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Biomedical subjects

H S Ruchlin

Publications and source records attributed to H S Ruchlin.

At least 19 recordsLinked to original sources
PubMed1991

Impact of work on the quality of life of community-residing young elderly.

Using a random sample of 310 Massachusetts community-residing elderly between the ages of 65 and 74, this study investigates the relationship between employment status and quality of life using a modified version of the Spitzer Uniscale QL index. The odds of reporting the highest quality of life rating, after controlling for socioeconomic and health characteristics, was 3.51:1 for those who worked versus those who did not do so.

Aged↗
PubMed1988

Cost-effectiveness of extracorporeal shock-wave lithotripsy.

A study was done comparing the charges and outcomes for extracorporeal shock-wave lithotripsy (ESWL) with those for percutaneous nephrostolithotomy (PCN), which was the treatment of choice at our hospital for stones of the upper urinary tract when ESWL was introduced. Using a retrospective cohort design, patients were matched for age, sex, physical status index (American Society of Anesthesiologists), stone size, and urinary tract obstruction. Twenty-nine pairs of PCN and ESWL patients with complete data were matched. The groups were not significantly different in the matching parameters. Seventy-two per cent of patients in each group (21/29) were stone-free after the initial hospitalization. PCN patients required more auxiliary procedures per patient than did the ESWL patients; in addition, 5 (17%) of the PCN patients had perforation of the renal pelvis and 5 (17%) required transfusions. On discharge, 48 per cent (14/29) of the PCN patients had nephrostomies compared with none of the ESWL patients. The ESWL group had a shorter mean length of stay (2.9 vs 8.7 days, p less than 0.0005) and lower charges in all categories. Total charges were significantly less for ESWL ($9,290 vs $11,796 for PCN, p less than 0.005) as were physicians' fees ($3,391 vs $5,607, p less than 0.0005), room and board charges ($825 vs $2,164, p less than 0.0005), and operating room fees ($313 vs $1,452, p less than 0.0005). We conclude that ESWL is a cost-effective means for treating stones of the kidney and upper urinary tract.

Cost-Benefit Analysis↗
PubMed1986

Alternative paths to long-term care: nursing home, geriatric day hospital, senior center, and domiciliary care options.

This paper examines certain quality of life outcomes, as well as comparative costs of care, for selected types of persons entering three very distinct types of alternative service programs that address the long-term care needs of vulnerable elderly persons: nursing homes (NH), geriatric day hospitals (GDH), and senior center (SC) programs. For selected outcomes, based on secondary analysis of the data gathered in another study, it was possible to add to the comparison samples of similar types of persons entering small foster-type domiciliary care homes (DC). From pools of persons entering these programs, six separate sets of comparison samples who were similar at baseline were constructed (GDH-SC, NH-SC, NH-GDH, NH-DC, SC-DC, GDH-DC). Only analyses pertaining to institutionalization and costs were conducted for the last three sets of comparison groups. Except for the issue of institutionalization, quality of life impact analysis showed only a few more post-test differences than would be expected by chance (although the few post-test differences that were observed in each case favored less restrictive settings). This more general similarity of outcome is indeed provocative, suggesting that in many ways the applicants adapted similarly to these quite distinct programs. Cost analyses found that nursing home and geriatric day hospital care, the two most restrictive settings, were also the two most expensive interventions.

Activities of Daily Living↗
PubMed1985

A gerontology internship program for medical students.

Although the aged are the country's major users of medical care and social services, traditional medical school curricula devote little time to the aged and their social needs. This article reports on a community-based gerontology internship established for pre-clinical medical students to sensitize them to the needs of the elderly in the community. Students were assigned to community agencies servicing the elderly; working with elderly clients, they learned about needs and services. Students, agency staff and program faculty found the internship a meaningful, consciousness-raising experience, and an excellent vehicle for preparing future physicians to interact with and care for their aged patients.

Aged↗
PubMed1977

A new strategy for regulating long-term care facilities.

This study analyzes the failure of current regulatory efforts to elicit an acceptable level of performance in long-term care facilities and proposes a strategy for correcting that failure. Seven factors are identified as being responsible for the failure of current regulatory efforts: inadequate financing, inadequate knowledge, bureaucratic apathy, legal constraints, political constraints, a fragmentation of agency responsibility, and a shortage of conforming beds. Public utility status, market regulation, and non-profit control are reviewed and rejected as alternatives to the current approach. A new strategy aimed at improving the regulatory process and environment is proposed. The process can be improved by adopting a program rather than taking a functional approach to agency organization; linking the inspection and rate-setting processes; creating a role for consumer groups in the inspection process; and exposing the process and results of regulation to public scrutiny. Five proposals are offered for improving the regulatory environment. These focus on eliminating barriers to entry, supporting alternatives to institutionalization, federalizing the Medicaid program, abandoning exclusive reliance on the medical model as the guide for regulatory standards, and changing the focus of regulation from structure-process to out-come.

Community Participation↗
PubMed1975

The long-term care marketplace: an analysis of deficiencies and potential reform by means of incentive reimbursement.

This study analyzes the institutional, economic, and regulatory deficiencies of the long-term care sector of the health industry and develops an incentive reimbursement model as a means for correcting or ameliorating some of the stated deficiencies. The reimbursement model presents a schema which attempts to match patients to facilities, needs to services, and services to cost. A capital expansion coupon program is proposed, both as a suitable vehicle for channeling incentive rewards accruing to nonprofit institutions, and as a mechanism for subsidizing the approved expansion and/or renovation plans of "efficient" providers of care.

Community Participation↗