Biomedical subjects
J R Griffith
Publications and source records attributed to J R Griffith.
Small-area analysis of gastrointestinal disease hospital discharge variation: are the poor at risk?
Capitation plans may place their enrollees at risk of rationed services if they do not adjust for underlying patient characteristics that dictate differing levels of care. To assess the degree to which population-based socioeconomic characteristics are associated with hospital use, this study explored small-area variation in hospital discharges for gastrointestinal and liver (GI) Diagnosis Related Groups (DRGs). Utilizing a 1980 Michigan database of 1.5 million discharges, we constructed age-adjusted, population-based discharge rates for the GI DRGs. We then evaluated the effect of poverty, defined by the percent of households in a hospital market community below the poverty line. Using regression techniques, we found that poverty explained 27.5% of the variation in GI hospital discharges, with the poor admitted more often (p less than 0.0001). Using cost weighted discharge rates as the dependent variable, we found that poverty explained 20.3% (p = 0.0003) of the variation in cost weighted discharges. These results suggest that poverty explains a significant amount of variation in hospital discharges and has a significant effect on associated small-area hospitalization costs in GI diseases. Practicing gastroenterologists and surgeons need to be aware of factors that influence patients utilizing their services in order to retain their role as patient advocates as changes in payment systems are suggested.
Micro-area variation in hospital use.
Many recent studies have demonstrated that hospital utilization rates vary widely across small geographic areas. The variation is often attributed to the style of practice of the provider. This study demonstrates that hospital utilization varies widely between "micro" areas within individual hospital market areas. Further, the study demonstrates that hospital utilization rates within a hospital market area are more similar to each other than to rates in "micro" areas within other hospital market areas. After adjustment for available demographic, socioeconomic, and epidemiological factors, the utilization rates within "micro" areas are highly related to the group of hospitals that dominates the market area. After simultaneously adjusting for age and poverty, the market share-dominant group explains 35 percent of the variance in surgical use rates of "micro" areas and 39 percent of the variance in medical use rates.
Virginal breast hypertrophy.
Virginal breast hypertrophy is reviewed. The latest advances regarding the etiology, clinical presentation, differential diagnosis, and treatment, both medical and surgical, are discussed.
Small-area variation in hospital discharge rates. Do socioeconomic variables matter?
Although numerous studies have been made of the determinants of small-area variation in hospital discharge rates, there is still disagreement about the role of socioeconomic factors. The lack of consensus stems, in part, from the difficulty in comparing results across studies that use different units and methods of analysis. Many of the studies using well-defined hospital service areas did not have the data needed to conduct a controlled analysis of the determinants of hospital utilization. Most of the studies that have performed controlled analyses have relied on larger geopolitical areas, which are not believed to capture self-contained health care systems. The study described here used a consistent set of data, three methods of analysis, and two units of analysis to test the importance of socioeconomic characteristics in explaining the variation in medical and surgical discharge rates in Michigan. Socioeconomic factors are found to be statistically significant determinants of the variation in both medical and surgical discharge rates, whether the method of analysis is simple correlations or multiple regressions, and whether the unit of analysis is the county or a well-designed hospital service area. These results suggest that previous small-area variation studies may have incorrectly concluded that socioeconomic characteristics do not explain differences in utilization rates.
Patterns of surgical and nonsurgical hospital use in Michigan communities from 1980 through 1984.
Hospital discharge rates vary substantially among 60 communities in Michigan. (R2 = 90 percent and R2 = 85 percent of the systematic variance is explained by community effects for nonsurgical and surgical discharges, respectively.) The ranking of communities by discharge rates is stable over a five-year period (Spearman rho = 0.78 for nonsurgical discharges and 0.72 for surgical discharges). Surgical discharge rates decreased substantially (4 percent per year) over this time period, while nonsurgical rates showed no consistent pattern. Communities with exceptional discharge rates showed no substantial or significant regression toward the mean through the five-year study.
Does race affect hospital use?
Based on 1980 hospital discharges in areas in the State of Michigan, with substantial Black populations, Blacks use approximately 50 per cent more hospital care than Whites, but about half this difference is associated with use in specific communities which affects both White and Black use. Black use is not associated with community size, per cent of Blacks, or available beds and doctors. After controlling for mortality and socioeconomic status, a small statistically non-significant difference in race-specific use remains for 23 Michigan communities. The elimination of race as an explainer of hospital use suggests progress in assuring equal access to hospitals, but differences in poverty, mortality, and some specifics of use remain.
Clinical profiles of hospital discharge rates in local communities.
Using comprehensive 1980 data for hospitalization of the 9 million citizens of Michigan's lower peninsula, the authors have previously demonstrated that the discharge rates of local communities differ by a range of 2 to 1. This article seeks to identify differences in the clinical profile of high-use compared to low-use communities. Population-based rates and percentages of total discharges were studied for major clinical activity groups, such as cardiovascular disease, frequent diagnoses, rarely occurring diagnoses, short- and long-stay diagnoses, certain surgical procedures, and major organ groups of the diagnostic classification system. Although high-use communities tend to admit proportionately fewer surgical cases and proportionately more nonsurgical cases, few other such patterns could be demonstrated.
The role of Blue Cross and Blue Shield in the future U.S. health care system.
In a recent speech to Blue Cross and Blue Shield executives and trustees, the author noted that despite the historic success of Blue Cross and Blue Shield Plans, the future contains challenges arising from an aging population, scarce national resources, and evolving technology. To continue to grow and to meet its customers' needs, he urged Blue Cross and Blue Shield to expand its efforts in several directions: emphasize control of services and costs for the customer; restructure the concept of provider participation; and positively reward providers who exceed minimum standards. He advocated joint ventures between Blue Cross and Blue Shield and nonprofit providers, especially in the area of aged care.
Forecasting bed needs and recommending facilities plans for community hospitals: a review of past performance.
A university-based hospital consulting group reviewed six studies of Michigan hospitals retrospectively in 1975. The studies represented all those done between 1967 and 1971 requiring forecasts of acute bed supply and service needs. The original studies developed forecasts using empirical studies of patient origin and rigorously prepared authoritative forecasts of county populations. The 1975 review compared forecasts of population, service population, and bed need against current values and also interviewed clients to assess retrospective satisfaction with the recommendations. Although the consultants strove steadily to minimize the bed supply and base population forecasts were accurate, the studies overestimated bed needs. Further, the clients were often dissatisfied with the original recommendations, and frequently acted to exceed them. Comparing the 1975 actual with what would now be recommended by the consultant indicates that the "error" cost the communities about $50 per person per year.
Defining hospital market efficiency--the community's task.
Hospitals must concentrate on both market and productive efficiency to control costs and satisfy customers' health care needs. Local communities can set market efficiency standards using data sets similar to the Michigan study's.
Direct bonding of orthodontic brackets to tooth structure.
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The bonding of polycarboxylate cement to gold.
A comparison is made of several types of treatment of the surface of gold which will promote greater bonding with polycarboxylate cement.
Cost effective acute care facilities planning in Michigan.
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Identification of some organic smog components based on rain water analysis.
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Cementation--materials and techniques.
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Guest editorial: Education for the profession--an AUPHA update.
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The properties and clinical application of the modern composite resin.
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