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Biomedical subjects

J A Showstack

Publications and source records attributed to J A Showstack.

13 recordsLinked to original sources
PubMed1979

Frequency and clinical description of high-cost patients in 17 acute-care hospitals.

To assess the potential impact of national "catastrophic" health insurance on the medical-care system, the frequency and clinical characteristics of high-cost patients were surveyed at 17 acute-care hospitals in the San Francisco Bay Area. The percentage of patients whose yearly hospital charges exceeded $4000 in 1976 ranged from 4 at a community hospital to 24 at a referral hospital. Hospital costs charged to these patients ranged from 20 to 68 per cent of total billings, with the highest percentages generally occurring at large referral hospitals. Forty-seven per cent of adult high-cost patients had chronic medical conditions, and only one in six suffered from an acute medical "catastrophe." In addition, more than 13 per cent of high-cost patients died in the hospital. National catastrophic health insurance is likely to pay for much chronic illness and terminal care and divert resources toward acute-care hospitals.

Acute Disease↗
PubMed1978

Psychiatric follow-up studies. Practical procedures and ethical concerns.

The difficulties of performing prospective psychiatric follow-up studies have recently increased due to growing concern over the ethical issues involved. In a study to determine the efficacy of different lengths of psychiatric hospitalization 235 patients were followed for 2 years after study hospitalization. Data were obtained on more than 90 per cent of the patients. The cost of performing 100 follow-up interviews ranged from $9,169 for patients living within a 6-mile radius of the study site, to $17,942 for patients living within the contiguous United States. It is concluded that through persistent effort useful data can be obtained by follow-up of psychiatric patients, while maintaining ethical standards which include respect for the rights and wishes of the patient.

Aftercare↗
PubMed1978

Financial incentives to perform medical procedures and laboratory tests: illustrative models of office practice.

Financial return is one of several factors that may affect a physician's decision to order services for a patient. The extent of financial incentives to perform in-office medical procedures and laboratory tests is illustrated by four hypothetical models of general internal medicine office practice. The model practices consist of fixed ratios of history and physical examinations to return visits, with numbers and types of medical procedures and laboratory tests increasing stepwise through the four models. The procedures and tests included are an electrocardiogram, urinalysis, complete blood count, sigmoidoscopy, tuberculin skin test, two-view chest x-ray, cardiovascular treadmill stress test, and an automated 12-channel blood chemistry test. Charges and office expenses are estimated at 1977 Northern California levels. Net incomes derived for the four models are as follows: $31,000, $55,000; $60,000; and $90,000. The demonstrated financial incentives, which apply not only to internal medicine, but to all fields of medical care, are in conflict with policies that would emphasize personal rather than technical services. National health insurance proposals should include a continuing review of medical services valuation.

California↗
PubMed1977

Short vs long hospitalization: a prospective controlled study. VI Two-year follow-up results for schizophrenics.

A controlled, prospective study examined the relative effectiveness of short-term versus long-term psychiatric hospitalization. The results of a two-year follow-up of a sample of 141 schizophrenic patients are reported here. The differences favoring long-term subjects that were apparent at one year postadmission had decreased by two years postadmission. However, there appears to be an interaction between prehospital functioning and length of hospital stay, with subjects who had good prehospital functioning doing better at two years when assigned to long-term hospitalization. Subjects with poor prehospital functioning did about equally well, regardless of length of stay, and may even have showed some tendency to do better with a shorter hospital stay. This reversal of effect was more prominent for women, although this sex difference was not statistically significant.

Aftercare↗
PubMed1977

Short vs long hospitalization: a prospective controlled study. VII. Two-year follow-up results for nonschizophrenics.

A controlled, prospective study examined the relative effectiveness of short-term versus long-term psychiatric hospitalization. Results of a two-year follow-up of a sample of 74 nonschizophrenic subjects are reported here. Two years after admission there were no statistically reliable differences in functioning between short-term and long-term subjects with diagnoses of either affective disorders, or neurosis and personality disorders (including hysterical personality disorder). The findings reported do not support extended hospitalization for patients with these diagnoses. Caution regarding these findings is suggested by an anecdotal impression that short-term hospitalization may not have allowed for proper diagnosis and treatment for some persons in the affective disorder group.

Adult↗
PubMed1977

Hospital costs.

Explore the source record for details and available documents.

Boston↗
PubMed1976

Short vs long hospitalization. A controlled study: III. Inpatient results for nonschizophrenics.

A controlled, prospective, two-year follow-up study examined the relative effectiveness of short-term vs long-term psychiatric hospitalization. Results of the inpatient phase for a sample of 74 nonschizophrenic patients are reported here. About four weeks after admission the patients hospitalized for a short stay were discharged, and at that time were functioning better than the patients in the long-stay group. When the patients hospitalized for a long stay were discharged, three to fur months after admission, they were then functioning as well as, but not noticeably better than, the patients in the short-stay group had been at their earlier time of discharge. Patients with affective disorders were more impaired at admission and improved more than patients with other diagnoses, regardless of length of stay.

Adult↗
PubMed1976

Short versus long hospitalization: a propspective controlled study. IV. One-year follow-up results for schizophrenie patients.

The authors compared treatment results for 141 schizophrenic patients randomly assigned to short-term or long-term hospitalization. Test results indicated that the long-term group was functioning significantly better one year after admission according to global measures only. The authors caution that the differences between the two groups, although statistically reliable, were modest and may have been confounded by the amount of psychotherapy the patients received after hospitalization. Although there appears to be a general advantage to the long-term approach, further work will be needed to identify patient subgroups for whom this more expensive treatment is cost effective.

Aftercare↗
PubMed1976

Short versus long hospitalization: a prospective controlled study. V. One-year follow-up results for nonschizophrenie patients.

The authors studied the effect of long-term versus short-term hospitalization on a group of 74 patients with the diagnoses of affective disorder, neurosis and personality disorder, and hysterical personality one year after their admission to the hospital. Although they had found in an earlier study that short-term patients seemed to integrate more rapidly in the hospital, the results reported in this study showed no statistically reliable differences between the long-term and short-term groups. In contrast to the author's results for schizophrenic patients, their findings for nonschizophrenic patients do not support extended hospitalization.

Follow-Up Studies↗