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Biomedical subjects

W E Scheckler

Publications and source records attributed to W E Scheckler.

At least 37 records · Page 2Linked to original sources
PubMed1990

Physician adaptation to health maintenance organizations and implications for management.

The growth of health maintenance organizations (HMOs) and other forms of managed care presents a challenge to traditional patterns of private practice. In Dane County, Wisconsin (Madison Metropolitan Area), the proportion of the population enrolled in closed-panel HMOs increased dramatically, from 10 percent in 1983 to over 40 percent by 1986. This study surveyed 850 practicing physicians regarding their expectations before, and experiences after this rapid change to competitive HMOs. Although most physicians expected a loss of earnings and lower-quality care, the majority reported that neither declined. However, most physicians expected and reported a decline in their autonomy. Primary care physicians were most supportive of the change to HMOs. The implications of these findings for management practices are discussed.

Adaptation, Psychological↗
PubMed1988

A creative method for determining the immunization status of a community hospital medical staff.

During 1985 and 1986, 191 of the 212 (90%) medical staff members in active private practice, who were surveyed responded to a one-page report regarding the status of their immunity and immunization to important infectious illnesses. Response rates were improved by including the survey form with the hospital privilege-renewal form that was required to be returned to the medical staff office. Of the respondents 96% reported prior history of chickenpox and 95% reported prior immunization to tetanus; of the 42 who reported prior bacille Calmette-Guérin (BCG) vaccination, only 17 reported a positive tuberculin skin test. An additional 32 medical staff members had a history of a positive tuberculin skin test with no prior BCG vaccination. Only 2 (1%) reported prior history of hepatitis B, and only 15 (8%) reported hepatitis B vaccination begun or completed at the time of the survey. This survey allows targeting of infection control activities, such as implementation of the hepatitis B vaccine promotion program and serologic testing of those with a negative history of chickenpox, to be developed for the medical staff. It allows the hospital infection control team instant access to data that can be simply obtained and updated regularly when information is needed about the immunization status of selected medical staff members during an outbreak situation.

Data Collection↗
PubMed1988

Description of case-mix adjusters by the Severity of Illness Working Group of the Society of Hospital Epidemiologists of America (SHEA).

Hospitals, insurance companies, and federal and state governments are increasingly concerned about reducing patient cost expenditures while maintaining high quality patient care. One method of reducing expenditures has been to tie hospital reimbursement with a prospective payment system based on diagnosis-related groups (DRGs). However, reimbursement under the DRG system is not acceptable for all patients in all hospitals because it is neither an accurate predictor of costs nor of clinical outcome. This deficiency poses significant problems for hospitals because DRGs are used nationwide as the prospective payment system for inpatients covered by Medicare. Several case-mix adjusters have been proposed to modify DRGs to improve their accuracy in predicting costs and outcome. We reviewed five of the most widely available indices: Acute Physiologic and Chronic Health Evaluation (APACHE II), Coded Disease Staging, Computerized Severity Index (CSI), Medical Illness Severity Group System (MEDISGROUPS), and Patient Management Categories (PMC). Recommendations for the use of a single case-mix adjuster cannot be made at this time because all indices have not been compared in sufficiently diverse settings and because some are better predictors of costs while others are better predictors of clinical outcome. Hospital epidemiologists and other infection control practitioners should be informed about these indices and their potential applications as they expand their role beyond infection control problems to issues concerning cost containment, quality assurance, and reimbursement.

Cost Control↗
PubMed1987

Rapid change to HMO systems: profile of the Dane County, Wisconsin, experience.

Dane County (Madison), Wisconsin, has experienced a dramatic transformation of its health services into competing closed-panel health maintenance organizations (HMOs). The change occurred literally overnight after the state, as the dominant employer, implemented price competition. In 1983, 22 percent of the 24,000 state employees in Dane County were enrolled in closed-panel HMOs; in 1984 about 85 percent enrolled in one of seven major competing physician HMO plans. In 1985 state employees basically stayed with the HMO they had chosen in 1984, and the only major shift was continued movement away from the standard fee-for-service plan. The Dane County HMO plans were less costly than fee-for-service plans to the state and to the state employee. Fee-for-service state enrollees self-reported greater use of inpatient hospital services and self-reported poorer health than employees selecting HMOs when controlling for age between the two groups. This article describes these changes, why they occurred, and the initial impact on employees as an example relevant to HMO development that may occur elsewhere.

Adult↗
PubMed1986

Nosocomial infections in 15 rural Wisconsin hospitals--results and conclusions from 6 months of comprehensive surveillance.

Fifteen rural Wisconsin acute care community hospitals with an average approved bed size of 55 and an average daily census of 28 patients participated in a nosocomial infection control project. Each hospital Infection Control Practitioner (ICP) was trained and conducted prospective nosocomial infection surveillance on all patients admitted to the hospital for 6 consecutive months between May 1, 1984 and April 30, 1985. Two hundred twenty nosocomial infections were reported among 13,420 discharged patients for an incidence rate of 1.64 infections per 100 discharged patients. One hundred sixty-four patients had one nosocomial infection. Twenty-three patients had two or more. Infection rates were highest among gynecology--4.9% and general surgery patients--4.0%, and lowest among newborns--0.3% and pediatric patients--0%. 39.7% of the infections were of the urinary tract, 27.9% of surgical wounds, 16% pneumonia, and 1.4% primary bacteremia. The other infections were in seven additional sites. Risk factors associated with acquisition of infections included old age, urinary catheterization, and/or a surgical procedure. The overall nosocomial surgical wound infection incidence for inpatient procedures was 1.9%, with incidences of 0.4% for hernia repair, 1.3% for cholecystectomy, 3.3% for appendectomy, 4.0% for total abdominal hysterectomy, and 3.9% for cesarean sections. The incidence of nosocomial infections was 2.7 infections per 100 discharged patients age 65 years or over and 0.9 infections per 100 discharged patients less than 65 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Infections and infection control among residents of eight rural Wisconsin nursing homes.

During 1984 and 1985, an initial prevalence survey and six consecutive months of comprehensive prospective surveillance were conducted in eight rural Wisconsin nonproprietary nursing homes managed by eight nonprofit hospitals in the same communities. Our purpose was to define the infections in the residents and the infection control programs in the nursing homes. The initial prevalence survey analyzed the records of all 403 residents of the eight nursing homes. The average resident was 83.4 years old and had 3.4 chronic diseases noted on the chart. During this initial survey, 52 (12.9%) of the residents were found to have 56 active infections of all types. During six consecutive months of comprehensive surveillance in the eight nursing homes, 265 episodes of acute infection were found for an overall incidence of 10.7 infections per 100 resident months. Clusters of infection by site, pathogen, or month of onset were quite uncommon throughout the study. Susceptibility testing of organisms recovered from infections failed to reveal any clinically important resistance patterns. Because nursing homes are different in many respects from hospitals, appropriately modified definitions and infection control strategies are required for nursing homes and their residents.

Aged↗
PubMed1982

Comparison of low-dose cinoxacin therapy and placebo in the prevention of recurrent urinary tract infections.

Fifty-nine female patients with a history of at least three episodes of urinary tract infection in the preceding year were enrolled in a two-center, double-blind study comparing cinoxacin and placebo as preventive therapy. Evaluation of efficacy was based on the results from 41 patients for whom complete data were available. In the cinoxacin-treated group, 18 of 20 patients remained asymptomatic during the study, compared with 11 of 21 patients in the placebo group. This difference between the two treatment groups was significant (P = 0.031). One patient in the cinoxacin group and eight patients in the placebo group developed an infection during the study. This difference was also significant (P = 0.045). Nine patients spontaneously reported adverse reactions, four in the cinoxacin group and five in the placebo group. In four instances, these were sufficiently severe for the treatment to be withdrawn from one patient who received cinoxacin and three patients who received placebo. The results of this study have shown that cinoxacin was significantly more effective than placebo in preventing urinary tract infection in patients with a history of frequent recurrent infections.

Adult↗
PubMed1979

Documentation of inpatient clinical experience of family practice residents: a manual system.

A simple, efficient, and inexpensive system for quantitatively documenting the range of clinical experience of individual residents on inpatient rotations is described. Information provided by this system can be used by program faculty to make informed educational decisions concerning both the design of rotations and individual resident program planning. The data are also useful to residency graduates to document their clinical experience when applying for hospital privileges.

Documentation↗
PubMed1978

Septicemia and nosocomial infections in a community hospital.

Data on the incidence of community-acquired and nosocomial septicemia, on the incidence and distribution of nosocomial infections, and on the additional hospital costs due to nosocomial infections are shown to be different in a community teaching hospital from data in university, federal, or country hospitals. Incidence of septicemia and nosocomial infection varies in direct relation to the underlying disease categories "nonfatal," "ultimately fatal," and "rapidly fatal." Patient population mixes of these underlying disease categories are different between community and noncommunity hospitals. These differences can account for the reported difference in incidence of septicemia and nosocomial infections between such hospitals. National extrapolation of incidence data must take these differences into account.

Costs and Cost Analysis↗
PubMed1978

Nosocomial infections in a community hospital: 1972 through 1976.

Of 78,057 patients discharged from a community hospital from 1972 through 1976, nosocomial infections developed in 3.58 per cent. Nosocomial infections of all types were 13.2 times more frequent for patients with rapidly fatal underlying illness and 3.4 times more frequent for patients with ultimately fatal underlying illness than in cases of nonfatal underlying illness. Outbreaks of epidemics or clusters of infections caused by the same organism were distinctly uncommon. These outbreaks accounted for only 49 of the 2,798 nosocomial infections found. No distinct trends, either increases or decreases, of infection rates by pathogen, site of infection, or service were noted during the study period. Sensitivity of the common pathogens to antibiotics also remained stable.

Bacterial Infections↗
PubMed1977

Septicemia in a Community Hospital 1970 through 1973.

Septicemia developed in 34 patients per 10,000 admissions to a community hospital during 1970 through 1973. Two thirds of the 207 patients had community-acquired septicemia, and one third had nosocomial septicemia. Septicemia-related mortality was 20.3%. Mortality and incidence of septicemia was substantially higher in patients with ultimately fatal and rapidly fatal underlying diseases. Septicemia was associated with shock in 9.7% of the patients. Foley catheterization and prophylactic antibiotic therapy could not be implicated as major risk factors for the development of septicemia. This study shows an incidence of Gram-negative bacteremia, septic shock, and mortality substantially less than that described in published data from noncommunity hospitals.

Blood↗