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D D Wirtschafter

Publications and source records attributed to D D Wirtschafter.

24 records · Page 2Linked to original sources
PubMed1976

Automation of a patient medical profile from insurance claims data: a possible first step in automating ambulatory medical records on a national scale.

This report describes how a detailed patient medical profile can be produced by the systematic collection and linkage of claims data in a state-wide Medicaid program. Extension of this system nationally could provide automated medical profiles for more than 20,000,000 people at a small increment in cost. The possibility that this cost could be offset by reduction of duplicated services currently provided deserves serious consideration by health care planners and administrators. The ability of the profile to portray a patient's clinical status accurately hinges on both the determination of health care administrators to adopt sensitive and precise diagnostic codes and on the adoption of improved data acquisition techniques. The deficiencies of the database are described, and methods of overcoming these problems are suggested.

Alabama↗
PubMedDate not supplied

Perinatal services in the era of managed care: a Kaiser Permanente physician's perspective.

Evolving market forces are reshaping current patient, parent, provider, insurer, and hospital relationships. The traditional individualistic focus for accountability and responsibility is being supplemented by population-wide responsibilities and accountabilities. These changes, often lumped together as "managed care", are being implemented with evolving ideas on how best to manage an organize collaborative activity. In this article it is reasoned that perinatal services will improve as objective outcome measures guide the development, evolution, and operation of competing managed care networks. The article illustrates how a managed perinatal care network works with experiences drawn from the perinatal service programs of Kaiser Permanente's Southern California Region.

California↗
PubMedDate not supplied

One health maintenance organization's experience: obstetric costs depend more on staffing patterns than on mode of delivery.

The objective of this study was to examine whether the mode of obstetric delivery is related to resource costs, case mix, maternal length of stay, or neonatal morbidity. Patients (27,289) who delivered babies at nine hospitals within one health maintenance organization in 1989 were the source of data. Case-mix adjustment and outcome measures (maternal length of stay and neonatal morbidity) were computed from discharge abstract indicators, whereas cost data (direct professional hours) came from departmental financial reports. Costs and outcomes were adjusted by regression analysis for differences in case mix and then compared by correlation analysis. Neither adjusted nor unadjusted cesarean-section rates and obstetric cost per case were significantly correlated over the range of observed cesarean-section rates. Aggregate cesarean-section rates and outcome indicators were also statistically unrelated. Cesarean-section rate variation across hospitals was unrelated to the observed variation in obstetric costs, which were closely related to variations in staffing and less closely to differences in patient case mix and scale.

Adult↗