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Biomedical subjects

B E Fries

Publications and source records attributed to B E Fries.

14 recordsLinked to original sources
PubMed1992

Predictors of the placement of cognitively impaired residents on special care units.

Nursing homes that have both special care units (SCUs) and traditional units were examined to determine the factors that cause homes to place cognitively impaired residents on the specialized units. Wandering, other problem behaviors, and Medicaid status were not significant predictors of placement. Logistic regression results indicated that functional status was the critical placement factor.

Activities of Daily Living↗
PubMed1992

The accuracy of the National Death Index when personal identifiers other than Social Security number are used.

This study analyzed the accuracy of the National Death Index when personal identifiers were used that included or excluded Social Security number. Computerized records of the Department of Veterans Affairs were used for comparison. Different combinations of identifiers other than Social Security number correctly identified from 83 to 92 percent of dead and 92 to 99 percent of living persons. These results should prove useful in ascertaining the mortality status of patient populations without information on Social Security numbers.

Databases, Factual↗
PubMed1991

International comparison of long-term care: the need for resident-level classification.

Differences between long-term care facilities in Stockholm (1134 residents) and New York (95,000 residents statewide) were examined. The comparison employed a resident classification system, Resource Utilization Groups (RUG-II), which links individuals' characteristics to resource use. Distributions of Activity of Daily Living functionality and RUG-II categories demonstrated significant differences between these two populations, with the Stockholm facilities more akin to the heavier care skilled nursing facilities in New York. These differences may indicate different uses of long-term care beds in the United States and Sweden and demonstrate the need for resident-level classification systems in cross-national studies.

Activities of Daily Living↗
PubMed1990

Designing the national resident assessment instrument for nursing homes.

In response to the Omnibus Reconciliation Act of 1987 mandate for the development of a national resident assessment system for nursing facilities, a consortium of professionals developed the first major component of this system, the Minimum Data Set (MDS) for Resident Assessment and Care Screening. A two-state field trial tested the reliability of individual assessment items, the overall performance of the instrument, and the time involved in its application. The trial demonstrated reasonable reliability for 55% of the items and pinpointed redundancy of items and initial design of scales. On the basis of these analyses and clinical input, 40% of the original items were kept, 20% dropped, and 40% altered. The MDS provides a structure and language in which to understand long-term care, design care plans, evaluate quality, and describe the nursing facility population for planning and policy efforts.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1990

A classification system for long-staying psychiatric patients.

Data on a sample of 890 Veteran's Administration long-staying psychiatric patients were studied to develop a classification system that explains actual daily resource use. Disturbed patients with lengths of stay of less than three years and those with psychotic conditions who are not withdrawn represent the two groups found to use significantly more resources in their daily care. The Long-Stay Psychiatric Patient Classification (LPPC) System, with six categories, explains 11.4% of the variability in per diem resource use and can be used for case-mix adjustment of payments for psychiatric care.

Data Interpretation, Statistical↗
PubMed1989

A psychiatric patient classification system. An alternative to diagnosis-related groups.

It is generally accepted that diagnosis-related groups (DRGs) for alcohol, drug, and mental disorders are inappropriate for inpatient prospective payment. To address this issue, the Veterans Administration (VA) supported a project to construct alternative classes that are more clinically meaningful, more homogeneous in their resource use, and that account for more variation in resource use among psychiatric and substance use cases than existing DRGs. This paper reports on this project. Using a data set containing universally available discharge data plus behavioral, social, and functional information obtained by a survey of 116,191 discharges from VA psychiatric beds, and with AUTOGRP as the classifying algorithm, a classification system was formed. Twelve psychiatric diagnostic groupings (PDGs) were identified, analogous to major diagnostic groups in the DRG system. Within each PDG, from 4 to 9 terminal groups of Psychiatric Patient Classes (PPCs) were formed and validated. The 12 substance abuse PPCs explain greater than 31% of the variation in length of stay; for the mental disorder PPCs the variance explanation is greater than 11%, a substantial improvement over DRGs that, for the same data set, explain less than 2 and 3%, respectively. With the addition of only 5 variables beyond those presently included in discharge data sets, greater precision for payment purposes can be achieved. Implications for adoption of this classification system are discussed.

Algorithms↗
PubMed1989

Case-mix classification of Medicare residents in skilled nursing facilities: resource utilization groups (RUG-T18).

Medicare residents in Skilled Nursing Facilities (SNFs) represent a small but unique population about which little is known. Data collected in a national sample of 2,564 Medicare residents in 38 SNFs were used to derive a resident classification system appropriate for use in a payment system. The classification system, Resource Utilization Groups-Medicare (RUG-T18) explains 55.5% of the per-diem resource cost differences of Medicare SNF residents. No classification system could be derived to provide significant explanation of per-episode costs. Although Medicare residents are admitted to SNFs immediately following an acute stay that is paid according to their diagnosis-related groups, the DRGs were ineffective in explaining SNF resource costs.

California↗
PubMed1985

Validation and use of resource utilization groups as a case-mix measure for long-term care.

A companion article describes the development of a patient classification system for long-term care patients, Resource Utilization Groups (RUGs). Three potential limitations of this system and its development are addressed here: the use of a subjectively determined dependent variable, geographic limitation of the data to Connecticut skilled nursing facilities, and limited assessment of the quality of the facilities studied. Additional systems of Resource Utilization Groups were derived, using the same clustering technique but employing two separate data sets from the Battelle Human Affairs Research Center. These data bases provided an objective dependent variable, wide geographic distribution of both skilled nursing facilities and intermediate care facilities, and homes specifically selected on the basis of quality. The RUGs derived from the two sets of Battelle data and the initial RUG system showed remarkable similarity in their patient groupings and in the case-mix indexes developed for nursing homes. The concurrence of the results obtained for these three systems greatly strengthens the basis for the use of this classification system as a case mix measure for long-term care.

Activities of Daily Living↗
PubMed1985

Resource utilization groups. A patient classification system for long-term care.

The ability to understand, control, manage, regulate, and reimburse nursing home care has been hampered by the unavailability of a classification system of long-term care patients. A study of 1,469 patients in Connecticut nursing homes has resulted in such a classification system that clusters patients with similar relative needs for resources, in particular, for nursing time. The nine groups formed can be used to develop a case-mix profile of the relative care needs of these patients, and their development demonstrates that only a few measures of the functional status of patients, rather than diagnosis or psychosocial/behavioral problems, are sufficient to form such a system.

Activities of Daily Living↗
PubMed1979

The effect of delay rules in controlling unscheduled visits to hospitals.

The increased demand of unscheduled visits to hospital outpatient facilities, and particularly to walk-in clinics, necessitates the consideration of means to control this flow and to reduce in-hospital waiting times. A model is developed in which a percentage of the unscheduled visits are assumed to be delayable, e.g., patients with non-urgent complaints who call may be asked to delay their arrivals for specified lengths of time. A simple rule for determining, dynamically, the length of this delay was examined by computer simulation. The results demonstrate significant reduction of in-facility waiting times while only marginally increasing the time patients wait from their initial contact with the clinic until seen by a practitioner.

Appointments and Schedules↗
PubMed1978

A delay-scheduling model for patients using a walk-in clinic.

Clinics receiving unscheduled visits experience wide fluctuations in the number of patients present at any one time, due to random arrival of patients and variations in the time needed for the evaluation and treatment. This can cause periods of congestion and long patient waiting times. Using a flexible technique for "delay scheduling," a study was conducted to determine the most efficient use of limited physician resources in the management of patients using a walk-in clinic. Delay scheduling makes it possible to shift work load from periods of high congestion to other times without compromising the walk-in nature of the clinic. A computer simulation model was used to evaluate the clinic performance with different physician staffing patterns and different rules for delay scheduling. The model was validated using actual data from the walk-in clinic and the results implemented. The delay scheduling and staffing changes resulted in reduction of manpower by 10% while significantly reducing the clinic-accountable waiting time.

Appointments and Schedules↗