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Biomedical subjects

D F Drake

Publications and source records attributed to D F Drake.

13 recordsLinked to original sources
PubMed2001

Benefits of an inpatient pulmonary rehabilitation program: a prospective analysis.

OBJECTIVE: To examine the effect of an inpatient pulmonary rehabilitation program on functional outcome, supplemental oxygen use, quality of life (QOL), and rehospitalization. DESIGN: A prospective study. SETTING: Inpatient pulmonary rehabilitation unit. PATIENTS: One hundred fifty-seven patients with moderate to severe chronic obstructive pulmonary disease (COPD) admitted to an inpatient pulmonary rehabilitation program over a 3-year period. INTERVENTION: Comprehensive interdisciplinary inpatient pulmonary rehabilitation program with an average length of stay of 21 days. MAIN OUTCOME MEASURES: Improvements in QOL questionnaire scores, COPD knowledge questionnaire scores, 6-minute walking test (with 3 ambulation categories: bed-bound, household ambulators, community ambulators), and supplemental oxygen use. Rehospitalization 1 year after completion of the program was also assessed and compared with hospital days for the year before the program. RESULTS: On discharge from the program, 88% of individuals walked farther (p <.0001), and community ambulators doubled their walking distance, whereas bed-bound patients decreased 10-fold; supplemental oxygen use dropped 33% during the day (p <.0001) and 57% during the night (p <.0001); 82% showed improved QOL (p <.0001); 67% showed improved knowledge of COPD (p <.0001); and 67% of the sample spent less time in the hospital during the 12 months after program completion compared with the 12 months before admission (p <.001). CONCLUSIONS: An inpatient pulmonary rehabilitation program leads to improved endurance and functional ambulation, decreased supplemental oxygen use, and fewer hospitalizations 1 year after discharge for patients with COPD.

Aged↗
PubMed1997

Managed care. A product of market dynamics.

The development of managed care is described as an unexpected product of competition between public and private purchasers of health care. Managed care is a series of purchasing techniques that employers have applied to reduce the cost of their employees' health benefits. Its most significant use has been as a device for bargaining with individual health care providers by encouraging or requiring employees to purchase health care services from a select set of providers. Selective contracting has broken a 40-year-old barrier to price competition among health care providers, who have responded to this negotiating tactic by forming or joining larger organizational units to strengthen their bargaining power. Although the so-called managed care revolution has reduced the rate of increase in health care costs by creating a more competitive price environment, it is simply a start toward a more effective health care market. It is very much a work in progress that will affect and be affected by both political and market changes occurring over the remainder of this century.

Community Participation↗
PubMed1995

What do Hillary Rodham Clinton and Newt Gingrich have in common?

In a somewhat tongue-in-cheek style, this article tries to persuade conservatives that it might be in their best interests to consider broader health system reform alternatives in their quest to reduce the cost of federal health entitlements for a balanced budget by 2002. The conventional means for reducing the federal budget by $450 billion in 7 years will inflict much pain on many voters. The substitution of a new, more targeted entitlement, prospectively, for all Americans represents an alternative that provides much gain to many and only some pain to a few.

Health Care Reform↗
PubMed1981

The struggle over health care controls continues.

Although the struggle between advocates of competitive or regulatory controls for the health care market is abstract and ideological, when it comes to specific markets, it is very concrete and pragmatic. Some detailed implications of market strategy control for individual hospital managers are presented.

Commerce↗
PubMed1978

Does money spent on health care really improve U.S. health status?

Whether increased expenditures for health care substantially improve the overall health care of the U.S. population poses a critical question for the formulators of a national health policy. Concentrating exclusively on the impact of the Medicare program on the health status of the aged poor, the author examines HEW data and assesses the linkage between increased expenditures and improved health.

Aged↗
PubMed1978

A primer on antitrust and hospital regulation.

This paper begins with a comparison of the effects of regulation and antitrust litigation on general market dysfunction. The authors then describe the medical marketplace and the effects both regulation and antitrust efforts have had in this arena. They conclude that public policy probably will continue to be concerned with regulation, given that traditional forces do not, and apparently cannot be made to, operate in the health care market. However, through tax benefits, cost-sharing programs, etc., for other-than-traditional modes of care, regulation can be more an instrument for expanding the range of consumer choice than it historically has been.

Commerce↗