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D H Mills

Publications and source records attributed to D H Mills.

At least 19 recordsLinked to original sources
PubMed1991

A critique of the use of generic screening in quality assessment.

This article summarizes available information on the efficiency and effectiveness of generic occurrence screening when used in quality assessment. Generic screening is relatively inefficient because of its multitiered review system and high rates of errors and false positives. Overall sensitivity may approach 70% to 80%, but specificity is estimated to range from about 22% to 73%. Effectiveness of generic screening in identifying problems in quality is limited by variability in peer review. Other limitations of generic screens include their lack of inherent relationship to the quality of patient care and their inability to provide direct performance measures for use in the periodic reappraisal of clinical privileges of medical staff members. We propose the monitoring of specific adverse surgical and medical clinical outcomes and related risk factors to increase efficiency in quality assessment and provide a more adequate database for the continual improvement of patient care and clinical performance.

California↗
PubMed1988

Whither malpractice litigation?

Existing tort reform has produced moderating effects on some states, particularly California. Continued escalation of claims frequency, however, and average paid-claim costs mean that other remedies will have to be sought if the professional liability problem is to be solved. Many sources, including the American Medical Association, have proffered radical changes, but most of these changes will cost more than physicians and hospitals can afford. Therefore, the availability of additional funds will determine the next stage of reform. In the meantime, physicians must become more expert in medical staff peer review if they expect to successfully affect future developments.

Humans↗
PubMed1988

Operational criteria for the determination of suicide.

Suicide is an important public health problem for which we have an inadequate public health database. In the United States, decisions about whether deaths are listed as suicides on death certificates are usually made by a coroner or medical examiner. These certification decisions are frequently marked by a lack of consistency and clarity, and laws and procedures for guiding these decisions vary from state to state and even from county to county. Without explicit criteria to aid in this decision making, coroners or medical examiners may be more susceptible to pressures from families or communities not to certify specific deaths as suicide. In addition, coroners or medical examiners may certify similar deaths differently at different times. The degree to which suicides may be underreported or misclassified is unknown. This makes it impossible to estimate accurately the number of deaths by suicide, to identify risk factors, or to plan and evaluate preventive interventions. To remedy these problems, a working group representing coroners, medical examiners, statisticians, and public health agencies developed operational criteria to assist in the determination of suicide. These criteria are based on a definition of suicide as "death arising from an act inflicted upon oneself with the intent to kill oneself." The purpose of these criteria is to improve the validity and reliability of suicide statistics by: (1) promoting consistent and uniform classifications; (2) making the criteria for decision making in death certification explicit; (3) increasing the amount of information used in decision making; (4) aiding certifiers in exercising their professional judgment; and (5) establishing common standards of practice for the determination of suicide.

Coroners and Medical Examiners↗
PubMed1985

Information please.

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Defensive Medicine↗
PubMed1978

Medical insurance feasibility study. A technical summary.

There are risks of adverse outcomes to patients in the course of health care management. A study was undertaken to measure these outcomes in California for 1974. Secondary benefits of the study include new insights into the types and sources of disabilities caused by health care management and the development of new methods for carrying out generic adverse-outcome monitoring.

California↗
PubMed1976

Medical injury information. A preparation for analysis and implementation of prevention programs.

The purpose of this communication is to offer the medical community an analytic design for a system to gather data about patients' injuries found in malpractice litigation. The goal of this system is to determine the causes of these injuries. The information to be gained will be of substantial benefit for the development of injury-preventive programs within the health care field.

Communication↗
PubMed1976

Going bare.

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California↗