摘要:

Reimbursing hospitals on the basis of treated cases, as in the New Jersey diagnosis-related groups (DRG) experiment, is equivalent to a centrally set pricing scheme, with all of its inherent difficulties. In addition to the problems of appropriate case definition, it is not obvious how hospitals should be classified to form reference groups for cost determination. Because empirically derived cost schedules are based on observed treatment patterns and resource use, they reflect variations in clinical appropriateness and quality and in resource use efficiency that characterize the system from which the data are drawn. If case-based schemes are to incorporate desirable performance incentives, they must be much better specified and take into account the complexity of hospital behavior. This article identifies the basic components of case-based systems of hospital reimbursement and discusses the analytic and empiric problems involved in their design.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In this article we evaluate a new severity of illness index for use in defining case mix groupings of hospitalized patients. We find that this index, which takes into account patient severity of illness, produces groups that are more homogeneous (with respect to total charges, length of stay, routine charges, and laboratory charges) than those produced by four other case mix grouping methods that do not reflect the total burden of the patient's illness. These results have important implications for programs of prospective reimbursement and for cross-hospital comparison studies.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The objective of this article is to present the methods used For the validation of a patient classification system that was based on the concept of types of care (PCTC system). The PCTC system was developed to improve placement decisions for long-term care patients and also to provide information required for planning in the field of long-term care. A sample of long-term care patients was selected from various institutions/programs and the patients in the sample were assessed and classified by the program practitioners (users) as well as an independent panel (criterion team) composed of a physician, a nurse, and a social worker, using prototype forms specially designed for the project. An objective and empiric classification model was developed by applying discriminant analysis, Bayesian classification procedure, and cluster analysis techniques. The classification validity was evaluated by the use of the R, H, and U methods.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

This article estimates the effects of personal, clinical, physician, and hospital characteristics in a simultaneous equations model of length of stay and ancillary services use for five narrowly defined medical and surgical conditions. These are tonsillectomy and adenoidectomy, gastroenteritis and colitis, inguinal hernia, coronary heart disease, and cholelithiasis. The data are derived from a sample survey of medical and financial records of patients discharged from any of 63 New England short-term general hospitals during the period July 1, 1969 through June 30, 1970. The results confirm the importance of a simultaneous equations formulation of utilization analysis and of inclusion of detailed measures of severity. Length of stay and ancillary services are significantly interrelated for all five conditions, corroborating results of a previous study of obstetric cases. Results for patient's employment status and value of time, attending physician specialty and mode of practice, and hospital size, control, and nature of teaching activities were less conclusive, but suggest differential effects across diagnoses, thus emphasizing the importance of a diagnostic-specific approach to utilization analysis.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Health care services for registered “band” Indians in Ontario are provided primarily by the Canadian Federal Government. Complex management methods preclude the direct involvement of Indian people in the decisions for their health resource allocation. Health indicators, need, and health status indexes are reviewed. The biostatistics of mortality and demography of the Indian and reference populations are aggregated with hospitalization/morbidity experience as the Chen G'1Index, as an indicator of normative and comparative need. This is weighted by linear measurements of perceived need for preventive medicine programs, as ranked and scaled values of priorities, ZjThese were determined by community survey on 11 Indian reserves using a nonprobabilistic psychometric method of “pair comparisons,” based upon “Thurstone's Law of Comparative Judgement.,” The calculation of the aggregate single unit Indian Health Status Index [Log.G'1]Zjand its potential application in a “zero-base” budget is described.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In 1979 skilled nursing facility staffing patterns in New York State were examined to test for significant differences in hours per patient day of nursing staff with respect to sponsorship, size, unionization, and region. Facilities that were cited for one or more nursing standard deficiencies were eliminated from consideration to control for quality of care differences. Also, adjustments in reported staffing hours were made to control for case mix differences among the facilities. A hierarchic analysis of covariance model was used to perform the analysis. The results indicated that, ceteris paribus, staffing on a per patient day basis was significantly higher for voluntary and public homes, homes in upstate locations, nonunionized homes, and homes with 99 beds or less.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Measurement of the costs of health care and work loss of chronic mental patients is a vital link between clinical care and political decisions. If costs associated with poor outcomes of deinstitutionalized patients are identified, the margin for investing in programs that could improve outcomes without raising overall costs is also identified. This study analyzed direct and indirect costs in the first year after 119 chronic schizophrenics, drawn from public and voluntary hospitals serving Manhattan's upper West Side, were discharged from the hospital. The main elements in direct costs were community aftercare, rehospitalizations, and general medical care. Wage loss was used as the measure of indirect costs and was based on comparison with national figures for similar age/ sex/ethnic groups. The risk of rehospitalization is the principal factor affecting direct costs. Wage loss because of unemployment was substantial. Because use of vocational rehabilitation services was low, these findings suggest the importance of developing employment opportunities and appropriate work environments.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A clustering method for the analysis of ambulatory morbidity data is presented. This approach reduces spurious variations resulting from idiosyncratic diagnosis labeling and coding habits of physicians and facilitates the analysis of the content of ambulatory medical care through the use of aggregate morbidity data. The clusters provide a tool that allows for the comparison of the content of practice based on different factors such as provider training, practice organization, and patient characteristics. Ninety-two diagnosis clusters were derived using the 1977 and 1978 National Ambulatory Medical Care Survey (NAMCS). These clusters incorporate 86 per cent of all ambulatory visits to office-based physicians in the contiguous United States. The clusters were constructed based on the consensus of a group of clinicians including both generalists, as well as selected subspecialists representing the spectrum of ambulatory medical practice. The diagnosis clusters presented are compatible with the International Classification of Diseases (ICDA-8 and ICD-9-CM) and the International Classifications of Health Problems in Primary Care (ICHPPC and ICHPPC-2). Several applications demonstrating the utility of the method are presented, and directions for future applications are suggested.

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1983

数据来源: OVID