Biomedical subjects

J F Burgess

Publications and source records attributed to J F Burgess.

7 recordsLinked to original sources

PubMed2000

Medical profiling: improving standards and risk adjustments using hierarchical models.

The conclusions from a profile analysis to identify performance extremes can be affected substantially by the standards and statistical methods used and by the adequacy of risk adjustment. Medically meaningful standards are proposed to replace common statistical standards. Hierarchical regression methods can handle several levels of random variation, make risk adjustments for the providers' case-mix differences, and address the proposed standards. These methods determine probabilities needed to make meaningful profiles of medical units based on standards set by all appropriate parties.

Hospitals, Veterans↗

PubMed2000

Performance status of health care facilities changes with risk adjustment of HbA1c.

OBJECTIVE: To develop a risk adjustment method for HbA1c, based solely on administrative data and to determine the extent to which risk-adjusted HbA1c changes the identification of high- or low-performing medical facilities. RESEARCH DESIGN AND METHODS: Through use of pharmacy records, 204,472 diabetic patients were identified for federal fiscal year 1996 (FY96). Complete information (HbA1c levels, demographic data, inpatient records, outpatient pharmacy utilization records) was available on 38,173 predominantly male patients from 48 Veterans Health Administration (VHA) medical facilities. Hierarchical mixed-effects models were used to estimate risk-adjusted unique facility-level HbA1c. RESULTS: Predicted HbA1c demonstrated expected patterns for major factors known to influence glycemic control. Poorer glycemic control was seen in minorities and patients with greater disease severity, longer duration of disease (using treatment type or presence of amputation as surrogates), and more extensive comorbidity (measured by an adapted Charlson index). Better glycemic control was seen in Caucasians, older diabetic patients, and patients with higher outpatient utilization. The number of performance outliers was reduced as a result of risk adjustment. For mean HbA1c levels, 7 facilities that were initially identified as statistically significant outliers were no longer outliers after risk adjustment. For high-risk HbA1c (>9.5%) rates, 12 facilities that were initially identified as statistically significant outliers were no longer outliers after risk adjustment. CONCLUSIONS: Risk adjustment using only administrative data resulted in substantial changes in identification of high or low performers compared with non-risk-adjusted HbA1c. Although our findings are exploratory, risk adjustment using administrative data may be a necessary and achievable step in quality assessment of diabetes care measured by rates of high-risk HbA1c (>9.5%).

Adult↗

PubMed1999

On measuring the hospital cost/quality trade-off.

This paper explores the relationship between cost and quality of hospital care. A total operating cost function is estimated for 137 US Department of Veterans Affairs hospitals for 1988-1993 using three rate-based measures of quality as regressors. The high likelihood of the existence of measurement error in quality in the cross section leads to the application of novel instrumental variable techniques. Results suggest that mortality and readmission indices are adjusted inadequately for illness severity. The measure on the failure to follow up inpatient discharges with outpatient care, however, appears to increase cost. The results of this paper underscore a number of practical difficulties and challenges facing government or other systems in evaluating the relative performance of their hospitals.

Cost Control↗

PubMed1995

Hospital staffing adjustments under global budgeting.

The U.S. Department of Veterans Affairs operates a hospital system that distributes a national global budget to 159 hospital units. Over recent years, cost containment and downward budgetary pressures have affected hospital performance and the quality of care delivered in unknown ways. This article examines hospital staffing levels as potential performance measures. We first develop a regression model to estimate the number and types of clinical staff required to meet current inpatient workloads at VA medical centers. We are able to improve on previous analyses by employing better data on physicians and by evaluating the behavior of hospitals in consecutive years. Our findings provide managers of hospital systems with promising new approaches for comparing hospital production processes and more information on the effects of global budgeting on individual hospital staffing within systems.

Budgets↗

PubMed1994

The effect of distance to VA facilities on the choice and level of utilization of VA outpatient services.

The 1987 survey of Veterans is used to explain the effects of distance to VA facilities on the choice and level of utilization of VA outpatient services by U.S. veterans. A two part discrete/continuous model is used to separate two elements of the decision to seek outpatient services from federally operated VA facilities. First, a discrete choice is made to seek care from the VA. Second, a continuous choice is made to seek a particular level of utilization. Distance is found to affect the initial discrete choice significantly for measured distances up to 60 miles at a decreasing rate. Once some VA outpatient contact is made, distance is a major factor only for the elderly in determining the amount of utilization. Disturbingly, elderly veteran users living more than 30-40 miles from the nearest VA are expected to make fewer visits in a year than younger veterans.

Aged↗

PubMed1991

Federal provision of health care: creating access for the underinsured.

Access to health care for the underinsured in America is a major current policy issue. Federal provision of health care has not been evaluated seriously as part of the solution to the problem despite the presence of federal health care provided to veterans, the class of Americans most completely guaranteed universal access. We first explore the arguments for and against universal access, clarifying issues but yielding no definitive solution. Then the federal health care system for veterans is used as a model for exploring problems that must be solved in a universal access plan. The discussion focuses on the effects of competition for patients and health care resources on costs, innovation, regulation, and quality.

Evaluation Studies as Topic↗

PubMedDate not supplied

Teaching and hospital production: the use of regression estimates.

Medicare's Prospective Payment System pays U.S. teaching hospitals for the indirect costs of medical education based on a regression coefficient in a cost function. In regression studies using health care data, it is common for explanatory variables to be measured imperfectly, yet the potential for measurement error is often ignored. In this paper, U.S. Department of Veterans Affairs data is used to examine issues of health care production estimation and the use of regression estimates like the teaching adjustment factor. The findings show that measurement error and persistent multicollinearity confound attempts to have a large degree of confidence in the precise magnitude of parameter estimates.

Confounding Factors, Epidemiologic↗