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Biomedical subjects

A Dobson

Publications and source records attributed to A Dobson.

At least 91 records · Page 5Linked to original sources
PubMed1989

Developing payment refinements and reforms under Medicare for excluded hospitals.

Four classes of specialty hospitals (children's, psychiatric, rehabilitation, and long-term) and two types of distinct-part units in general hospitals (psychiatric and rehabilitation) have been excluded from the Medicare hospital prospective payment system since it was enacted by Congress in 1983. The number of these facilities and the Medicare dollars expended have more than doubled in less than 5 years, prompting renewed policy interest in developing payment reform. In this context, the substantial research and policy development efforts to refine case-mix classification and payment policies for these facilities are reviewed and examined. Findings are discussed relative to possible legislative and regulatory directions.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1989

CHD in Australia and New Zealand.

Death rates from coronary heart disease (CHD) have been declining in Australia and New Zealand for 20 years. Data from the three MONICA Project Centres in Newcastle (Australia), Perth (Australia), and Auckland (New Zealand) show similar trends for fatal CHD but differing trends for non-fatal myocardial infarction (MI). In Auckland, there has been a consistent decline in out-of-hospital death rates but no decline in non-fatal MI rates. In Perth, the greater contribution to the overall decline has been from out-of-hospital deaths, but in-hospital death rates and non-fatal MI rates have also declined. There is also some evidence of an increase in survival following MI in Perth. In Newcastle, both death rates and non-fatal MI rates have declined. The limited data available suggest that at least one-half of the decline in mortality can be attributed to improvements in population risk-factor levels. Improvements in medical management of both risk factors and established disease are also making contributions to the decline.

Adult↗
PubMed1988

Comparison of event rates among three MONICA centres.

Data from three MONICA centres in Auckland (New Zealand) and Newcastle and Perth (Australia) are used to explore some of the issues involved in comparing event rates and case fatality among MONICA centres. Auckland and Newcastle follow the "hot pursuit" method of identifying and interviewing patients while they are still in hospital. Perth follows the "cold pursuit" method, in which patients are identified by search of computerized hospital records after discharge and all data are abstracted retrospectively from case notes. Fatal cases are identified by the same method in the three centres. The distribution of events by MONICA diagnostic classification varied among centres, with Perth having the highest proportion of definite myocardial infarction events and the lowest proportion of possible myocardial infarction events. These differences appear to be due to the different methods of event ascertainment and data collection, and to variations in post mortem rates between centres. For comparisons among these three centres, the categories of non-fatal definite myocardial infarction and of all coronary heart disease deaths (that is those in the MONICA categories fatal definite myocardial infarction, fatal possible myocardial infarction, and fatal cases with insufficient data) appear to be the most useful.

Adult↗
PubMed1988

Improvement in arterial oxygen tension with change in posture in anaesthetised horses.

Observations were made on horses spontaneously breathing oxygen, with halothane at a constant end tidal concentration. The horses were positioned in dorsal recumbency for the first 45 minutes of each anaesthetic episode during which the arterial oxygen tension (PaO2) was found to peak and then decline. The remaining 60 minutes of each anaesthesia was used to test the effect of various manoeuvres on PaO2. The PaO2 of horses decreased further both when remaining in dorsal recumbency and when repositioned in right or left recumbency. In contrast, placing the horses in sternal recumbency for these remaining 60 minutes caused the PaO2 to rise rapidly providing evidence for redistribution of ventilation. Replacing some inspired oxygen with less absorbable nitrogen did not improve PaO2 in dorsal recumbency. Thus there was no evidence that the low PaO2 of dorsal recumbency was associated with alveoli that had collapsed because of gas absorption.

Anesthesia↗
PubMed1988

Effects of metoclopramide, clenbuterol and butorphanol on ruminoreticular motility of calves.

Rate and amplitude of contractions of the rumen dorsal sac and reticulum of 6 male Holstein calves ages 12 to 20 weeks were monitored with electromyography, strain gauges and an intraruminal pressure catheter. Heart rate and mean arterial pressure were measured with ultrasound. The effects of metoclopramide, a dopamine antagonist, clenbuterol, a beta-2 adrenergic agonist, and butorphanol, a narcotic agonist/antagonist, were observed utilizing dosages bracketing those employed clinically. Metoclopramide significantly decreased the intraruminal pressure peaks associated with cyclical contractions without changing their rate. Clenbuterol had no measurable effect on the ruminoreticulum. Butorphanol totally inhibited ruminoreticular contractions for periods of 6 to greater than 40 min depending on dosage. Only clenbuterol significantly affected cardiovascular function; it increased heart rate and decreased mean arterial pressure. Both metoclopramide and butorphanol produced behavioral changes in the calves.

Animals↗
PubMed1987

Fatal peptic ulcer complications and the use of non-steroidal anti-inflammatory drugs, aspirin, and corticosteroids.

Although non-steroidal anti-inflammatory drugs are known to cause peptic ulcer and its complications, controversy exists about the number of deaths from ulcer which are attributable to their use. A case-control study was therefore performed to determine whether prior use of non-steroidal and other anti-inflammatory compounds was associated with an increased case fatality rate from complications of peptic ulcer. Non-steroidal anti-inflammatory drugs were used by 39% of a series of 80 patients who had died from peptic ulcer complications and by 37% of 160 controls who were survivors matched for sex, age, ulcer site, and nature of complication (odds ratio 1.1; 95% confidence interval 0.6 to 2.1). Similarly, the rates of prior use of aspirin by cases and controls were almost identical (odds ratio 1.2; 95% confidence interval 0.5 to 1.9). Thus neither nonsteroidal anti-inflammatory drugs nor aspirin were associated with increased case fatality rates from peptic ulcer complications. In contrast, corticosteroids were associated with an increased mortality (odds ratio 4.2; 95% confidence interval 0.9 to 25.6). Although this increase in the estimated relative risk was not statistically significant, a review of the case records indicated that most deaths in steroid users were due to serious sepsis, indicating that there might be a causal association between use of the drugs and the mode of death.

Adult↗
PubMed1987

Refining case-mix adjustment. The research evidence.

We review case-mix adjustment, which is the process of adjusting for differences in the cases treated in different hospitals so that their costs or outcomes can be compared. We examine the Medicare payment system, which rests on case-mix adjustment, and identify areas, including outlier payments, in which payment accuracy might be improved without better measurement of the severity of illness. There is no available measure of severity of illness that would produce a large improvement in the accuracy of Medicare payments if used to supplement or replace the system of diagnosis-related groups. Evidence regarding whether better measurement of severity would substantially change the distribution of payments across hospitals is mixed. Considerable evidence suggests that the intensity of medically appropriate treatment for patients in the same diagnosis-related group varies substantially for reasons other than the severity of illness. Despite great demand for measures of the quality of care, important technical problems must be solved before we can be confident that differences in case-mix-adjusted outcomes reflect differences in the quality of care.

Diagnosis-Related Groups↗
PubMed1986

Impact of the Medicare prospective payment system for hospitals.

This article describes some of the available evidence on the impact of the Medicare prospective payment system (PPS) for hospitals during its first year, on hospitals, other payers for inpatient hospital services, other providers of health care, and Medicare beneficiaries. In addition, because the impetus for the enactment of the new system stemmed from concern over the financial status of the Medicare program, the first-year impact of PPS on Medicare program expenditures is also described.

Data Collection↗
PubMed1986

The future of Medicare policy reform: priorities for research and demonstrations.

The Medicare program, the largest health insurance program in the United States, is clearly at a crossroads as it enters its third decade. Historical increases in health care expenditures, plus a changing political and economic landscape, have set the groundwork for policy reform. Basic reform strategies, most notably reimbursement arrangements, are discussed. In 1983, Congress enacted the prospective payment system (PPS), which initiated a fundamental change in the way hospitals are paid for care delivered to Medicare beneficiaries. But PPS is only a steppingstone to broader reforms such as capitation and evolving organizational models in the delivery of care. Policymakers' considerations of coverage of services, such as long-term care and organ transplants, are also discussed. Within the context of these policy reforms, the authors shape an agenda for research and demonstrations--the blueprint for taking us from "here to there."

Health Services Research↗
PubMed1986

First 6 months of Medicaid data.

This is the first in a series of comprehensive Medicaid program reports based on National Medical Care Utilization and Expenditure Survey (NMCUES) data. Preliminary analyses are presented based on data from the first half of 1980, which include the personal characteristics and medical care utilization patterns of noninstitutional Medicaid enrollees and the health insurance coverage of the U.S. noninstitutionalized population. More comprehensive analyses employing full calendar year 1980 data will be available in subsequent reports. The information contained in this report is useful in appraising the impact of eligibility, benefit package, and reimbursement policy on Medicaid enrollee health care utilization at both the Federal and the State Medicaid level. Despite the expectations of the Medicaid program's architects that it would be smaller and less significant than the Medicare program, the Medicaid program has experienced dramatic growth in the number of recipients and total expenditures since its creation. By early 1980, State Medicaid program expenditures accounted for between 10 and 15 percent of individual State general operating funds. The Medicaid program is continuing to grow relative to State budgets. State budgets have been expanding by only about 9 percent per year, while Medicaid budget expenditures have been expanding at approximately twice that rate. These factors are forcing States to devise program changes concerning eligibility, benefits, or reimbursement approaches that will enable them to maintain fiscal stability as expenditures increase and the Federal role changes. These problems present a major challenge to policymakers and administrators at both the Federal and State levels. Solutions to these problems are difficult because of the differences in Medicaid programs, the constantly changing character of the Medicaid programs within States, and a lack of data to describe, monitor, and forecast Medicaid program activities in a consistent fashion. NMCUES was designed with these data problems in mind. Survey Background The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) is to collect information that will improve our understanding of the way Americans use and pay for health care. In addition to providing reliable statistical descriptions of the types of health services consumed and the amount of dollars expended for health care by the Nation, NMCUES was designed to permit health policy analysts to investigate a broad range of issues concerning the financing and delivery of health services in the United States. NMCUES data reflect health care experiences of the civilian noninstitutionalized population during 1980.(ABSTRACT TRUNCATED AT 400 WORDS)

Ambulatory Care↗
PubMed1985

Changes in blood flow distribution in equine lungs induced by anaesthesia.

The distribution of blood flow to the lungs was measured with labelled microspheres injected into horses before and during anaesthesia. Anaesthesia was induced with glycerol guaiacolate ether and ketamine, and maintained with the spontaneous breathing of halothane in oxygen. In a preliminary group of six horses, flow distribution was observed during anaesthesia in sternal, dorsal and right lateral recumbency. In two other groups, each of four horses, the flow distribution with time during either sternal or right lateral recumbency was observed. A small, constant proportion of the 15 micron diameter microspheres bypassed the lungs. No increase in shunting with anaesthesia was detected. Blood flow distributed predominantly cranioventrally in the conscious horse in concordance with the expected effects of hydrostatic forces within the lung. In the anaesthetized horse a stable distribution rapidly developed whereby the flow was directed preferentially caudodorsally and evenly divided between the left and right lungs regardless of whether the horse was on its back, side or sternum. We conclude that an unidentified factor overrides gravitational effects on perfusion in the anaesthetized horse. If under anaesthesia, ventilation were distributed according to gravity, hypoxia would arise from this disassociation of ventilation from perfusion. The hypoxia would be most intense in dorsal recumbency, and least intense in sternal recumbency. This was reflected in the degree of hypoxaemia observed. A small but significant change in flow distribution with the phase of the respiratory cycle was detected in the conscious, standing horse.

Anesthesia, General↗
PubMed1985

Shaping public policy from the perspective of a data builder.

During the past six decades, data analysis and research studies have been instrumental in shaping public and private health care policy. Policymakers obtain the knowledge they need for making policy decisions through exposure to and examination of data generated through research studies, experimentation, demonstrations, and analyses. In this article, U.S. hospital care policy has been divided into phases. As the development of health care policy has progressed in each phase, decisionmakers have consistently increased their reliance on data.

Health Policy↗