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Biomedical subjects

A M Sear

Publications and source records attributed to A M Sear.

At least 19 recordsLinked to original sources
PubMed2000

Measuring hospital efficiency: a comparison of two approaches.

OBJECTIVE: To compare the results of scoring hospital efficiency by means of two new types of frontier models, Data Envelopment Analysis (DEA) and stochastic frontier regression (SFR). STUDY SETTING: Financial records of Florida acute care hospitals in continuous operation over the period 1982-1993. STUDY DESIGN: Comparable DEA and SFR models are specified, and these models are then estimated to obtain the efficiency indexes yielded by each. The empirical results are subsequently examined to ascertain the extent to which they serve the needs of hospital policymakers. DATA COLLECTION: A longitudinal or panel data set is assembled, and a common set of output, input, and cost indicators is constructed to support the estimation of comparable DEA and SFR models. PRINCIPAL FINDINGS: DEA and SFR models yield convergent evidence about hospital efficiency at the industry level, but divergent portraits of the individual characteristics of the most and least efficient facilities. CONCLUSIONS: Hospital policymakers should not be indifferent to the choice of the frontier model used to score efficiency relationships. They may be well advised to wait until additional research clarifies reasons why DEA and SFR models yield divergent results before they introduce these methods into the policy process.

Bed Occupancy↗
PubMed1998

Use of the Internet for real-time class instruction in a graduate health services administration program.

The Internet has been used as a medium for distance learning for several years. Many universities are using Internet technologies such as electronic mail, LISTSERVs, newsgroups, and web pages to supplement or replace traditional classroom meetings. However, these modes of communication when used in place of traditional classroom instruction lack the interactivity among students and between the students and the instructor that would be achieved in the ideal classroom setting. Internet teleconferencing, however, appears to offer the opportunity for real-time, interactive class meetings on the Internet. This paper details the use of the Internet for real-time teleconferencing as a substitute for classroom meetings at the graduate university level, and offers some insight into the quality and usability of Internet teleconferencing given currently available hardware, software, and communications links.

Data Display↗
PubMed1992

Operating characteristics and comparative performance of investor-owned multihospital systems.

Investor-owned multihospital systems (IOMS's) have grown in number and influence in the United States in recent years, but very little is known about their comparative characteristics and performance. Since 1982 all hospitals in Florida have been required to submit standardized financial and operating data to the Health Care Cost Containment Board. This study analyzes data for the three largest IOMS's in Florida (American Medical International, Hospital Corporation of America, and Humana) for the years 1982-1989. Efficiency ratios, operating characteristics, and operating margins were compared. A multiple regression analysis was performed to determine the amount of variance in operating margins, which was explained by the efficiency measures and operating characteristics.

Data Collection↗
PubMed1991

Comparison of efficiency and profitability of investor-owned multihospital systems with not-for-profit hospitals.

It is often assumed that investor-owned hospitals are more market driven than are not-for-profit hospitals, and that they will maximize output and minimize inputs, to the exclusion of other management strategies. To resolve the conflicting research evidence, this study analyzed efficiency and profitability measures for approximately 50 investor-owned and 60 not-for-profit hospitals in Florida for the period from 1982 through 1988. The results indicate that the investor-owned hospitals used significantly fewer FTE staff per bed, had significantly fewer manhours per adjusted patient day, and paid significantly less in wages and had significantly higher operating margins (profit) than did the not-for-profit institutions.

Diagnosis-Related Groups↗
PubMed1991

Ownership of the medical radiograph.

Current hospital policies controlling original diagnostic radiographs do not serve the best interests of either the patients or the institutions. A survey of 200 randomly selected hospitals shows that approximately 40% of the hospitals would not release the original radiograph directly to the patient. Even more important, hospitals will destroy original radiographs without prior notification of the patient. Although statutes and case law support the institutional ownership of the x-ray film, there is a strong legal trend allowing the patient the use of the film. There are potential problems with patient control of the original radiographic image, but there is no evidence that these problems would develop if current hospital policies were changed to allow the patient physical possession of the films. Because there are economic incentives for hospitals to destroy the original radiographs, hospital policies should be liberalized to allow patients to acquire and maintain possession of their own original radiographic images.

Copying Processes↗
PubMed1989

Hospital charges: analysis and comparison.

The validity of studies comparing charges between hospitals is threatened by differences in hospital case mix and severity of illness within diagnoses. The method presented here uses readily available Blue Cross claims data to make interhospital comparisons of charges.

Blue Cross Blue Shield Insurance Plans↗
PubMed1988

An expert system for determining Medicaid eligibility.

The eligibility requirements for AFDC Medicaid are so extensive and complicated that most health care providers do not attempt to ascertain whether or not a particular patient is eligible for the program, even when no other source of payment is available. This results in lost revenue for health service providers nationwide amounting to hundreds of millions of dollars per year. Computer technology, in the form of expert systems, offers an opportunity to rationalize the Medicaid eligibility determination process and to do real-time assessments of patient eligibility. This article presents an expert system called MEDELEX (MEdicaid ELigibility EXpert) for determining Medicaid eligibility. The program (when run on an 8 MHz MS-DOS microcomputer with at least 640 KB of RAM) requires about 20 min for data entry and 5 sec for the actual eligibility determination. The expert system was written in Prolog and has been designed in such a way that it can be readily modified to take into account the state-to-state variability in eligibility requirements for AFDC Medicaid.

Aid to Families with Dependent Children↗
PubMed1987

Cardiovascular screening: effects of a mobile unit on hospital admissions.

This study analyzes the effects of a mobile cardiovascular screening unit on the caseload of a 239-bed private hospital that specializes in cardiovascular services. In April 1985 Providence Hospital of Columbia, South Carolina began sending a mobile van with a technician and cardiovascular diagnostic equipment to seven hospitals outside the Columbia metropolitan area. During the first year of operation the mobile unit completed 787 tests on 735 patients. Comparing the first year of operation to the prior year, there was a 4.8 percent decrease in admissions to cardiology and a 42.1 percent increase in admissions to cardiovascular surgery. There was a 628 percent increase in outpatient tests performed on residents of the counties where the van operated when tests performed by van personnel were added to outpatient tests at the hospital. Thus, the mobile unit is an effective tool for increasing this hospital's market share for these procedures.

Cardiovascular Diseases↗
PubMed1982

Effects of cost-sharing on users of a state's health service program.

This study analyzed some of the effects of the introduction of cost-sharing on users of the state's health service program. The study population had previously received services at no charge and consisted of people with provider-determined medical need, and included, but was not limited to people in financial need. The study sample was selected from 3 years of program service records (1977-1980). Sampling was random and stratified by key variables. Time-series analysis as well as pre/post-policy comparisons were employed. Analysis of changes in the distributions of service user characteristics and in services provided indicated that use of services was not affected adversely and that lower-income, medically needy people were not deterred from using services following the introduction of cost-sharing. Limitations to the study are reviewed, and implications of using cost-sharing in programs such as Medicaid are considered.

Adolescent↗
PubMed1977

Contraceptive method continuation according to type of provider.

A study was undertaken at the main PROFAMILIA clinic in Bogota, Colombia to compare the effectiveness of nurses and physicians in the delivery of family planning services. Contraceptive method continuation was the major outcome variable in this analysis. Clients were randomly assigned to physicians or nurses on their first visit and for the duration of care. On all revisits, data were collected pertaining to method prescribed, side effects, pregnancy, and method changes. There was a field survey at eight months to locate clinic drop-outs and determine their contraceptive use status. There were no significant differences in method continuation between clients who received services from physicians and those who received services from nurses. At nine months, the overall continuation of the first method prescribed was 79.1 per cent in the physicians' group and 75.8 per cent in the nurses' group (t = 1.057, p greater than .20). When controlling for first method used, the IUD users in the physicians' group had a continuation rate of 86.1 per cent and in the nurses' group 84.0 per cent (t = 0.556, p greater than .50). Of the pill users who received services from physicians, 78.1 per cent were continuing at nine months and 74.3 per cent of the pill clients in the nurses' group were continuing at nine months (t = 0.573, p greater than .50). There were no differences in pregnancy rates, side effects rates, and method change rates between the two groups. It may be concluded that these nurses were as effective as physicians in the delivery of family planning services.

Adult↗