Search PubMed⌕ Search

Biomedical subjects

B J McNeil

Publications and source records attributed to B J McNeil.

At least 91 records · Page 5Linked to original sources
PubMed1988

Changes in ambulatory testing for hypertensive patients 1971-1980.

To determine temporal changes in the outpatient use of diagnostic tests, the authors studied ambulatory testing for 208 patients diagnosed with uncomplicated hypertension, cared for by 15 private office internists in 1971 through 1980. Patients diagnosed and treated earlier in the decade tended to have significantly higher blood pressure. After adjustment for blood pressure, use of diagnostic tests in terms of total charges for testing per patient per year peaked between 1973-74 and thereafter remained fairly stable at a level slightly lower than that in 1973-74. Considering the decade as a whole, use of tests was generally greater for patients with higher blood pressure readings (P less than 0.05). These findings suggest that use of tests for hypertensive patients in outpatient settings is related to severity of disease. Although treatment of new patient groups may be one factor increasing medical costs, the use of tests per se may have stabilized for diseases in which the diagnostic technologies have remained stable.

Ambulatory Care↗
PubMed1988

Modified DRGs as evidence for variability in patient severity.

The authors were interested in exploring the extent to which differences in the complexity of patients could be determined by modifications in combinations of the ICD-9-CM codes used to define DRGs. The 150 most common medical and surgical DRGs in one teaching hospital were studied. With clinical experts they identified 41 DRGs that were believed to have subgroups reflecting quite different types of patients, one group sicker and costlier than the other. Using a national data set, the authors then showed that 24 of these DRGs showed significant differences in standardized charges. In 11 of these 24 DRGs the higher cost subgroups were seen proportionately more often in major teaching hospitals compared with other types of hospitals. Results suggest that clinical modifications of a few DRGs would lead to clinically more meaningful case-mix groupings. These same results can also serve as the basis for a discussion on the implication of DRG payments for those DRGs with distributional differences among the higher-cost subgroups.

Costs and Cost Analysis↗
PubMed1988

Radiology work-load measurements reflecting variables specific to hospital, patient, and examination: results of a collaborative study.

The authors coordinated the efforts of 44 hospitals in the United States to develop average times required for technologists to perform each of 19 radiologic examinations. When applicable, the overall average times were compared with extant Canadian work-load statistics. In six of the 14 examinations for which Canadian standards exist, the average times differed by 25% or more. The data were further analyzed to adjust time estimates for the effects of different hospital characteristics (e.g., number of beds, teaching status), patient characteristics (e.g., ambulation, outpatient status), and examination characteristics (e.g., number of views, resident involvement). The key factors and the magnitude of their effects varied from examination to examination, but the effects were generally large enough to have managerial significance. The factors can be evaluated by individual hospitals to produce customized estimates of average examination times. The data presented in this report can be used in management control systems by radiology departments in hospitals of varying sizes and teaching characteristics.

Allied Health Personnel↗
PubMed1988

Assessment of radiologic tests: control of bias and other design considerations.

The assessment of new radiologic tests can be seriously hampered by the presence of systematic bias. Biases can arise from incomplete verification of the sample population; omission of uninterpretable tests; absence of a definitive reference test; extraneous factors affecting interpretation; and extrapolation factors including variations in test efficacy among patients, hospitals, and the radiologists who interpret the tests. The authors review these biases that affect the results of efficacy studies and provide guidelines to avoid these problems.

Evaluation Studies as Topic↗
PubMed1988

Patient satisfaction as an indicator of quality care.

In this review of the theoretical and empirical work on patient satisfaction with care, the most consistent finding is that the characteristics of providers or organizations that result in more "personal" care are associated with higher levels of satisfaction. Some studies suggest that more personal care will result in better communication and more patient involvement, and hence better quality of care, but the data on these issues are weak and inconsistent. Further research is needed to measure specific aspects of medical care and the ways in which patient reports can complement other sources of information about quality. In addition, more research on the determinants of satisfaction and the relationship between quality and satisfaction among hospitalized patients is recommended.

Attitude↗
PubMed1988

Chronic osteomyelitis: the relative roles of scintigrams, plain radiographs, and transmission computed tomography.

We evaluated the relative contribution of transmission computed tomograms (CT), plain radiographs, and bone/gallium scans in the diagnosis of 27 patients with suspected active chronic osteomyelitis. All patients were imaged with all modalities and had surgical proof of the presence or absence of disease. At surgery, osteomyelitis was shown to be active in 20 patients, 15 of whom had sequestra, and inactive in the remaining seven. CT depicted all 15 sequestra, but was falsely positive in three patients, all of whom had bone remodeling only and had negative bone/gallium scintiscans. Plain radiographs had a limited value; they detected sequestra, which was the only findings to indicate the presence of active disease, in 5 patients out of the 15 with surgical proof thereof. The authors conclude that, considering the shortcoming of other modalities with regard to depicting sequestra, scintigraphy is helpful in confirming the presence or absence of active disease and therefore in preventing unnecessary surgery.

Adult↗
PubMed1987

Determinants of physicians' preferences for alternative treatments in women with early breast cancer.

To learn about factors, that influence a physician's decision making, a mail survey was conducted asking physicians about their preferences for radical mastectomy vs. local excision plus irradiation, and for adjuvant chemotherapy vs. no adjuvant treatment for two hypothetical women with operable, clinical stage I breast cancer - one 35 years old and the other 60 years old. Two hundred and sixty-one physicians from varied specialties in Connecticut and Massachusetts returned the questionnaire. Approximately half of the respondents would accept either mastectomy or limited surgery plus radiation therapy for either patient. Adjuvant chemotherapy was recommended by 97% of respondents for the younger patient and by 66% for the older patient. Several factors appeared to be related to therapeutic preferences. An individual physician's attitude towards patient involvement in decision making was the most important predictor of surgical preference for both the patients, whereas the role of specialty (i.e., surgeons vs. other providers) was more important for the surgical management of the older patient. For the decision involving adjuvant chemotherapy, specialty, hospital size, and presence of radiotherapy equipment on site were important predictors. Factors other than survival (such as disease-free interval and cosmetic results) were viewed as important standards of effectiveness by some physicians.

Adult↗
PubMed1987

Differences in ambulatory test ordering in England and America. Role of doctors' beliefs and attitudes.

Forty-five American and English doctors were surveyed to determine whether differences in their beliefs about the incidence and morbidity of complications and the role of testing for patients with chronic hypertension could be contributing to the large cross-national differences previously demonstrated in ambulatory test use for such patients. For each of nine tests, the number the English doctors thought they "should order" was significantly less than that of the American group. English doctors also estimated a lower incidence for each of seven possible complications of hypertension, but there was no difference in perceived morbidity of the complications. Both groups thought results from testing would alter therapy for only a small proportion of patients; however, the English estimate was significantly smaller than the American (16 percent versus 27 percent: p less than 0.05). The reasons given for testing were very similar in the two countries except that American doctors ranked as more important the reason that patients used the quantity of test ordering as an indicator of quality care. These results suggest that differences in ambulatory test use are consistent with physicians' beliefs about the number of tests they should be ordering, disease incidence, the likelihood that testing will affect patient care, and patient expectations. Further study should be directed toward understanding the contributions that differences in physician beliefs about the natural histories of diseases and patient expectations make to variations in test ordering.

Ambulatory Care↗
PubMed1987

Variations in ambulatory test use: what do they mean?

This article discusses the meaning of variations in ambulatory test use with emphasis on practice setting, availability of testing services, financial incentives, and physician and patient characteristics.

Ambulatory Care↗
PubMed1987

Disease activity in osteomyelitis: role of radiography.

To determine the impact of radiographic findings on the interpretation of bone and gallium scans of patients with active osteomyelitis, the authors reviewed the medical records and radiologic examinations of 104 patients. The only diagnostic finding of active disease on radiographs was the presence of a sequestrum (three patients). Other findings--such as erosion, soft-tissue swelling, and periosteal reaction--proved nonspecific and did not differentiate active from inactive disease. Furthermore, these findings did not significantly change the sensitivity or specificity of the bone and gallium scans, either in detecting or in excluding the presence of active disease.

Adolescent↗
PubMed1987

The emergence of geriatric assessment units. The "new technology of geriatrics".

Previous studies have suggested that geriatric assessment units may provide important benefits to the care of elderly persons. In early 1985 we surveyed personnel at 104 (91%) of the existing 114 geriatric assessment units associated with medical schools and Veterans Administration medical centers for information on the units' development and operation. Although almost 80% of the units were hospital based, most (61%) provided care for outpatients. Nearly half (47%) began operation in 1983 or later; of those in existence before 1983, two thirds have increased their capacity since then. The types of personnel and their training differed substantially among units. Fifty percent of the physicians had had no formal training in geriatrics. Of the 104 units, 99 (95%) did routine assessment. The estimated time spent per new patient in outpatient units was 2.7 +/- 2.1 (SD) hours. These data suggest that geriatric assessment units are proliferating rapidly, have differing structures, and consume substantial resources. Further efforts are needed to define their optimal structure, targets, and function.

Geriatrics↗
PubMed1987

The chemistry laboratory. Development of average, fixed, and variable costs for incorporation into a management control system.

In order to estimate real cost savings achievable from reductions in laboratory test volume and in order to provide a management tool to help achieve such savings, we developed a management system for our chemistry laboratory. The system estimates the fixed costs (i.e., equipment, direct overhead, and indirect overhead costs), the variable costs (i.e., labor and supplies), and the total costs for each of the 81 tests performed in our hospital's chemistry laboratory. A monthly management report compares predicted changes in total variable costs (based on test volume) to actual variable cost changes. One useful insight from the system is that substantial savings may be realized from reducing low-volume, high-variable cost tests that are not normally the target of test-reducing strategies. The savings per test not ordered was estimated to be $5.24 for the low-volume, high-variable cost tests but only $0.45 for the high-volume, low-variable cost tests, nearly a 12-fold difference. A 10% volume reduction of the former (a reduction of only 6,400 tests annually) would achieve 63% of the savings from a 10% volume reduction of the latter (a reduction of 120,000 tests annually). An effective management reporting system, which tracks actual cost savings, is probably necessary to achieve these savings.

Autoanalysis↗
PubMed1986

The influence of diagnostic radiography on the incidence of breast cancer and leukemia.

Little accurate information is available on the influence of diagnostic radiography on the incidence of cancer in the general population, largely because of a lack of knowledge of the numbers and the age distributions of patients undergoing radiographic examinations. We used such information from a closed population in Maine that was followed for a year, along with data from the literature on the absorbed dose from typical examinations and a mathematical model linking dose to the incidence rate of cancer, to estimate the numbers of cases of radiologically induced cancer of the bone marrow and breast. Our data indicate that about 1 percent of all cases of leukemia and less than 1 percent of all cases of breast cancer result from diagnostic radiography. In addition, such tumors generally occur late in life; the incidence of radiation-induced leukemia was highest at 69 years, and the incidence of radiation-induced breast cancer was highest at 76 years. Thus, diagnostic radiography has only a small influence on the occurrence of leukemia and breast cancer.

Adolescent↗
PubMed1986

The use of ambulatory testing in prepaid and fee-for-service group practices. Relation to perceived profitability.

To examine the influence of method of payment on ambulatory testing by internists, we compared the rate at which patients with uncomplicated hypertension were tested by 10 doctors practicing in large fee-for-service groups with that by 17 doctors in large prepaid groups. We examined the use of individual tests and asked the doctors in the fee-for-service groups what they believed about the profitability and costs of tests. After correcting for the patient's age, sex, duration of disease, and severity of disease as measured by pretreatment blood pressure, and for the doctor's year of medical school graduation, we found that 50 percent more electrocardiograms were obtained among patients in fee-for-service practices (0.69 per patient per year vs. 0.45, P = 0.006), and 40 percent more chest radiographs (0.49 vs. 0.35, P = 0.11). Fee-for-service doctors believed that both tests were associated with high profit and costs. These results suggest that the use of certain high-profit, high-cost tests is higher in large fee-for-service groups than in large prepaid groups. Although the generalizability of conclusions based on this limited study must be considered tentative, the findings suggest that it may be appropriate to consider changing the payments for tests as part of a more general reform of the fee schedules.

Ambulatory Care↗
PubMed1986

Relationship of beliefs and behavior in test ordering.

Understanding the reasons physicians order diagnostic tests may be useful in designing strategies to promote cost-effective practice and helpful in developing appropriate endpoints for evaluations of new diagnostic technologies. Testing by 27 private office physicians for 324 hypertensive patients was examined and the doctors were surveyed for their beliefs about appropriate levels of use for common tests, how they compared with other doctors in frequency of use, and their reasons for ordering tests. Beliefs about appropriate levels of testing were correlated with actual use (0.45 to 0.63, Pearson). Usage also correlated with beliefs about relative ordering patterns. Annual testing charges incurred by physicians who believed they ordered tests "more frequently" than average were higher than those who believed they ordered tests "less frequently" than average ($122 +/- $46 versus $51 +/- $15, p less than 0.05). Reasons for ordering tests were (in order of importance): establishing a baseline, assessing prognosis, reassuring patients, and helping with treatment decisions. These results suggest that "high usage" physicians may know who they are; and therefore strategies of feedback to modify behavior should be designed to do more than educate physicians about their own utilization. Second, evaluations of technology must consider more than contributions to immediate treatment decisions.

Attitude of Health Personnel↗
PubMed1986

Clinical efficacy of dental radiography in the detection of dental caries and periodontal diseases.

This article reports the ability of dental radiographs to correctly detect evidence of dental caries and periodontal disease (sensitivity) and to correctly establish the absence of these diseases (specificity). The analysis used a unique data set that was collected as part of the Veterans Administration Dental Longitudinal Study in Boston. Periapical, panoramic, and posterior bitewing radiographs were independently compared with a consensus radiographic standard of all three radiographs read simultaneously. Findings showed that the sensitivities of all three radiographs to detect dental caries were lower than expected, at approximately 60%, whereas the sensitivities to detect evidence of periodontal disease averaged approximately 85%. Panoramic radiographs were substantially less sensitive for detecting dental caries than periapical and posterior bitewing radiographs, but no difference between these modalities was observed in the analysis of sensitivity to periodontal disease. The proportion of false-negative and false-positive readings from dental radiographs was substantial and requires further investigation.

Adult↗
PubMed1986

The use of panoramic radiography in the evaluation of asymptomatic adult dental patients.

This article examines the efficacy of panoramic radiography alone and in combination with intraoral films as part of the "full-mouth" radiographic evaluation of asymptomatic dental patients in the diagnosis of dental caries and periodontal disease. Three full-mouth radiographic surveys--the panoramic alone, the panoramic plus posterior bitewing, and the periapical plus posterior bitewing--are compared. Two forms of measurement--comparative and incremental--were used to identify the radiographic survey with the highest single diagnostic yield when measured against the consensus standard. The findings show that the panoramic radiograph alone exhibits very low sensitivities to dental caries, ranging from 0.6% on anterior teeth to 25.6% on premolars. Even when posterior bitewing radiographs are added to the panoramic films, the sensitivities are significantly below those of the full-mouth periapical and bitewing survey. In contrast, the sensitivities of all three radiographic surveys in the diagnosis of periodontal disease are quite high, ranging from 87% to 96%, so that differences are not clinically significant. However, specificities tended to be low for periodontal disease and high for caries. Thus, for dental caries and (to a lesser extent) periodontal disease, the panoramic radiograph was inferior to the full-mouth intraoral series in its ability to correctly detect evidence of the disease.

Adult↗