PubMed Health⌕ Search

Biomedical subjects

I Wickings

Publications and source records attributed to I Wickings.

9 recordsLinked to original sources
PubMed1994

Comparative hospital databases: value for management and quality.

OBJECTIVES: To establish an accurate and reliable comparative database of discharge abstracts and to appraise its value for assessments of quality of care. DESIGN: Retrospective review of case notes by trained research abstractors and comparison with matched information as routinely collected by the hospitals' own information systems. SETTING: Three district general hospitals and two major London teaching hospitals. PATIENTS: The database included 3905 medical and surgical cases and 2082 obstetric cases from 1990 and 1991. MAIN MEASURES: Accessibility of case notes; measures of reliability between reviewers and of validity of case note content; application of high level quality indicators. RESULTS: The existing hospital systems extracted insufficient detail from case notes to conduct clinical comparative analyses for medical and surgical cases. The research abstractors at least doubled the diagnostic codes extracted. Interabstractor agreement of about 70% was obtained for primary diagnosis and assignment to diagnosis related group. These data were sufficient to create a comparative database and apply high level quality indicators designed to flag topics for further study. For obstetric-specific indicators the rates were comparable for abstractors and the hospital information systems, which in each case was a departmentally based system (SMMIS) producing more detailed and accessible data. CONCLUSIONS: Current methods of extracting and coding diagnostic and procedural data from case notes in this sample of hospitals is unsatisfactory: notes were difficult to access and recording is unacceptably incomplete. IMPLICATIONS: Improvements as piloted in this project, are readily available should the NHS, hospital managers, and clinicians see the value of these data in their clinical and managerial activities.

Data Collection↗
PubMed1987

Combining clinical budgets and DRGs for quality management.

Global and clinical budgets are being introduced in the U.K. as elsewhere to control health care costs. They are in fact showing effectiveness in terms of cost-control. They do not, however, adequately address outcomes and quality of care. DRGs could be used as a tool for associating costs with outcome and quality measures. If constructed carefully, the categorization through DRGs could give health system managers information about which prices for treatments can be reduced without affecting quality standards but can also provide a warning when lower prices begin to be associated with deterioration of outcomes.

Budgets↗
PubMed1984

Is there a general theory for health care budgeting?

This article suggests that a broad theoretical framework is needed within which the empirical evidence about the results of the many different health care funding systems can be analysed. A possible framework is described. The article also proposes that when policy makers select the budgetary system most likely to produce the patterns of health care that are required they should also install output and quality controls designed to avoid any predictable and undesirable side effects. Reimbursement under the budget could be made conditional upon an adequate performance as measured by the controls.

Budgets↗