ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The effect of a greater volume of patients with similar conditions being treated at a hospital on the outcomes achieved is studied using a variety of categories of patients, 15 surgical and 2 medical, and involving 550,000 patients treated in over 1,200 nonfederal United States acute care hospitals. After demonstrating that there are significant differences in the outcomes of patients, taking into account patient health status, the authors examine the impact of being treated in a hospital with a high or low volume of similar patients. Strong and consistent evidence is found that high volume is associated with better outcomes for surgical patients, which supports regionalizing patient care by procedure. Two additional variables, relative difficulty of the procedure and risk level of the patients, are analyzed to determine whether they change the relationship between volume and outcome. Some evidence is found that low-volume hospitals are associated with the poorest outcome for low-risk surgical patients. The evidence for medical patients is weak and mixed. Possible alternative explanations for the observed findings for surgical and medical patients are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The effect of a greater volume of patients with similar conditions being treated at a hospital on the outcomes achieved is investigated for almost 500,000 selected surgical and medical patients treated in over 1,200 nonfederal United States hospitals. In Part I the authors found strong and consistent evidence for surgical patients that high volume is associated with better outcome; evidence for medical patients was mixed. In this paper the authors include other hospital variables related both to volume and outcome—hospital size, teaching status, and expenditures—to determine whether they mask the true relationship; still, strong and consistent evidence that greater volume produces better outcome was found for both surgical and medical patients. This relation was significant for low-, medium-, and high-risk patients. Among the hospital variations added, only size was consistently and strongly related to outcome; greater size was associated with poorer outcome after accounting for volume. The potential importance of the findings for reducing deaths and days in hospital on a national level is discussed. The evidence is strongly supportive of the need for policies that would promote greater regionalization of a given service, and not greater size, to obtain better quality outcome for patients treated.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The number of bed clays per inpatient episode, the length of stay (LOS), is a major indicator of hospital performance and a basic measure of patients' resource consumption. Hospital reimbursement on the basis of treated cases requires a system for accurately identifying case categories. Diagnosis Related Groups (DRGs) have been proposed for this purpose. An initial study to analyze variations in length of stay and resource consumption within DRGs is presented. Regression analysis of variation in ALOS for 7 DRGs, in terms of 8-10 independent variables not included in the classification scheme itself, was done. Results indicate that 30-65% of the large intra-DRG LOS variations are explainable by indicators of case complexity and severity despite the homogeneity claimed for the DRGs. For certain DRGs, such variations are also related to admission factors. Results indicate the need for more precise patient taxonomies than the ICDA-8-based DRGs.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The authors of this study examine temporal patterns of medical expenditures by Medicare beneficiaries. A random sample of 204,917 individuals who were alive and in the program from 1974 to 1977 was investigated. Individuals hospitalized in 1974 were found to have twice the rate of hospitalization in 1975, 1976, or 1977 compared with individuals who were not hospitalized in 1974. The increased rate of hospitalization remained constant throughout the 3 years. Individuals with large medical expenditures in 1974 were 20 times more likely to have large medical expenditures the following year, and this rate declined slowly in the following 2 years. The results suggest that the value of a Medicare voucher or the level of Medicare's payment to health maintenance organizations should include an adjustment factor for prior health care utilization. The results also suggest that multiyear limits on total Medicare coinsurance and deductible payments would be more equitable than single-year limits.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The authors studied differences in the rate of hospitalization of a random sample of all general and family practitioners in the state of Washington. The study was designed to identify nonmedical factors that affect the rate at which physicians hospitalize ambulatory patients. They found that the hospitalization rate varied greatly among physicians and that this rate appeared to be sensitive to nonmedical factors. The following independent variables were significantly associated with higher rates of hospitalization while controlling for other factors: low hospital occupancy rates, low per capita income in the county, group practice, a broader scope of outpatient practice, and a busier outpatient practice. They conclude that physicians are sensitive to a range of nonmedical factors in their decision to utilize hospital resources. These findings suggest that a substantial proportion of all hospitalizations are discretionary, and that changes in practice organization or hospital occupancy rates will affect the rate of hospital use.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Theoretic modeling suggests that common office tests as a group are profitable. To determine whether practicing internists perceive this profitability and whether their perceptions differ for different tests or for patients with different types of insurance coverage, the authors surveyed 111 physicians in private office practice. Respondents' estimates of receipts for tests done on patients with Medicare or Blue Cross/Blue Shield coverage were higher than their estimated costs for the testing. Estimates of receipts from Medicaid patients were lower than estimated costs of testing. After standardizing the estimated receipts from patients with different insurance coverages, the authors found that the average estimated profits for different tests on an “average insured patient” varied sixfold, from $5.99 for an electrocardiogram to $1.01 for a urinalysis. The authors suggest that perceived financial incentives are extremely variable by test. Different insurance coverages are perceived as providing varying financial incentives for testing; Medicaid provides a disincentive. Appropriate reform of the existing fee schedules should be selective by test and coverage.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Five hundred fifty-eight patients admitted to a general/medical surgical intensive care unit were studied 2 years after hospital discharge to determine whether they were still alive, were able to perform daily activities, and had returned to work. The overall 2-year survivorship (hospital and long-term) was 63.5%. Two-year survival was considerably lower for patients with certain condition or treatment characteristics than for others. This ranged from 14% 2-year survival for patients with 48 or more hours of coma to 82.2% for patients with no condition or treatment characteristics recorded. Once a patient was discharged alive, the 2-year cumulative survival of surgical ICU patients (84.6%) was significantly better than that of medical ICU patients (76.5%). Among ICU survivors responding to a follow-up survey, 85% were able to perform daily activities, but only 66% were working. Of the 44 patients experiencing a change in ability to perform daily activities at time of follow-up compared with pre-ICU admission, functional status of 34 (77%) improved, while 10 (23%) got worse. By comparison, of the 45 patients experiencing a change in working status, only 7 patients (16%) who did not work prior to ICU admission had returned to work, whereas the remaining 38 patients (84%) who worked prior to ICU admission were not working at time of follow-up study.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The impact of prenatal visits on birth weight in six countries is studied using data from an international collaborative maternity care monitoring project. The analyses presented pertain only to those women having singleton live births and whose pregnancies went to term. Results of the analyses indicate that around the world the number of prenatal visits is significantly related to birth weight. Controlling for other variables known to influence birth weight does not change the relationship. Further, contrary to previous research, there are no significant interactions with other variables.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID