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Biomedical subjects

D H Gustafson

Publications and source records attributed to D H Gustafson.

At least 55 records · Page 3Linked to original sources
PubMed1984

Evaluation of a sampling approach. Nursing home reimbursement and level of care determination.

Under existing federal regulations, it is mandated that the care of all nursing home residents be reviewed annually. A four-year demonstration project in Wisconsin tested a sampling approach to nursing home resident review. The rationale for the sampling approach is that one can more effectively identify pervasive problems with resident care by an in-depth examination of a sample of residents than by cursory assessment of all residents. If problems are identified in the sample, all residents can then be reviewed. However, reimbursement for nursing home care is also influenced by level of care and given that nursing home inspectors review the appropriateness of level of care, the issue arises as to what impact a sampling approach would have on reimbursement. This evaluation compares the changes in reimbursement owing to resident review under the sampling and federally mandated, 100% review methods. The results indicate that reviewing a sample of nursing home residents may offer similar reductions in nursing home reimbursement as a 100% resident review--but at a lower cost.

Cost-Benefit Analysis↗
PubMed1984

Assessment of level of care: implications of interrater reliability on health policy.

In Wisconsin, level-of-care assessments are used to set Medicaid reimbursement and determine nursing home eligibility. This study examined three methods of assessing level of care: 1) the Wisconsin quality assurance project (QAP) method, based on observations of patients, patient records, and staff interviews; 2) the Wisconsin standard (STD) method, based primarily on a clinical record review; and, 3) an adaptation of New York's "DMS-I," a checklist with numerical weights used to set level of care. Results address interrater reliability, the agreement between assessments by research teams and actual levels of care set by the State, and the implications that agreement has for reimbursement.

Costs and Cost Analysis↗
PubMed1983

An evaluation of multiple trauma severity indices created by different index development strategies.

Evaluation of the effectiveness of emergency trauma care systems is complicated by the need to adjust for the widely variable case mix found in trauma patient populations. Several strategies have been advanced to construct the severity indices that can control for these population differences. This article describes a validity and reliability comparison of trauma severity indices developed under three different approaches: 1) use of a multi-attribute utility (MAU) model; 2) an actuarial approach relying on empirical data bases; and 3) an "ad hoc" approach. Seven criteria were identified to serve as standards of comparison for four different indices. The study's findings indicate that the index developed using the MAU theory approach associates most closely with physician judgments of trauma severity. When correlated with a morbidity outcome measure, the MAU-based index shows higher levels of agreement than the other indices. The index development approach based on the principles of MAU theory has several advantages and it appears to be a powerful tool in the creation of effective severity indices.

Actuarial Analysis↗
PubMed1975

A decision theory approach to measuring severity in illness.

The purpose of this study was to evaluate the applicability of a multiattribute utility model for measuring the severity of a patient's illness. A single medical problem (an analysis of the costs and benefits of different burn care systems) was used to test the model. Physicians estimated the relative importance of and severity functions for criteria influencing severity. The model's estimates of severity were compared with survival rates of more than 6000 actual patients and with physicians' rankings of hypothetical patients. Although continued validation is needed, the multiattribute utility model appears to have potential as an index for illness severity and, possibly, health status.

Burns↗