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Biomedical subjects

L J Kozak

Publications and source records attributed to L J Kozak.

At least 19 recordsLinked to original sources
PubMed2001

Trends in the use of episiotomy in the United States: 1980-1998.

BACKGROUND: Despite a relative paucity of clinical evidence justifying its routine use, approximately 40 percent of all vaginal deliveries include an episiotomy. The purpose of this study is to examine trends in episiotomy in the United States from 1980 through 1998, a period during which calls increased to abandon routine episiotomy. METHODS: Data were obtained from the National Hospital Discharge Survey, which is conducted annually and based on a nationally representative sample of discharges from short-stay non-Federal hospitals. RESULTS: From 1980 through 1998 the episiotomy rate in the United States dropped by 39 percent. Rates decreased for all age and racial groups investigated, in all four geographic regions, and for all sources of payment. Significant differences remained between groups in 1998, including a higher rate for white women than for black women, and a higher rate for women with private insurance than for women with Medicaid or in the self-pay category. The incidence of first- and second-degree lacerations to the perineum increased for women without episiotomies, but the more severe third- and fourth-degree lacerations remained more frequent for women with episiotomies. Women with episiotomies were more likely to have forceps-assisted deliveries or vacuum extractions. CONCLUSIONS: Despite dramatic declines in the use of episiotomy during the last two decades, it remains one of the most frequent surgical procedures performed on women in the United States, and it continues to be performed at a higher rate for certain groups of women.

Adult↗
PubMed2000

National hospital discharge survey: annual summary, 1998.

OBJECTIVES: This report presents 1998 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by demographic characteristics of patients discharged, geographic region of hospitals, conditions diagnosed, and surgical and nonsurgical procedures performed. Measurements of hospital use include number and rate of discharges and days of care, and the average length of stay. Estimates of first-listed diagnoses, days of care, all-listed diagnoses, and all-listed procedures are presented according to their code number in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). METHODS: The estimates are based on data collected through the National Hospital Discharge Survey. The survey has been conducted annually by the National Center for Health Statistics since 1965. In 1998, data were collected for approximately 307,000 discharges. Of the 495 eligible non-Federal short-stay hospitals in the sample, 478 (97 percent) responded to the survey. RESULTS: An estimated 31.8 million inpatients were discharged from non-Federal short-stay hospitals in 1998. These patients used an estimated 160.9 million days of care. Patients 65 years of age and over accounted for 39 percent of discharges and used 48 percent of days of care. Heart disease and deliveries made up 26 percent of first-listed diagnoses. One or more procedures were reported for 63 percent of discharges. The cesarean rate per 100 deliveries increased from 20.8 in 1995 to 22.5 in 1998. An estimated 3.8 million newborn infants were discharged from short-stay hospitals after average stays of 3.2 days.

Acute Disease↗
PubMed1999

National hospital discharge survey: annual summary, 1997.

OBJECTIVES: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1997 and selected trend data. Estimates are provided by demographic characteristics of patients discharged, geographic region of hospitals, conditions diagnosed, and surgical and nonsurgical procedures performed. Measurements of hospital use include number and rate of discharges and days of care, and the average length of stay. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey. The survey has been conducted annually by the National Center for Health Statistics since 1965. In 1997, data were collected for approximately 300,000 discharges. Of the 501 eligible non-Federal short-stay hospitals in the sample, 474 (95 percent) responded to the survey. Diagnoses and procedures were coded according to the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM.

Adolescent↗
PubMed1999

Changing patterns of surgical care in the United States, 1980-1995.

National inpatient and ambulatory surgery data were combined to examine changes over time in the location and amount of surgical care. The main pattern was a decline in the rate of inpatient operations that was outweighed by growth in ambulatory operations. However, the rate of inpatient operations did not decrease for patients age 65 years or over, despite the growth in ambulatory surgery. Other patterns seen for specific types of operations were the substitution of ambulatory for inpatient operations, increases primarily in the rate of inpatient operations, and decreases in total operations. These patterns have implications for control of health care costs.

Adolescent↗
PubMed1999

National hospital discharge survey: annual summary, 1996.

OBJECTIVES: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1996 and selected trend data. Estimates are provided by demographic characteristics of patients discharged, geographic region of hospitals, conditions diagnosed, and surgical and nonsurgical procedures performed. Measurements of hospital use include number and rate of discharges and days of care, and the average length of stay. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually by the National Center for Health Statistics (NCHS) since 1965. In 1996, data were collected for approximately 282,000 discharges. Of the 507 eligible non-Federal short-stay hospitals in the sample, 480 (95 percent) responded to the survey. Diagnoses and procedures are coded according to the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM.

Adolescent↗
PubMed1998

Ambulatory and inpatient procedures in the United States, 1995.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1995. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS). NHDS provides data on hospital inpatient care, and NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For NHDS, data were collected for approximately 263,000 discharges from 466 non-Federal short-stay hospitals (92 percent response rate). For NSAS, data were collected for approximately 122,000 ambulatory surgery discharges from 489 hospitals and freestanding ambulatory surgery centers (80 percent response rate). RESULTS: An estimated 69.2 million procedures were performed on 38.7 million discharges from hospitals and freestanding ambulatory surgery centers during 1995: 39.8 million procedures were for inpatients, and 29.4 million were for ambulatory patients. Females had more procedures than males, and the rate of procedures increased with age in ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were endoscopy of small intestine, arteriography and angiocardiography, extraction of lens, and endoscopy of large intestine.

Adolescent↗
PubMed1998

Detailed diagnoses and procedures, National Hospital Discharge Survey, 1996.

OBJECTIVES: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1996. Estimates of first-listed diagnoses, all-listed diagnoses, days of care for first-listed diagnoses, and all-listed procedures are shown by sex and age of patient and geographic region of hospital. METHODS: The estimates are based on data collected through the National Hospital Discharge Survey for 1996. The survey has been conducted annually by the National Center for Health Statistics since 1965. In 1996, data were collected for approximately 282,000 discharges from 480 non-Federal short-stay hospitals. Diagnoses and procedures are presented according to their code number in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).

Adolescent↗
PubMed1998

Ambulatory and inpatient procedures in the United States, 1996.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1996. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery-(NSAS). NHDS provides data on hospital inpatient care, and NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For NHDS, data were collected for approximately 282,000 discharges from 480 non-Federal short-stay hospitals (95 percent response rate). For NSAS, data were collected for approximately 125,000 ambulatory surgery discharges from 488 hospitals and freestanding ambulatory surgery centers (81 percent response rate). RESULTS: An estimated 71.9 million procedures were performed on 39.9 million discharges from hospitals and freestanding ambulatory surgery centers during 1996: 40.4 million procedures were for inpatients, and 31.5 million were for ambulatory patients. Females had more procedures than males, and the rate of procedures increased with age in ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were arteriography and angiocardiography, endoscopy of small intestine, endoscopy of large intestine, and extraction of lens.

Adolescent↗
PubMed1997

Ambulatory surgery in the United States, 1994.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures done on an ambulatory basis in hospitals and freestanding ambulatory surgery centers in the United States during 1994. Data are presented by types of facilities, age, sex, geographic region, and disposition for ambulatory surgery visits. Major categories of procedures and diagnoses are shown by age, sex, and region. METHODS: The estimates are based on data collected from the national Survey of Ambulatory Surgery, conducted for the first time in 1994 by the national Center for Health Statistics. The 1994 data were abstracted from 118,000 medical records in 494 hospitals and freestanding ambulatory surgery centers.

Adolescent↗
PubMed1997

Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups.

OBJECTIVES: The National Hospital Discharge Survey (NHDS) was used to evaluate potentially avoidable hospital conditions as an indicator of equity and efficiency in the US health care system. METHODS: With the use of 1990 data from the NHDS, the National Health Interview Survey, and the census, national rates of hospitalization were calculated for avoidable conditions by age, race, median income of zip code, and insurance status. RESULTS: An estimated 3.1 million hospitalizations were for potentially avoidable conditions. This was 12% of all hospitalizations in 1990 (excluding psychiatric admissions, women with deliveries, and newborns). Rates of potentially avoidable hospitalizations were higher for persons living in middle- and low-income areas than for persons living in high-income areas, and were higher among Blacks than among Whites. These class and racial differences were also found among the privately insured. Differences among income and racial groups for persons aged 65 and over were not significant. CONCLUSIONS: Inequalities in potentially avoidable hospitalizations suggest inequity and inefficiency in the health care delivery system. Avoidable hospital conditions are a useful national indicator to monitor access to care.

Adolescent↗
PubMed1997

Ambulatory and inpatient procedures in the United States, 1994.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1994. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS). The NHDS provides data on hospital inpatient care, and the NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For the NHDS, data were collected for approximately 277,000 discharges from 478 non-Federal short-stay hospitals (93 percent response rate). For the NSAS, data were collected for about 118,000 ambulatory surgery discharges from 494 hospitals and freestanding ambulatory surgery centers (80 percent response rate). RESULTS: An estimated 68.4 million procedures were performed on 38.0 million discharges from hospitals and freestanding ambulatory surgery centers during 1994: 40.7 million procedures were for inpatients, and 27.7 million were for ambulatory patients. Females had more procedures than males did and the rate of procedures increased with age in both ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were endoscopy of large intestine, arteriography and angiocardiography, endoscopy of small intestine, and extraction of lens.

Adolescent↗
PubMed1993

Long-stay patients in short-stay hospitals.

In 1980 and 1990, only 4-5 percent of patients in short-stay hospitals were hospitalized for more than 3 weeks. The number of discharges and days of care for these long-stay patients were lower in 1990 as compared with 1980, but they continued to use more than a quarter of all hospital days in 1990. Long-stay patients were more likely than all patients to be 65 years of age and over and have Medicare as their expected principal source of payment. For long-stay and all patients, private insurance covered smaller proportions of discharges and days of care, and Medicaid covered larger proportions in 1990 than in 1980. Long-stay patients were more likely than all patients to be discharged dead or transferred to other hospitals or nursing homes. Long-stay and all patients were more likely to be transferred at discharge in 1990 than in 1981. The Northeast Region had a larger proportion of long-stay patients than of all patients, and that proportion increased from 1980 to 1990. The proportion of long-stay discharges and days of care in the Midwest decreased during this period. In 1980 and 1990, more than 50 percent of the discharges and days of care for long-stay patients were for diseases of the circulatory system, mental disorders, neoplasms, or injury and poisoning. Despite the overall decreases in hospital use by long-stay patients, their discharges and days of care increased significantly from 1980 to 1990 for diagnoses such as septicemia, psychoses, and miscellaneous complications of surgical and medical care. Over time, decreases were seen in long-stay discharges and days of care for a variety of diagnostic categories, including malignant neoplasm of trachea, bronchus, and lung; diabetes mellitus; and fracture of the neck of the femur. Long-stay patients had a higher rate of procedures per 1,000 discharges in 1990 than in 1980, and a higher rate than all patients in both years. Approximately half of all the procedures performed on long-stay patients in 1980 and two-thirds in 1990 were miscellaneous diagnostic and therapeutic procedures, operations on the cardiovascular system, or operations on the digestive system. The rates of numerous procedures, especially diagnostic tests, increased for long-stay and all patients from 1980 to 1990.

Age Distribution↗
PubMed1992

Estimates from two survey designs: national hospital discharge survey.

The methodology for the National Hospital Discharge Survey (NHDS) has been revised in several ways. These revisions, which were implemented for the 1988 NHDS, included adoption of a different hospital sampling frame, changes in the sampling design (in particular the implementation of a three-stage design), increased use of data purchased from abstracting service organizations, and adjustments to the estimation procedures used to derive the national estimates. To investigate the effects of these revisions on the estimates of hospital use from the NHDS, data were collected from January through March of 1988 using both the old and the new survey methods. This study compared estimates based on the old and the new survey methods for a variety of hospital and patient characteristics. Although few estimates were identical across survey methodologies, most of the variations could be attributed to sampling error. Estimates from two different samples of the same population would be expected to vary by chance even if precisely the same methods were used to collect and process the data. Because probability samples were used for the old and new survey methodologies, sampling error could be measured. Approximate relative standard errors were calculated for the estimates using the old and new survey methods. Taking these errors into account, less than 10 percent of the estimates were found to differ across survey methodologies at the 0.05 level of significance. Because a large number of comparisons were made, 5 percent of the estimates could have been found to be significantly different by chance alone. When there were statistically significant differences in nonmedical data, the new methods appeared to produce more accurate estimates than the old methods did. Race was more likely to be reported using the new methods. "New" estimates for hospitals in the West Region and government-owned hospitals were more similar than the corresponding "old" estimates to data from the census of hospitals conducted by the American Hospital Association. The numerous significant differences in estimates for bed size categories between the two survey methodologies reflected the change in the universe and definition of beds for the new survey. Few statistically significant differences were found in the medical data using the old and the new survey methods. Two main differences, in estimates for cataract and alcohol dependence syndrome, may have resulted from problems with the new survey. A measurement error, reporting outpatients to the NHDS, is one possible explanation of the higher estimates for diagnosis of cataract using the new survey methods.(ABSTRACT TRUNCATED AT 400 WORDS)

Bias↗