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Biomedical subjects

A Laughlin

Publications and source records attributed to A Laughlin.

11 recordsLinked to original sources
PubMed1997

Preadolescent suicidal behavior: the role of cognitive functioning.

The recent suicidal behavior of fifty-three hospitalized preadolescents was assessed in interviews with children and their parents. Children described by their parents as more suicidal scored higher on measures of verbal intelligence and language production than their less suicidal counterparts, with unique variance predicted only by language production ability. The results suggest that parents of preadolescents with better language production skills may be more aware of their youngsters' suicidal thoughts than parents of children with poorer language production ability.

Child↗
PubMed1994

The prevalence of suicidal behavior among preadolescent children who are psychiatric inpatients.

The prevalence of suicidal behavior displayed by preadolescent children hospitalized on inpatient psychiatric units is estimated to range between 18% and 80% of the population. The current study provides an independent estimate of the prevalence of this problem. A semistructured interview was used to assess suicidal behavior displayed by 61 admissions to a child psychiatric inpatient unit between April 1988 and September 1989. According to the Pfeffer Spectrum of Suicidal Behavior Scale, 63% of the sample engaged in some form of suicidal behavior. Preadolescents and their parents reported similar rates of suicidal thoughts, threats and attempts. The dangerousness of recent suicidal behavior was not found to differ by age, sex, legal custody status or socioeconomic status.

Child↗
PubMed1993

The psychosocial climate of families with suicidal pre-adolescent children.

A structured interview measure of suicidal behavior and a questionnaire measure of family psychosocial climate were administered to 43 pre-adolescent psychiatric inpatients and their parents. Results showed that suicidal behavior tended to be associated with greater family conflict and with less family organization, cohesion, and achievement orientation.

Child↗
PubMed1992

The relationship of suicidality and psychiatric diagnosis in hospitalized pre-adolescent children.

Two structured interview measures of suicidal behavior were administered to 43 child psychiatric inpatients between the ages of 7 and 11 and their parents. DSM-III-R diagnoses were assigned to the children, with twenty-six Axis I and Axis II diagnostic categories represented. Generally, the interview measures of suicidal behavior were found to be unrelated to psychiatric diagnosis. The results suggest that to better understand pre-adolescent suicidal behaviors, it may be more useful to examine associations between these behaviors and the biopsychosocial dimensions that underlie the diagnostic categories.

Child↗
PubMed1986

Mode of admission and cost for surgical DRGs.

The purpose of this study was to confirm the hypothesis that emergency department admissions were more expensive than their nonemergency counterparts per diagnosis-related group (DRG) and to see if this characteristic was displayed across many hospitals. All surgical admissions (N = 39,682) to the 11 acute-care hospitals of the New York City Health and Hospitals Corporation were analyzed during an 18-month period to yield a study population (N = 26,569) of matched DRG subgroups (ED vs nonED) at each hospital of at least five patients per variable for that particular DRG. A cost-per-patient analysis was conducted for each admission. Total costs for the study population were $163,360,636. A total of 75.8% of surgical admissions (N = 20,143) were admitted in DRGs in which ED admissions were more costly than their nonED-matched counterparts. The following was the trend in percentage of total specialty admissions in DRGs in which ED admissions were more costly than nonED admissions: urology (88.4%); ear, nose, and throat (86.2%); general and vascular (80.1%); cardiothoracic (78.0%); orthopedics (75.6%); plastic surgery (62.1%); neurosurgery (60.5%); and ophthalmology (46.0%). Route of admission (ED vs nonED) was an identifier of higher-cost patients per DRG across hospitals in a large public hospital system. These data demonstrate that hospitals with substantial numbers of surgical ED admissions may face significant financial risk under DRG reimbursement, and suggests that the DRG system does not adequately compensate hospitals for the higher cost of the emergency surgical admission.

Data Collection↗
PubMed1986

Surgonomics: the cost dynamics of craniotomy.

Prospective payment systems using the diagnostic related group (DRG) mechanism are being phased in for Medicare inpatient hospital care. The purpose of this study was to examine a common neurosurgical procedure (001), craniotomy without trauma, and characterize the cost dynamics of this DRG. All patients (n = 50) treated in this DRG at the Long Island Jewish Medical Center during 1983 had their financial charges exclusive of physician fees examined. The findings were: (a) each hospital service category had wide charge variances around the mean; (b) emergency (ER) admissions were 200% more expensive than nonemergency (non-ER) admissions; (c) ER admissions seemed to have no greater severity of illness than non-ER admissions, but had a significantly different referral pattern (i.e., admission from the ER to a nonneurosurgical service with a subsequent neurosurgical referral); (d) this DRG when grouped into clinical "subproducts" (i.e., craniotomy for tumor, hematoma, hydrocephalus, aneurysm, benign cyst, and other) showed marked charge differences; and (e) the most expensive 25% of patients had five times higher charges than the least expensive 25% for both ER and non-ER admissions. This type of financial analysis may give surgeons a methodology with which to address the problems of cost containment in a more serious manner.

Adult↗
PubMed1986

Source of admission and cost: public hospitals face financial risk.

We studied all admissions to the 11 acute care hospitals of the New York City Health and Hospitals Corporation (April 1983-September 1984) matching emergency room (ER) admitted diagnostic related group (DRG) subgroups in each hospital with at least five non-ER admitted patients (N = 222,961). Mean cost per ER patient ($8,385) was greater than non-ER mean cost per patient ($4,386) for Medicare and non-Medicare. Our data suggest that public hospitals with a high proportion of ER admissions may be at a financial disadvantage under DRG reimbursement.

Costs and Cost Analysis↗
PubMed1986

Value of routine pathology in herniorrhaphy performed upon adults.

The value of routine pathologic study of specimens taken at herniorrhaphy performed upon adults was assessed. All 789 patients who underwent inguinal or femoral herniorrhaphy at the Long Island Jewish Medical Center from January 1983 through July 1984 were studied. Patients were classified into five groups; 1, no specimen was sent for pathologic evaluation; 2, confirmation of hernia sac; 3, confirmation of hernia sac with additional expected pathologic findings (such as lipoma or hydrocele); 4, unexpected additional pathologic findings which appeared abnormal at operation, and 5, unexpected additional pathologic findings which appeared normal at operation. During this time period there were 935 herniorrhaphy procedures performed. Three of 1,020 specimens examined contained unexpected pathologic findings (groups 4 and 5): non-Hodgkin's lymphoma, liposarcoma and atypical lipoma. Only one specimen (group 5) with an abnormal pathology report showed an atypical lipoma which appeared normal at operation (0.098 per cent). The outcome of the operation was not altered by the pathology results in these three patients from either group 4 or 5. Aggregate charges for all specimens was $30,528.00 (a mean charge per patient of $48.00). Annual savings to the health care system of the United States by omitting routine pathologic examination of specimens from groups 1, 2 and 3 would be $18 million. Although there may be some justification for routine tissue testing for medical and legal reasons and quality assurance purposes or for specimens which appeared abnormal at operation, these data suggest that for patients who undergo herniorrhaphy, little positive effect on the outcome is gained from routine pathologic examination of specimens which appeared normal at operation.

Adult↗
PubMed1985

The financial effects of emergency department-generated admissions under prospective payment systems.

The purpose of this study was to assess the financial impact (revenues vs expenses) as measured by hospital charges and costs vs diagnosis-related group (DRG) revenues of prospective payment systems on emergency department-generated admissions for a large teaching hospital under two payment systems: Medicare and an all-payor system. All emergency department admissions were analyzed for the years 1983 (N = 4,273) and 1984 (N = 4,125) under both systems, using standard DRG methodology. Our findings were as follows: (1) With charges as a measure of expense under both payment schemes, all clinical departments had large groups of unprofitable patients: Medicare, $12,895,038; all-payor system, $15,553,893. (2) When costs were computed as the expense measure (using our hospital's cost-to-charge ratio), Medicare patients produced a deficit ($2,363,163); however, under an all-payor system there was a small net profit ($4,267,859). (3) The implementation of federalized DRG reimbursement rates increased our losses for this population from 1983 to 1984. (4) Reductions in outlier reimbursement (10%) and teaching costs (25%) caused our revenues to drop substantially, potentiating our losses. These findings suggest that hospitals with large emergency department admission populations, particularly Medicare patients, may be at a significant financial disadvantage under prospective payment systems.

Costs and Cost Analysis↗