PubMed Health⌕ Search

Biomedical subjects

D Conrad

Publications and source records attributed to D Conrad.

At least 37 records · Page 2Linked to original sources
PubMed1996

Managing care, incentives, and information: an exploratory look inside the "black box" of hospital efficiency.

OBJECTIVE: We sought to estimate the impact of individual dimensions of hospitals' managed care strategies on the cost per hospital discharge. STUDY SETTING/DATA SOURCES: Thirty-seven member hospitals of seven health systems in the Pacific, Rocky Mountain, and Southwest regions of the United States were studied. STUDY DESIGN: Separate cross-sectional regression analyses of 21,135 inpatient discharges were performed in 1991 and 23,262 discharges in 1992. The multivariate model was estimated with hospital cost per discharge as the dependent variable. Model robustness was checked by comparing regression results at the individual discharge level with those at the level of the hospital/clinical condition pair. DATA COLLECTION/EXTRACTION METHODS: Information on hospitals' managed care strategies was provided by mail and phone survey of key informants in 1991 and 1992. Other hospital characteristics were collected from AHA Annual Survey data, and discharge data from hospital abstracting systems. PRINCIPAL FINDINGS: The pooled discharge analysis indicated three dimensions of hospital managed care strategy that consistently related to lower costs per hospital discharge: the proportion of hospital revenues derived from per case or capitation payment, the hospital's mechanisms for sharing information on resource consumption with clinicians, and the use of formalized, systematic care coordination mechanisms. CONCLUSIONS: Three strategies appear to hold promise for enhancing the efficiency of inpatient resource use: (1) "fixed price" hospital payment incentives, (2) hospital approaches to sharing resource use information with clinicians, and (3) the application of formal care management mechanisms for specific clinical conditions.

Aged↗
PubMed1995

Community organization to promote breast cancer screening among women ages 50-75.

BACKGROUND: To reduce breast cancer mortality, ways to promote the use of mammography screening among women age 50 and above are needed. Community organization may be a useful approach. METHODS: The Washington State Community Breast Cancer Screening Project involved implementation of promotional activities initiated by physician and lay community boards in two communities. Two comparable communities served as controls for evaluation purposes. Random-digit-dial telephone interviews were used to assess recent use of mammography at baseline and follow-up in independent samples of women ages 50 to 75 from the four communities. The extent of exposure to intervention activities and the relationship between exposure to intervention activities and mammography use were estimated from data collected at follow-up. RESULTS: Exposure to patient reminders from physicians, wallet reminder cards, and newspaper advertisements were consistently related to mammography use. Physician office staff encouragement and a display board were significantly related to mammography use only in Intervention Communities A and B, respectively. Neither exposure to promotional activities nor the change in prevalence of mammography use was significantly higher in the intervention communities than in the comparison communities at follow-up. CONCLUSIONS: Although several activities were useful in promoting mammography use, organization of the community did not enhance efforts undertaken spontaneously by comparable communities.

Aged↗
PubMed1995

Tort reform and malpractice liability insurance.

Legal factors related to the malpractice liability insurance purchased by general dentists in the United States were investigated using a comprehensive multivariate model that assessed the contribution of legal provisions affecting the probability of a malpractice claim, the probability of a payment, and the average size of the payment. General practice dentists in the United States were selected randomly, and 3,048 dentists were studied by mail survey. A number of legal statutes (periodic payment allowed, percentage fault liability informed consent limits, limits on res ipsa loquitor, attorney fee control, some statute of limitations provisions) had the intended effect of reducing the malpractice insurance sought by dentists. Other provisions, such as binding arbitration, may have unintended cost-raising effects. Previous malpractice claims were associated with purchasing greater amounts of insurance. These findings have implications for future changes in the legal system as part of health care reform.

Dentistry↗
PubMed1994

Analysis of automated administrative and survey databases to study patterns and outcomes of care.

Large computerized databases often arise from national surveys, insurance claims, and statewide health care registries. These databases are increasingly used to examine patterns of medical care and certain outcomes of care and may be helpful in planning clinical trials. They are highly representative of defined populations, but have limited clinical information. Methods have been developed to identify episodes of low back pain and to quantify the severity of unrelated, comorbid medical conditions. Pitfalls in analysis are discussed, including limitations of diagnosis and procedure coding, cross-sectional nature of most data, limited clinical detail, and the necessarily observational (not experimental) nature of any group comparisons. There is growing interest in expanding the clinical information in such databases, for both quality improvement and research purposes.

Cross-Sectional Studies↗
PubMed1994

Malpractice claims during 1988-1992: a national survey of dentists.

Between 1988 and 1992, almost a quarter of surveyed dentists reported at least one patient complaint to malpractice insurance carriers. The incidence of claims more than doubled in that time and payment size increased nearly five times between 1988 and 1991. These and other trends in professional liability are examined in this national survey of general dentists.

Age Factors↗
PubMed1994

Costing medical care: using Medicare administrative data.

This paper describes how the PORTS are using data from the Medicare administrative records systems to study the medical care costs of specific conditions. The general strengths and weaknesses of the Medicare databases for studying cost related issues are discussed, and the relevant data elements are examined in detail. Changes in the nature of the data collected over time are noted. Information is provided on how the PORTS are using these data to estimate the cost to Medicare of treating Medicare beneficiaries with specific conditions and the social (opportunity) cost of treating these patients. Furthermore, information is provided on how data from the Medicare administrative records system can be used to determine the cost of services for patients who have been identified through other large databases (i.e., state hospital discharge tapes) or who have been enrolled in prospective cohort studies.

Costs and Cost Analysis↗
PubMed1993

Subcellular localization of squalene synthase in rat hepatic cells. Biochemical and immunochemical evidence.

In the present study we investigated the subcellular localization of squalene synthase (farnesyl-diphosphate:farnesyl-diphosphate farnesyltransferase, EC 2.5.1.21). Squalene synthase catalyzes the formation of squalene from trans-farnesyl diphosphate in two distinct steps and is the first committed enzyme for the biosynthesis of cholesterol. Recently, a truncated form of the enzyme from rat hepatocytes was purified, and monospecific antibodies for squalene synthase were produced. This enabled the subcellular localization of squalene synthase by three different methods: (i) analytical subcellular fractionation and measurements of enzyme activities; (ii) immunodeterminations of squalene synthase in the isolated subcellular fractions with a monospecific antibody; and (iii) immunoelectron microscopy. All three methods gave consistent results. The data clearly illustrate that squalene synthase enzymatic activity and squalene synthase are exclusively localized in the endoplasmic reticulum. In rat hepatic peroxisomes we were not able to detect any squalene synthase. In addition, we also demonstrated that squalene synthase in the microsomal fraction is dramatically regulated by a number of hypolipidemic drugs and dietary treatments.

Animals↗
PubMed1993

The binding of Pneumococcal lipoteichoic acid to human erythrocytes.

Previous studies have evaluated the binding characteristics of lipoteichoic acids (LTA) composed of polyglycerol phosphate to mammalian cell membranes. This present study was performed to evaluate the binding characteristics of Pneumococcal LTA, a polyribitol phosphate containing LTA, to human erythrocytes. Binding was found to be specific, reversible, and dependent on temperature and time. Maximum binding was achieved within 2 h at 37 degrees C. Scatchard plot analysis of the binding revealed a biphasic plot which suggests two receptor sites with different affinities. Competitive inhibition studies with LTA composed of polyglycerol phosphate and isolated from Streptococcus pyogenes and Lactobacillus fermentum revealed significant inhibition of Pneumococcal LTA-binding to the erythrocyte membrane by these heterologous LTAs. These results demonstrate that Pneumococcal LTA binds specifically to human erythrocytes and that the receptor site is similar for other structurally different LTAs.

Bacterial Adhesion↗
PubMed1990

Investigations concerning the potential for using 1H NMR relaxometry or high-resolution spectroscopy of plasma as a screening test for malignant lung disease.

In 158 plasma samples, obtained from patients with lung carcinoma, lung metastases, and infectious or inflammatory lung diseases and from healthy controls, the NMR relaxation times T1 and T2 of water protons were measured at a resonance frequency of 20 MHz by pulsed NMR techniques and adjusted to a standardized total plasma protein concentration. For one-third of these samples water-suppressed 500-MHz 1H NMR spectroscopy at 37 degrees C was used (a) to determine the widths of the composite lipid methyl and methylene signals, and (b) to quantitate individual lipid methylene signal components that could be detected in resolution-enhanced spectra. In addition, hematological parameters and the plasma levels of several acute phase proteins and apolipoprotein-A were monitored. No diagnostically significant differences between lung carcinoma patients and patients with nonmalignant lung disease could be found for any of the plasma NMR parameters, nor could T1 or lipid linewidth data distinguish between any patient group and healthy controls. However, the mean T2 was significantly shortened by about 15% for any kind of lung disease compared to healthy controls. Similar but less significant results were found for apolipoprotein-A levels. A linear discriminant function, calculated from the apolipoprotein-A and T2 data, did not improve the differentiation between malignant and nonmalignant lung disease but did improve the discrimination between tumor patients and healthy controls up to a sensitivity and specificity of 80 and 96.5%, respectively. T2 correlates inversely with plasma fibrinogen levels and the blood sedimentation rate and, therefore, appears to monitor a general inflammatory status of a tumor patient rather than the presence or absence of cancer. For all groups except healthy pregnant women, the lipid methylene composite signal linewidth correlates inversely with the fraction of mobile triglyceride present (mainly as VLDL), as estimated from resolution-enhanced spectra.

Blood Proteins↗
PubMed1988

The structure and function of dental-care markets. A review and agenda for research.

The growth of dental health services over the past 15 years has produced several issues in dentistry. Because economic markets are the cornerstone of dental delivery in the US, informed responses to these issues require a thorough understanding of dental-care markets. The empirical literature is reviewed to examine the structure of dental markets, to assess the major determinants of market equilibrium, and to examine the social and health consequences of dental-care markets. Results reveal that while dental markets are imperfectly competitive, it is unclear whether prices exceed competitive levels. Little is known about the effects of dental markets on public oral health and society. Future research is proposed in two broad areas: 1) updating early studies conducted when few Americans had dental insurance benefits; and 2) path-breaking research to advance our knowledge of dental-care markets in particular and medical-care markets in general.

Community Participation↗
PubMed1987

An improved method for protoplast formation and its application in the fusion of Rhodotorula rubra with Saccharomyces cerevisiae.

Protoplasts from various strains of red-pigmented yeasts were generated at high frequency using improved procedures. The use of sulphur-containing amino acids and 2-deoxyglucose in growth media led to impaired cell wall synthesis and rendered cells very susceptible to treatment with mercapto-ethanol and various lytic enzymes. Use of individual lytic enzymes separately resulted in relatively low frequencies of protoplasts from most of the red yeasts examined, whilst use of beta-glucuronidase, Novozyme and Zymolyase in series markedly increased stable protoplast formation. The latter effects were shown to be strain specific. The ability to generate large numbers of red yeast protoplasts prompted the attempt to examine intergeneric fusion between auxotrophs of a strain of Saccharomyces cerevisiae and Rhodotorula rubra. Putative hybrids were selected as variously-pigmented prototrophic colonies growing on minimal medium and stabilised by subculturing on the latter medium. Unusual cream, orange and yellow hybrid colonies were generated, composed of cells of varying morphologies (chains, multibudded). The majority of stable hybrids contained one nucleus, although several heterokaryons were also observed. Some hybrids possessed the phenotypes of both parents: fusant wcat41 grew as rapidly as the S. cerevisiae parent but also contained an inducible phenylalanine ammonia-lyase (PAL) which appeared to be more active than that of the Rhodotorula parent.

Culture Media↗
PubMed1986

Cost and outcome of care for patients with chronic obstructive lung disease. Analysis by physician specialty.

We studied the effect of physician specialization and board certification on costs and outcome of health care for a group of 213 patients with chronic lung disease followed prospectively for a year. Linear, semilogarithmic, and logistic regressions were used to control for differences in pulmonary function, functional ability, and sociodemographic characteristics. The cost of health services during the year was estimated from the total charges incurred. Patient's pulmonary function, functional ability, number of medical conditions, and insurance status were significant predictors of total cost. Combinations of these variables were important determinants of institutional days, outcome health status, and survival. Physician specialization and board certification were not significant descriptors of total costs or outcomes, although large variances limited the power of these findings. We conclude that differences in characteristics of primary care physicians do not appear to affect significantly the total cost or outcome of care for patients with moderate to severe chronic lung disease.

Aged↗
PubMed1985

Delegation of expanded functions to dental assistants and hygienists.

One hundred and twenty-six dental offices in Washington State kept a record of each time an expanded function was performed by the dentist, hygienist, or assistant. There were five two-week recording periods starting in February 1979 and ending in February 1981. Consistent with increasing productivity, dentists most frequently delegate tasks to dental assistants rather than dental hygienists and delegate an individual task consistently if it is delegated at all. For tasks that may be delegated to the assistant, a relationship was found between the per cent of dentists delegating an individual task and the amount of the dentist's time that is freed through delegating that task. From the perspective of quality of care, the per cent of dentists who delegate a task was inversely related to the complexity of the task.

Dental Assistants↗
PubMed1985

Utilization of dental services in the United States and an insured population.

Dental service utilization rates among 1.2 million Pennsylvania Blue Shield dental insureds are compared to rates in the US population. Insurance appears to stimulate the utilization of dental services above national norms; children appear to be a major beneficiary of insurance's incentive effect on dental service use. The implications of these findings for health planners and dental insurance providers are discussed.

Adolescent↗
PubMed1985

Purification of human B cell growth factor.

Human B cell growth factor (BCGF, 12,000 to 14,000 daltons) has been purified from lectin-stimulated, peripheral blood mononuclear cell-conditioned medium. The purification procedure involves a series of column chromatographic steps incorporating ion exchange, affinity binding, and gel filtration. This procedure is centered around a relatively high yield single chromatographic step, for the removal of co-eluting cytokines from BCGF, that is based on differential binding characteristics to the weak ion-exchange matrix, hydroxylapatite. Reverse-phase high-pressure liquid chromatographic separation on a C18-Bondapak column effectively separates the BCGF and TCGF moieties, yet is characterized by poor yields. High-pressure liquid chromatographic procedures on anion exchange and size exclusion provided the final purification step for BCGF, at an analytical level, resulting in a single band with a m.w. of 12,000 on a SDS-polyacrylamide gel.

Chromatography, Affinity↗