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Biomedical subjects

P D Henteleff

Publications and source records attributed to P D Henteleff.

11 recordsLinked to original sources
PubMed1989

Policy, resources and practice: a palliative care ward.

The Palliative Care Program undertook a commitment to assure direct admission of patients, terminally ill at home, to inpatient beds. This was accomplished by a priority policy which distinguished Home Care patients from those to be transferred. A simulation enabled us to define a rule for the control of transfers. It also made it possible to anticipate the impact of an increase in demand which might exceed the capacity of the ward and to estimate the size of ward expansion which might be necessary. In fact, the program adjusted to increased demand by modifying both practice and policy, always guided by the boundaries originally identified by the computer simulation. The calculated limits have corresponded remarkably to both the physical resources and to the staff's capacity for work.

Health Policy↗
PubMed1978

Assessing the impact of tonsillectomies.

This paper explores outcomes associated with the tonsillectomy operation using multiple control groups and a large claims-based data bank from the Canadian province of Manitoba. Given the difficulty of conducting large-scale clinical trials of common surgical procedures, the use of multiple methods for evaluating such interventions is both advocated and implemented in this study. When the data are restricted to respiratory diagnoses, the findings suggest that, on the average, tonsil surgery saves between one half and one and a half episodes of illness per patient over the two years after surgery. Such savings are much more pronounced among individuals having several tonsillitis episodes in the preoperative year. However, when all medical claims are considered, the estimated savings from the tonsillectomy operation are somewhat reduced. Individual variation in predisposition to "see the doctor" appears to account for such results; visits about conditions other than respiratory take up much of the "savings" produced by tonsil surgery. The findings are discussed in terms of the costs and benefits of the tonsillectomy operation, and future research needs are outlined.

Adenoidectomy↗
PubMed1977

Elective surgical rates--do high rates mean lower standards? Tonsillectomy and adenoidectomy in Manitoba.

We used claims data from the Canadian province of Manitoba to test alternative explanations for regional differences in tonsillectomy and adenoidectomy rates. Respiratory morbidity, standards of selection for operation, and surgical resources were compared with elective surgical rates across geographic areas. Statistically significant correlations were not found. Individual practice patterns were then examined. In some regions, a few physicians accounted for the great majority of tonsil/adenoid operations. In other regions, the work was much more widely distributed. Despite great variation among individual physicians in the frequency of performing tonsil/adenoid operations and the standards of selection for operation, use of these procedures and standards applied were only weakly related to such variables as physician age, place of training and specialty.

Adenoidectomy↗
PubMed1977

A new audit prodecure applied to an old question: Is the frequency of T&A justified?

A unique medical audit procedure has been employed to combine the scope of population data with the detail of case histories. All tonsillectomy and adenoidectomy (T&As) in Manitoba for one year were studied. A group of individuals treated for respiratory illness but not having T&As were also identified. Individual histories were reconstructed from medical insurance claims. These cases were reviewed to test conformity between practice and authoritative standards for surgical intervention. The quality of the data on which this procedure depends withstood a battery of challenges. The analysis indicates that most cases selected for surgery lack evidence of meeting authoritative standards. However, a sizeable group of individuals not selcted for surgery perhaps should have been, if the same standards are applied. Also, those physicians performing the most operations had the highest criteria for patient selection.

Adenoidectomy↗