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Biomedical subjects

J V Kelly

Publications and source records attributed to J V Kelly.

At least 19 recordsLinked to original sources
PubMed1994

Graduate medical education consortia: expectations and experiences.

Graduate medical education (GME) consortia are formal associations of medical schools, teaching hospitals, and other organizations involved in residency training, with central support, direction, and coordination allowing members to function collectively. GME consortia are not well documented in the literature, although they are included in many GME reform proposals. Proponents expect consortia to improve the organizational structure and governance of residency training programs and, through local coordination and possibly the allocation of resources, to help members meet national workforce goals regarding both numbers and practice locations for generalist and specialist physicians. The authors contrast the expectations of educators and policymakers for the future performance of GME consortia with the experiences of 36 functioning consortia, gathered in a 1993 national survey conducted by the Maine Medical Center and the Association of American Medical Colleges. Respondents account for nearly 10% of all residency training programs and 17% of all residents nationwide. The participating consortia differ markedly in their structures, functions, and other features, although nearly 85% have been convened by medical schools and closely affiliated hospitals. Fewer than half function with governing boards; 40% offer a single integrated residency training program in each discipline; and 58% allocate resources. A common concern of consortium members was physician distribution by specialty, but only 31% identified "increasing the number of generalist physicians" as a major accomplishment to date. To improve their performance, consortium participants call for greater commitment and leadership from the medical school and university, better definition of the community's GME needs, more information about the flow of GME funds locally, greater authority to allocate resources, and incentives for shifting allegiances from individual institutions to the consortium community as a whole.

Data Collection↗
PubMed1991

House staff recruitment to municipal and voluntary New York City residency programs during the AIDS epidemic.

OBJECTIVE: To determine the impact on house staff recruitment of large numbers of patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Trends in yearly survey data from the National Resident Matching Program from 1983 to 1990 were examined for residency programs in New York City, NY, where AIDS is epidemic, in the four largest US cities with the fewest AIDS cases, and nationally. Within New York City, trends were compared for residency programs serving large numbers of AIDS patients (high AIDS) and for other programs (low AIDS). MAIN OUTCOME MEASURES: Number of matches in each study year as compared with the baseline year of 1983 and the yearly percentage of positions offered that were filled by matches. RESULTS: During the study period, New York City experienced a greater decline in US graduate matches than did the four low-AIDS cities or the nation. Within New York City, recruitment to municipal programs, all with large AIDS patient populations, dropped from 241 to 173 matches (28.2%) despite a 3.6% increase in positions. However, recruitment to both high-AIDS and low-AIDS voluntary programs improved in all years except 1990. After controlling for numbers of offered positions, high-AIDS and low-AIDS voluntary programs again showed similar trends until 1990. CONCLUSIONS: These observations cannot be attributed to AIDS alone. Multiple economic and social factors, including AIDS, may have contributed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Faculty practice plans: the organization and characteristics of academic medical practice.

The contemporary academic medical center is a complex organization providing medical and other professional health education, biomedical and behavioral research, and a comprehensive range of patient care services. This paper presents data from the Association of American Medical Colleges' 1989 survey of 125 member faculty practice plans. The survey data showed that 62% of the 74 responding plans were units or associations within the medical school corporate structure. Plans were organized along a broad continuum from the autonomous, departmental model with decentralized governance and management to the group model with centralized governance and management. The growth of managed care, increased competition, and a greater reliance by the medical school on clinical practice income as a financing source are causing the practice plan to expand beyond billing of professional fees. The survey data showed that 75% of the practice plans operated satellite centers, and 61% planned to build new ambulatory care facilities in order to expand and improve services to patients. The practice plans also have adapted to changes in third-party reimbursement and are establishing mechanisms to negotiate managed care contracts involving multiple clinical departments to increase referrals and maintain patient shares; 86% of the plans participate in at least one managed-care organization. The role of the practice plan will continue to evolve in response to the needs of the academic medical center for a cooperative and supportive environment in which to conduct its traditional missions of teaching, research, and patient care.

Academic Medical Centers↗
PubMed1990

What do mortality studies reveal about hospital volume, teaching status, and ownership?

Numerous recent studies use risk-adjusted patient mortality rates to measure hospital performance, focusing on such hospital characteristics as volume of patients, teaching status, and ownership. This article summarizes the empirical findings of these studies, critiques their methods and models, and offers recommendations for overcoming several obstacles to meaningful correlation of patient outcomes and provider performance.

Health Services Research↗
PubMed1989

A severity classification system for AIDS hospitalizations.

The authors describe a new model for classifying hospitalized patients with acquired immunodeficiency syndrome (AIDS) according to their severity of illness. In the first phase of the project, a clinical model indicating the relative severity of AIDS complications was formulated, based on the clinical literature and expert opinion. In the second phase, the model was tested empirically using data on in-patient mortality of over 6,000 adult AIDS hospitalizations in New York State during 1985. The ordering of AIDS-related complications in the clinical model was revised to reflect a continuum of increasing likelihood of death in the hospital. The final classification system for AIDS hospitalizations has 20 substages, grouped into three stages, with in-patient mortality rates increasing from 6% to 60%. The system is automated and can be applied to different AIDS populations to analyze resource use and outcomes of hospital care.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Duration and costs of AIDS hospitalizations in New York. Variations by patient severity of illness and hospital type.

This study uses the Severity Classification for AIDS Hospitalizations to examine and contrast the duration and costs of hospitalizations among 6,142 AIDS discharges from New York hospitals during 1985. Multivariate regression analyses of resource-use differences suggest that more severely ill AIDS patients have considerably longer stays and higher total charges, regardless of hospital type. Severity of illness alone accounts for most of the explained variation in hospital length of stay (LOS) and total charges. In contrast, other patient characteristics, such as gender, race, and reported drug use, are less important predictors of resource use. It was also found that public teaching hospitals serve somewhat more severely ill AIDS patients than those treated in private teaching hospitals. The study concludes that the AIDS severity classification facilitates interhospital comparisons of illness levels and variations in resource use.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Heart disease and hospital deaths: an empirical study.

This study examines the effects of selected characteristics of hospitals and physicians on the mortality rates of heart patients who survive their first day in the hospital. Separate multivariate regression analyses are conducted for three groups: (1) patients who undergo a direct heart revascularization or coronary artery bypass graft (CABG) operation; (2) patients who undergo a cardiac catheterization and do not undergo a CABG operation; and (3) patients with a principal diagnosis of acute myocardial infarction (AMI) who do not undergo surgery. The number of patients in each group treated by specific physicians, and the number treated in specific hospitals, measure provider experience with similar patients. Other hypothesized determinants of in-hospital mortality include: (1) patient severity of illness, age, sex, and the presence of comorbidities; (2) hospital ownership, size, location, teaching status, resources expended, and the presence of a coronary care unit; and (3) board certification status of the attending physician or surgeon who operated. Empirical results show that presence of a coronary care unit decreases the chance that CABG patients will die in the hospital but is not significant for other heart patients included in this study. Patients with atherosclerosis who receive a CABG or a cardiac catheterization procedure are more likely to survive in hospitals with high volumes of these procedures. However, hospital volume of AMI admissions was not a factor in survival; AMI patients are more likely to survive when their attending physicians treat high volumes of AMI patients. Also, AMI patients whose physicians are board certified in family practice or in internal medicine are less likely to die compared to AMI patients with physicians not board certified. Similarly, AMI patients hospitalized in teaching facilities are less likely to die compared to AMI patients in hospitals not affiliated with a medical school.

Adolescent↗
PubMed1986

Physician and hospital factors associated with mortality of surgical patients.

Recent studies have found an inverse relationship between hospital-specific mortality rates for selected conditions and the number of patients hospitalized with these conditions. These studies have not examined whether this inverse relationship is a result primarily of the nature and volume of services provided to patients by individual physicians or whether it reflects special characteristics of high-volume hospitals. This study examines these issues, using data that link characteristics of primary surgeons to the discharge abstract records of patients. The study analyzes variation in hospital mortality associated with: the total volume of specific surgical procedures performed in the hospital, the volume of these procedures performed by the patient's primary surgeon, physician board certification, and other factors including patient severity of illness, patient age, hospital control, teaching status, size, and location. The findings confirm the inverse relationship found in other studies between patient mortality and the total volume of specific surgical procedures performed in the hospital. Physician board certification and hospital's medical school affiliation also are found to be associated with lower patient mortality rates. However, there is no statistical relationship between the volume of services provided by individual surgeons and outcome, suggesting that the volume-outcome relationship reflects hospital rather than physician characteristics.

Aneurysm↗
PubMed1985

Pseudotumor cerebri in pregnancy. Case reports and review of literature.

Pseudotumor cerebri is a rare disorder occurring in the reproductive age range of females, thus occurring infrequently in pregnancy. We are reporting three cases and reviewing the reports in English since 1960. Presentation, diagnosis, etiology, treatment, and pregnancy outcome are discussed in this review of the literature. Overall, pregnancy outcome does not appear to be adversely affected and the risk of recurrence in subsequent pregnancies does not appear to be increased. Medical management and observation are usually effective. Pregnancy termination is rarely, if ever required.

Adolescent↗