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Biomedical subjects

S A Schroeder

Publications and source records attributed to S A Schroeder.

14 recordsLinked to original sources
PubMed1979

Frequency and clinical description of high-cost patients in 17 acute-care hospitals.

To assess the potential impact of national "catastrophic" health insurance on the medical-care system, the frequency and clinical characteristics of high-cost patients were surveyed at 17 acute-care hospitals in the San Francisco Bay Area. The percentage of patients whose yearly hospital charges exceeded $4000 in 1976 ranged from 4 at a community hospital to 24 at a referral hospital. Hospital costs charged to these patients ranged from 20 to 68 per cent of total billings, with the highest percentages generally occurring at large referral hospitals. Forty-seven per cent of adult high-cost patients had chronic medical conditions, and only one in six suffered from an acute medical "catastrophe." In addition, more than 13 per cent of high-cost patients died in the hospital. National catastrophic health insurance is likely to pay for much chronic illness and terminal care and divert resources toward acute-care hospitals.

Acute Disease↗
PubMed1979

Medical student instructional costs in a primary care clerkship.

Using a variety of techniques, such as logs kept daily by the faculty, direct observation, and on-site interviews, the authors determined the instructional costs of a required third-year primary care clerkship based in an ambulatory care setting. Included in the analysis were labor costs of both faculty members and nonfaculty personnel, space and materials, and general university overhead. Total instructional costs were $54.20/student/day. If other third-year clinical clerkships generate equivalent costs, the direct instructional costs of clerkships for third-year medical students would be in excess of $11,500/student/year. The study results imply that ambulatory-based teaching of medical students generates considerable costs and thus requires support from student tuition, federal or state government, or other sources.

Ambulatory Care↗
PubMed1978

Financial incentives to perform medical procedures and laboratory tests: illustrative models of office practice.

Financial return is one of several factors that may affect a physician's decision to order services for a patient. The extent of financial incentives to perform in-office medical procedures and laboratory tests is illustrated by four hypothetical models of general internal medicine office practice. The model practices consist of fixed ratios of history and physical examinations to return visits, with numbers and types of medical procedures and laboratory tests increasing stepwise through the four models. The procedures and tests included are an electrocardiogram, urinalysis, complete blood count, sigmoidoscopy, tuberculin skin test, two-view chest x-ray, cardiovascular treadmill stress test, and an automated 12-channel blood chemistry test. Charges and office expenses are estimated at 1977 Northern California levels. Net incomes derived for the four models are as follows: $31,000, $55,000; $60,000; and $90,000. The demonstrated financial incentives, which apply not only to internal medicine, but to all fields of medical care, are in conflict with policies that would emphasize personal rather than technical services. National health insurance proposals should include a continuing review of medical services valuation.

California↗
PubMed1978

Frequency and morbidity of invasive procedures: report of a pilot study from two teaching hospitals.

The medical services of two teaching hospitals were assessed for the frequency of and complications from invasive procedures. There were 231 procedures performed on 303 patients. The frequency of procedures was significantly higher at one hospital (62% vs 39%, P less than .01). Twenty-nine complications occurred in 20 cases: 14% of patients who underwent procedures had at least one complication. Left-sided cardiac catheterization was the most common procedure. Procedures with more than one complication included the following: left-sided cardiac catherization (18% probability of complication); arteriovenous shunt (60% probability); thoracentesis (19%); bronchoscopy (25%); and percutaneous liver biopsy (8%). While no permanent damage or deaths were observed, over three fourths of the complications either required specific therapy or prolonged hospitalization or both. This study suggests invasive procedures are common and carry appreciable risks of serious complications. Appropriate clinical decision making and medical-legal protection require accurate estimates of those risks.

California↗
PubMed1977

Variation among physicians in use of laboratory tests. II. Relation to clinical productivity and outcomes of care.

Previous studies from this institution have shown extreme variation in laboratory and x-ray use among comparably trained physicians caring for similar patients. In addition, essentially no correlation (r = --.13) existed between a physician's lab use profile and subjective estimates of clinical competence. This study compares variations in lab use with both clinical productivity and outcome of care. Costs of lab tests of 149 long-term ambulatory hypertensive patients cared for by 13 faculty internists during one year were computed. Variation in mean annual lab costs per patient among the internists was great (range, $8-$161; standard deviation, $42). Outcomes of care were estimated using hypertension as an indicator condition. The physicians were scored according to percentage of hypertensive patients with systolic and diastolic pressures below specified levels. Correlation between lab use profiles and outcomes was negative (r = --.42) but not significant. Clinical productivity was estimated by two methods: adjusted panel size and subjective estimates of efficiency by the clinic administrator. Correlations between lab use behavior and each estimate of productivity were negligible (.13 and --.16 respectively). These data indicate that in this setting there is no positive association between a physician's frequency of lab use and either clinical productivity or outcomes of care.

Adolescent↗
PubMed1977

Hospital costs.

Explore the source record for details and available documents.

Boston↗
PubMed1976

The feasibility of an outcome approach to quality assurance--a report from one HMO.

Recent federal legislation has contained the stipulation that participating health maintenance organizations (HMOs) include a quality assurance program which stresses health outcomes. This provision was ostensibly directed at correcting alleged abuses in HMOs serving the urban poor. One version of the outcome method was employed for an 18-month period at an urban HMO caring for 2,000 Medicaid subscribers. The program involved comparing diagnostic accuracy and therapeutic outcomes for clinical conditions relevant to the study population with ideal standards established by the HMO. Three conditions were selected: contraception, depression, and hypertension. The results revealed widespread underdiagnosis (44-74%) in each condition and unacceptable therapeutic outcomes in two. Data collection was hampered by shifts in geography and financial eligibility among the denominator population and low response rates (38-63%) to telephone and mail surveys. Applying the general project guidelines to specific conditions proved considerably more difficult than anticipated. Further refinement of this approach to quality assessment must occur before its widespread use is feasible. Its effectiveness in improving quality remains to be seen. This experience raises doubts regarding the wisdom of legislating a specific outcome approach to quality assessment before feasibility and effectiveness have been demonstrated in organized health settings.

Adolescent↗