Biomedical subjects
Publications and source records attributed to L J Shuman.
This paper begins with a definition of microcosting, including the specification of design criteria and a general model framework. The necessity for micro- as opposed to macro-costing is discussed. Examples of microcosting systems are provided. Relative value scale and case-mix alternatives to microcosting are presented.
Why were these applications of simulation technology unsuccessful? Parochialism, the volunteer nature of EMS planning, and limited regional commitment to resolve such complex problems at the local level all combined to present significant barriers to implementation. Political factors which posed the most significant barriers included: conservative attitudes concerning the funding and regulation of EMS activities by local governments; general opposition to governmental intervention in the private sector; strong resistance to mandatory standards for EMS; jurisdictional disputes between EMS-related agencies; lack of cooperation between the local governments; competition between prehospital-care providers and between hospitals; overemphasis on local jurisdictional boundaries in the planning and delivery of services; and the allocation of EMS resources, such as ambulances, according to political priorities, rather than more objective criteria. Based upon the results of the four field tests, the following observations are relevant: 1. RURALSIM is a very complex simulator. While every effort was made to assure generalizability, for any given situation, it required extensive modification and tailoring. The result was a model capable of handling a rather diverse set of situations, but one that could not be turned over to the general public for use. To implement RURALSIM required the participation of the University of Pittsburgh research team. The newer simulation languages now available alleviate this problem somewhat. 2. RURALSIM's complexity was needed to examine the different alternatives proposed by local planners. It was particularly needed in order to simulate each region's existing system. Such "base-line" simulations were required in order to achieve face validity and provide a basis for comparing alternatives. 3. With hindsight, a major weakness was the limited amount of face-to-face interaction between local planners and decision makers and the University of Pittsburgh staff. Only two trips to the region were budgeted. This proved to be insufficient and placed too much responsibility for model interpretation and analysis on the local contractors. 4. In none of the four test sites did the contractors and/or local health planners have the authority, influence and/or incentives necessary to develop regional EMS systems. In particular, none of the contractors were in the position to be decision makers, nor was there ever only one decision maker. This is not a criticism of the contractors, who did their best under difficult circumstances. Rather, it is a criticism of the state of eMS system development in the US in the early 1980s. There were few examples where regional systems developed successfully in the face of serious opposition from local interests.(ABSTRACT TRUNCATED AT 400 WORDS)
This paper is concerned with the dual sequential problems of (1) determining an acceptable personnel schedule over a specified time period, and (2) adjusting that schedule during the course of its execution in reaction to daily changes in both demand and available personnel. The first problem is schedule formulation; the second sequential problem is schedule execution. A rule-based, hierarchical system has been developed for first modeling and then solving both the schedule formulation and the schedule execution problems as a two-phase dependent process. The system is applied to the scheduling and staffing of nurses. A double-blind evaluation was conducted, which ascertained the quality of the resultant schedules in terms of maintainability, coverage, and personal satisfaction. The evaluation indicates that for units on which personnel changes have occurred, the prototype appears to perform as well as human schedulers.
Explore the source record for details and available documents.
Although previous studies conducted in prepaid group practice settings have indicated that the cost of providing coverage for outpatient psychotherapy may be offset by lower utilization of medical/surgical services among those who receive the benefit, no such studies have been conducted in a fee-for-service setting, nor have actual before and after claims costs been compared. This study establishes a methodology for using routinely collected Blue Cross claims data to show how the acquisition and use of a given benefit affects total utilization patterns and the overall costs of providing third-party coverage. The use and cost of outpatient psychiatric coverage in one subscriber group is the particular application given to this methodology in this report. Blue Cross claims records of 136 subjects who utilized outpatient psychiatric benefits over a 48-month period were analyzed. Results indicate that overall medical/surgical utilization is reduced for that subgroup who used the outpatient psychotherapy benefit and that average costs dropped by $9.41, from $16.47 per patient per month before outpatient psychotherapy to $7.06 after contact, with costs being adjusted to reflect parity with the base year. Factors other than psychiatric intervention which may have brought about this cost reduction as well as policy implications of these results are discussed.
Explore the source record for details and available documents.
This study was conducted to determine whether implementation of a specific formalized concurrent utilization review system which involved making a prior determination of length of stay had any more effect on average length of stay than continuance of a utilization review method not involving assignment of such a target date. The system studied was the Pre-Discharge Utilization Review (PDUR) program used for Medicaid patients in Pennsylvania. Analysis was conducted using discharge abstracts for Medicaid patients under age 65 who were discharged with one of 14 common diagnoses for certain Allegheny County hospitals in 1972 and 1973. Comparisons were made for each individual diagnosis to control for possible differences in case mix. Results indicate that there was no general reduction in length of stay which could be attributed to the PDUR program.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.