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Biomedical subjects

D R Longo

Publications and source records attributed to D R Longo.

At least 37 records · Page 2Linked to original sources
PubMed1994

The measurement of community benefit: issues, options, and questions for further research.

Community benefit from a conceptual perspective can be traced to the philanthropic and humanitarian spirit that dominated the earliest foundations of the hospital as a social institution. However, the measurement of community benefit is a recent development and one rarely addressed in the literature in any detail. This article outlines the various concepts integral to community benefit measurement that must be taken into account for a program to demonstrate community accountability in an era where hospitals and health care institutions are increasingly required to evaluate and document their value to society. The perspective taken is that of a practicing health care executive. The use of the discussed concepts will assist health care executives and their staff in designing and evaluating programs, and will also assist academics in preparing students for this important professional responsibility.

Community Health Services↗
PubMed1994

The impact of outcomes measurement on the hospital-physician relationship.

Hospitals and physicians have a mutually dependent relationship. Although both are responsible for patient care, conflicts arise as physicians attempt to maintain professional autonomy and hospitals attempt to maintain organizational stability. In recent years the outcomes measurement movement has influenced this relationship in a variety of ways. This review chapter traces the major sociological, historical, theoretical, and political influences that have contributed to these conflicts. Additionally, based on an analysis of these trends, speculation is offered on the future of the hospital-physician relationship as society increasingly holds both groups responsible for outcomes of care.

Conflict, Psychological↗
PubMed1993

Patient practice variation. A call for research.

This article presents a theoretic framework, "patient practice variation," currently missing from the investigations of medical care variation. Resource utilization, immediate, and long-term outcomes may be better explained by including utilities under control of the patient into small area variation studies. This especially may be important in the area of prenatal and maternal care and certain chronic diseases, such as diabetes. The quality of care measures must incorporate patient satisfaction and quality of life in addition to more objective physiologic outcomes.

Health Services Research↗
PubMed1990

Profile of hospital governance: a report from the nation's hospitals.

During the 1980s, hospital governing boards struggled to solve a host of new and difficult problems while attempting to meet the needs of their communities. As we enter the last decade of the 20th century, different challenges lie ahead. To meet these challenges, hospital boards must first understand their various responsibilities. The results of this survey will provide a starting point to understand how hospitals are currently dealing with issues such as governing board composition and organization, board/CEO relations, and governing board operations. (Future articles in Trustee will focus on individual aspects of the survey.) In so doing, readers may begin to unlock the key to increased effectiveness.

Data Collection↗
PubMed1990

Application of severity measurement systems for hospital quality measurement.

As hospitals increasingly emphasize efforts to measure and improve quality of care, the related issue of severity measurement emerges as a topic of strong interest. Severity measures can support hospital quality management in at least two areas: selection of medical records for individual case review and monitoring of patterns of care including analysis of rates of adverse outcomes. Some systems currently available for measuring the severity of general medical and surgical admissions in acute care hospitals base severity scores on data available in computerized discharge abstracts, while others use detailed clinical data abstracted directly from patient medical records. One is based on both detailed medical record data and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes. This article discusses issues important to the definition and measurement of patient severity and examines the strengths and limitations of specific systems and their potential contributions to quality management.

Acute Disease↗
PubMed1988

Extent of DNR policies varies across healthcare settings.

A cross-section random survey of acute care hospitals, psychiatric hospitals, long-term care facilities, and hospices was conducted in 1986 to determine the extent of use, the nature, and the implementation of do-not-resuscitate (DNR) policies. Data also were collected to identify the common problems of implementing DNR policies, as well as how conflicts in the use of DNR orders are resolved. The survey found that 30.7 percent of healthcare organizations have a formal policy, 28 percent have an informal policy, and 41.3 percent have no policy. Formal policies were found in 56.9 percent of acute care and 42.9 percent of hospice care settings, compared with 11.4 percent in psychiatric and 20.1 percent in long-term care settings. Although predictors varied across the four settings studied, formal policies were associated with larger organizations, the use of consultation, accreditation by the Joint Commission on Accreditation of Healthcare Organizations, and the presence of an ethics committee. The recognition of a living will plays a small role in the presence of a formal DNR policy. Given the growing concern of the American public and healthcare organizations over DNR orders, the implications of this study call for careful attention to DNR and related medical and ethical issues and the establishment of policies that clearly delineate when, how, and with whom such issues are discussed and resolved.

Cross-Sectional Studies↗
PubMed1984

Structural determinants of hospital closure.

In a retrospective case-control study, structural characteristics of hospitals that closed during the years 1976-1980 were contrasted with three comparison groups: hospitals that were acquired in a merger; hospitals that joined a multihospital system; and hospitals that remained autonomously opened, to investigate these characteristics as predictors of closure. Characteristics investigated included environmental, structural, and process variables. The independent variables were measured 5 years prior to outcome. Findings indicate that closed hospitals resemble hospitals acquired in a merger ("failure"), and likewise autonomous hospitals resemble hospitals that join a multihospital system ("success"). The most important predictors of hospital failure were the physician-to-population ratio, the East North Central and West North Central census regions, the level of diversification, low occupancy rate, location in a standard metropolitan statistical area, the chief executive officer's lack of affiliation in the American College of Hospital Administrators, profit status, bed size of less than 50, and presence in a state with a rate-setting agency. Surprisingly, this study shows the bed-to-population ratio to be unrelated to closure. In addition, the findings strongly support the open-system perspective, which, unlike the closed-system perspective, is concerned with the vulnerability of the organization to the uncontrollable and often unpredictable influences of the environment.

Bed Occupancy↗