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Biomedical subjects

P Shelton

Publications and source records attributed to P Shelton.

At least 19 recordsLinked to original sources
PubMed2001

The effects of a collaborative model of primary care on the mortality and hospital use of community-dwelling older adults.

BACKGROUND: This study evaluates the ability of a model of collaborative primary care practice to reduce mortality and hospital use in community-dwelling elderly persons. METHODS: Four rural and four urban clinic sites in east central Illinois were randomized to form treatment and comparison clinics from which patients were enrolled and followed prospectively for 2 years. Patients from the practices of participating physicians were eligible if they were aged 65 and older, were living in the community, and had at least one risk factor as determined prior to the study. Medicare hospital data were obtained from the Health Care Financing Administration. Demographic and health status measures were obtained by telephone interview every 12 months throughout the study. RESULTS: The treatment group experienced a 49% reduction in all-cause mortality during the second year of the study (odds ratio, 0.51, 95% confidence interval, 0.29-0.91, p = .02). There were no significant differences between treatment and comparison patients in percentage of persons hospitalized, hospital length of stay, or Medicare payments. Although measures of health status indicated that the treatment group was significantly sicker at baseline at the end of 1 year, these differences disappeared by the end of 2 years. CONCLUSIONS: The collaborative primary care model evaluated in this study significantly reduced mortality in the second year, without increasing hospital use. These findings suggest that a collaborative primary care team that enhances primary care practice can result in better patient outcomes.

Aged↗
PubMed2001

Caregivers' utilization of health services: results from the Medicare Alzheimer's Disease Demonstration, Illinois site.

OBJECTIVES: The purpose of this study is to examine the effect of the Medicare Alzheimer's Disease Demonstration and Evaluation (MADDE) conducted in Illinois on the use of health services and Medicare expenditures by caregivers of persons with dementia. DESIGN: Prospective randomized clinical trial. SETTING: The MADDE (1989-1994), Illinois site. PARTICIPANTS: A cohort of 412 Medicare-eligible caregivers of persons with dementia. MEASUREMENTS: Medicare claims files provided data on the number of hospitalizations, hospital bed days, emergency department visits, and total Medicare Part A expenditures. RESULTS: After adjustment for baseline variables, the caregivers in the treatment group, when compared with those in the comparison group, had a lower likelihood of any hospitalization during the study period (odds ratio 0.58 (95% confidence interval (CI)=0.35-0.97), P= .037) and a reduced, but not significant, likelihood of emergency department use (odds ratio 0.66 (95% CI=0.40-1.08), P= .095). For those who were hospitalized, there were no significant differences between the treatment and comparison group caregivers in the number of hospitalizations, hospital length of stay, or Medicare payments. CONCLUSION: These results suggest that enhanced chronic illness case management directed at persons with dementia and their caregivers can reduce the need for acute hospital care.

Aged↗
PubMed2000

Spatial discrimination is abnormal in focal hand dystonia.

BACKGROUND: In patients with focal hand dystonia, abnormal digit representations in the primary somatosensory cortex (S1) could be the result of enlarged and overlapping receptor fields, as suggested by an animal model of dystonia. A possible clinical correlate of this S1 abnormality is a disturbed spatial discrimination capability. OBJECTIVE: To test the hypothesis that somatosensory spatial discrimination is abnormal in focal hand dystonia. METHODS: Seventeen patients with focal hand dystonia underwent a quantitative evaluation of somatosensory spatial frequency (gap detection, JVP domes, applied to the distal phalanx of the index finger) and single-touch localization (Von Frey monofilaments, applied to the middle phalanx of the index finger). RESULTS: Compared with control subjects, patients had a decreased performance in both the gap detection (p = 0.004) and the localization (p = 0.013) tasks. The extent of spatial frequency abnormality correlated with age in both groups. CONCLUSIONS: These findings, together with a previously shown temporal discrimination deficit, support a role for sensory dysfunction in the pathophysiology of dystonia.

Adult↗
PubMed2000

Integrated risk assessment and feedback reporting for clinical decision making in a Medicare Risk plan.

The challenge of tapping into the rich resource of population-based, aggregated data to inform and guide clinical processes remains one of the largely unrealized potentials of managed care. This article describes a multifaceted approach of using health-related data to support providers in clinical decision making as an adjunct to case management and primary care delivery. The goal is to provide data that can be used for clinical decision making that is population based, yet individualized for specific patient care situations. Information reporting holds great potential in the clinical care of patients because it can be used to identify persons who could benefit from early detection, intervention, or treatment. It has been suggested that one of the keys to success in managed Medicare is the timely use of information that is detailed, comprehensive, and real-time describing key parameters of clinical encounters.

Aged↗
PubMed2000

Sensory discrimination capabilities in patients with focal hand dystonia.

To explore the concept that dystonia may result from dysfunction of the sensory system, 14 patients with focal hand dystonia were tested during two somatosensory discrimination tasks. Compared with controls, patients had a higher threshold in a task involving discrimination of two electric stimuli closely related temporally, an abnormality that correlated with the degree of severity of dystonia. There was no significant difference in a single-touch, gross localization task. The possible relevance of these findings to the pathogenesis of dystonia is discussed.

Adult↗
PubMed2000

The community assessment risk screen (CARS): identifying elderly persons at risk for hospitalization or emergency department visit.

OBJECTIVE: To develop and validate an instrument for identifying community dwelling elderly patients at increased risk for hospitalizations or emergency department (ED) encounters. STUDY DESIGN: Prospective cohort study. PATIENTS AND METHODS: The development cohort consisted of 411 Medicare fee-for-service patients and the validation cohort consisted of 1054 individuals enrolled in a Medicare Risk Demonstration. Baseline demographic, health status, and utilization measures were obtained from telephone interviews and mailed questionnaires. Service utilization data for the development cohort were obtained from Medicare claims files. Utilization and cost data for the validation cohort were obtained from submitted claims. RESULTS: Logistic regression identified 3 characteristics that were predictors of hospitalizations or ED visits during the following year in the development cohort: having 2 or more comorbidities, taking 5 or more prescription medications, and having had a hospitalization or ED encounter in the previous 12 months. A scoring system (range 0 to 9) was developed for each predictor variable and patients in the validation cohort were assigned to low (0 to 3) and high (4 to 9) risk categories. When compared with the low-risk group, the high-risk group was significantly (P < .01) more likely to be hospitalized (33% versus 14%), to have an ED visit (34% versus 15%), and to have higher per-member-per-month (PMPM) charges ($977 versus $445) during the following 12 months. CONCLUSION: The Community Assessment Risk Screen (CARS) is a simple instrument that can be used to identify elderly patients who are at higher risk for health service use and increased costs.

Aged↗
PubMed1999

Process reengineering: the role of a planning methodology and picture archiving and communications system team building.

The acquisition of a picture archiving and communications system (PACS) is an opportunity to reengineer business practices and should optimally consider the entire process from image acquisition to communication of results. The purpose of this presentation is to describe the PACS planning methodology used by the Department of Defense (DOD) Joint Imaging Technology Project Office (JITPO), outline the critical procedures for each phase, and review the military experience using this model. The methodology is segmented into four phases: strategic planning, clinical scenario planning, installation planning, and implementation planning. Each is further subdivided based on the specific tasks that need to be accomplished within that phase. By using this method, an institution will have clearly defined program goals, objectives, and PACS requirements before vendors are contacted. The development of an institution-specific PACS requirement should direct the process of proposal comparisons to be based on functionality and exclude unnecessary equipment. This PACS planning methodology is being used at more than eight DOD medical treatment facilities. When properly executed, this methodology facilitates a seamless transition to the electronic environment and contributes to the successful integration of the healthcare enterprise. A crucial component of this methodology is the development of a local PACS planning team to manage all aspects of the process. A plan formulated by the local team is based on input from each department that will be integrating with the PACS. Involving all users in the planning process is paramount for successful implementation.

Computer Systems↗
PubMed1997

Highlights of the Digital Imaging Network-Picture Archiving and Communications System Project.

The Department of Defense issued its requirements for a Digital imaging Network-Picture Archiving and Communications System (DIN-PACS) in a Request for Proposals to industry in January, 1997. The DIN-PACS shall be an open systems network of digital devices designed for the effective acquisition, transmission, display and management of diagnostic imaging studies. This network is primarily based on two international standards, Digital imaging and Communications in Medicine (DICOM) and Health Level 7 (HL7). The DIN-PACS is required to communicate in a bidirectional manner with the Department of Defense standard hospital information system called the Composite Health Care System (CHCS) through an HL7 compliant interface. The DIN-PACS model and its published specifications stress functionality and performance rather than system architecture to allow industry to propose optimal approaches for implementation. This paper discusses the functional requirements of the DIN-PACS in terms of its internal operations as well as its communication with external systems and components. This is a US government work. There are no restrictions on its use.

Diagnostic Imaging↗
PubMed1997

Population-based research data as a means to address health outcomes.

Health care restructuring efforts have been influenced by changes in public policy, payment mechanisms, and societal values. In today's environment, leading issues focus on quality and cost-effective care. Health care systems are moving from a concentration on structures and processes of care to an expanded view that encompasses the exploration, documentation, and improvement of patient outcomes. This article presents an overview of the domains of health outcomes, widely used surveys in the measurement of outcomes, methodological issues related to interpreting outcome measures, and trends for clinical practice and future research.

Community Health Planning↗
PubMed1997

Management of nursing within a collaborative physician group practice.

Today's changing health care environment suggests the need for integration of high-quality primary medical and nursing care to address the complex psychosocial and environmental aspects of health in the elderly. This article describes a model of geriatric primary collaborative care between nurses and physicians that has been successfully implemented in a large primary care group practice setting.

Aged↗
PubMed1996

Clinical and health service research needs in the group practice organization.

Clinical and health services research will play a more important role in group practice organizations because it provides a vehicle to identify and answer critical questions. Study initiatives can identify, describe, quantify, and help predict trends in clinical practice. Systematic investigation is a means to link structure and processes of care to clinical parameters, patient outcomes, and cost variables. Findings can be used to support sound clinical, quality of care, and educational decision making. The ultimate goal of research is to promote the appropriate access and delivery of quality care in a cost-effective manner.

Costs and Cost Analysis↗
PubMed1996

Case management in a capitated system: the community nursing organization.

This article describes the Community Nursing Organization, a federal health care model designed to provide specific ambulatory and outpatient services to medicare beneficiaries via a nurse managed delivery system under capitated financing. A primary nurse provider, working with the elderly client, family, physician, health care service providers, and community organizations, assesses the need for care and arranges for appropriate services. This nurse must also authorize payment of those services covered by the Community Nursing Organization (CNO). A 3-year demonstration project is currently under way. Findings at 1 year indicate that the system may have a positive effect on client health status.

Aged↗
PubMed1995

Functional organisation of the metathoracic femoral chordotonal organ in the cricket Acheta domesticus

The metathoracic chordotonal organ of the cricket Acheta domesticus (Gryllidae) consists of two closely associated scoloparia situated proximally within the femur with their distal ends connected by a pair of ligaments to an apodeme arising from the tibia. The smaller scoloparium is associated with the dorsal ligament, which arises from the dorsal surface of the apodeme 150 &micro;m from its proximal end. The larger scoloparium is attached directly to the proximal end of the apodeme by a larger ventral ligament. Both ligaments are composed of bundles of attachment cells containing densely packed microtubules. Longitudinally orientated, Acid-Fuchsin-staining fibrils are found in an extracellular matrix surrounding the individual attachment cells. Similar fibrils occur in the sheath surrounding each ligament. The fibrils are thickest and most densely packed in the sheath surrounding the ventral ligament. They are thinner and more sparsely distributed in the sheath of the dorsal ligament. The finest fibrils are found in the extracellular matrix surrounding individual attachment cells. Staining with phosphotungstic acid provides the first evidence that they are elastic. The ventral ligament also contains a spring-like cuticular core arising as a proximal extension of the apodeme. As femoro-tibial angle changes, the cuticular core changes in length, shortening with tibial extension and lengthening with flexion. Ventral ligament attachment cells terminate at different levels along the cuticular core. This arrangement provides a new possible mechanism for differential sensitivity of the sensory neurones associated with the attachment cells.

Journal Article↗
PubMed1994

Establishing an internal medicine practice: a model to determine economic feasibility.

To make informed career decisions, physicians must acquire a basic knowledge in medical management and health care economics as they evaluate the potential survival and growth of a primary care practice. Health care providers considering a specific community and local leaders and hospital administrators attempting to recruit internal medicine physicians need a method by which they can evaluate a community's potential for supporting a first or additional primary care physician. To develop this method, we conducted a detailed survey of nonmetropolitan internal medicine generalists and primary care physicians. Data collected from internal medicine physicians and their administrative staff reflected the volume of ambulatory and hospital visits and the direct and indirect costs of the practice over the previous 24 months. Using the fixed and operating cost data, as well as number of patient visits and patient care revenue, we designed a model to project the economic feasibility of establishing an internal medicine practice in a specific community. This model can be used to project the number of adult primary care visits a community can generate for a prospective physician, as well as to estimate the direct and indirect costs, annualized capital costs, gross revenue, and net income of the practice.

Adolescent↗
PubMed1994

A generalist physician-based model for a rural geriatric collaborative practice.

This article describes a geriatric collaborative practice model in which primary care physicians (family practice and internal medicine) and nurse case managers are key members of a multidisciplinary team providing care to elderly rural patients in east central Illinois. Client characteristics, nursing case management roles, and the strengths and benefits associated with this geriatric collaborative model are presented.

Aged↗
PubMed1993

Women's participation in community health education: an empirical study.

This study identifies reasons for participation in community health education and determines if selected sociodemographic variables correlate with reasons for participation. The subjects were women (N = 400) who had attended hospital-based health education programs in a midwest urban area. An instrument was developed containing 36 items describing the concept "reasons for participation." Factor analysis revealed six interpretable factors: social acceptance, professional/personal advancement, personal insight, personal satisfaction, fulfillment of responsibilities, and self-enrichment. Age, marital status, occupation, number of children, educational attainment, and family income correlated with three of the six factors.

Adult↗