Biomedical subjects

A S Ash

Publications and source records attributed to A S Ash.

72 records · Page 4Linked to original sources

PubMed1992

Postoperative adverse events of common surgical procedures in the Medicare population.

Mortality rates are the most widely used measure in assessing patient outcome from hospitalization. However, they may be an insensitive measure of quality for surgical patients because death is a relatively rare outcome. A random sample of patient data (n = 8126) selected from the Medicare files of seven states was used to identify, through chart abstraction, clinical postoperative complications of surgery that could serve as measures of quality. Four surgical procedures were studied: 1) coronary artery bypass grafting; 2) coronary angioplasty; 3) cholecystectomy; and 4) prostatectomy. Severity at admission was controlled for using severity-of-illness models developed with chart-abstracted data to predict adverse events after these four procedures. 30-day mortality rates ranged from 1.0% to 6.6%, while the prevalence of postoperative adverse events identified from chart review was greater (6.9% to 33.3%). There were significant differences between patients with and without adverse events. For example, coronary artery bypass graft patients with adverse events had prolonged postsurgical lengths of stay (18.5 +/- 13.2 vs. 13.2 +/- 6.2, P less than 0.001) and higher mortality rates (15.2% vs. 2.6%, P less than 0.001). The R-square values using clinical indicators at admission to predict the occurrence of any adverse event ranged from 0.05 to 0.13. Clinically meaningful adverse events of surgery can be successfully identified through chart abstraction and appear to be valid measures of postoperative complications among surgical patients. Severity adjustment at admission only modestly predicts the occurrence of these adverse events.

Aged↗

PubMed1991

Admission and mid-stay MedisGroups scores as predictors of hospitalization charges.

This study examines the ability of MedisGroups, a severity measure based on clinical data abstracted from the medical record, to predict hospitalization charges. MedisGroups measures severity both on admission and approximately 1 week into the hospital stay. The data base contained 23,361 admissions of Medicare beneficiaries in six conditions from 836 hospitals in seven states between January 1985, and May 1986. In all six conditions, higher admission and mid-stay severity scores were generally associated with higher charges. Across the six conditions, the R2 values for predicting charges using diagnosis-related group (DRG) class ranged from 0.06 to 0.32 using trimmed data. Adding admission MedisGroups scores to DRG class produced R2 values ranging from 0.09 to 0.33, while adding mid-stay scores yielded R2 values from 0.15 to 0.41, and adding both admission and mid-stay scores produced R2 levels ranging from 0.17 to 0.42. Very little of the superior predictive power of the mid-stay score could be attributed to its serving as a proxy for length of stay.

Diagnosis-Related Groups↗

PubMed1991

Admission and mid-stay MedisGroups scores as predictors of death within 30 days of hospital admission.

We examined the ability of MedisGroups, a severity measure based on clinical data abstracted from the medical record, to predict mortality 30 days following admission. MedisGroups measures severity both on admission and approximately one week into the hospital stay. The data base was a random sample of 20,985 admissions of Medicare beneficiaries with one of six conditions from 833 hospitals in seven states between January 1985 and May 1986. In all six conditions, higher admission and mid-stay severity scores were generally associated with higher risk of death. Across the six conditions, the R-squared values for predicting death using admission scores ranged from 0.01 to 0.16; R-squared values using mid-stay scores ranged from 0.03 to 0.34; and R-squared values from combining admission and mid-stay scores ranged from 0.05 to 0.41. Admission MedisGroups score was thus only modestly predictive of 30-day mortality. While the mid-stay score was more powerful, it may not be an appropriate severity adjuster to screen for quality using hospital mortality rates because it could be influenced by substandard care.

Cholecystectomy↗

PubMed1990

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↗

PubMed1988

Admission MedisGroups score and the cost of hospitalizations.

Concerns about the insensitivity of Medicare's diagnosis-related groups (DRGs) to illness severity heightened interest in the potential of alternative patient classification systems to improve the fairness of hospital reimbursement. This article examines the ability of admission MedisGroups score to explain the costs of hospital stays. The database contained 54,112 patients 65 years or older discharged in 28 high-frequency DRGs from 1984 to the middle of 1986 from 24 hospitals across the country. Admission MedisGroups score alone explained 3% of costs using trimmed data. Addition of admission MedisGroups score to DRGs modestly improved ability to predict differences in cost: for trimmed data, DRGs alone explained 52% of the variation in costs, compared with 55% when admission MedisGroups score was added. Within individual DRGs, the explanatory power of admission MedisGroups score ranged from 0% to 21%. The level of explanatory power was not related to the spread of cases across admission MedisGroups scores within DRG. No consistent clinical pattern explained these differences across DRGs.

Aged↗

PubMed1972

Changes in the activity of sarcoplasmic reticulum fragments and actomyosin isolated from skeletal muscle of thyroxine-treated cats.

1. Sarcoplasmic reticulum fragments (SRF) and actomyosin were isolated from skeletal muscle of cats treated either with thyroxine or with placebo tablets, for 5-16 months.2. Ca(2+) uptake and binding by SRF, measured in the presence and absence of oxalate respectively, were reduced by thyroxine treatment.3. Actomyosin from the thyroxine-treated animals underwent ATP-induced syneresis at a faster rate than did that from the controls.4. Syneresis of the actomyosin preparations from controls and treated animals was inhibited to the same extent by EGTA when rates of syneresis were made the same by adjustment of the KCl concentration in the assay media. In contrast, at any given KCl concentration, syneresis of actomyosin from thyroxine-treated animals was inhibited to a lesser extent by EGTA.5. At the end of the isolation procedure, the amount of Ca(2+) remaining in the actomyosin suspension was similar for both treated and control animals.6. It was concluded that the effect of thyroxine on skeletal muscle may be the result of an action on both the sarcoplasmic reticulum and the contractile protein complex.

Actomyosin↗

PubMed1970