Biomedical subjects

T L Panniers

Publications and source records attributed to T L Panniers.

7 recordsLinked to original sources

PubMed1997

Determining an appropriate clinical problem for expert system development in the neonatal intensive care unit.

The purpose of this pilot study was to demonstrate the use of the Nominal Group Technique (NGT) to identify a clinical problem for expert system (ES) development. NGT is a research method that allows individual judgments about a problem to be combined effectively. Problem identification is the necessary first step for the development of an expert system for use by neonatal nurse practitioners (NNPs) caring for neonates in the neonatal intensive care unit (NICU). Five NNPs identified 21 clinical problems encountered when caring for infants in the NICU and reduced these to the 5 most amenable to ES development. Of these 5 problems, fluid management in the very low birthweight (VLBW) infant was chosen for projected ES development.

Data Collection↗

PubMed1988

Validity and reliability issues in alternative patient classification systems.

The validity and reliability issues involved in using alternative patient classification systems were reviewed. Disease Staging and Patient Management Categories (PMCs) were applied separately and in conjunction with DRGs to three populations of patients drawn from a nine-hospital community data base. Data were examined with analyses that were as consistent as possible with hospital-based reviews of resource utilization. Questions focused on content and context validity (partially assessable by homogeneity), general and statistical reliability (measured by variance reduction), gaming, and cost. Ordinal stratifications were inconsistently produced, and improvement to DRGs' homogeneity was generally negligible. When used alone, staging produced only half the variance reduction of DRGs. PMCs, when used alone, appeared to produce sizeable variance reductions that may have been due to the large number of one- and two-case categories produced. Staging had category overlap, was expensive, and was unidimensional and subject to manipulation. PMCs had potentially serious logic problems, and both were inadequately documented. Neither system was considered appropriate for all needs, but each might work adequately under well-defined and limited conditions.

Diagnosis-Related Groups↗

PubMed1987

Severity of illness, quality of care, and physician practice as determinants of hospital resource consumption.

Health care providers continue the debate over why it costs more to care for patients than the DRG reimbursement rate allows. This study examines severity of illness (measured by the AS-SCORE rating), quality of care (measured by the Adverse Patient Occurrences Inventory), and physician practice patterns as sources of variability in hospital resource use by patients in two DRGs. Both instruments independently account for some of the intra-DRG variability in length of stay and total charges. The study indicates that there is a positive relationship between severity of illness and decreased quality of care and that physician practice does not affect variation in resource use when cardiovascular complications, severity of illness, and quality of care are controlled.

Adult↗

PubMed1986

The Adverse Patient Occurrences Inventory: validity, reliability, and implications.

The Adverse Patient Occurrences (APO) Inventory, a quality of care screening instrument, was tested for validity and reliability. A positive relationship was found between the relative proportion of adverse events experienced by patients with diagnoses in two diagnosis-related groups and their hospital costs and lengths of stay. As hospitals strive to provide efficient care, they will require measures such as the APO instrument to assess the quality of care they give. Such information can also help hospitals meet regulatory agencies' requirements.

Cross Infection↗

PubMed1985

The ICD-9-CM DRGs: increased homogeneity through use of AS-SCORE.

AS-SCORE, applied to DRGs, has the potential for providing a system of case-mix measurement that will be more meaningful to physicians, nurses, and hospital administrators as they attempt to predict their patients' use of hospital resources. Urban hospitals and teaching hospitals may find such a system crucial to adequate reimbursement for the more severely ill patients they treat. The system is easily taught and gives reliable scores. The system is clinically coherent because it takes into account all of a patient's conditions and complications. When combined with a cost accounting system for nursing services, the system is sensitive to patients' nursing care requirements. Further studies should be conducted to determine the applicability of AS-SCORE to other nonhomogeneous medical and surgical groupings of the I-9 DRG system. Not all DRGs may need to be subcategorized by a severity-of-illness measure; some DRGs, for example, contain patients who are very similar, such as those who undergo tonsillectomy or normal vaginal delivery. Thus, if subcategorization by severity is not needed for all DRGs, it may be possible to use the AS-SCORE measure and, at the same time, to keep the number of groups small enough to be manageable. These studies should also be conducted in hospitals in other parts of the country to determine the replicability of the findings despite regional variations in facilities and practice methods.

Costs and Cost Analysis↗

PubMedDate not supplied

A decision-analytic approach to clinical nursing.

The purpose of this study was to explore the usefulness of applying decision analysis to nursing decisions about a complex, emergent patient problem. A convenience sample of 31 nurses quantified their intuitive ideas into five mutually exclusive decision alternatives. A decision-analytic process and a preference analysis of each decision alternative were conducted. Nurses' intuitive decision alternatives were compared to the decision alternatives prescribed by the decision-analytic process. Eleven nurses (35%) demonstrated agreement between their first-ranked intuitive choice and the choice prescribed by the decision-analytic model. When the relative ranking of the vector of five treatment choices derived intuitively was compared to the relative ranking prescribed by the decision-analytic model, results showed significant disagreement between nurses' intuitive and quantitative choices.

Adult↗

PubMedDate not supplied

Contract negotiation. The basics.

The contractual process for the purchase of a health-care facility information system is a major endeavor for today's informatics practitioners as more facilities purchase information solution from vendors rather than producing proprietary systems. The goal of the contractual process is not simply to protect either party from future litigation but to produce a clearly understood document that outlines the duties and responsibilities of both the organization and the vendor. This document should anticipate and set forth contingencies for problems that may arise in the future. Guidelines are offered to assist nurses who are members of the acquisition team better understand the contract review process.

Contract Services↗