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Biomedical subjects

D A Conrad

Publications and source records attributed to D A Conrad.

At least 37 records · Page 2Linked to original sources
PubMed1995

Incentive effects of workers' compensation benefits: a literature synthesis.

Increasingly, the health care community and public policymakers are recognizing the role of economic and psychosocial factors in disability in addition to their traditional attention to environmental, physical, and somatic influences on health and illness. In particular, current discussions of health reform include serious consideration of the integration of workers' compensation and health plan benefits. This article synthesizes what is known regarding one important aspect of health policy: the effects on disability behavior of changes in workers' compensation benefits. The best available literature reveals that an increase of 10 percent in workers' compensation benefits is related to a 1 to 11 percent increase in the frequency of workers' compensation claims and a 2 to 11 percent increase in duration per claim. The article examines the sensitivity of these parameter estimates to differences in research design and proposes an idealized study methodology that, the authors hope, would improve the precision of estimates of the incentive effects of workers' compensation payments.

Accidents, Occupational↗
PubMed1995

Malpractice premiums in 1992: results of a national survey of dentists.

According to a 1992 national survey, more than 95 percent of general dentists in the United States purchased malpractice insurance. The authors evaluated the survey findings to identify factors that had the greatest effect on dentists' insurance premium costs. Premiums were higher for dentists who had been the subject of previous complaints or claims, as well as for those who owned their practices. States with fewer lawyers had lower premiums. Finally, state limits on use of dental hygienists, number of offices and the extent of water fluoridation also affected premium levels.

Fees and Charges↗
PubMed1994

Economic decision analysis in the diagnosis and treatment of low back pain. A methodologic primer.

This article outlines basic principles for the economic analysis of clinical decisions. Using a hypothetical scenario involving a patient with low back pain, the specific application of cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA) is illustrated; and the two methodologies are compared. Cost-benefit analysis is advanced in the "gold standard" among the two approaches because it forces decision makers to explicitly value both the cost and health consequences of alternative clinical actions.

Cost-Benefit Analysis↗
PubMed1994

Dental malpractice liability insurance market: surveys of insurers and insurance commissioners.

Surveys of malpractice insurers and state insurance commissioners in 1992 show a highly concentrated market with opportunities for greater competition. Fewer than 50 firms write coverage nationally. Weighted premiums for $1 million/$3 million coverage vary across U.S. census divisions from $1,700 in the South to $3,000 in the Northeast. These data may be of interest to practitioners who purchase insurance and will aid dental associations in effectively participating in revisions of malpractice liability statutes as part of overall health care reform.

Data Collection↗
PubMed1993

Coordinating patient care services in regional health systems: the challenge of clinical integration.

Regional health systems attempting to achieve the vertical integration of health services ultimately must achieve clinical integration. The thesis of this article is that vertical integration in health care involves the coordination of inputs (equipment, supplies, human resources, information, and technology) and intermediate outputs (preventive, diagnostic, acute, chronic, and rehabilitative services) to attain the end goal of optimal personal health. Given this perspective on vertical integration, the coordination of specialty services and primary care within a system structure--that is, the clinical integration of patient care--is central to the realization of vertically integrated regional health systems. Institution-level and environmental factors that facilitate and challenge the attainment of clinical integration are elucidated, and a set of clinical integrating mechanisms are outlined with presentation of real-world examples of those mechanisms. The analysis concludes by summarizing the next steps in realizing the vision of clinically integrated, regional systems of health care.

Comprehensive Health Care↗
PubMed1992

Oral aztreonam, a poorly absorbed yet effective therapy for bacterial diarrhea in US travelers to Mexico.

OBJECTIVE: To evaluate a poorly absorbed antimicrobial with in vitro activity against all major bacterial enteropathogens in oral therapy for bacterial diarrhea. DESIGN: One hundred ninety-one US students with diarrhea acquired in Mexico received 100 mg of aztreonam or matching placebo three times a day for 5 days. Stools were cultured for bacterial enteropathogens before and after therapy. SETTING: We studied US students who acquired diarrhea in Mexico (travelers' diarrhea) in view of the high frequency of bacterial agents in this setting. MAIN OUTCOME MEASURE: We examined time of clinical recovery, treatment failures, adverse experiences, and microbiologic eradication from stool of the etiologic agent in subjects randomized to receive aztreonam or placebo. RESULTS: Aztreonam reduced the average duration of diarrhea compared with the placebo: for all cases, by 40 hours (P much less than .01); for those with enterotoxigenic Escherichia coli diarrhea, by 50 hours (P less than .01); for those with shigellosis, by 90 hours (P, not significant [small sample size]); for all bacterial agents, by 57 hours (P much less than .01). Clinical failures during the 5 days of therapy were seen in six patients (6%) receiving aztreonam and 25 (27%) receiving placebo (P less than .01). Pathogen eradication occurred in 95% of those receiving aztreonam and in 70% of those receiving the placebo (P less than .01). All bacterial enteropathogens were susceptible in vitro to aztreonam. The drug was well tolerated. CONCLUSIONS: Oral aztreonam, which is poorly absorbed, was well tolerated and was an effective therapy for bacterial diarrhea in US adults in Mexico.

Administration, Oral↗
PubMed1990

Vertical integration in health services: theory and managerial implications.

A vertically integrated health care system is an arrangement whereby a health care organization offers, either directly or through others, a broad range of patient care and support services. This article discusses the market forces and strategic considerations driving the recent trend toward vertical linkages in health care markets and examines some of the managerial implications and issues associated with this vertical restructuring trend.

Capital Financing↗
PubMed1990

The Planetree Model Hospital Project: an example of the patient as partner.

The Planetree Model Hospital Project at Pacific Presbyterian Medical Center in San Francisco uses a patient-centered philosophy to incorporate the patient as a partner in the care process. This article describes the Planetree unit and discusses two aspects of the program--training patients to be partners and increasing nurse satisfaction. Such programs have the potential for improving the health outcomes of patients and aiding hospitals by assuring quality of care with greater patient participation, by improving public relations, and by promoting staff satisfaction.

Hospital Bed Capacity, 100 to 299↗
PubMed1990

Pathologic response of the lung to irritant gases.

The pathologic response of the lung to irritant gases ranges from the acute exudative phase through the subacute proliferative phase to the chronic fibrosing phase. These responses are based on damage to the Type I cells, and possibly endothelial cells, and the subsequent proliferative and repair processes in the surviving animals. Responses to high dose exposures appear at the microscopic level as exudation of protein rich fluids into alveoli (alveolar edema) and subsequent death due to anoxia. Physiologically, this could be described as a mismatch of ventilation with perfusion, resulting in impaired gas exchange. Animals surviving this acute exudative phase resolve the alveolar edema to fibrin, and Type II cells become hypertrophic and hyperplastic in the process of replacing the damaged Type I cells. The acute and subacute responses also elicit inflammatory changes in the interstitium of the lung that may progress to fibrosis in the chronic stage of a survivable exposure. Diagnostic cases in livestock involving irritant gases reflect similar toxic injuries to the lung.

Ammonia↗
PubMed1988

The cost and efficacy of home care for patients with chronic lung disease.

A randomized controlled trial was conducted to assess efficacy and cost of sustained home nursing care for patients with chronic lung disease. Three hundred one patients were randomly assigned to a respiratory home care group (RHC) that received care from respiratory home care nurses, a standard home care group (SHC) that received care from regular home care nurses, or an office care group (OC) that received whatever care they needed except for home care. Patients were followed for 1 year. At the end of the study year, there was no difference in survival, pulmonary function, or everyday functioning among the three groups. Average annual cost of care for all study patients was $7,647 (1981-82 dollars). The average annual health care costs for patients in the RHC group was $9,768; for those in the SHC group, $8,058; and for those in the OC group, $5,051 (F = 6.45, df = 2/298, P = 0.02). These results suggest that the current policy of limited coverage of home nursing services by Medicare and other third-party payers may be appropriate.

Activities of Daily Living↗
PubMed1988

Cost-justification analysis of prenatal maternal serum alpha-feto protein screening.

The costs to an insurer of a 10-year maternal serum alpha-feto protein (MSAFP) screening program were subtracted from future medical care costs avoided by the insurer (benefits) to examine whether such a program would be cost-justified from the perspective of a managed health care system (i.e., result in net costs greater than or equal to 0). The analysis considered MSAFP screening for neural tube defects (NTDs) alone and then was repeated to consider screening for both NTDs and Down's syndrome. Using a 5% discount rate for future dollars, the costs to the insurer of a screening program for NTDs alone over 10 years exceeded costs avoided by $10.00 per person screened. Adding screening for Down's syndrome using the same MSAFP test increased the net cost by $22.00 to a total of--$32.00 per screenee. The estimate of the cost to the insurer was sensitive to assumptions regarding the costs of medical care avoided, the expense of MSAFP, the proportion of screened women requiring a genetic amniocentesis, and the cost of that procedure. The conclusion that screening would not result in a cost savings to the insurer was not changed by reasonable assumptions regarding 1) the appropriate discount rate; 2) the costs of MSAFP; 3) the costs of genetic amniocentesis; 4) the sensitivity of MSAFP; 5) the proportion of the population requiring genetic amniocentesis; and 6) the costs of 10 years of medical care for someone affected by Down's syndrome or an NTD. Other analyses suggested that screening for NTDs or Down's syndrome would be cost-justified when viewed from the perspective of society. The present work suggests this conclusion does not hold when the perspective of the insurer is taken because avoided costs of care realized by society exceed those realized by the insurer.

Adult↗
PubMed1988

The decision to integrate vertically in health care organizations.

A scheme to help health care managers make decisions regarding vertical integration (and deintegration) strategies and to alert health care managers to a more analytic view of vertical integration that may help avoid costly mistakes is presented. Central to the decision-making scheme is the comparison between the costs of purchasing goods and services from (and selling them to) other organizations and the costs of acquiring (and supplying) the same goods and services within one's own organization. Whether outside or inside an organizational boundary, these costs (called transaction costs) may be important in determining whether vertical integration is an appropriate organizational strategy (Williamson 1975).

Contract Services↗
PubMed1987

Aerosolized ribavirin treatment of respiratory syncytial virus infection in infants hospitalized during an epidemic.

Thirty-three infants with predisposing conditions and/or severely symptomatic with respiratory syncytial virus (RSV) infection were treated with aerosolized ribavirin during a 12-week period at Oklahoma Children's Memorial Hospital. These patients were compared with 97 untreated patients with RSV infection hospitalized during the same epidemic. Despite preconditions which selected for a more seriously ill treatment group, patients who received ribavirin showed prompter resolution of the illness than did untreated controls. Greatest clinical improvement in treated patients occurred between the first and second days of ribavirin therapy; mean ribavirin treatment duration was 4.5 days. Ten of 22 ribavirin-treated patients continued to excrete RSV after conclusion of antiviral therapy. No adverse hematologic, renal or metabolic effects occurred with ribavirin therapy. Our experience with ribavirin therapy during a major epidemic confirms and extends the results of previous controlled evaluations demonstrating this treatment safe and effective in high risk and seriously ill infants with RSV bronchiolitis and bronchopneumonia.

Administration, Inhalation↗