The practice of sending a patient to another program or practitioner for services or advice which the referring source is not prepared to provide.

Services provided by an individual ethicist (ETHICISTS) or an ethics team or committee (ETHICS COMMITTEES, CLINICAL) to address the ethical issues involved in a specific clinical case. The central purpose is to improve the process and outcomes of patients' care by helping to identify, analyze, and resolve ethical problems.

Consultation via remote telecommunications, generally for the purpose of diagnosis or treatment of a patient at a site remote from the patient or primary physician.

A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family.

The interactions between physician and patient.

The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial.

The different methods of scheduling patient visits, appointment systems, individual or group appointments, waiting times, waiting lists for hospitals, walk-in clinics, etc.

Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)

Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.

The seeking and acceptance by patients of health service.

Patient-based medical care provided across age and gender or specialty boundaries.

The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups.

Predetermined sets of questions used to collect data - clinical data, social status, occupational group, etc. The term is often applied to a self-completed survey instrument.

Organized services in a hospital which provide medical care on an outpatient basis.

Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up.

Those physicians who have completed the education requirements specified by the American Academy of Family Physicians.

Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc.

Recording of information on magnetic or punched paper tape.

The art and science of studying, performing research on, preventing, diagnosing, and treating disease, as well as the maintenance of health.

Persons trained in philosophical or theological ethics who work in clinical, research, public policy, or other settings where they bring their expertise to bear on the analysis of ethical dilemmas in policies or cases. (Bioethics Thesaurus)

Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.

Physicians whose practice is not restricted to a specific field of MEDICINE.

An occupation limited in scope to a subsection of a broader field.

The use of one's knowledge in a particular profession. It includes, in the case of the field of biomedicine, professional activities related to health care and the actual performance of the duties related to the provision of health care.

Country located in EUROPE. It is bordered by the NORTH SEA, BELGIUM, and GERMANY. Constituent areas are Aruba, Curacao, Sint Maarten, formerly included in the NETHERLANDS ANTILLES.

A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney.

Acquiring information from a patient on past medical conditions and treatments.

Elements of limited time intervals, contributing to particular results or situations.

An instrument for reproducing sounds especially articulate speech at a distance. (Webster, 3rd ed)

Patient involvement in the decision-making process in matters pertaining to health.

The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.

The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.

Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.

The capability to perform acceptably those duties directly related to patient care.

A medical specialty concerned with the skin, its structure, functions, diseases, and treatment.

Recording of visual and sometimes sound signals on magnetic tape.

Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility.

A detailed review and evaluation of selected clinical records by qualified professional personnel for evaluating quality of medical care.

The reciprocal interaction of two or more professional individuals.

Any type of research that employs nonnumeric information to explore individual or group characteristics, producing findings not arrived at by statistical procedures or other quantitative means. (Qualitative Inquiry: A Dictionary of Terms Thousand Oaks, CA: Sage Publications, 1997)

Medical care provided after the regular practice schedule of the physicians. Usually it is designed to deliver 24-hour-a-day and 365-day-a-year patient care coverage for emergencies, triage, pediatric care, or hospice care.

Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.

Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.

Recording of pertinent information concerning patient's illness or illnesses.

Prospective patient listings for appointments or treatments.

Nurses who are specially trained to assume an expanded role in providing medical care under the supervision of a physician.

The total amount of work to be performed by an individual, a department, or other group of workers in a period of time.

The teaching or training of patients concerning their own health needs.

Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services.

Directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.

An evaluation procedure that focuses on how care is delivered, based on the premise that there are standards of performance for activities undertaken in delivering patient care, in which the specific actions taken, events occurring, and human interactions are compared with accepted standards.

Transmission and interpretation of tissue specimens via remote telecommunication, generally for the purpose of diagnosis or consultation but may also be used for continuing education.

Conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes school admission or job interviews.

Individuals referred to for expert or professional advice or services.

Public attitudes toward health, disease, and the medical care system.

The identification, analysis, and resolution of moral problems that arise in the care of patients. (Bioethics Thesaurus)

The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment.

Conformity in fulfilling or following official, recognized, or institutional requirements, guidelines, recommendations, protocols, pathways, or other standards.

A direct communication system, usually telephone, established for instant contact. It is designed to provide special information and assistance through trained personnel and is used for counseling, referrals, and emergencies such as poisonings and threatened suicides.

The expected function of a member of the medical profession.

Individuals licensed to practice medicine.

A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas).

The storing or preserving of video signals for television to be played back later via a transmitter or receiver. Recordings may be made on magnetic tape or discs (VIDEODISC RECORDING).

A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence.

The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)

Small-scale tests of methods and procedures to be used on a larger scale if the pilot study demonstrates that these methods and procedures can work.

A system of medical care regulated, controlled and financed by the government, in which the government assumes responsibility for the health needs of the population.

The use of persons coached to feign symptoms or conditions of real diseases in a life-like manner in order to teach or evaluate medical personnel.

An infant during the first month after birth.

The giving of advice and assistance to individuals with educational or personal problems.

Health care provided on a continuing basis from the initial contact, following the patient through all phases of medical care.

Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient.

Those facilities which administer health services to individuals who do not require hospitalization or institutionalization.

Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.

Design of patient care wherein institutional resources and personnel are organized around patients rather than around specialized departments. (From Hospitals 1993 Feb 5;67(3):14)

Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.

Communication, in the sense of cross-fertilization of ideas, involving two or more academic disciplines (such as the disciplines that comprise the cross-disciplinary field of bioethics, including the health and biological sciences, the humanities, and the social sciences and law). Also includes problems in communication stemming from differences in patterns of language usage in different academic or medical disciplines.

The smallest continent and an independent country, comprising six states and two territories. Its capital is Canberra.

Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.

Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function.

The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea.

Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.

Knowledge, attitudes, and associated behaviors which pertain to health-related topics such as PATHOLOGIC PROCESSES or diseases, their prevention, and treatment. This term refers to non-health workers and health workers (HEALTH PERSONNEL).

Organized periodic procedures performed on large groups of people for the purpose of detecting disease.

A subspecialty of internal medicine concerned with the study of neoplasms.

Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).

Health services required by a population or community as well as the health services that the population or community is able and willing to pay for.

The controlling of access to health services, usually by primary care providers; often used in managed care settings to reduce utilization of expensive services and reduce referrals. (From BIOETHICS Thesaurus, 1999)

Health services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.

Care alleviating symptoms without curing the underlying disease. (Stedman, 25th ed)

The electronic transmission of radiological images from one location to another for the purposes of interpretation and/or consultation. Users in different locations may simultaneously view images with greater access to secondary consultations and improved continuing education. (From American College of Radiology, ACR Standard for Teleradiology, 1994, p3)

Those factors, such as language or sociocultural relationships, which interfere in the meaningful interpretation and transmission of ideas between individuals or groups.

Interactions between health personnel and patients.

Major administrative divisions of the hospital.

The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders.

Evaluation procedures that focus on both the outcome or status (OUTCOMES ASSESSMENT) of the patient at the end of an episode of care - presence of symptoms, level of activity, and mortality; and the process (ASSESSMENT, PROCESS) - what is done for the patient diagnostically and therapeutically.

A field of anatomical pathology in which living tissue is surgically removed for the purpose of diagnosis and treatment.

Hospitals maintained by a university for the teaching of medical students, postgraduate training programs, and clinical research.

Systematic and thorough inspection of the patient for physical signs of disease or abnormality.

The observation and analysis of movements in a task with an emphasis on the amount of time required to perform the task.

Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact.

An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.

Directions written for the obtaining and use of DRUGS.

Educational programs designed to inform physicians of recent advances in their field.

The capability to perform the duties of one's profession generally, or to perform a particular professional task, with skill of an acceptable quality.

Visits to the patient's home by professional personnel for the purpose of diagnosis and/or treatment.

The concept concerned with all aspects of providing and distributing health services to a patient population.

Social and economic factors that characterize the individual or group within the social structure.

Incorrect diagnoses after clinical examination or technical diagnostic procedures.

Non-optimal interval of time between onset of symptoms, identification, and initiation of treatment.

Theoretical representations and constructs that describe or explain the structure and hierarchy of relationships and interactions within or between formal organizational entities or informal social groups.

A medical facility which provides a high degree of subspecialty expertise for patients from centers where they received SECONDARY CARE.

The organization and operation of the business aspects of a physician's practice.

Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.

A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis.

Voluntary cooperation of the patient in following a prescribed regimen.

Customer satisfaction or dissatisfaction with a benefit or service received.

Hospital department responsible for the organization and administration of psychiatric services.

The study of the heart, its physiology, and its functions.

Excessive, under or unnecessary utilization of health services by patients or physicians.

An individual's objective and insightful awareness of the feelings and behavior of another person. It should be distinguished from sympathy, which is usually nonobjective and noncritical. It includes caring, which is the demonstration of an awareness of and a concern for the good of others. (From Bioethics Thesaurus, 1992)

Facilities which administer the delivery of health care services to people living in a community or neighborhood.

Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.

Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.

Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed.

Disorders having the presence of physical symptoms that suggest a general medical condition but that are not fully explained by a another medical condition, by the direct effects of a substance, or by another mental disorder. The symptoms must cause clinically significant distress or impairment in social, occupational, or other areas of functioning. In contrast to FACTITIOUS DISORDERS and MALINGERING, the physical symptoms are not under voluntary control. (APA, DSM-V)

Hospital or other institutional ethics committees established to consider the ethical dimensions of patient care. Distinguish from ETHICS COMMITTEES, RESEARCH, which are established to monitor the welfare of patients or healthy volunteers participating in research studies.

A general concept referring to the organization and administration of nursing activities.

The confinement of a patient in a hospital.

Maleness or femaleness as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or effect of a circumstance. It is used with human or animal concepts but should be differentiated from SEX CHARACTERISTICS, anatomical or physiological manifestations of sex, and from SEX DISTRIBUTION, the number of males and females in given circumstances.

A method of data collection and a QUALITATIVE RESEARCH tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions.

Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.

Interaction between the patient and nurse.

Planning and control of time to improve efficiency and effectiveness.

An educational process that provides information and advice to individuals or families about a genetic condition that may affect them. The purpose is to help individuals make informed decisions about marriage, reproduction, and other health management issues based on information about the genetic disease, the available diagnostic tests, and management programs. Psychosocial support is usually offered.

Pathological processes of the ear, the nose, and the throat, also known as the ENT diseases.

Transmission of information over distances via electronic means.

Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.

A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.

Printed publications usually having a format with no binding and no cover and having fewer than some set number of pages. They are often devoted to a single subject.

Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols.

Institutions with an organized medical staff which provide medical care to patients.

Medical complexes consisting of medical school, hospitals, clinics, libraries, administrative facilities, etc.

Feeling or emotion of dread, apprehension, and impending disaster but not disabling as with ANXIETY DISORDERS.

Hospitals engaged in educational and research programs, as well as providing medical care to the patients.

Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided.

Hospital department responsible for the administration and provision of diagnostic and therapeutic services for the urologic patient.

Organized services to provide health care for children.

Professional medical personnel approved to provide care to patients in a hospital.

Methods to determine in patients the nature of a disease or disorder at its early stage of progression. Generally, early diagnosis improves PROGNOSIS and TREATMENT OUTCOME.

Institutions specializing in the care of cancer patients.

Diagnostic, therapeutic and preventive health services provided for individuals in the community.

Situations affecting a significant number of people, that are believed to be sources of difficulty or threaten the stability of the community, and that require programs of amelioration.

The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.

A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases.

Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project.

Any group of three or more full-time physicians organized in a legally recognized entity for the provision of health care services, sharing space, equipment, personnel and records for both patient care and business management, and who have a predetermined arrangement for the distribution of income.

Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.

A province of Canada lying between the provinces of Manitoba and Quebec. Its capital is Toronto. It takes its name from Lake Ontario which is said to represent the Iroquois oniatariio, beautiful lake. (From Webster's New Geographical Dictionary, 1988, p892 & Room, Brewer's Dictionary of Names, 1992, p391)

Total pharmaceutical services provided to the public through community pharmacies.

Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment.

Invasion of the host RESPIRATORY SYSTEM by microorganisms, usually leading to pathological processes or diseases.

New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms.

Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care. (Dictionary of Health Services Management, 2d ed)

A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system.

A state in northeastern Australia. Its capital is Brisbane. Its coast was first visited by Captain Cook in 1770 and its first settlement (penal) was located on Moreton Bay in 1824. The name Cooksland was first proposed but honor to Queen Victoria prevailed. (From Webster's New Geographical Dictionary, 1988, p996 & Room, Brewer's Dictionary of Names, 1992, p441)

Providers of initial care for patients. These PHYSICIANS refer patients when appropriate for secondary or specialist care.

Diseases of the muscles and their associated ligaments and other connective tissue and of the bones and cartilage viewed collectively.

An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.

The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.

Differences of opinion or disagreements that may arise, for example, between health professionals and patients or their families, or against a political regime.

An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided.

The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.

Communication between persons or between institutions or organizations by an exchange of letters. Its use in indexing and cataloging will generally figure in historical and biographical material.

The act of regarding attentively and studying facts and occurrences, gathering data through analyzing, measuring, and drawing conclusions, with the purpose of applying the observed information to theoretical assumptions. Observation as a scientific method in the acquisition of knowledge began in classical antiquity; in modern science and medicine its greatest application is facilitated by modern technology. Observation is one of the components of the research process.

Practice of a health profession by an individual, offering services on a person-to-person basis, as opposed to group or partnership practice.

Services specifically designed, staffed, and equipped for the emergency care of patients.

The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.

Components of a national health care system which administer specific services, e.g., national health insurance.

Government-controlled hospitals which represent the major health facility for a designated geographic area.

Communications via an interactive conference between two or more participants at different sites, using computer networks (COMPUTER COMMUNICATION NETWORKS) or other telecommunication links to transmit audio, video, and data.

Situations or conditions requiring immediate intervention to avoid serious adverse results.

Health services, public or private, in urban areas. The services include the promotion of health and the delivery of health care.

Hospitals controlled by various types of government, i.e., city, county, district, state or federal.

The principles of professional conduct concerning the rights and duties of the physician, relations with patients and fellow practitioners, as well as actions of the physician in patient care and interpersonal relations with patient families.

The privacy of information and its protection against unauthorized disclosure.

Patterns of practice in nursing related to provision of services including diagnosis and treatment.

Usually a written medical and nursing care program designed for a particular patient.

Services for the diagnosis and treatment of disease and the maintenance of health.

A health care system which combines physicians, hospitals, and other medical services with a health plan to provide the complete spectrum of medical care for its customers. In a fully integrated system, the three key elements - physicians, hospital, and health plan membership - are in balance in terms of matching medical resources with the needs of purchasers and patients. (Coddington et al., Integrated Health Care: Reorganizing the Physician, Hospital and Health Plan Relationship, 1994, p7)

The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles.

The services rendered by members of the health profession and non-professionals under their supervision.

Interfacility or intrahospital transfer of patients. Intrahospital transfer is usually to obtain a specific kind of care and interfacility transfer is usually for economic reasons as well as for the type of care provided.