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Biomedical subjects

I G Fiedler

Publications and source records attributed to I G Fiedler.

7 recordsLinked to original sources
PubMed1999

Economics of managed care in spinal cord injury.

OBJECTIVE: To determine and describe trends in economic variables related to the care of individuals with spinal cord injury (SCI) and significant changes in these trends coincident with major developments in medical care cost control. DATA SOURCES: Data from the National Spinal Cord Injury Statistical Center (NSCISC) database were used to review the economic trends in SCI management from 1973 to 1998 and their relation to managed care and other health care cost-containment measures. A panel of SCI health care specialists was interviewed to determine the appropriate data variables to be reviewed. The Shepherd Center Care Health Management Program, Atlanta, GA, is presented as an example of a fiscally successful managed care program for patients with SCI. DATA EXTRACTION: Data from the NSCISC database for the years studied were extracted and converted to a form suitable for analysis by means of the statistical software SAS. DATA SYNTHESIS: Statistical techniques included multiple regression analysis, logistic regression analysis, and model selection methods. CONCLUSIONS: Trends in economic variables, in the care of individuals with SCI show changes coincident with the introduction of Diagnostic Related Groups (DRGs) and managed care as models for provider reimbursement. Significant changes occurred in acute care charges, rehabilitation charges, length of stay, rehospitalization 1 year postinjury, time from injury to admission to a Model System, and discharges to a nursing home.

Cost Control↗
PubMed1993

Specificity of ICD-9-CM coding practices for stroke rehabilitation.

Designed for acute care classification, the 9th version of the International Classification of Disease, Clinical Modification (ICD-9-CM) is also used to describe the principal diagnosis in medical rehabilitation. ICD-9-CM (ICD-9) coding practices for all stroke cases found in two nationally representative databases were examined (sample sizes over 17,000 and over 2,000). Of the more than 100 codes selected, four were indicated for 67% and 72% of stroke cases in the two data sets, respectively. Codes 436 and 438 distinguish acute from late stroke effects; whereas code 434.9 identifies stroke, but not its duration. The most frequently used code in the larger database, 342.9, refers to the manifestation of hemiplegia rather than to diagnosis, and thus is not specific to stroke. Other less frequently selected ICD-9 codes are more specific to the underlying pathophysiology (e.g., thrombosis, embolus or hemorrhage). Results emphasize the need for more precise selection of etiologic ICD-9 codes for stroke rehabilitation so that they describe specific pathology.

Cerebrovascular Disorders↗
PubMed1991

A recruitment model for selecting residents.

The process of selecting residents is an important issue in medical training. In an attempt to quantify and thereby objectify this process, a model for selection was developed. The model, using scaled scores reflective of each of the applicants' characteristics, was used to rank applicants in the Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin, Milwaukee. Data derived from the selection process were analyzed over a three-year period, 1986-1989. Statistical analysis of the data showed that as few as three experienced faculty members were needed to interview reliably. The statistically significant correlation (p less than .01) between those who interviewed and those who did not interview was necessarily influenced by the fact that those who did not interview had access to the narrative descriptors of those who did. These findings suggest that the use of this recruitment model would permit a more cost-effective approach to the selection of residents.

Cost-Benefit Analysis↗
PubMed1988

Continuity of care. A teaching model.

Recent changes in health care mandate innovative approaches to teaching. Rehabilitation as part of the continuum of disability motivated the "continuity of care model." This model permits the presentation of rehabilitation in its global sense: from onset of injury through re-integration into the community. This report describes a curriculum for physical medicine and rehabilitation residents that comprises a three-phase approach to rehabilitation: acute care, inpatient rehabilitation and community re-entry. The curriculum is adaptable for medical students. A secondary benefit of the project for the resident is a better understanding of relevant cost benefit/cost effective concepts in the delivery of quality services. The close interaction of residents with community agencies permits these agencies to gain a better understanding of the medical needs of disabled people.

Adult↗
PubMedDate not supplied

Integration of physical medicine and rehabilitation into the undergraduate medical curriculum. The Undergraduate Education Committee of the Association of Academic Physiatrists Workgroup.

The incorporation of PM&R into the medical student curriculum thus provides benefits at multiple levels: to patients, to medical students, and to practitioners already in the field. The knowledge about PM&R gained by the medical student is spread to disciplines outside of PM&R through the learning of principles and specific factual data that can be applicable for practitioners caring for a variety of patients. It is the position of this organization that each academic department work to integrate education in PM&R into the medical school curriculum.

Curriculum↗