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Biomedical subjects

D P Pasternak

Publications and source records attributed to D P Pasternak.

At least 19 recordsLinked to original sources
PubMed1999

Risk-adjusted measurement of primary cesarean sections: reliable assessment of the quality of obstetrical services.

A two-hospital system reported widely disparate Cesarean section rates in its component institutions. Statistical analysis determined that the apparent discrepancy was due primarily to patient-related factors. When risk-adjusted, both hospitals' rates were indistinguishable from expected rates. Reporting Cesarean section rates without appropriate risk adjustment yields potentially misleading results. Since reliable risk adjustment currently exists only for primary Cesarean sections, primary rates should be reported separately from "raw" rates for other procedures.

Cesarean Section↗
PubMed1996

Does disease management work?

Is disease management the "solution of the month" or a valid approach to organizing patient care? In the era of rapid change in health care, disease management is emerging as one technique suited to improving measurable health care outcomes at greater cost effectiveness. By taking a leading role in the process, those physician executives who commit to this approach can greatly enhance the potential of these programs to accomplish the desired results.

Cost Control↗
PubMed1994

Determining costs associated with quality in health care delivery.

This article examines the costs associated with quality in health care delivery. A model applicable to health care settings is specified according to investments in quality and the cost of not achieving quality. The premises and basic theories underlying the model are explored. The model was developed at Lovelace Health Systems in Albuquerque, New Mexico, as a decision making tool. The specific cost elements comprising the quality cost model are identified and illustrated using the working model adopted at Lovelace. The managerial impact of the quality cost model and the implications for other health care organizations are examined.

Decision Making, Organizational↗
PubMed1993

Creating a satisfying practice setting for physicians. The experience of a hospital-based group practice.

Medical groups are challenged to develop a satisfying context for physicians to deliver patient care. This article reports on the efforts of the Lovelace Medical Center and the Lovelace Clinic, P.C. (professional corporation), in Albuquerque, New Mexico, to create a distinctive environment for its medical staff members. A job-design model is examined wherein core job characteristics and physician growth-need strength influence critical psychological states and satisfaction. The results of this longitudinal study suggest that from the perspective of primary care physicians, the practice setting at Lovelace has improved markedly between 1984 and 1990. In addition, fewer changes were observed for specialists, ostensibly due to extremely favorable perceptions of the practice setting at Lovelace during this time period. The implications of these results point primarily to the value of consciously designing and periodically monitoring the practice environment within medical groups.

Attitude of Health Personnel↗
PubMed1993

Critical factors in recruiting health maintenance organization physicians.

What factors facilitate successful physician recruiting by health care organizations? Answers surfaced in a study of physician recruiting by a large HMO in the Southwest. Professional networking and word-of-mouth advertising appear to be the prominent means by which physicians learn of attractive staff positions. Successful recruiting also depends on a practice setting that fosters quality care, emphasis on patient care delivery, and collegial interaction.

Employment↗
PubMed1975

Reversible nephrotoxicity associated with cephalothin therapy.

A 53-year-old man with scalp cellulitis developed acute renal failure after sodium cephalothin therapy. The patient probably had preexisting renal disease. Discontinuance of cephalothin was followed by improvement of the renal function. Specimens from a renal biopsy performed during the recovery phase showed nonspecific changes in the renal tubular epithelium, similar to those seen in animals treated with large doses of cephalothin. Previously reported cases of cephalothin nephrotoxicity, along with this case, caution the clinician to proceed with care in the treatment of azotemic patients with cephalothin.

Acute Kidney Injury↗
PubMedDate not supplied

Meet the mandate to measure clinical quality.

The mandate for health care organizations to be accountable for quality, as well as price, is now unavoidable. The Joint Commission's ORYX project is requiring every hospital to measure clinical outcomes of a majority of its patients within the next three years. This mandate can be met best with systems of clinical outcomes measurement that provide valid, reliable risk adjustment; yield meaningful information about many different diseases and procedures; and measure more than mortality or cost--all using primarily billing data. New outcomes measurement tools with all of these capabilities are available and have already enabled quality improvement in dozens of hospitals across the U.S.

Accreditation↗