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Biomedical subjects

K Devers

Publications and source records attributed to K Devers.

8 recordsLinked to original sources
PubMed2000

Implementing capitation of Medicaid mental health services in Colorado: is "readiness" a necessary condition?

Two consortia of community mental health centers in Colorado varied in their administrative readiness for changing to a capitated system and, ultimately, implemented capitation using different organizational arrangements. The objective was to assess the impact of this natural experiment on administrative change, costs, and utilization of services during the first two years postcapitation. Prior to capitation, one was rated as having greater "readiness" than the other and received a capitation contract from the state, while the other did not. A private, for-profit managed behavioral health organization was awarded a contract and formed a joint venture with the less "ready" consortium, providing managed care expertise to complement the consortium's expertise in delivering mental health services. Two years later, these consortia do not look different either administratively or in their patterns of service utilization and costs. These findings suggest alternative ways of successfully implementing a capitated public mental health system.

Capitation Fee↗
PubMed2000

Qualitative research: a consumer's guide.

Qualitative research is best characterized as a family of approaches whose goal is understanding the lived experience of persons who share time, space and culture. Although they are often judged as a single entity, the approaches actually vary in their theoretical assumptions and canons of evidence. Four qualitative research domains that are currently used in studying education for health are reviewed here. They are ethnographic/field work approaches, use of interviews and surveys, audiovisual records, and the study of documents. Characteristics of each domain and brief examples are provided. In addition to introducing the four research domains, we offer some general guidelines on how to be a good consumer of qualitative research. We pose a series of questions about the importance of the research question, study design, and trustworthiness of qualitative research results. In addition, we focus on how research results are presented and discussed. We conclude with the observation that qualitative research approaches are only as good as the questions they set out to illuminate. In the arena of education for health a number of good and important questions remain unaddressed and would benefit by being studied using qualitative research approaches.

Journal Article↗
PubMed1994

Intensive care at two teaching hospitals: an organizational case study.

OBJECTIVE: To examine structural and organizational characteristics at two ICUs with marked differences in risk-adjusted survival. METHODS: We performed on-site organizational analysis in two ICUs at two major teaching hospitals. Our main outcome measures were interviews and direct observations by a team of clinical and organizational researchers; demographic, clinical, and survival data for 888 ICU admissions; and questionnaire responses from 70 nurses and 42 physicians on ICU structure and organization. ICU performance was measured using risk-adjusted survival and the ratios of actual to predicted ICU length of stay and resource use. RESULTS: Structural and organizational questionnaires, self-evaluation by staff members, and the research team's implicit judgments following detailed on-site analysis failed to distinguish units with higher and lower risk-adjusted survival. Both units exhibited practices to emulate and practices to avoid. CONCLUSIONS: The methods used in this study can identify organizational problems and potential means for improvement. The best practices and suggestions for improvement at these units provide examples of methods for improving ICU management.

Adult↗
PubMed1993

Value and cost of teaching hospitals: a prospective, multicenter, inception cohort study.

OBJECTIVE: To examine variations in case-mix, structure, resource use, and outcome performance among teaching and nonteaching intensive care units (ICU). DESIGN: Prospective inception cohort study. PATIENTS: A consecutive sample of 15,297 patients at 35 hospitals, which compared 8,269 patients admitted to 20 teaching ICUs at 18 hospitals vs. 7,028 patients admitted to 17 non-teaching ICUs at 17 hospitals. INTERVENTIONS: None. MEASUREMENTS: We selected demographic, physiologic, and treatment information for an average of 415 patients at each ICU, and collected data on hospital and ICU structure. Outcomes were compared using ratios of observed to risk-adjusted predicted hospital death rates, ICU length of stay, and resource use. MAIN RESULTS: When compared to nonteaching ICUs, teaching ICUs had twice the number of physicians who regularly provided services and cared for significantly younger and more severely ill (p < .001) patients. Risk-adjusted ICU length of stay was similar, but resource use was significantly (p < .001) greater in teaching ICUs, with $3,000 (10.5%) of estimated total costs for an average ICU admission related to increased use of diagnostic testing and invasive procedures in teaching ICUs. Risk-adjusted hospital death rates were not significantly different (p = .1) between all teaching and nonteaching ICUs, but were significantly (p < .05) better in four teaching ICUs, but in only one nonteaching ICU. The 14 hospitals that were members of the Council of Teaching Hospitals had significantly better risk-adjusted outcome in their 16 ICUs than all others (odds ratio = 1.21, confidence interval 1.06 to 1.38, p = .004). CONCLUSIONS: Teaching ICUs care for more complex patients in a substantially more complicated organizational setting. The best risk-adjusted survival rates occur at teaching ICUs, but production cost is higher in teaching units, secondary to increased testing and therapy. Teaching ICUs are also successfully transferring knowledge to trainees who, after their training, are achieving equivalent results at slightly lower cost in nonteaching ICUs.

Adolescent↗
PubMed1993

Improving intensive care: observations based on organizational case studies in nine intensive care units: a prospective, multicenter study.

OBJECTIVE: To examine organizational practices associated with higher and lower intensive care unit (ICU) outcome performance. DESIGN: Prospective multicenter study. Onsite organizational analysis; prospective inception cohort. SETTING: Nine ICUs (one medical, two surgical, six medical-surgical) at five teaching and four nonteaching hospitals. PARTICIPANTS: A sample of 3,672 ICU admissions; 316 nurses and 202 physicians. MATERIALS AND METHODS: Interviews and direct observations by a team of clinical and organizational researchers. Demographic, physiologic, and outcome data for an average of 408 admissions per ICU; and questionnaires on ICU structure and organization. The ratio of actual/predicted hospital death rate was used to measure ICU effectiveness; the ratio of actual/predicted length of ICU stay was used to assess efficiency. MEASUREMENTS AND MAIN RESULTS: ICUs with superior risk-adjusted survival could not be distinguished by structural and organizational questionnaires or by global judgment following on-site analysis. Superior organizational practices among these ICUs were related to a patient-centered culture, strong medical and nursing leadership, effective communication and coordination, and open, collaborative approaches to solving problems and managing conflict. CONCLUSIONS: The best and worst organizational practices found in this study can be used by ICU leaders as a checklist for improving ICU management.

Critical Care↗