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Biomedical subjects

S DesHarnais

Publications and source records attributed to S DesHarnais.

15 recordsLinked to original sources
PubMed1999

Community perceptions of the effects of rural hospital closure on access to care.

The purpose of this case study was to ascertain the perceptions of health professionals who were located in six rural communities where hospital closure occurred, regarding the impact of closure on community residents. These health professionals were asked to respond to questions about effects of hospital closures on the availability of medical services such as emergency care, physician services, hospital services and nursing home care. To control for trends in medical services utilization that were unrelated to hospital closure, the study design included comparison areas where similar hospitals remained open. A standardized questionnaire was administered to three health professionals in each of the areas that experienced a hospital closure and also in the matched comparison areas. Interviews of the health professionals in closure areas provide evidence suggestive of some perceived negative effects of hospital closure on these communities. These negative effects include difficulty recruiting and retaining physicians, concern of residents about the loss of their local emergency room, and increased travel times to receive hospital services. The perceived effects of closure appeared to be mediated by the distance required for travel to the nearest hospital. Respondents perceived increased travel times to most significantly affect vulnerable populations, such as the elderly, the disabled and the economically disadvantaged. Respondents in the majority of comparison areas also reported access barriers for vulnerable populations. These barriers primarily center on problems of obtaining transportation and enduring the rigors of travel. Improvements in the availability of transportation to medical care may offer some stabilization to communities where hospitals closed; however, it also is the case that transportation improvements are needed to increase access to care in rural communities where hospitals remained open.

Attitude to Health↗
PubMed1999

A tale of two bounties: the impact of competing fees on physician behavior.

This study examines how the volume of privately insured services provided in hospital inpatient and outpatient departments changes in response to reductions in Medicare physician payments. We hypothesize that physicians consider relative payment rates when choosing which patients to treat in their practices. When Medicare reduces its payments for surgical procedures, as it did in the late 1980s, physicians are predicted to treat more privately insured patients because they become more lucrative. We use data from 182 hospitals for seventeen major procedures groups, covering a forty-five-month period between 1988 and 1991 that encom passes a twenty-four-month period before the reduction in Medicare fees and twenty-one months after the reduction. Our findings are consistent with the predictions for a number of procedure groups, but not for all of them. One implication of the findings is that societal savings from Medicare fee reductions are overstated if one does not also consider spillover effects in the private insurance market.

Aged↗
PubMed1996

Variations in practice patterns: antiviral drug use in hospitalized patients with herpes infections.

This study describes patterns of antiviral drug use for patients hospitalized with chickenpox, herpes simplex, and herpes zoster infections, and also for a subgroup of herpes patients with severe infections (systemic infections, eye infections, encephalitis, hemorrhagic pneumonitis, and other severe conditions). Our findings demonstrate that there is great deal of variation in the use of antiviral drugs for these herpes patients, and that much of this variation is apparently unrelated to medical indications for antiviral drug use. Instead, patterns of use are associated with patient characteristics (age, race) and with hospital characteristics (location, teaching status, number of beds). Because these drugs are effective when used properly, treatment guidelines and protocols may be needed so that improved drug use will produce better patient outcomes.

Adolescent↗
PubMed1996

Do physicians cost shift?

This study analyzes whether physicians charge their privately insured patients more-a practice known as cost shifting-in response to Medicare payment reductions. As part of congressional legislation in 1989 and 1990, Medicare reduced its payment rates for selected procedures by as much as 30 percent. Here we examine whether reductions in Medicare rates increase how much physicians charge privately insured patients. Our data provide no evidence that physicians respond to Medicare payment reductions by shifting costs to their privately insured patients.

Aged↗
PubMed1994

Information management in the age of managed competition.

BACKGROUND: Today's information requirements differ from those of the past, in terms of both the internal and external reporting needs of health care organizations. Demands for information are currently generated by physicians, quality managers, total quality management (TQM) teams, marketing staff, financial managers, regulators, insurance plans, accreditation agencies, purchasers, coalitions, and other customers. DISCUSSION: Health care organizations respond to these demands in different ways, depending on their size and type. Six aspects of information needs that would be relevant under managed competition are analyzed: standardization, linkages among data banks, risk adjustment, comprehensive institution-based indicators and information systems, comprehensive population-based indicators and information systems, and methods for protecting confidentiality of patient records. RECOMMENDATIONS: Six recommendations to hospitals/managed care plans that decide to establish information management systems are made: set goals, set priorities, describe current system, identify external data sources, develop (a plan), and check back (reassess).

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Applications for risk-adjusted outcome measures.

This paper reports on the development and application of multiple risk-adjusted measures of hospital performance (mortality, readmission, complications). The indices are based on patient-level data so they can be aggregated at any level (hospital, specialty, physician), are easy to use and interpret by hospitals, and provide an inexpensive method for evaluating hospital performance using existing databases. This paper focuses on the development of practical applications of these measures in the quality improvement process.

Hospital Mortality↗
PubMed1991

Changes in rates of unscheduled hospital readmissions and changes in efficiency following the introduction of the Medicare prospective payment system. An analysis using risk-adjusted data.

The purpose of this study was to analyze changes in rates of unscheduled readmissions and changes in technical efficiency following the introduction of the Medicare Prospective Payment System (PPS). We developed the Risk-Adjusted Readmissions Index (RARI), which allowed us to make comparisons in rates of unanticipated readmissions across hospitals and over time. Data envelopment analysis (DEA), a linear programming technique, was used to measure changes in technical efficiency by comparing the inputs used and the outputs produced across a cohort of hospitals, while adjusting for changes over time in case mix and case complexity. Rates of unscheduled readmissions and efficiency scores were computed for a sample of 245 hospitals for each year. Although both readmission rates and efficiency scores increased for most hospitals, there was no evidence that those hospitals that experienced the greatest increases in efficiency had the largest increases in their rates of unscheduled readmissions.

Abstracting and Indexing↗
PubMed1991

Measuring outcomes of hospital care using multiple risk-adjusted indexes.

Using existing data sources, we developed three risk-adjusted measures of hospital quality: the risk-adjusted mortality index (RAMI), the risk-adjusted readmissions index (RARI), and the risk-adjusted complication index (RACI). We describe the construction and validation of each of these indexes. After these measures were developed, we tested the relationships among the three indexes using a sample of 300 hospitals. Actual numbers of adverse events were observed for each hospital and compared to the number predicted by the RAMI, RARI, and RACI models. Then each hospital was ranked on each index. Our results showed that no relationship existed between a hospital's ranking on any one of these indexes and its ranking on the other two indexes. This result provides some evidence that no measure of quality should be used by itself to represent different aspects of the quality of hospital care. Adequate overall measures of hospital quality will need to include multiple measures in order to be credible and to reflect the complexity of hospital care. The findings suggest that consumers, payers, and policymakers cannot simply choose one hospitalwide measure, such as the mortality rate, to validly represent a hospital's performance: those hospitals with high rankings on their mortality rates do not necessarily rank high on their readmission rates or complication rates.

Abstracting and Indexing↗
PubMed1990

Current uses of large data sets to assess the quality of providers. Construction of risk-adjusted indexes of hospital performance.

This article examines how large data sets can be used for evaluating the effects of health policy changes and for flagging providers with potential quality problems. An example is presented, illustrating how three risk-adjusted measures of hospital performance were developed using patient discharge abstracts. Advantages and disadvantage of this approach are discussed.

Comorbidity↗
PubMed1988

Trends and regional variations in hospital utilization and quality during the first two years of the prospective payment system.

The Commission on Professional and Hospital Activities monitored both Medicare and non-Medicare hospital discharges for a cohort of 646 U.S. nonfederal, short-term general hospitals from nonwaivered states over the period 1980-1985. Using this data base and a linear forecasting model, we studied utilization and quality-of-care trends for the years preceding implementation of the prospective payment system (PPS) and the two years following its implementation. We found that Medicare discharges declined significantly in both 1984 and 1985, length of stay was unchanged from 1984 to 1985 (except in the West, where further declines occurred), and skilled nursing facility and home health care use for postdischarge care increased both years. Our unadjusted measures of quality showed no adverse effects in either 1984 or 1985 for Medicare patients.

Commission on Professional and Hospital Activities↗
PubMed1987

The early effects of the prospective payment system on inpatient utilization and the quality of care.

Concern is often expressed that hospitals may be making cost/quality trade-offs under Medicare's prospective payment system. To evaluate the early effects of PPS on inpatient utilization and quality of care, we studied a cohort of 729 U.S. short-term general hospitals from nonwaivered states. We used a linear forecasting model to project 1984 figures based on trends from 1980 to 1983. We found no evidence that the quality of care deteriorated in 1984 for Medicare patients. Consultation rates remained constant, and in-hospital deaths and readmission rates were consistent with previous trends for the Medicare population. Overall, it appears that PPS has reduced hospital utilization without producing deterioration in the quality of care.

Coronary Care Units↗
PubMed1983

Blue Cross and Blue Shield of Michigan hospital laboratory on-site review project.

Blue Cross and Blue Shield of Michigan assessed the intensity of inpatient laboratory use for similar patients in a sample of 30 short-term hospitals in three geographic areas. Hospital records were abstracted for 1,834 patients treated in 1980 for uncomplicated (Stage 1) admissions involving eight common diagnoses. It was found that patients treated in osteopathic teaching hospitals received significantly more laboratory tests than similar patients in allopathic teaching or nonteaching hospitals. Statistically significant differences were also found among the three geographic areas in the sample.

Blue Cross Blue Shield Insurance Plans↗
PubMed1977

Computed tomography: the cost-benefit dilemma.

Although cost-benefit analysis is used for most systems of health care planning, its use in evaluating CT scanning is not appropriate. The authors suggest that cost-effectiveness is a more reasonable approach to the economic analysis of CT installations. Cost effectiveness attempts to assure that disease is treated with the most effective means available which minimizes the cost of such treatment. This method involves such factors as the impact of CT on the existing health care system, health outcome of patients, and reduction of hospital occupancy.

Cost-Benefit Analysis↗
PubMedDate not supplied

HQEF update: master's degree program guidelines for a concentration in healthcare quality management.

The Healthcare Quality Educational Foundation (HQEF), in its quest to identify formal educational opportunities for healthcare quality leaders, determined that academia lacked a standardized curriculum for healthcare quality management. Because a majority of the members of the National Association for Healthcare Quality (NAHQ) expressed a need for master's degree programs, the foundation appointed a committee composed of academicians and quality management professionals to define a curriculum appropriate for a master's degree program with a concentration in healthcare quality management. This article identifies the HQEF's goals and outlines the activities undertaken by the committee to define guidelines for colleges and universities interested in developing master's degree programs.

Curriculum↗