Biomedical subjects

Judith E Glazner

Publications and source records attributed to Judith E Glazner.

6 recordsLinked to original sources

PubMed2005

Injuries from slips and trips in construction.

Construction injuries preceded by a slip or trip were documented using data from the building of the Denver International Airport (Denver, Colorado, USA), the largest construction project in the world at the time. Slips and trips occurred at a rate of 5/200,000 h worked accounting for 18% of all injuries and 25% of workers' compensation payments, or more than $10 million. Slips contributed to the vast majority (85%) of same-level falls and over 30% of falls from height, as well as a significant number of musculoskeletal injures sustained after slipping or tripping but without falling. The injury burden would have been under-recognized in analyses of most coded compensation records. In contrast to other types of injuries, the most common contributing factors were environmental in nature including conditions of walking and working surfaces, terrain and weather. Due to the very dynamic nature of construction work, reducing slips and trips will require a focus on environmental and organizational solutions that evolve as the site changes and the construction project evolves.

Accidental Falls↗

PubMed2005

Methods for using narrative text from injury reports to identify factors contributing to construction injury.

BACKGROUND: Several methods exist for classifying injuries from written text, thereby identifying possible points of intervention. We describe an innovative method for such classification. METHODS: Using Haddon's matrix as a framework, two independent reviewers coded text from over 4,000 injury reports into a qualitative software package to identify factors contributing to injuries sustained during construction of Denver International Airport (DIA). We compared our classification scheme with three others. RESULTS: This process created a coded data set, an expanded version of Haddon's matrix adapted for construction injury, and coding rules for interpreting narrative text. Haddon's matrix provides a flexible theoretical framework for coding information about a spectrum of contributing factors. CONCLUSIONS: Narrative descriptions from injury reports can provide detail on circumstances surrounding injuries and identify factors contributing to injury. Forms guiding investigators to explicitly consider human, organizational, and environmental factors could foster more complete descriptions of factors contributing to construction injury.

Accidents, Occupational↗

PubMed2005

Uncomplicated acute renal failure and hospital resource utilization: a retrospective multicenter analysis.

BACKGROUND: Although acute renal failure (ARF) complicating nonrenal organ dysfunction in the intensive care unit is associated with significant mortality and hospital costs, hospital resource utilization attributed to uncomplicated ARF is not well known. The goal of this study is to characterize the costs and lengths of stay (LOSs) incurred by hospitalized patients with uncomplicated ARF and their important determining factors. METHODS: We obtained hospital case-mix data sets from 23 Massachusetts hospitals for a 2-year period (1999 to 2000) from the Massachusetts Division of Health Care Finance and Policy. A total of 2,252 records of patients hospitalized with uncomplicated ARF were identified. Patient records of other common medical diagnoses were studied for comparison. RESULTS: Patients hospitalized with uncomplicated ARF incurred median direct hospital costs of 2,600 dollars, median hospital LOS of 5 days, and mortality of 8%. Dialysis was independently associated with significantly greater hospital costs and LOSs for patients with uncomplicated ARF (P < 0.05). Male sex and nonwhite race were associated with significantly lower hospital costs and LOSs, whereas type of hospital had opposing effects on these 2 resource utilization outcomes (P < 0.05). Unadjusted aggregate resource utilization associated with uncomplicated ARF exceeded that of many other common illnesses. CONCLUSION: Demographic and hospital factors, as well as dialysis therapy, are significant determinants of hospital resource utilization for patients with uncomplicated ARF. Uncomplicated ARF appears to incur greater hospital costs and longer LOSs compared with other common medical conditions. Greater focus should be directed toward further understanding of the factors influencing resource utilization for ARF.

Acute Kidney Injury↗

PubMed2004

The cost of giving childhood vaccinations: differences among provider types.

OBJECTIVE: To describe costs to providers of delivering childhood immunizations. METHODS: We collected variable costs--costs that vary with the amount of services rendered--including cost of practitioner and staff time and supplies, using a cost accounting method, from 12 practices (4 pediatric practices, 4 family practices, and 4 public health agencies) in rural and urban areas in Colorado. For private practices, we estimated fixed costs--costs that do not vary with the amount of services, eg, rent and insurance). We also collected reimbursement information for vaccinations for private practices. RESULTS: Variable costs per shot (excluding vaccine cost) were 8.15 dollars for pediatric practices, 5.79 dollars for family practices, and 5.41 dollars for public health agencies. Total costs per shot, including fixed costs, were 10.67 dollars for pediatric practices and 7.57 dollars for family practices. Average reimbursement for pediatricians and private family practices was 8.27 dollars and 6.68 dollars, respectively. For pediatric practices, average variable costs were barely exceeded by average reimbursement, and reimbursement was 22% less than average total costs. This contrasts with an earlier study of the rural practices investigated here, in which there was a comfortable margin between reimbursement and variable costs. CONCLUSION: The decline in the ratio of reimbursement to cost for private practices, particularly for pediatric practices, suggests that referral to public agencies by private providers for vaccinations may increase and that if vaccinations are not as frequently provided in the child's medical home, then the currently high childhood immunization rates may be in jeopardy.

Child Health Services↗

PubMedDate not supplied

Primary-care visits and hospitalizations for ambulatory-care-sensitive conditions in an inner-city health care system.

OBJECTIVE: Hospitalizations for ambulatory-care-sensitive conditions (ACSCs) are a marker for access barriers for children and a possible outcome measure for primary-care interventions. We assessed the relationship between primary-care utilization and subsequent ACSC hospitalization among inner-city children. METHODOLOGY: We conducted a nested, case-control study of children born in 1993 in Denver Health (DH), a "safety-net" delivery system in Denver, Colo. Utilization of preventive care and other primary-care services was compared between children hospitalized for ACSCs and nonhospitalized children, who were matched by age and duration of care. Comparisons were adjusted for demographics, payer, and chronic health conditions. RESULTS: Of 2531 children, 115 (4.5%) were hospitalized for ACSCs. Sixty-eight percent were Hispanic, and 78% were enrolled in Medicaid. Children with ACSC hospitalization and nonhospitalized children made a similar number of preventive-care visits (2.7 +/- 2.0 vs 3.0 +/- 2.1 visits, P =.30) and other primary-care visits (4.4 +/- 4.6 vs 3.6 +/- 4.6, P =.16) between birth and hospitalization (for cases) or the same time period (for controls). After multivariate adjustment, each additional preventive-care visit (odds ratio = 0.87; 95% confidence interval: 0.67-1.12) was associated with a nonsignificant reduction in the risk of hospitalization for ACSC. CONCLUSIONS: Because ACSC hospitalizations are uncommon and the association between primary care and subsequent hospitalization is weak, a reduction in ACSC hospitalizations may not be a feasible outcome measure for interventions to increase the rate of preventive- or primary-care visits for underserved children within individual delivery systems.

Ambulatory Care↗

PubMedDate not supplied

Using an immunization registry: effect on practice costs and time.

INTRODUCTION: Immunization registries can consolidate immunization records scattered among different providers, allowing immunization documentation for legal purposes, generation of needed-immunization lists, inventory management, and outreach for underimmunized children. They have been endorsed by the Centers for Disease Control and Prevention and health professionals as a means of sustaining high immunization rates. However, some providers perceive the cost of registry use as a barrier to participation. We sought to determine the effects of registry use on cost and time. METHODS: We used a pre-post design and a cost-accounting approach to measure labor costs and time for immunization-related activities possibly affected by registry use before development of a regional registry in Colorado and after the registry was being fully used. Two rural family practices, 2 rural community health centers (CHCs), 3 urban pediatric practices, and 2 rural public health agencies participated in both periods. RESULTS: Cost per shot increased slightly in the postregistry period for private practices and CHCs ($0.56 per shot in 2001 dollars) and public health agencies ($0.38). Since costs can increase for several reasons, including salary increases above inflation, we analyzed time spent per shot and found that staff time decreased for private practices and CHCs but increased substantially for public health agencies. CONCLUSIONS: The study findings suggest to private practices that registry participation can provide a net benefit by making the vaccination process more efficient and, absent above-average salary increases, less costly. Public health agencies, however, would have to rely exclusively on the registry and eschew the use of paper vaccination records to realize efficiencies seen by other practice types.

Costs and Cost Analysis↗