Stella Burnside. Interview by Tom Keighley.
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Community Health Services↗
Biomedical subjects
S Burnside
Publications and source records attributed to S Burnside.
Illness severity and costs of admissions at teaching and nonteaching hospitals.
This research examined the hypothesis that greater severity of illness explains the higher costs of hospitalizations at teaching compared with nonteaching hospitals. Medical records of 4439 cases within eight common conditions were reviewed at five tertiary teaching, five other teaching, and five nonteaching hospitals in metropolitan Boston, Mass. We assessed acute physiologic status, severity of the principal diagnosis, comorbidities, and functional status. The principal diagnosis was more severe for teaching hospital patients in four conditions, but few significant differences were found for the other severity dimensions by condition. Across all conditions combined, except for functional status, severity was significantly higher at teaching hospitals, but the absolute differences were small. After adjusting for diagnosis related groups, costs were higher at tertiary teaching compared with other teaching and nonteaching hospitals. Further adjusting for severity and other patient characteristics explained 18% (90% confidence interval, 4 to 33) of the higher costs at tertiary compared with nonteaching hospitals.
Boston↗
The relationship of oral contraceptive use to rheumatoid arthritis.
Current use of oral contraceptives among 71 women aged 17 to 45 diagnosed for the first time as having definite or probable rheumatoid arthritis at Group Health Cooperative of Puget Sound was compared with oral contraceptive use among matched controls. Twenty-three percent of cases and 13% of controls were current users of oral contraceptives at the index date (relative risk estimate = 2.0, 95% CI = 0.97-4.21). We conclude that current oral contraceptive use was not protective against the development of rheumatoid arthritis in this population.
Adolescent↗
Coding of acute myocardial infarction. Clinical and policy implications.
STUDY OBJECTIVE: To evaluate the appropriateness of diagnostic coding of acute myocardial infarction across teaching and nonteaching hospitals. DESIGN: Retrospective review of a random sample of medical records to find evidence of the occurrence and active treatment of acute myocardial infarction during the admission. SETTING: Five tertiary teaching, five other teaching, and five nonteaching hospitals in metropolitan Boston. CASES: Random sample of hospital admissions assigned a discharge diagnosis of acute myocardial infarction between October 1984 and September 1985. MEASUREMENT AND MAIN RESULTS: Of the 1003 cases reviewed, 260 did not meet the clinical criteria for acute myocardial infarction. At tertiary hospitals, 175 (41.7%) failed to qualify, compared with 25 (9.1%) at nonteaching facilities. In a large fraction of the disqualified cases, the patients had been admitted to exclude the diagnosis of acute myocardial infarction; although explicitly "ruled out," an acute myocardial infarction code was assigned. Sixty-six cases from teaching hospitals did not qualify because the patient had been admitted only for coronary angiography after an uneventful postmyocardial infarction course. Almost one-third of these patients had had their infarcts from 5 to 8 weeks before the angiography admission. CONCLUSIONS: Cases with an inappropriate discharge diagnosis of acute myocardial infarction may be concentrated in teaching hospitals. This finding could have implications for Medicare's diagnosis-related group payment system and governmental and other research efforts that use these data for such purposes as drawing inferences about the quality of hospital care.
Boston↗
Breast cancer in mothers given diethylstilbestrol in pregnancy.
We compared the incidence of breast cancer in 3033 women who had taken diethylstilbestrol (DES) in pregnancy during the period from 1940 to 1960 with the incidence in a comparable group of unexposed parous women. We ascertained vital status in 95 per cent of the exposed women and in 93 per cent of the unexposed women and received completed questionnaires for 88 and 85 per cent, respectively. With over 85,000 woman-years of follow-up in each group, the incidence of breast cancer per 100,000 woman-years was 134 in the exposed group and 93 in the unexposed group, yielding a crude relative risk of 1.4 (95 per cent confidence interval, 1.1 to 1.9). The elevated incidence did not appear to be due to bias or to confounding by other risk factors measured in the study. Breast-cancer mortality was slightly higher in the exposed women (relative risk, 1.1) but not significantly so (95 per cent confidence interval, 0.7 to 2.0). We conclude that the incidence of breast cancer is moderately increased in women given DES, but we cannot exclude the possibility that some unrecognized concomitant of DES exposure accounts for this increase.
Actuarial Analysis↗