Biomedical subjects
Publications and source records attributed to L K Demlo.
The implications of effectiveness research are far-reaching. Thus, the specification of a broad research agenda and the soundness of the underlying research methodologies and data bases are critical. This article discusses the quality of administrative data and the infrastructure supporting an ongoing effectiveness research effort.
The influence of patients' extramedical characteristics on physician decisions to hospitalize patients is examined by use of the hypothetical case approach. In addition, physician and market condition characteristics are examined as possible correlates of physician responsiveness to patients' extramedical conditions. The findings provide additional evidence that, for at least some cases, the likelihood of a physician's admitting a patient to the hospital is influenced by the patient's living arrangements, travel time to the physician's office, and the extent to which medical care would cause a financial hardship for the patient. Variation in physician responsiveness to these extramedical conditions is quite large. This variation in responsiveness is not consistently related to physician specialty or hospital occupancy rates, but is correlated with physician time spent giving outpatient care.
Small-area differences in hospital use were examined using hospital discharge abstract data for the populations of seven small service areas in Iowa that exhibited substantial variation in admission rates during 1980. The results indicate a marked difference in the age composition of the patient populations with older patients being more common among residents of high-use areas, higher age- and sex-adjusted discharge rates per 1000 in the high-use areas across many diagnostic categories, frequently higher average lengths of stay in high-use areas, a lack of conformity between discharge patterns for selected surgical procedures and diagnoses, and more readmissions to the same hospital during a 12-month period for residents of high-use areas. This data set comprises one part of a study of small-area differences that also employed household surveys, physician surveys, and other existing data sets. The findings illustrate the potential and limitations of hospital discharge abstracts as a data base for evaluating hospital discharge abstracts as a data base for evaluating hospital utilization differentials.
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This article reviews currently used quality assurance techniques. It assumes a broad definition of quality that includes attention to the content and professional judgment exercised in the provision of health services, as well as the appropriateness of resource utilization. Emphasis is on more or less generic approaches to review that can be applied regardless of the specific health profession involved. After describing and contrasting various quality assurance techniques, the article concludes with a general discussion of effectiveness, problems in initiating behavior change, and opportunities for further research and evaluation.
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The most recent study by the Institute of Medicine of the reliability of hospital discharge data abstracted from patients' medical records documents the continuing presence of a substantial level of imprecision and error, affirming the findings of earlier studies. The most obvious factors leading to unreliability stem from inadequacies in the face sheets of medical records. Significant improvements could be attained if the discharge summary were routinely used to abstract information on patient disposition and principal diagnosis and if the operative report were routinely used to abstract information on principal procedure. Additional recommendations are offered for developmental activities intended to improve the designation of diagnosis, diagnostic classification schemes and hospital medical records systems.
Two recent studies by the Institute of Medicine on the reliability of hospital discharge data abstracted from patients' medical records raise serious questions about the adequacy of information on diagnoses and procedures. The findings are particularly timely, since increasingly important decisions about the content of medical care and levels of reimbursement may be based on such information. A series of recommendations are offered to guide the use and improvement of abstracted medical record information.
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