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Robert J Greenstein

Publications and source records attributed to Robert J Greenstein.

7 recordsLinked to original sources
PubMed2006

Changes in critical care beds and occupancy in the United States 1985-2000: Differences attributable to hospital size.

OBJECTIVE: To determine the relationship between hospital size and changes in the number of critical care medicine (CCM) beds, proportion of hospital beds allocated to CCM, and CCM occupancy in acute care hospitals in the United States from 1985 to 2000. DESIGN: A 16-yr (1985 to 2000) retrospective analysis was performed using the Hospital Cost Report Information System (Centers for Medicare and Medicaid Services, Baltimore, MD) on U.S. acute care hospitals that provided CCM. Hospitals were stratified into four groups (small, 1-100 beds; medium, 101-300 beds; large 301-500 beds; and extra large, >500 beds). SETTING: Nonfederal, acute care hospitals with CCM units in the United States. SUBJECTS: None. INTERVENTIONS: None. MEASUREMENTS: Changes in the number of hospitals, non-CCM and CCM beds, the proportion of CCM to hospital beds, and their occupancy rates. MAIN RESULTS: Between 1985 and 2000, the number of hospitals providing CCM decreased overall (4,150 to 3,581, -13.7%). The greatest decreases were seen in large (-39%) and extra-large (-40%) hospitals. Small hospitals increased minimally (3.3%). The number of non-CCM beds decreased (820,300 to 566,900, -30.9%), most prominently in large (-44.2%) and extra-large (-46.1%) hospitals. In contrast, CCM beds increased overall (69,300 to 87,400, 26.1%), especially in small (27%) and medium (44.2%) hospitals. The proportion of total hospital beds assigned to CCM increased (71.8%), most markedly in large (93.5%) and extra-large (85.7%) hospitals. Non-CCM occupancy decreased (-6.4%), particularly in small (-7.5%) and extra-large (-5.8%) hospitals. However, regardless of hospital size, CCM occupancy changed negligibly (0.4%). At every time point studied, CCM occupancy was greater than non-CCM occupancy within each size group. As hospital size increased, occupancy rates increased. CONCLUSIONS: Across hospitals of all sizes, CCM bed numbers are increasing, whereas non-CCM bed numbers are decreasing. Although the CCM bed capacity is increasing at a greater percentage rate in smaller hospitals, the assignment of hospital beds to CCM remains higher in the larger hospitals. In addition, CCM bed occupancy is greater in larger institutions. These findings may help guide the future development of hospital size-based CCM benchmarking standards and guidelines.

Bed Occupancy↗
PubMed2004

Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs.

OBJECTIVE: To establish a database that permits description and analysis of the evolving role, patterns of use, and costs of critical care medicine (CCM) in the United States from 1985 to 2000. DESIGN: Retrospective study combining data from federal (Hospital Cost Report Information System, Center for Medicare and Medicaid Services, Baltimore, MD) and private (Hospital Statistics, American Hospital Association, Chicago, IL) databases to analyze U.S. hospitals, hospital and CCM beds, and occupancy. CCM costs were calculated by the Russell equation and compared with national health care and financial indexes. SETTING: Nonfederal, acute care hospitals with CCM units in the United States. SUBJECTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed hospitals with CCM units and focused on hospital and CCM beds, CCM occupancy, and CCM costs. CCM costs were compared with national cost indexes. Between 1985 and 2000, the total number of U.S. hospitals decreased by 8.9% (6,032 to 5,494) and acute care hospitals offering CCM decreased by 13.7% (4,150 to 3,581). The total number of beds in hospitals with CCM units decreased by 26.4% (889,600 to 654,400). In contrast, CCM beds increased by 26.2% (69,300 to 87,400). CCM occupancy was constant at 65%. CCM bed costs per day increased by 126% (1,185 to 2,674 US dollars). Although CCM costs increased by 190.4% (19.1 billion to 55.5 billion US dollars), the proportion of national health expenditures allocated to CCM decreased by 5.4%. In 2000, CCM costs represented 13.3% of hospital costs, 4.2% of national health expenditures, and 0.56% of the gross domestic product. CONCLUSIONS: CCM is increasingly used and prominent in a shrinking U.S. hospital system. CCM occupancy is lower than expected. Despite its increasing use and cost, CCM is using proportionally less of national health expenses and the gross domestic product than previously estimated.

Bed Occupancy↗
PubMed2003

Is Crohn's disease caused by a mycobacterium? Comparisons with leprosy, tuberculosis, and Johne's disease.

Although Crohn's disease is considered to be autoimmune in origin, there is increasing evidence that it may have an infectious cause. The most plausible candidate is Mycobacterium avium subspecies paratuberculosis (MAP). Intriguingly, Koch's postulates may have been fulfilled for MAP and Crohn's disease, even though they still have not been met for Mycobacterium leprae and leprosy. In animals MAP causes Johne's disease, a chronic wasting intestinal diarrhoeal disease evocative of Crohn's disease. Johne's disease occurs in wild and domesticated animals, including dairy herds. Viable MAP is found in human and cow milk, and is not reliably killed by standard pasteurisation. MAP is ubiquitous in the environment including in potable water. Since cell-wall-deficient MAP usually cannot be identified by Ziehl-Neelsen staining, identification of MAP in human beings requires culture or detection of MAP DNA or RNA. If infectious in origin, Crohn's disease should be curable with appropriate antibiotics. Many studies that argue against a causative role for MAP in Crohn's disease have used antibiotics that are inactive against MAP. However, trials that include macrolide antibiotics indicate that a cure for Crohn's disease is possible. The necessary length of therapy remains to be determined. Mycobacterial diseases have protean clinical manifestations, as does Crohn's disease. The necessity of stratifying Crohn's disease into two clinical manifestations (perforating and non-perforating) when interpreting the results of antibiotic therapy is discussed. Rational studies to evaluate appropriate therapies to cure Crohn's disease are proposed.

Animals↗
PubMed2002

Implantable gastric stimulation (IGS) as therapy for human morbid obesity: report from the 2001 IFSO symposium in Crete.

This supplement contains reports from a symposium on a novel approach to treat obesity, gastric myo-electrical stimulation, that was held at the IFSO in Greece in 2001. There were four presentations. Xavier Pi-Sunyer from Columbia University in New York discussed medical risks of obesity. Karl Miller from Austria presented technical aspects of the surgery. Valerio Cigaina from Italy, the originator of the concept, reviewed his 7-year results with this therapy. Finally, Jerome D'Argent from France gave his preliminary results employing higher energy electrical stimulation parameters. Customarily weight loss data are presented as percent excess weight lost (%EWL), an antiquated measurement, e.g. all subjects were purchasing life insurance, the poor and minorities were under-represented and those with heart disease, malignancies or diabetes were excluded. In this supplement weight loss data are presented in a novel manner: percent excess body mass index (BMI) lost %EBL. This innovation merits an explanation and justification. The NIH/NIDDK convened a panel, chaired by Professor Pi-Sunyer, that concluded that for adults a BMI of 25 should be considered the upper limit of normal. Accordingly, we have proposed that BMI units in excess of 25 be considered to represent 100% of the excess weight of an individual. The USA FDA has agreed to accept weight loss data presented as %EBL. The intriguing data presented justify further evaluation of this novel, potentially useful and relatively benign treatment of obesity.

Congresses as Topic↗