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Biomedical subjects

C Fleming

Publications and source records attributed to C Fleming.

At least 19 recordsLinked to original sources
PubMed1992

Studying outcomes and hospital utilization in the elderly. The advantages of a merged data base for Medicare and Veterans Affairs hospitals.

That veterans aged 65 years and older are eligible to receive care either in the Veteran Affairs (VA) health care system or in the private sector under Medicare confounds the analysis of veterans' health services utilization and outcomes in two ways. First, changes in eligibility or financial barriers to access with regard to either system influence veterans' decisions about where to seek needed care. Second, analyses of VA care for elderly veterans that rely solely on VA data sources underestimate both overall utilization and treatment complications. Similarly, failure to consider the contribution of health care delivery in the VA system may confound analyses of health care utilization by the Medicare-eligible population. To study the magnitude of such confounding influences, we linked the Medicare and VA health care administrative databases for residents of New England and New York. Results indicated that, for ten surgical procedures commonly performed in the elderly, as well as for hospitalizations resulting from acute myocardial infarction and hip fracture, VA patients receive from 17.6% to 37.4% of hospital care outside the VA system. Private hospitalizations account for 5.5% to 19.5% of the care received by veterans within 6 months after an initial episode of care in a VA hospital. It was also found that initial hospitalizations for study conditions in the VA accounted for 3.6% of all such hospitalizations among elderly Medicare-eligible men. Although overall hospital utilization appears to be underestimated in VA data sources, it was found that ascertaining mortality from sources available within the VA produced excellent results when compared with deaths recorded in the Medicare enrollment files. A national, merged VA-Medicare data base is feasible and would enhance the validity of analyses of health care delivery both for elderly veterans and for the Medicare population.

Aged↗
PubMed1992

The accuracy of Medicare's hospital claims data: progress has been made, but problems remain.

BACKGROUND: Health care databases provide a widely used source of data for health care research, but their accuracy remains uncertain. We analyzed data from the 1985 National DRG Validation Study, which carefully reabstracted and reassigned ICD-9-CM diagnosis and procedure codes from a national sample of 7050 medical records, to determine whether coding accuracy had improved since the Institute of Medicine studies of the 1970s and to assess the current coding accuracy of specific diagnoses and procedures. METHODS: We defined agreement as the proportion of all reabstracted records that had the same principal diagnosis or procedure coded on both the original (hospital) record and on the reabstracted record. We also evaluated coding accuracy in 1985 using the concepts of diagnostic test evaluation. RESULTS: Overall, the percentage of agreement between the principal diagnosis on the reabstracted record and the original hospital record, when analyzed at the third digit, improved from 73.2% in 1977 to 78.2% in 1985. However, analysis of the 1985 data demonstrated that the accuracy of diagnosis and procedure coding varies substantially across conditions. CONCLUSIONS: Although some diagnoses and all major surgical procedures that we examined were accurately coded, the variability in the accuracy of diagnosis coding poses a problem that must be overcome if claims-based research is to achieve its full potential.

Abstracting and Indexing↗
PubMed1992

Radical surgery in the treatment of localized carcinoma of the prostate.

New methods of early detection combined with recent advances in surgical techniques have resulted in more patients undergoing radical surgery for treatment of localized carcinoma of the prostate. Over 350 radical prostatectomies have been performed by our group since January 1987. We review the role of radical prostatectomy in the treatment of prostate cancer and our experience with 100 patients undergoing radical retropubic prostatectomy since the advent of nerve-sparing techniques to preserve potency.

Follow-Up Studies↗
PubMed1991

Is coronary-care-unit admission restricted for elderly patients? A multicenter study.

BACKGROUND: To investigate whether elderly patients are more likely to experience restricted access to high technology medical care, we examined the impact of age on the likelihood of coronary care unit (CCU) admission for patients with acute myocardial infarction. METHODS: As part of a prospective investigation of emergency room triage for patients with suspected cardiac ischemia, we studied 4223 patients presenting to six hospitals. Because CCU admission is the accepted standard of care for acute infarction, we defined nonadmission to the CCU as a restriction of access to care. We used a logistic regression model to control for gender, hospital, and CCU occupancy at the time of admission and examined the relationship between age and CCU nonadmission. RESULTS: Patients 75 years or older with acute myocardial infarction were 2.5 times more likely not to be admitted to the CCU than younger patients (RR 2.5, 95% CI 1.64, 3.85). Coronary unit admission was restricted even when the physician's admitting diagnosis was "myocardial infarction" (RR 7.1, 95% CI 2.1, 25.0) or "rule-out myocardial infarction" (RR 1.5, 95% CI 1.1, 2.1). Observed differences in clinical presentation or severity of illness between older and younger patients did not account for these findings. CONCLUSION: Our findings suggest that physicians may intentionally restrict access to coronary care for elderly patients with acute myocardial infarction.

Adult↗
PubMed1989

Ethical issues in caring for the patient with advanced cancer.

The patient in the advanced stages of cancer presents many challenges for the nurse caregiver. To care for the patient effectively as the end of life approaches requires a shift in focus from cure or treatment of the disease to the management of the associated symptoms. This is the primary goal of palliative care, a unique approach to meeting the needs of this vulnerable patient group. The clinical issues that are common in the care of the patient with advanced cancer may raise specific ethical concerns for the nurse. Managing the symptoms with the goal of palliative care in mind will help to frame these concerns more clearly. Communicating with patients and families on an ongoing basis in a clear and sensitive manner will help to ensure that patients' decisions are known and respected. Nurses need to be prepared to assist in these difficult situations. A nursing ethics group is one method that has been found to be effective in developing nurses' expertise in this area.

Adult↗
PubMed1989

Ethics committees in health care institutions in the New York City metropolitan region: a report of two nursing surveys.

Two surveys were conducted independently to ascertain whether health care institutions in the New York City metropolitan region currently have ethics committees and to gather information related to their functioning and use by nurses. Comparable findings in the overlapping samples suggest that approximately one-third of surveyed institutions do not have interdisciplinary ethics committees. Where the committees do exist, they may not be adequate to address nurses' ethical concerns.

Bioethical Issues↗
PubMed1987

A review of work-related fatal injuries in New Zealand 1975-84--numbers, rates and trends.

Deaths resulting from work-related injuries during 1975 to 1984 in New Zealand were identified and reviewed. Nine hundred and eighty-six members of the workforce (workers) were killed at work during this period. This excluded deaths resulting from traffic-related injuries on public roads which occurred during a person's work activity and injuries which occurred whilst travelling to or from work. The estimated average work-related fatal injury rate for New Zealand was 7.2/100,000 workers/year. Variations in fatal injury rate by year of injury, age, sex and race were observed. Occupation and industry fatality rates were also estimated and gross variations by occupation were found. Those occupations with the highest estimated rates included helicopter and agricultural pilots, demolition labourers, deer cullers and commercial deer shooters. These rates are likely to be biased to some degree. Occupations with the largest number of workers killed during this 10 year period were farmers (109), fishermen (79) and forestry workers (68).

Accidents, Occupational↗
PubMed1985

Polio: long-term problems.

The most common long-term problems seen in polio are brace problems, knee recurvatum, increasing weakness due to overuse and ankle equinus. A definite increased incidence of problems is seen after the patient is more than 30 years post-polio. The basis for most of these problems is chronic mechanical strain of weak musculature and substituting ligaments. Overuse can cause increasing weakness resulting in pain and decreasing function. It is therefore important to follow polio patients closely, especially those that are more than 30 years post-polio. If signs of overuse or chronic mechanical strain are noted, treatment should not be delayed.

Adolescent↗