Biomedical subjects

D Fairchild

Publications and source records attributed to D Fairchild.

7 recordsLinked to original sources

PubMed1999

Capitation and its effects on physician satisfaction.

OBJECTIVE: Capitation is an increasingly common method of paying physicians, but few data exist on its impact on physician satisfaction. This study examines the perceived effects of capitation on physician satisfaction at a large, academic medical center. STUDY DESIGN: Survey of physicians at a single, tertiary care hospital. METHODS: Physicians in a physician hospital organization were surveyed at an urban teaching hospital which received capitation for 5% of patients at the time of the survey but was preparing for a sharp increase in capitation. We used a 5-point Likert scale to assess physicians' satisfaction with their practice, and to compare satisfaction under fee-for-service and expected satisfaction under capitation. RESULTS: Of the 734 physicians surveyed, 147 were excluded because they had no direct patient care responsibilities. Of the remaining 587 physicians, 363 replied, giving a response rate of 62%. Overall, 57% of physicians were satisfied with their practice. Compared to their satisfaction under fee-for-service reimbursement, they were much less satisfied with their ability to care for capitated patients (17 of 19 questions, p < 0.05). The greatest differences were for freedom to order necessary tests and freedom to obtain referrals (0.9 and 0.8 on the 5-point scale, respectively, both p < 0.0001). Multiple logistic regression analyses revealed four independent predictors of overall satisfaction: patient load (OR = 2.7, 95% CI = 1.9-3.9), efficiency in resource utilization (OR = 1.5, 95% CI = 1.1-2.1), perceived employment stability (OR = 1.7, 95% CI = 1.3-2.2), and control over clinical time schedule (OR = 1.6, 95% CI = 1.2-2.0). CONCLUSIONS: Physicians initially encountering capitation payment have strong negative perceptions about it, even for areas in which some policy experts expect capitation to benefit patient care. Physician education and focusing on management relations may help smooth the transition to capitated reimbursement.

Academic Medical Centers↗

PubMed1998

Measuring and improving quality using information systems.

Information systems (IS) are increasingly important for measuring and improving quality. In this paper, we describe our integrated delivery system's plan for and experiences with measuring and improving quality using IS. Our approach is that for quality measurement to be practical, it must be integrated with the routine provision of care, and whenever possible should be done using IS. Thus, at one hospital, we now perform almost all quality measurement using IS. However, IS are not only useful for measuring care, but represent powerful tools for improving care using decision support. Specific areas in which IS has already been particularly effective include reducing the unnecessary use of laboratory testing, reporting important abnormalities to key providers rapidly, adverse drug event detection and prevention, initiatives to reduce the costs of drugs, and making critical pathways available to providers. The next wave of effort will be to promote widespread use of computerized guidelines, which is likely to prove more challenging. However, the advent of managed care in the U.S. has produced strong incentives to provide high quality care at low cost, and our perspective is that only with better IS than exist today will this be possible on a widespread basis. Such systems make feasible implementation of care improvement and cost reduction initiatives on a scale which could not previously be considered.

Decision Making, Computer-Assisted↗

PubMed1998

Systemic effects of pegylated recombinant human megakaryocyte growth and development factor in combination with recombinant murine granulocyte colony-stimulating factor in a murine model of myelosuppression.

Megakaryocyte growth and development factor (MGDF) stimulates megakaryopoiesis and thrombopoiesis in vivo. Previous studies indicate that administration of pegylated recombinant human (PEG-rHu) MGDF in combination with recombinant murine granulocyte colony-stimulating factor (rMuG-CSF) prevented lethality and reduced hematotoxicity in carboplatin-treated/irradiated mice, a disease-state animal model of radio-chemotherapy. In the current study we have further characterized the effects of PEG-rHuMGDF in combination with rMuG-CSF with respect to clinical chemistry, hematology variables, and histologic evaluations to determine whether any potential toxicological interaction exists both in normal and myelosuppressed mice. Myelosuppression and subsequent thrombocytopenia in mice was induced with a combination of a single intraperitoneal injection of 1.25 mg carboplatin followed 4 h later with sublethal gamma irradiation exposure of 500 rad. Both normal and carboplatin-treated/irradiated mice were administered daily subcutaneous injections of 50 micrograms/kg PEG-rHuMGDF alone and in combination with 10 micrograms/kg rMuG-CSF for 21 consecutive days. Administration of PEG-rHuMGDF alone or in combination with rMuG-CSF to carboplatin-treated/irradiated mice increased survival 70 and 100%, respectively, and accelerated platelet recovery. Microscopic examination of nonhematopoietic organs showed no evidence of any morphological changes in normal and carboplatin-treated/irradiated animals. In hematopoietic organs clinically significantly increased granulopoiesis and megakaryopoiesis, as well as extramedullary granulopoiesis within the mandibular and mesenteric lymph nodes, were present. The erythroid line was unaffected by cytokine treatment. In normal, non-carboplatin-treated/irradiated mice, platelet counts increased 6 and 12-fold above baseline in the groups administered PEG-rHuMGDF alone or in combination with rMuG-CSF, respectively. The results of this study provide a basis for coadministration of PEG-rHuMGDF with Filgrastim (rHuG-CSF) in the clinical treatment of myelosuppression induced by radiation and chemotherapy.

Animals↗

PubMed1995

Dose-response comparison of recombinant human nerve growth factor and recombinant human basic fibroblast growth factor in the fimbria fornix model of acute cholinergic degeneration.

Both nerve growth factor (NGF) and basic fibroblast growth factor (bFGF) have been proposed for the treatment of Alzheimer's disease. This study describes a comparative, dose-response analysis of recombinant human (rh)NGF and rhbFGF in a rat unilateral fimbria-fornix model of acute cholinergic neuronal degeneration. Doses for rhNGF were 0.6, 6, 60, 600 and 1,800 ng/rat/day and for rhbFGF were 600, 1,800, 3,000 and 6,000 ng/rat/day, delivered for 4 weeks. The number of surviving septal cholinergic neurons was evaluated using ChAT immunohistochemistry. In control animals, the number of ChAT-positive neurons remaining on the lesioned side was between 22 and 18% compared to the non-lesioned side. Infusion with either neurotrophic factor increased the number of ChAT-positive neurons on the lesioned side in a dose-dependent manner. The maximal response to rhbFGF peaked at 3,000 ng/rat/day with a cell savings of 47%. However, there was evidence of neuropathological changes associated with rhbFGF. In contrast, rhNGF produced a maximal response with an infusion of 600 ng rhNGF/rat/day and a cell savings of 70% and no evidence of neuropathology, indicating that rhNGF was better tolerated and more efficacious than rhbFGF.

Acetylcholinesterase↗

PubMed1985

Cholinergic kindling: what has it taught us about epilepsy?

We reviewed recent evidence that chemical kindling of epileptic seizures can be induced by injection into the amygdala of multiple cholinergic muscarinic agonists, and blocked by multiple muscarinic antagonists. The stereospecific induction of kindling by (+) but not by (-) acetyl-beta-methylcholine shows that some types of repeated synaptic activation can produce epilepsy, in the absence of specific brain damage. The failure of bicuculline (but not of carbachol) to produce kindling with amygdaloid injections, and its ability to produce a limited seizure spread in neocortex, suggest that repetitive seizure activity alone is not sufficient to produce kindling. A review of some recent neurochemical changes in the synaptic apparatus associated with some types of kindling suggests potential areas for future investigation, but no cause-and-effect relationship between neurochemical and behavioral changes can be inferred so far.

Amygdala↗

PubMed1982

Interferon inhibits PWM induced B cell differentiation but not onset of proliferation.

The dependence of B lymphocyte differentiation into plasmacytes on anteceding B and T cell proliferation was studied using interferon as a probe. Possible correlations of the effect of interferon on PWM induced T and B cell proliferation and B cell differentiation into either kappa or lambda light chain immunoglobulin synthesizing plasmacytes have been investigated. The hypothesis that the observed inhibition of the PWM induced formation of plasmacytes by interferon is due to putative enhanced suppressor cell activity resulting from increased T cell proliferation is tested. Human, peripheral blood lymphocytes were exposed to PWM in the presence or absence of human leukocyte interferon. Proliferation was assayed by pulse cytophotometric analysis of cell kinetics, as well as [3H]TdR labelling of S-phase cells. Incidence of plasmacytes was detected by immunofluorescence using kappa or lambda light chain specific antibody. During continuous [3H]TdR labelling of stimulated cells, interferon inhibited incorporation of precipitable label by 40% at 96 and 144 h, indicating reduced net DNA synthesis by interferon treated cells. The relative fraction of cells in S-phase as well as G1- and G2 + M- was similar for treated and untreated cells. The fraction of cells rosetting SRBC remained stable for both treated and untreated cells. The size of the interferon treated population was persistently smaller once proliferation began. The time of initiation of proliferation was comparable for treated and untreated cells. Consistent with the findings of others using cell lines, interferon apparently induces a dilation of all cell cycle phases, thereby reducing the rate of proliferation. The same reduction occurred for both T and B cells. Time of initiation of DNA synthesis was, in contrast, not delayed by interferon, suggesting it is specific for events during the proliferative cell cycle. The occurrence of both kappa and lambda light chain immunoglobulin secreting plasmacytes was inhibited by interferon. The degree of inhibition was comparable for both kinds of plasmacytes detected. While not delaying the onset of DNA synthesis, interferon apparently retards subsequent cell proliferation and inhibits the differentiation of B cells to plasmacytes. The data indicate that active cellular proliferation and B cell differentiation require interferon sensitive events which cells initially recruited from quiescence by PWM do not. The inhibition of the incidence of plasmacytes cannot be attributed to an imbalance of T cell proliferation relative to non-T cells.

B-Lymphocytes↗

PubMedDate not supplied

Using information systems to measure and improve quality.

Information systems (IS) are increasingly important for measuring and improving quality. In this paper, we describe our integrated delivery system's plan for and experiences with measuring and improving quality using IS. Our belief is that for quality measurement to be practical, it must be integrated with the routine provision of care and whenever possible should be done using IS. Thus, at one hospital, we now perform almost all quality measurement using IS. We are also building a clinical data warehouse, which will serve as a repository for quality information across the network. However, IS are not only useful for measuring care, but also represent powerful tools for improving care using decision support. Specific areas in which we have already seen significant benefit include reducing the unnecessary use of laboratory testing, reporting important abnormalities to key providers rapidly, prevention and detection of adverse drug events, initiatives to change prescribing patterns to reduce drug costs and making critical pathways available to providers. Our next major effort will be introduce computerized guidelines on a more widespread basis, which will be challenging. However, the advent of managed care in the US has produced strong incentives to provide high quality care at low cost and our perspective is that only with better IS than exist today will this be possible without compromising quality. Such systems make feasible implementation of quality measurement, care improvement and cost reduction initiatives on a scale which could not previously be considered.

Computer Communication Networks↗