ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A classification methodology is presented that can be used to evaluate the heterogeneity of reimbursement categories and service groups in multivariate terms. This methodology, called Grade of Membership analysis, has several properties that are particularly important in such assessments. First, simultaneously with the determination of the multivariate profile of characteristics that describe a group, the methodology determines the degree to which each case is described by that profile, which means that the model can explicitly represent the heterogeneity of individual cases in any derived classification scheme. Second, the estimates of the model's parameters are produced by maximum likelihood procedures; hence, the classification and group descriptions generated by the model can be statistically evaluated. Third, because of the way the group profiles are constructed, the results of the analysis will be reasonably robust to the selection of new samples. The analysis is illustrated using data on hospital discharges for the state of Maryland in 1981. The purpose of the analysis is to examine the association between the patterns of clinical and service attributes identified by the procedures with DRG category assignments.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Ventricular fibrillation, an abnormal cardiac rhythm, occurs in at least twothirds of the 400,000 people who die out of the hospital from sudden cardiac arrest. This rhythm can be treated successfully by electric countershock, a procedure known as defibrillation. The survival rate following such cardiac arrest is directly related to the rapidity of response; the shorter the time from collapse to defibrillation, the more patients will survive. There are two basic options to shorten the time from collapse to defibrillatory shock. The first is to upgrade the emergency medical system. The second is to provide spouses and family members of potential cardiac arrest patients with automatic home defibrillators. This article considers the effectiveness of the second option, home defibrillation, compared with that of an equally costly upgrade in existing emergency medical service systems. The comparisons depend on the existing level of emergency medical service system, the cost of the home defibrillator, and the rate at which a home defibrillator would be used appropriately. The comparisons suggest that in many circumstances home defibrillation is an appropriate option to be considered.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This paper uses a General Health Policy Model to determine the costeffectiveness of an experimental behavioral program for patients with chronic obstructive pulmonary disease (COPD). Patients were randomly assigned to either experimental or control groups, and only those in the experimental groups were given the behavioral strategies. Health status information was collected over 18 months, and the Health Policy Model translated program outcomes into well-year equivalents. At the end of the program, greater improvements in health status were observed in the experimental subjects, and a total of 4.41 well-years were produced. Costs of the program were gathered on a per-year basis using an administrative perspective. Both costs and health effects were discounted to present value using a 5% discount rate. Dividing costs by effects, the COPD program produced well-years at a unit cost of $24,256. Comparing the cost-utility figure to those of other health care programs using the General Health Policy Model, the behavioral program appears reasonably cost-effective as an adjunct therapy for patients suffering from COPD.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The statistical methodology of health research experiments published in Lancet,the New England Journal of Medicine, andMedical Carebetween 1975 and 1980 for the presence or absence of an error of experimental design and analysis was examined. The error is the result of inappropriately using patient-related observations as the unit of analysis to form conclusions about provider behavior or outcomes determined jointly by patients and providers. The error was present in 20 of 28 (71%) health care experiments addressing an issue of health provider professional performance. Its usual effect is to increase erroneously the power of an experiment to detect differences between experimental and control groups. It is likely that this type of error could be avoided by the explicit and prospective definition of hypotheses and the populations to which they are intended to pertain.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Effective physician involvement in quality assurance in hospitals is necessary both to identify problems in patient care and to bring about problem resolution. This report describes a controlled, longitudinal study designed to measure effects on physician performance of involving physicians in setting medical audit criteria, reviewing audit results, and receiving concurrent reminders on a case-by- case basis. Unexpected low hemoglobin levels was the topic for audit. During phase 1 of the study, three randomly composed physician groups were involved in criteria setting plus review of audit results, review of audit results alone, or no treatment. During phase 2, 6 months later, the physicians in all three groups were exposed to 4 months of concurrent reminders. During phase 1, the group involved in review of audit results only achieved 51% compliance with the preset criteria compared with 26% for the group involved in criteria setting and review of audit results (P = 0.002). During phase 2, when concurrent reminders were provided, the group that was formerly the control group in phase 1, achieved 77% compliance as compared with 56% for the group previously involved in criteria setting and review of audit results (P = 0.004). These findings challenge the common assumption that physicians should be involved in criteria setting. They also suggest that providing the individual physician with information concurrently on a case-by-case basis may be superior to reviewing audit results for changing physician behavior.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID