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Biomedical subjects

R M Saywell

Publications and source records attributed to R M Saywell.

36 records · Page 2Linked to original sources
PubMed1989

Hospital and patient characteristics of uncompensated hospital care: policy implications.

For this study, a sample of 1,689 patients classified as "charity" and "bad debt" cases in 1986 were identified from 27 general acute care hospitals and one tertiary hospital in Indiana. Half of the hospitals were in rural areas and 57 percent were small (less than 150 beds). Most of the patients (87.2 percent) incurred uncompensated amounts under $2,500, and 40 percent of the cases were below $500. About 72 percent of the patients with uncompensated care were from the same county as the location of the hospital (range from 30.9% to 100.0%). The majority of the cases (79.4 percent) with over $5,000 in uncompensated care were treated in urban hospitals. The average age of these patients was 27.2 years. Fifty-four percent of the patients were single, 60.7 percent were female, and nearly all (83.0 percent) were discharged to home care. Only 44.6 percent of the patients with uncompensated care had no insurance; 46.8 percent had some form of commercial insurance which covered part of the charges for care. The most common diagnosis for these patients was pregnancy and childbirth (22.8 percent), with injury and poisoning second (10.7 percent). The cases with $5,000 or more in bad debt (about 4 percent of the cases) account for 28.3 percent of the total uncollected amount. Bad debt represents a cost of doing business. Any national effort to contain health care costs must address this problem.

Costs and Cost Analysis↗
PubMed1989

The impact of the prospective payment system on the treatment of hip fractures in the elderly.

A review of 386 Medicare patients with hip fractures admitted to a private, suburban, teaching hospital from 1981 through 1987 revealed that since the implementation of the prospective payment system in 1984, average hospital stays declined from 17.0 days to 12.9 days (24.1%). Although the mean number of physical therapy sessions declined from 11.1 to 9.8 (11.7%), the average number of treatments per day during the physical therapy phase actually increased from 1.2 before to 1.4 after the prospective payment system. The proportion of patients discharged to nursing homes remained the same (52.9% vs 53.6%); the proportion of patients remaining in a nursing home 6 months after hospital discharge did not differ significantly (22.6% vs 19.9%). Furthermore, there were no differences in the 6-month ambulation status. Total adjusted average hospital charges for the pre- and post-prospective payment system groups did not increase significantly ($7295 vs $7565). These findings do not support the contention that the quality of care provided Medicare patients with hip fractures has deteriorated in this hospital environment.

Aged↗
PubMed1988

Comparative costs of a cooperative care program versus inpatient hospital care for obstetric patients.

The cost of obstetric care delivered in a cooperative care unit was compared with the cost for similar patients treated in a traditional inpatient maternity unit. The study sample contained 1,683 consecutive patients representing 23 diagnosis categories. The analysis indicates that cooperative care patients had significantly lower total hospital costs. This cost savings persisted even when we controlled for case severity. The only exception was for the obstetric patient requiring intra-abdominal surgery. For fiscal year 1986, hospital cost savings for the 576 patients who used the cooperative care unit was +80,640 or approximately +105,000 in total patient charges. The majority of the savings came from a reduction in routine nursing services that are directly attributable to the cooperative care unit. We conclude that cooperative care can be an economically feasible alternative for most obstetric patients.

Adult↗
PubMed1986

Cost analysis of extracorporeal shock wave lithotripsy relative to other surgical and nonsurgical treatment alternatives for urolithiasis.

The impact and associated costs of new urolithiasis treatment methods, including extracorporeal shock wave lithotripsy (ESWL), were examined in a series of 1781 patients treated between March 1, 1983, and February 28, 1985. An accounting cost methodology was used to derive estimates of direct and indirect hospital costs, as distinct from charges billed to the patient. The average hospital cost per case for ESWL was lower by 27% and significantly different (P less than 0.05) than the average cost for surgically treated patients. The difference in cost between ESWL and percutaneous lithotripsy was not statistically significant. The invasiveness of the treatments studied was directly related to length of hospital stay and cost. Projecting our findings to the entire urolithiasis population of the United States, we estimate that the usage of ESWL, if applied only to patients who would otherwise receive surgery, could result in an annual hospital cost savings of $124,436,520. We conclude that although the institutional cost of acquiring ESWL is high, its application results in a significant cost savings for patients previously requiring surgery, it is no more expensive than percutaneous stone removal, and it has the advantage of being less invasive than any other treatment method. The potential national savings in health care costs may not be realized if the indications for this less invasive technology are defined more broadly than are those for open surgical procedures, as seems likely, and unless limits are placed on the number of lithotripters made available nationally. Indications for ESWL need to be clearly defined based on careful studies of risks, potential benefits, and costs.

Accounting↗
PubMed1981

An examination of the relationships between physicians' clinical and hospital-utilization performance.

To examine the relationships between measures of attending physician teams' clinical and utilization performance, inpatient hospital audits were conducted in 22 Maryland and western Pennsylvania nonfederal short-term hospitals. A total of 6,980 medical records were abstracted from eight diagnostic categories using the Payne and JCAH PEP medical audit procedures. The results indicate weak statistical associations between the two medical care evaluation audits; between clinical performance and utilization performance, as measured by appropriateness of admissions and length of stay; and between three utilization measures. Based on these findings, it does not appear valid to use performance in one area to evaluate performance in the other in order to measure or evaluate and ultimately improve physicians; clinical or utilization performance.

Clinical Competence↗
PubMed1979

A performance comparison: USMG-FMG attending physicians.

To determine whether patterns of differences in performance exist between United States Medical Graduate and Foreign Medical Graduate attending Physicians, two types of inpatient hospital audits (Payne Process Audit and the Joint Committee on Accreditation of Hospitals' Performance Evaluation Program-P.E.P. Audit) were conducted in 22 Maryland and Pennsylvania non-federal, short-term hospitals. A total of 6,980 medical records were abstracted from eight diagnostic categories for 1,321 attending physicians; 985 of which were USMGs and 331 were FMGs. The results from both audits indicate that while there is evidence of a strong hospital-type of physician interaction for many of the diagnoses, there was no significant overall difference in performance between USMG and FMG attending physicians. The largest and most consistent differences in physician performance were associated with hospital characteristics, not physician characteristics.

Clinical Competence↗
PubMed1976

Foreign medical graduates and Maryland Medicaid.

To determine whether foreign medical graduates provide a disproportionate share of medical care to the poor, Medicaid vendors in Maryland were compared with all licensed physicians in the State. Foreign medical graduates constitute 22 per cent of all physicians in Maryland but 36 per cent of the Medicaid vendors. In addition, of all the vendors for fiscal 1974, 94 per cent who were licensed in 1972 or 1973 were foreign medical graduates. This disproportional representation in the Medicaid program is concentrated in the specialties of general surgery, internal medicine and general practice. Thirty-two per cent of all foreign medical graduates in Maryland are board-certified physicians, but only 22 per cent of those who are Medicaid vendors are board certified. For United States medical graduates, 48 per cent of all physicians are board certified, but this figure increases to 52 per cent for the Medicaid vendors. Finally, representation of foreign medical graduates among Medicaid vendors tends to be highest in areas with the highest physician-to-population ratios and with the highest percentages of total Medicaid payments.

Certification↗
PubMedDate not supplied

Cost of hospitalizations for heart failure: sodium retention versus other decompensating factors.

OBJECTIVE: To determine the cost of heart failure-related hospital admissions and to compare the cost of admissions for sodium retention with the cost of admissions for other decompensating factors. DESIGN: Retrospective, non-experimental, cost analysis. SETTING: Midwestern university-affiliated, tertiary care, medical center. SAMPLE: Two hundred seven heart failure-related admissions, 117 (57%) of which were for sodium retention leading to volume overload. OUTCOME MEASURES: Cost of hospitalization. PROCEDURE: Data obtained from the patient and financial records of patients hospitalized for heart failure in 1992 were analyzed using the ratio of cost-to-charge accounting procedure. RESULTS: The total cost was $2,442,720 for the 207 heart failure-related admissions; the average cost was $12,400 per admission. Approximately half of the cost of the hospitalizations was expended in the 4 cost centers comprising routine and critical care services, which incorporate room charges and nursing care. Another one third of the cost was for supplies, medications, and laboratory tests. Admissions as a result of sodium retention had lower costs than admissions as a result of other factors. CONCLUSION: The cost of hospitalization for heart failure is high. Routine services, supplies, medications, and laboratory tests used by these patients contribute to the high cost of care. Improved outpatient management strategies are necessary to reduce hospital admissions as a result of sodium retention.

Adult↗
PubMedDate not supplied

ENT experience in a family medicine clerkship: is there enough?

BACKGROUND: Curriculum planning is an essential process at any institution of learning. Currently, at Indiana University, a 1-week required otorhinolaryngology clerkship is being considered for removal from the curriculum, and this exposure is planned for integration into other primary care clerkships. A data collection system for patient encounters was created to obtain objective quantitative data about ear, nose, and throat conditions in the family medicine clerkship. METHODS: A total of 445 students filled out 56,151 patient encounter forms that contained the diagnoses, patient age, student comfort levels, and student responsibilities. RESULTS: Of the 56,151 encounters, 22.9% involved a condition involving an ear, nose, or throat (ENT) diagnosis, and the overall top-10 diagnoses reflect a typical family practice. Few students reported being given the opportunity to perform procedures. CONCLUSIONS: It appears that students are receiving sufficient practice in taking patient histories and performing initial patient physicals for ENT cases and that they see a sufficient number of ENT cases. However, students had more limited opportunity to perform and/or assist with ENT procedures or to be involved with patient education and ENT counseling. The number of ENT cases in the third-year clerkship is sufficient, and the experience is mostly more than adequate. Our study indicates that ENT training is a significant part of the family medicine clerkship, and curriculum integration is possible, though concerns about procedural skills will need to be addressed.

Clinical Clerkship↗
PubMedDate not supplied

Cost analysis of heart transplantation from the day of operation to the day of discharge.

Hospital costs from the day of transplantation to the day of discharge were examined in a consecutive series of 53 patients who underwent orthotopic heart transplantation between October 1982 and February 1987. An accounting cost methodology was used to convert billable charges, to costs for 29 separate hospital cost centers. Total cost per case has shown a statistically significant decrease of over $30,000 with no indication of a change in patient selection or a decrease in 3-month survival. Most of the cost reductions occurred in five cost centers: operating room, blood and intravenous therapy, medical supplies, heart station, and routine services, as evidenced by decreases in wages and supplies. The results support the premise that new technologies can become more cost-efficient over time and suggest that as the medical team becomes more proficient and experienced, cost reductions can become a reality.

Accounting↗
PubMedDate not supplied

Reducing the costs of patient transfers.

This study examined the potential cost savings of a new patient transfer device that uses air pressure to assist in the movement of patients. The analysis for a single hospital indicates that this new technology is no less expensive than traditional patient transfer methods if only the direct costs of staff utilization are considered. However, reductions are projected for indirect costs associated with work-related back injuries. A methodology is recommended for conducting similar evaluations at other institutions.

Air Pressure↗
PubMedDate not supplied

Indiana family physician attitudes and practices concerning smoking cessation.

Most physicians are aware of the health benefits of smoking cessation and agree they have a responsibility to help smokers quit. Many physicians, however, do not regularly address smoking cessation with their patients. Questionnaires were sent to 2,095 family practice physicians in Indiana. Information obtained included: demographic data; office-based smoking cessation practices; counseling; and physicians' perceptions of intervention outcomes. Most physicians (86%) asked new patients if they smoked, and 23% questioned patients about their exposure to passive smoke. Younger physicians, female physicians and urban physicians were more likely to ask new patients if they smoked. A formal smoking cessation program was used by 28% of the responding physicians. Among those not using a program, 7% reported plans to implement one in the coming year, 40% were not planning to implement one, and 53% were unsure. Physician and practice characteristics were not correlated with the use of smoking cessation programs. Only 11% of physicians considered their smoking cessation counseling skills to be excellent; 27% indicated the need for improvement in skills. One-half (52%) believed their counseling efforts were effective; almost half (45%) believed that current reimbursement policies limited their involvement in smoking cessation interventions. Most respondents have not instituted smoking cessation programs in their practices. It is likely that a combination of strategies, including both undergraduate, graduate and continuing medical education programs and reform in reimbursement practices for cessation programs, will be required to achieve significant increases in long-term smoking abstinence rates.

Adult↗
PubMedDate not supplied

Assessing prenatal care in a family practice residency clinic.

BACKGROUND AND OBJECTIVES: This study demonstrates how one family practice residency clinic characterized obstetric clinic patients and assessed obstetric care using birth certificate data (demographic characteristics and risk factors) and birth outcome indicators. METHODS: We compared clinical characteristics and birth outcomes for 901 patients who were delivered by family physicians from the family practice residency clinic with a matched and unmatched group of patients who were delivered by other physicians in the county during 1990-1993. RESULTS: The study clinic patients were at higher risk and had lower use of prenatal care. However, the outcomes of the study clinic patients were significantly better (fewer labor and delivery complications, procedures, Cesarean deliveries, abnormal conditions of newborn, low birth weight deliveries, and preterm birth) or no different from the comparison group of non-clinic patients. CONCLUSIONS: The analysis of birth certificate data provided a favorable assessment of prenatal care provided by a family practice residency clinic. This type of analysis permits comparisons of birth outcomes with other local or regional providers, statewide providers, and the year 2000 national objectives established by the National Center for Health Statistics.

Adolescent↗