Diagnosis-related groups, route of admission, age and outcome for general surgical patients.
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Adolescent↗
Biomedical subjects
E Muñoz
Publications and source records attributed to E Muñoz.
[Treatment of chronic renal failure: effects of a supplemented diet with essential amino acids].
We evaluated the results of essential amino acids supplementation added to a protein restricted diet (0.6 g/kg/day) in patients with advanced renal failure (creatinine clearance under 20 ml/min). A diet containing food with high biologic value was used as control. Diets were tested during 7 months. Anthropometric and nutritional (serum albumin and transferrin) values were normal in both groups both at the beginning and at the end of the treatment period. A slight increase in weight in the natural diet group and in serum phosphorus level in the amino acid supplemented group was observed. Two patients in each group required chronic dialysis, renal function remaining stable in the rest. We conclude that both forms of diet supplementation were effective in preserving nutritional status possibly in delaying deterioration of renal function in patients with advanced renal failure.
Amino Acids, Essential↗
[Crohn disease metastatic to the skin].
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Aged↗
[Acquired bullous epidermolysis and multiple myeloma].
A case of epidermolysis bullosa acquisita (EBA) with negative direct immunofluorescence and multiple myeloma is reported. Epidermolysis bullosa acquisita has been associated with several systemic diseases, but only three cases diagnosed of EBA have been associated with multiple myeloma in the literature.
Epidermolysis Bullosa Acquisita↗
Diagnosis related group 'all payor' hospital payment and medical diseases. Financial risk and hospital cost in medical noncomplicating condition-stratified diagnosis related groups.
There are many health policy issues related to diagnosis-related group (DRG) hospital payment. Previous work by our group had suggested that some DRGs did not adequately comorbidities. Despite recommendations by federal advisory committees, the secretary of Health and Human Services has proposed no major changes to DRGs along these lines. We analyze resource consumption in any of the 88 non-complicating condition (CC)-stratified medical DRGs using the DRG prospective "all payor system" in effect at our hospital. Analysis of 12,340 medical patients by payor (Medicare, Medicaid, Blue Cross, and commercial insurance) in these non-CC-stratified medical DRGs for a three-year period demonstrated that patients with more CCs per DRG for each payor generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, higher financial risk under DRG payment, and a higher mortality, compared with patients in these same DRGs with fewer CCs. These findings suggest that new prospective DRG all payor systems may be inequitable to certain groups of patients or types of hospitals vis-à-vis the non-CC-stratified medical DRGs. Health policy leaders should be encouraged to stratify many medical DRGs by the numbers and types of CCs to more equitably reimburse hospitals under DRG all payor systems.
Costs and Cost Analysis↗
Age, resource consumption, and outcome for medical patients at an academic medical center.
At the national level debate is growing about the effects of the diagnosis related group (DRG) hospital payment system on patient access and quality of care. Recent changes to the DRG system have dropped any stratification by age and have delayed any other major change to improve payment equity. We characterized hospital resource consumption and outcome by age for all medical admissions (N = 31,838) to a large academic medical center (January 1, 1985, through December 31, 1987) using the DRG format. Mean hospital cost per patient, hospital length of stay, percentage of outliers, and mortality increased with age. The mean DRG case-mix index and the number of diagnostic codes per patient also rose with age. The DRG payment for all patients would have produced an aggregate profit of $34,426,951 ($1081 profit per patient); however, patients aged 71 years or older generated loses (the highest with patients aged 85 years or older--a $2177 loss per patient). As the financial position of American hospitals continues to deteriorate, these data suggest that the current DRG payment scheme may be inequitable for the medical patient aged 71 years or older, thus providing financial disincentives to treat the elderly medical patient and perhaps limiting their access and quality of care in the future.
Academic Medical Centers↗
Hospital resource consumption and outcome. Route of admission and age for hospitalized otolaryngology patients.
Hospitals and physicians face new payment mechanisms that provide incentives to study health policy, management, and economics. The purpose of this study was to analyze hospital resource consumption and outcome based on age and the route of hospital admission (emergency [ER] vs nonemergency [non-ER]). We analyzed all adult otolaryngology hospital admissions (N = 1589) during a three-year period (1985 through 1987) to a large northeastern academic medical center. Hospital resource consumption, measured by hospital length of stay and total hospital cost per patient, rose with age for ER and non-ER admissions. Severity of illness, clinical resource utilization, and mortality demonstrated these same characteristics. Diagnosis related group prospective hospital payment generated financial risk for ER admissions and elderly patients. Analysis demonstrated ER admission as more predictive of subsequent hospital resource consumption and outcome with changes in age compared with non-ER admission. Our findings suggest that in the future physicians and hospitals may find that age and the route of admission may be useful in stratifying patients regarding cost and outcome.
Academic Medical Centers↗
Hospital costs, cancer patients, and surgical diagnostic related groups.
This study of 4,359 Medicare patients in 107 noncancer stratified surgical Diagnostic Related Groups (DRGs) tested the hypothesis that patients with a diagnosis of a malignancy (i.e., cancer) in these DRGs would have higher resource utilization than patients without a diagnosis of a malignancy (i.e., noncancer) in these same surgical DRGs. The 1,008 cancer patients had 3.2 times the financial loss ($1,617 per patient vs. $510 per patient) compared to the 3,351 noncancer patients (P less than .05). Patients with cancer had a greater percentage of outliers, more diagnosis (P less than .0001) and procedures (P less than .0001) per patient, and a higher mortality (P less than .01) than patients without cancer. These findings raise the question of the equity of DRG payment for patients with cancer in many surgical DRGs. Financial disincentives to treat certain groups of Medicare cancer patients at our hospital may affect both their access and quality of care in the future.
Aged↗
Utilization and outcome in the medical patient referred to surgery.
The objective of this study was to test the hypothesis that hospitalized patients referred to a general surgical service from a medical service for a surgical procedure would have higher hospital costs and longer lengths of stay per diagnosis-related group (DRG) than patients admitted directly to the general surgical service. Hospital costs by DRG, exclusive of physician's fees, were analyzed for all adult general surgical admissions treated at our hospital from January 1, 1985 to March 31, 1986 (3,028 patients) to yield a population of patients in those DRGs with patients referred to general surgery from medicine (1,495 patients). Patients within each DRG were then disaggregated by either direct admission to general surgery (1,412 patients) or referral to the general surgical service from the medical service (83 patients). Mean cost per patient was 146.5 percent higher for referral patients than for direct admission patients, as was the total length of stay. Mortality was higher for referral patients than for direct admission patients. Factors analyzed which contributed to this greater resource utilization and higher mortality were (1) a greater severity of illness, (2) higher diagnostic costs, and (3) delays in diagnosis or treatment. The DRG payment for referral patients also produced a substantial deficit for the hospital, whereas direct admission patients produced a profit of +1,105,596. This data suggests that direct admission to the surgical service of patients likely to need surgery might lower their hospital costs and improve the quality of their care.
Diagnosis-Related Groups↗
Hospital costs and resource characteristics for cardiothoracic surgical hospital deaths.
No major changes in the federal Medicare diagnostic-related group (DRG) prospective hospital payment system have been implemented by the United States Congress. We analyzed hospital resource consumption for 1,567 cardiothoracic surgical patients by outcome (ie, survivors versus nonsurvivors). The 76 patients who died had a much greater intensity of hospital resource utilization and represented a substantial financial risk under DRG pricing schemes compared with the 1,491 survivors. Only patients who died within 1 week of admission to the hospital generated a financial surplus under DRGs. A long hospital stay for nonsurvivors produced a substantial deficit (patients with a stay greater than 60 days generated a $154,433 loss per patient). The cardiothoracic patients admitted on an emergency basis who died tended to have a shorter length of stay and represented a lower financial risk under DRGs compared with patients admitted on a nonemergency basis who died. Among nonsurvivors, patients referred for cardiothoracic surgical procedures from other clinical services had lower resource utilization and financial risk under DRGs compared with nonreferrals. These data suggest significant inequities in the current DRG prospective payment system vis-à-vis cardiothoracic surgical patients who die. Variables predictive of greater hospital resource utilization by outcome included a longer hospital stay, nonemergency admission, and admission directly to the cardiothoracic surgical service. Methods to improve the equity of DRG payment vis-à-vis cardiothoracic surgical nonsurvivors should be implemented in the future.
Adolescent↗
Financial risk and hospital cost for elderly patients in non-age stratified urology DRGs.
The Diagnostic Related Group (DRG) hospital payment system may be inequitable for certain groups of Medicare patients. This study of 216 Medicare urology patients in the ten non-age stratified urology DRGs demonstrated that patients seventy years of age and older (70+) had higher resource consumption than patients under seventy years of age (70-). Findings were: (1) older patients (70+) had higher total hospital costs (+12,022 per patient) than younger patients (70-) (+9,872 per patient); (2) a longer hospital length of stay (14.2 days vs 11.6 days); (3) financial risk of +1,756 loss per (70+) patient vs +1,309 profit per (70-) patient (p less than 0.05); (4) more diagnoses and procedures per patient, and (5) a higher mortality (4.0% vs 3.3%). These findings suggest that the current DRG scheme may be inequitable vis-a-vis the older urology patient in non-age stratified DRGs, and thus could limit access and quality of care for these patients in the future.
Age Factors↗
Hospital costs, cancer patients, and gynecology diagnostic related groups.
This study of 115 Medicare gynecology patients in five noncancer-designated gynecology diagnostic related groups (DRGs) demonstrated that patients with a diagnosis of a malignancy (N = 52) had significantly higher hospital resource utilization compared to patients without a malignancy (N = 63) in these gynecology DRGs. Cancer patients had higher total hospital costs (P less than 0.001), longer hospital length of stay (P less than 0.01), significant financial losses under DRGs (P less than 0.01), greater percentage of outliers (P less than 0.05), greater severity of illness, and greater mortality (P less than 0.001) compared to noncancer patients in these same gynecology DRGs. These findings raise the question of whether hospitals will be adequately reimbursed by DRGs for many gynecology cancer patients. Disincentives for hospitals to treat gynecology cancer patients under the current DRG reimbursement system may affect both the access to and the quality of care.
Aged↗
Cyclic and linear sweep voltammetry of cefazolin and cefmetazole: electroanalytical applications.
A study of the variables influencing the voltammetric behaviour of cephalosporins and cefamycins bearing substituents of the S-R' type (R' = non-electroactive group) has been carried out in order to determine the most suitable conditions for obtaining reproducible peaks for the determination of both types of antibiotic and the calculation of kinetic and thermodynamic parameters. The voltammetric behaviour of cefazolin and cefmetazole has also been studied. The voltammetric peak yielded by these two antibiotics at high sweep rates and low concentrations is due solely to the reduction of adsorbed molecules as the contribution of those molecules moving to the electrode through diffusion to the current is negligible. The peak current of cefazolin varies linearly with its concentration in the range 10(-9)-10(-7) M, whereas the linear range for cefmetazole is between 10(-8) and 5 X 10(-7) M, which allows the electroanalytical determination of the two antibiotics at these concentrations.
Cefazolin↗
Control of lymphokine expression in T helper 2 cells.
In this report we present evidence that Con A-activated T helper 2 cells transcribe the interleukin 2 (IL-2) gene when cycloheximide is added 3 hr after stimulation. This IL-2 mRNA can be translated into functional protein. However, no steady-state mRNA for gamma-interferon can be detected under the same experimental conditions. Furthermore, when cycloheximide is administered at time 0 of activation, no IL-2 mRNA is seen. Nuclear run-on experiments indicate that IL-2 transcription in T helper 2 cells depends on the presence of cycloheximide. It is likely, therefore, that activation of T helper 2 cells leads to the production of a labile regulatory protein that represses the expression of the IL-2 gene. These findings provide insight into the molecular mechanism that governs the differentiation of interleukin 4-producing T helper 2 cells from IL-2-producing precursor cells.
Animals↗
Gastroenterology, diagnosis-related groups, and age.
Hospitals are now being reimbursed by a prospective Diagnosis-Related Group (DRG) classification system. There have been no major changes in the Federal Medicare DRG classification system since its inception 5 years ago. In this project, we analyzed all gastrointestinal (GI) medicine admissions by age and resource utilization at a large academic medical center. Total hospital costs for the 3,598 GI patients (January 1, 1985, through December 31, 1987) were $18,460,604. Although DRG reimbursement for all patients for the 3-year period would have generated an aggregate profit of $957,760, four out of five age categories of patients 65 years of age and above would have generated losses; the highest loss was for patients 85 years and over, at $2,235 per patient. Older GI patients (i.e., 65 years and over) had higher hospital costs, longer lengths of stay, more diagnoses and procedures per patient, and a higher mortality rate than younger patients. Both intensive care unit (ICU) and blood utilization rose with age. Thus, older GI patients consumed a disproportionately larger share of hospital resources. Our study suggests that the current DRG reimbursement scheme may be inequitable relative to the older GI medicine patient; financial disincentives from DRGs may affect elderly patients' access to and quality of care in the future.
Academic Medical Centers↗
Hospital costs, use of resources, and dynamics of death associated with diabetes mellitus.
The federal Medicare DRG (diagnosis-related group) system is entering its sixth year. The hospital industry contends that DRGs are under-reimbursing for the hospital care provided. Our analysis by outcome (ie, survival vs death) of 3,329 patients with insulin-dependent or non-insulin-dependent diabetes mellitus showed that the 242 diabetes-related deaths were associated with a much more intense use of hospital resources and a substantial financial risk under DRG pricing schemes, compared with the 3,087 diabetic survivors. Only deaths within one week of admission to the hospital were profitable under DRGs. Patients who died after a hospital stay of more than 60 days generated a loss of $28,377 per patient. Diabetic patients who died after emergency admission tended to have a shorter hospitalization and to pose less financial risk under DRGs than those who died after nonemergency admission. Those who died after referral from other clinical services tended to have greater use of resources and to pose greater financial risk under DRGs than those not referred. These data suggest significant inequities in the current Medicare DRG prospective payment system vis-à-vis deaths from diabetes. Long hospitalization, nonemergency admission, and referral from another clinical service were shown to be good predictors of greater use of hospital resources for diabetic patients who died. However, since hospitals are not compensated for the increased utilization, diabetic patients may suffer a decline in quality of and/or access to medical care in the future.
Adolescent↗
Health care financing policy for hospitalized pulmonary medicine patients.
Several federal bodies provide ongoing analyses of the Medicare DRG prospective hospital payment system. Many states are using DRG prospective "all payor systems" for hospital reimbursement (based on the federal model). In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers pay by the DRG mode; New York State has been All Payor since 1/1/88. This study simulated DRG All Payor methods on a large sample (n = 1,662) of pulmonary medicine patients for a two-year period using both federal and New York DRG reimbursement now in effect at our hospital. Medicare patients had (on average) a longer hospital length of stay and total hospital cost compared to patients from Medicaid, Blue Cross, and other commercial payors. Medicare patients also had a greater severity of illness compared to patients from Blue Cross Medicaid or other payors. All payors, however, (Medicaid, Blue Cross, Medicare and commercial insurers) generated significant financial risk under the DRG All Payor scheme. These data suggest that federal, state, and private payors may be underreimbursing for the care of the hospitalized pulmonary medicine patients using the DRG prospective hospital payment scheme. Health care financing policy, as demonstrated in this study, may limit both the access and quality of care for many pulmonary medicine patients in the future.
Aged↗
Hospital costs, resource characteristics, and the dynamics of death for surgical patients.
This article details data that suggest significant inequities in the current DRG prospective payment system vis-à-vis surgical mortalities. Important health policy issues, in addition to the ability of outcome data to function as a proxy for quality, involve the usefulness of stratifying DRGs vis-à-vis outcome or severity of illness in the future. Much interest has emerged in outcome data--especially with regard to its ability to function as a risk-adjusted quality-of-care screen for hospitals. A study of hospital resource consumption comparing survivors and mortalities demonstrated that surgical mortalities had a much greater intensity of hospital resource utilization and a substantial financial risk under Medicare's DRG prospective payment pricing system, as compared to surgical survivors. Hospital length of stay for mortalities proved very unprofitable. Emergency-admitted patients who died tended to have shorter hospital stays and less financial risk under DRGs than nonemergency mortalities. Mortalities referred to surgery from other clinical services tended to have greater resource utilization and financial risk under DRGs than nonreferred mortalities.
Adult↗