Biomedical subjects

R Kohli

Publications and source records attributed to R Kohli.

39 records · Page 3Linked to original sources

PubMedDate not supplied

The cost and efficiency of hospital care provided by primary care physicians and medical subspecialists.

There is a perceived excess of subspecialists compared with primary care doctors, but there are few severity-adjusted data that characterize the care provided by these physician groups. In a nationwide hospital network, we studied outcomes of 17,185 patients who were hospitalized for 1 of 9 common internal medicine illnesses. For 4 of 9 conditions, the subspecialists treated more severely ill (P < .001) patients. The raw total charges for their care were higher (P < .002) for 4 of 9 conditions and longer stays were required for 2 conditions. After adjusting for severity of illness, differences between the physician groups became minimal. In nine-severity adjusted medical illnesses, subspecialists and primary care physicians provide care that produces similar results for length of stay, charge, and mortality. Health care manpower projections should be re-evaluated in light of this information.

Adult↗

PubMedDate not supplied

The utility of hospital administrative data for generating a screening program to predict adverse outcomes.

A system to predict which patients will suffer medical complications or poor financial outcomes during a hospitalization would be very useful to providers of medical care. To develop such a system, we applied two previously developed indices that predict in-hospital complications to all 321,558 adult patients discharged from our hospital network. The indices identified 26,377 patients (8.2%) who experienced one or more medical complications. For these patients, high-risk admitting diagnoses were identified. We tabulated 4235 admitting diagnoses and focused on 26 (0.6%) diagnoses that were high-risk and high-volume for complications. We found that 25% of patients with these admitting diagnoses experienced complications during hospitalization. Prevention of these complications could have saved 1241 hospital days, 11 lives, and $10.5 million. Administrative data available at the time of admission can be useful in identifying the small subset of patients who are likely to experience adverse clinical outcomes during a hospitalization and those who are likely to generate adverse financial outcomes for the hospital.

Adult↗

PubMedDate not supplied

Use of colchicine to treat severe constipation in developmentally disabled patients.

BACKGROUND: Patients with severe developmental disabilities often have concurrent decreased neuromuscular tone of the gastrointestinal tract, which can lead to a weak gag reflex, esophageal reflux, aspiration, and severe intractable constipation. High doses of multiple laxatives are frequently needed to maintain bowel motility in these patients. Colchicine, a natural alkaloid that is primarily used for the treatment of acute attacks of gout, causes an increase in gastrointestinal motility by neurogenic stimulation. The purpose of this study was to determine whether daily colchicine administration can improve bowel function and reduce laxative use in profoundly disabled patients with severe, intractable constipation who currently require large doses of multiple laxatives. METHODS: Twelve developmentally disabled patients who required three or more different laxatives to manage their chronic constipation were selected to participate in a double-blind, crossover study. Eleven patients who completed the study received placebo treatment for 8 weeks and colchicine treatment for 8 weeks. The total number of bowel movements and the total number of laxatives used during each of the two 8-week periods were compared. RESULTS: Eight of 11 patients experienced an improved bowel pattern while on colchicine compared with placebo, as defined by an increase in total number of bowel movements or a decrease in total number of rectal laxatives used. No clinically important complications were related to use of colchicine. CONCLUSIONS: Colchicine appears to be a valuable adjunct in the management of severe intractable constipation. Larger, long-term studies are needed to confirm these preliminary results.

Adult↗