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Biomedical subjects

B E Fries

Publications and source records attributed to B E Fries.

66 records · Page 4Linked to original sources
PubMed1985

Validation and use of resource utilization groups as a case-mix measure for long-term care.

A companion article describes the development of a patient classification system for long-term care patients, Resource Utilization Groups (RUGs). Three potential limitations of this system and its development are addressed here: the use of a subjectively determined dependent variable, geographic limitation of the data to Connecticut skilled nursing facilities, and limited assessment of the quality of the facilities studied. Additional systems of Resource Utilization Groups were derived, using the same clustering technique but employing two separate data sets from the Battelle Human Affairs Research Center. These data bases provided an objective dependent variable, wide geographic distribution of both skilled nursing facilities and intermediate care facilities, and homes specifically selected on the basis of quality. The RUGs derived from the two sets of Battelle data and the initial RUG system showed remarkable similarity in their patient groupings and in the case-mix indexes developed for nursing homes. The concurrence of the results obtained for these three systems greatly strengthens the basis for the use of this classification system as a case mix measure for long-term care.

Activities of Daily Living↗
PubMed1985

Resource utilization groups. A patient classification system for long-term care.

The ability to understand, control, manage, regulate, and reimburse nursing home care has been hampered by the unavailability of a classification system of long-term care patients. A study of 1,469 patients in Connecticut nursing homes has resulted in such a classification system that clusters patients with similar relative needs for resources, in particular, for nursing time. The nine groups formed can be used to develop a case-mix profile of the relative care needs of these patients, and their development demonstrates that only a few measures of the functional status of patients, rather than diagnosis or psychosocial/behavioral problems, are sufficient to form such a system.

Activities of Daily Living↗
PubMed1979

The effect of delay rules in controlling unscheduled visits to hospitals.

The increased demand of unscheduled visits to hospital outpatient facilities, and particularly to walk-in clinics, necessitates the consideration of means to control this flow and to reduce in-hospital waiting times. A model is developed in which a percentage of the unscheduled visits are assumed to be delayable, e.g., patients with non-urgent complaints who call may be asked to delay their arrivals for specified lengths of time. A simple rule for determining, dynamically, the length of this delay was examined by computer simulation. The results demonstrate significant reduction of in-facility waiting times while only marginally increasing the time patients wait from their initial contact with the clinic until seen by a practitioner.

Appointments and Schedules↗
PubMed1978

A delay-scheduling model for patients using a walk-in clinic.

Clinics receiving unscheduled visits experience wide fluctuations in the number of patients present at any one time, due to random arrival of patients and variations in the time needed for the evaluation and treatment. This can cause periods of congestion and long patient waiting times. Using a flexible technique for "delay scheduling," a study was conducted to determine the most efficient use of limited physician resources in the management of patients using a walk-in clinic. Delay scheduling makes it possible to shift work load from periods of high congestion to other times without compromising the walk-in nature of the clinic. A computer simulation model was used to evaluate the clinic performance with different physician staffing patterns and different rules for delay scheduling. The model was validated using actual data from the walk-in clinic and the results implemented. The delay scheduling and staffing changes resulted in reduction of manpower by 10% while significantly reducing the clinic-accountable waiting time.

Appointments and Schedules↗
PubMedDate not supplied

Use of administrative records to describe longitudinal patterns of health services use among veterans.

Administrative records of the Department of Veterans Affairs (DVA) and the National Death Index were linked to create a four-year longitudinal database that describes the clinical status, hospital and nursing home use, and mortality for a nationwide cohort of persons admitted to DVA nursing homes (n = 23,039). Using Social Security Numbers as identifiers, the records of only 6% of these persons had logically inconsistent or implausible patterns. Nineteen percent of the remaining records had correctable logical errors. Information on the creation, consistency, and potential uses of this database may prove useful to health services researchers interested in describing longitudinal patterns of health care use across multiple settings within and outside the DVA.

Bias↗
PubMedDate not supplied

The RAI-PC: an assessment instrument for palliative care in all settings.

Large numbers of persons in most types of healthcare settings have palliative care needs that have considerable impact on their quality of life. Therefore, InterRAI, a multinational consortium of researchers, clinicians, and regulators that uses assessment systems to improve the care of elderly and disabled persons, designed a standardized assessment tool, the Resident Assessment Instrument for Palliative Care (RAI-PC). The RAI-PC can be used for both the design of individual care plans and for case mix and outcomes research. Some elements of this instrument are taken from the resident assessment instrument (RAI) mandated for use in all nursing homes in the United States and widely used throughout the world. The RAI-PC can be used alone or in counjunction with the other assessment tools designed by the InterRAI collaboration: the RAI for homecare (RAI-HC), for acute care (RAI-AC), and for mental health care (RAI-MH). The objective of this study was to field test and carry out reliability studies on the RAI-PC. After appropriate approvals were obtained, the RAI-PC instrument was field tested on 151 persons in three countries in more than five types of settings. Data obtained from 144 of these individuals were analyzed for reliability. The reliability of the instrument was very good, with about 50 percent of the questions having kappa values of 0.8 or higher, and the average kappa value for each of the eight domains ranging from 0.76 to 0.95. The 54 men and 95 women had a mean age of 79 years. Thirty-four percent of individuals suffered pain daily. Eighty percent tired easily; 52 percent were breathless on exertion; and 19 to 53 percent had one or more other symptoms, including change in sleep pattern, dry mouth, nausea and vomiting, anorexia, breathlessness at rest, constipation, and diarrhea. The number of symptoms an individual reported increased as the estimated time until death declined. The "clinician friendly" RAI-PC can be used in multiple sites of care to facilitate both care planning and case mix and outcomes research.

Adult↗
PubMedDate not supplied

Determination of optimal variable-sized multiple-block appointment systems.

The single-block appointment system is the most common method of scheduling ambulatory care clinics today. Several studies have examined various appointment systems ranging from single-block appointments on one extreme to individual appointments on the other, and including mixtures of these such as multiple-block (m-at-a-time) and block/individual systems. In this paper we analyze a general single-server multiple-block system, one permitting blocks of variable size. In the analysis we use a dynamic programming approach, with some modifications to compensate for the non-Markov nature of the problem. Analytical results and approximations which significantly reduce the computational requirements for a solution are obtained. Examples demonstrate that under certain weightings of the criteria of waiting, idle, and overtime, the generality of the system considered here allows performance superior to that of other commonly used systems.

Appointments and Schedules↗