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Biomedical subjects

A C Brewster

Publications and source records attributed to A C Brewster.

14 recordsLinked to original sources
PubMed1993

QMHC interview: Alan C. Brewster, M.D.. Interview by Marie E. Sinioris.

Information systems for severity-of-illness measurement and case mix adjustment are at the cutting edge of health care quality technology. The rapid rise of these systems in the past decade has paralleled hospital needs for better data on clinical processes and the burgeoning need among health care customers for better data on clinical outcomes and the relative performance of providers. The dual nature of the demand is fueling what promises to be a decade of growth for the developers of severity systems. To get a better handle on the status of these software-based tools, QMHC interviewed Alan C. Brewster, M.D., Vice Chairman and cofounder of MediQual Systems, Inc., and a principal developer of the widely used MedisGroups system.

Diagnosis-Related Groups↗
PubMed1993

Predicted probabilities of hospital death as a measure of admission severity of illness.

This paper evaluates a new method for assessing hospital admission severity of illness based on disease-specific models (logistic regression) of the probability of in-hospital mortality. Results for the 26 disease groups in MDC 4--Diseases of the Respiratory System, MDC 5--Diseases of the Circulatory System, and MDC 6--Diseases of the Digestive System are presented using data on all 1991 admissions from 111 hospitals throughout the United States. These disease models are empirically derived using clinical findings from laboratory, radiology, pathology, diagnostic procedures, patient history and physical exam, as well as patient age and sex. Each predictive algorithm is presented, and the strong predictive performance of these models is indicated by the average C statistic of .870. A predicted probability of death is calculated for each hospital patient in the study sample, and these probabilities comprise a continuous variable that indicates admission severity of illness.

Algorithms↗
PubMed1989

Analyzing in-hospital mortality and morbidity with adjustment for admission severity.

Recognition of the need for measuring quality has increasingly permeated the thinking of leaders in industry. Until relatively recently, however, measuring health care quality was a novel concept. For many reasons a variety of constituencies have begun to see the need for information about the quality of health care. Here, we describe a particular model for quality measurement in the inpatient setting and present an approach for preliminary screening of data to identify potential areas for effectiveness review. For purchasers of health care, this type of information would be helpful as a first screen for identifying areas for more in-depth review by hospitals. Some caveats relating to the approach are also discussed.

Health Services Research↗
PubMed1985

Measuring the effect of illness severity on revenue under DRGs.

Hospital financial managers have come to recognize that to profitably operate a hospital under DRGs, they must consider factors other than length of stay. They must also look at illness severity, medical care effectiveness, and treatment efficiency. It is therefore advantageous to develop a method that measures the effect of admission severity on DRG payment and provides information on medical care effectiveness and treatment efficiency improvements. The method described in this article, the admission severity measure, allows the manager to consider both these quality and cost issues.

Costs and Cost Analysis↗
PubMed1985

MEDISGRPS: a clinically based approach to classifying hospital patients at admission.

The Medical Illness Severity Grouping System--called MEDISGRPS--is an admission-oriented patient severity grouping system that uses objective, key clinical findings to place patients in one of five severity groupings. Data from five hospitals indicate that severity level at admission is an important predictor of resource use, is essential for analysis of patients who deteriorate and/or respond poorly to therapy, and is useful to further specify DRGs. Measures of effectiveness and efficiency using MEDISGRPS are suggested.

Diagnosis-Related Groups↗
PubMed1983

Pleuropericarditis: an extraintestinal complication of inflammatory bowel disease. Report of three cases and review of literature.

We report three cases of pleuropericarditis complicating the clinical course of inflammatory bowel disease. This extraintestinal complication developed in all three patients during the quiescent phase of the disease. One patient had ulcerative colitis, while two patients had Crohn's disease. Aspirin and/or indomethacin were effective in treating two of the three patients, and the third patient required prednisone in addition. Chest symptoms in patients with inflammatory bowel disease should be evaluated to exclude myopericardial-pleural disease.

Adult↗
PubMed1977

A urinary double-radioisotope technique for the detection of fat malabsorption.

The possibility that the unreliability of urinary excretion of radioactivity after the administration of oral 131I-triolein, as a measure of fat absorption, is due to variable renal clearance of iodide prompted investigation of a double-radioisotopic method. Intravenously administered radioiodide should be cleared identically with radioiodide split from absorbed fat and serve as an internal standard. Oral 131I-triolein was given in an 80 gm fat liquid meal; 125I-iodide was given intravenously; urine was collected fractionally for 72 hr. Accepted stool fat excretion data and stool radioactivity excretion data developed in this study were used to define groups of normals (less than 5.4 gm of fat or less than 7.8% 131I) and malabsorbers (greater than 5.4 gm of fat or greater than 7.8% 131I). In 26 normals urinary 131I ranged from 24.6% to 77.1% in 48 hr and 27.7% to 86.8% in 72 hr; in the malabsorbers these values lay between 0.6% and 62.8% in 48 hr and 1.0% and 66.8% in 72 hr, showing much overlap with normal. An index of the cumulative percentage of urinary 131I/125I X 100 at either 48 or 72 hr completely separated the groups, the index in normals ranging from 68.7 to 100 in 48 hr and 72.5 to 100 in 72 hr, whereas the malabsorbers varied between 2.0 and 64 in 48 hr and 2.2 and 67.5 in 72 hr.

Dietary Fats↗
PubMedDate not supplied

Quality improvement's new focus yields quantitative results.

Health care quality improvement methods are now undergoing fundamental change. The emphasis is shifting from inspection of physician practices to continuous improvement of clinical processes validated by quantitative results. This change is long overdue. Traditional quality assurance methods that operate retrospectively and alienate physicians are not useful in a marketplace where quality and cost control are a matter of survival. Physician practices are only as good as the institutional processes they rely upon, and any quality improvement method that alienates physicians is doomed. Quality improvement is impossible without the support of physicians, because true improvement is driven and quantified by clinical data. Physicians are needed to interpret that data.

Clinical Protocols↗