摘要:

The utility of the Abbreviated Injury Scale (AIS), the most widely used anatomic scale for rating severity of injuries, and its derivative for assessing the combined effect of multiple injuries, the Injury Severity Score (ISS), were tested for their ability to predict functional disability at time of discharge from the hospital and 6 months after discharge. The ISS has been shown to correlate well with mortality and length of stay, but the relationship to levels of subsequent disability has not been examined. Five hundred and ninety-seven patients (aged 16-45 years) were interviewed at time of discharge and 6 months after discharge to ascertain functional disability along three dimensions: activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility. The authors report on the relationship between severity and functional disability at time of discharge and 6 months after discharge for a subset of 473 patients who did not suffer a severe brain injury. The results show that the relationship between ISS and status at discharge and 6 months after discharge is not monotonically increasing, as it is with mortality and length of stay (LOS). Rather, the proportion of people with severe injuries who report limitations is lower than for those with moderately severe injuries as defined by the ISS. Further, it is shown that the AIS of the most severe extremity and spinal cord injury carry considerably more weight when predicting functional status at discharge and 6 months after discharge than do the AIS scores of injuries to any other body region, although the relative explanatory power of each type of injury varies with the nature of the functional disability and the time interval between the initial insult and assessment.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The diagnosis-related group (DRG)-based Medicare prospective payment system pays hospitals a fixed amount for the care of similar patients. The DRG definitions serve as the modifier of payment for Medicare patients. The dependence on these patient definitions raises many questions, among them the reason(s) for observed resource variability within a DRG. Various severity-of-illness measures have been shown to account for some of the resource variability noted within the DRGs. Most severity-of-illness studies to date, however, have not attempted to assess the effect of other known sources of resource variation, such as differing physician practice patterns. The authors examined the ability of severity of illness, as defined by disease staging, and physician practice variation to explain residual intra-DRG variability in length of stay. They demonstrate that physician practice variation accounts for more variance reduction than does severity of illness.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The hospitalization rate of HMOs is reported to be 444 bed days per 1,000 enrollees per year. It is often forgotten that there is also out-of-plan utilization. A review of previous studies and a survey of reporting practices by three HMOs illustrate many problems with HMO utilization data. HMO rates, like those of other insurers, reflect only the hospital admissions that the plans know about and pay for, not the total hospital experience of their enrollees. While only a thorough tracking of subscriber utilization of all insurers and institutions will provide estimates of the magnitude of unreported admissions and their impact on utilization rates, this report enumerates the ways in which patients may receive inpatient care without the HMO having a record of the admissions and/or having to pay for them. It was found that admissions can be unreported 1) when another insurer or institution pays (e.g., Medicare, No Fault, Workmen's Compensation, duplicate coverage, school health and liability insurance or VA, military, municipal, and state hospitals); 2) when the HMO does not cover benefits (e.g., cosmetic and oral surgery, experimental procedures, long-term psychiatric, chronic, or rehabilitation stays); and 3) when HMO coverage is denied for procedural reasons (e.g., catastrophic stays covered by reinsurance, newborns, voluntary “leakage”, or improper following of HMO procedures). True HMO rates are unknown but are estimated by some authors to be 7-37% higher than the reported figure, depending on which types of unreported use are estimated. There is a need for future analyses to quantify true hospitalization rates of enrollees of HMOs and other insurers.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A statistical methodology based on the Cox proportional hazards model (a survival time analysis method), an alternative to the approach underlying DRGs, is presented. The method is used to obtain an estimate of the length-of-stay (LOS) distribution of a patient incorporating either patient-specific or hospital variables. A percentile of the distribution chosen to minimize prediction error serves as the assigned LOS. Absolute deviation is used as the loss function both to determine the choice of a predicted LOS and to examine how well the scheme works. Multiple assignment schemes may also be developed from this approach. The results of the method, tested on a national probability sample of 4,608 psychiatric patients treated in psychiatric units of general hospitals, suggest that with respect to average absolute deviation, the proposed methodology may provide a scheme that is superior to the present DRG scheme. For the sample, the average percent improvement obtained using the median of the estimated LOS distribution as the predicted LOS over the sample mean of the DRG group is 19%. A two assignment strategy results in average improvements over DRGs of 43%.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Utilization of physician services by initial subscribers to a Canadian consumer- sponsored medical care plan was examined for the period 1965-1979. After stratification by sex and age, 1,046 individuals aged 18-44 years were sampled and their records abstracted to yield the annual number of in-plan physician visits. The most frequently attending 10% of patients generated almost 30% of all visits. Moreover, those who initially made most frequent use of physician services persisted in doing so over the 15-year period. Utilization patterns differed between the sexes. Women, with a median of 40 visits, made more frequent use of services than men, with a median of 27 visits. Among men, the group that was oldest at enrollment utilized services more heavily than their younger counterparts, and this increased relative utilization became more pronounced with time. Corresponding effects were not seen in women, even after adjustment for prenatal visits. Adjustment for prenatal visits also had only a minimal effect on the frequency and duration of nonattendance. Ascertainment of out-of-plan utilization indicated that for the most recent year of follow-up, 20% of the patients made at least one out-of-plan visit. Although this had little effect on patients' relative utilization status, it had a substantial effect on the identification of nonattenders.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

One hundred one patients, 70 years and older, who were discharged to the community from an acute-care hospital were followed for 1 year to isolate risk factors affecting the probability of readmission. A total of five interviews were conducted with each patient. Postdischarge outcome at any point in time was defined as either readmission to a health care institution or continuous survival in the community. At 1 year, 47 individuals had experienced at least one unplanned readmission. Logistic regressions were used to study risk factors influencing the probability of readmission at 6 weeks, 6 months, and 1 year after release from the hospital. In the short run, sex, being widowed, a weighted severity-of-illness factor, and life satisfaction were significant; previous hospitalization and admission and discharge location were additional variables significant in the long run. An explanation is offered for why some risk factors useful in postadmission studies do not function as well as risk factors in postdischarge studies.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Recent reviews indicate that attempts to validate the Health Belief Model (HBM) have produced only modest support for it and that the HBM may be incomplete in its organization and development as an expectancy-value model. As an alternative, the Fishbein and Triandis models are discussed. The author investigated the utilities of the Fishbein and Triandis models as predictors of behavioral intention and behavior, using obtaining versus not obtaining an influenza vaccination as the health behavior. Eligible participants were patients at high risk for flu complications, registered at the Seattle VA Medical Center's Medical Comprehensive Care Unit (MCCU) clinic. A random sample of 439 patients was selected to participate in a two-wave longitudinal survey in which the Fishbein and Triandis model components were assessed at the beginning of the 1983 flu season, and a measure of flu shot-getting behavior was obtained at the end of the season. Both models accounted for significant and substantial proportions of variance in intentions and behavior. Comparisons of these models revealed that the three-component Triandis Intention model and the overall Triandis model were superior to the Fishbein model in predicting intention and behavior. The potential use of this model for developing interventions is discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Validity assessment and the underreporting of dysfunction have been major problems in health-related quality-of-life measurement, including collecting data for analysis by the General Health Policy Model, using the Quality of Well-being scale (QWB). This analysis compares the results of self- versus interviewer modes of measurement and short, direct-answer questions versus probing algorithms in the QWB. The comparisons are made in terms of 1) correlations; 2) aggregate frequencies; 3) individual subject classifications; and 4) the actual state, established using evidence from multiple sources. Despite extremely high correlations between QWB scores from the two modes (>0.98), the lowest interviewer mode sensitivity (0.86) and predictive value dysfunctional (0.91) were substantially superior to the highest self-classification characteristics (0.66 and 0.73). In the populations studied, specificities and predictive values functional were equivalent (>0.94) for the two modes. The probe pattern of the interviewer mode was also less susceptible to false reports of dysfunction. These results are consistent with the underreporting of dysfunction noted by several major investigations of health status measurement. The authors conclude that interviewer-administered instruments using question algorithms are necessary if health-related quality of life is to be measured with sufficient reliability and validity to evaluate major clinical trials and follow-up studies.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID