medical students, interns and
residents to learn better management
techniques for medical practice and, as
Estes expressed it, "to learn to listen to
the consumer of his services and
inter-relate with him."
The University Health Service Clinic,
which sees between 100 and 200
patients a day, will serve as the
laboratory for one phase of the
program. Estes said the data-gathering
process will be similar to
time-and-motion studies, and it will go
something like this:
As the patient enters the clinic, his
name, identifying number, accession
number (indicating whether he's the first
patient of the day, the 23rd patient,
etc.) and the time will be recorded.
The patient will carry with him a
plastic card with the accession number
coded on it. At each point throughout
his clinic visit—for example, initial
examination. X-ray, laboratories, final
session with doctor, release from
clinic—the plastic card will be inserted
POPULATION STUDIES—Dr. George C. Myers (left), Director of Duke's Center for
Demographic Studies, discusses a graph of his projections about disease elimination
and the elderly population with Dr. Erdman B. Palmore, associate professor of
psychiatry and sociology.
into an automatic dial telephone.
This will transmit to a central
computer the patient's location, the
time he got to the lab or wherever he
happens to be, plus additional
information such as the physician's
code, tests that were ordered, the
diagnosis, the charges, and a variety of
other data.
"At the end of the day," Estes
explained, "each patient can be 'tracked'
through the clinic. The aggregate data
can provide us such information as
patients seen by category, time of day,
diagnosis; the average time required for
each step in the clinic visit sequence;
average services utilized for each
diagnosis; and average cost per patient."
The clinic can then experiment with
its system to try to develop ways of
increasing efficiency and shortening the
time the patient must be there.
Estes said modifications to be used
and studied will include use of a medical
history the patient fills out himself, use
of intermediate level health workers
such as physician's assistants and nurse
practitioners, use of screening-type
laboratory tests, and others.
"In each such study," Estes said,
"the objective will be to evaluate each
modification in terms of cost, efficiency,
patient acceptance and outcome."
By and large, physicians are not
formally trained in management
techniques. "The physician must learn
how to delegate tasks safely, how to
evaluate and manage the work of various
professionals within his practice and ho\A/
to evaluate the quality of medical
services in terms of outcome and patient
acceptance," Estes said.
A major objective of the Duke
studies," he said, "is to show that
research can and must be applied to
how the doctor's office or clinic is
managed and how the patients are
treated, just as research has proved to be
essential in uncovering the cause of
disease itself."
A second aspect of the grant study
will take place in what Estes calls "a
community laboratory setting," and he
believes it may be an eye-opener for
many medical students and young
physicians.
A striking feature of medical care in
recent years is the requirement that care
be provided in a manner much more
responsive to the needs and desires of
(Continued on page 2)