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Biomedical subjects

D B Nash

Publications and source records attributed to D B Nash.

At least 73 records · Page 4Linked to original sources
PubMed1991

Urinary tract infection: economic considerations.

Urinary tract infection results in significant morbidity and mortality while consuming large amounts of national resources. The prevention, diagnosis, and treatment of urinary tract infection produce both costs and benefits, and economic analysis provides a rational framework for looking at these effects. The goals and methods of economic analysis in medicine are summarized, and strategies to address uncomplicated cystitis, nosocomial urinary tract infection, and pyelonephritis are reviewed, with an emphasis on the economic trade-offs faced by decision makers.

Acute Disease↗
PubMed1991

Teaching the tenets of quality: a survey of medical schools and programs in health administration.

This article reports the results of a survey of medical schools and programs in health administration to determine the national scope of the teaching of quality assurance in higher education. The responses from 98 medical schools and 64 schools of public health or health administration programs suggest that medical schools have not yet successfully integrated training in QA into the medical school or residency curriculum. Health administration programs appear to give QA courses more serious attention, to offer a more well-rounded program in QA, and to evaluate students' progress in QA courses more carefully. No statistically significant differences were found between public and private medical schools, between undergraduate and graduate levels, or across geographic regions in response rates or in provision of QA training.

Canada↗
PubMed1991

Clinical outcomes management and disease staging.

Clinical outcomes management includes multiple approaches for evaluating and improving the quality and cost effectiveness of medical care. The usefulness of outcomes assessments depends, in part, on how well the clinical issues have been specified and whether the analyses are sensitive to the diverse clinical characteristics of the patients receiving the medical care in question. Measures of severity of illness and, in particular, Disease Staging, have an important role in outcomes assessment by classifying diseases along dimensions that have prognostic significance. This article reviews current applications of Disease Staging for outcomes assessment and management.

Clinical Protocols↗
PubMed1991

Managing outcomes: the perspective of the players.

Outcomes management is most deeply rooted in clinical issues that interrelate concerns about quality with cost effectiveness of care. This is ground-breaking activity from many perspectives. Researchers must work more closely with clinicians and decision makers than ever before. Hospital executives must contend with many new external data demands and determine how to operationalize outcomes management programs within their institutions. There are new roles for clinician executives who act as change agents within health care organizations, while data on outcomes of care can lead to increased bargaining power among purchasers of services. In this article we discuss the major implications this new focus on managing outcomes is having on researchers, hospital executives, clinicians, and the purchasers of health care services.

Chief Executive Officers, Hospital↗
PubMed1990

Practice guidelines and outcomes. Where are we headed?

Major forces are at work within the health care system that drive the development of clinical standards or guidelines. This process must be tied in a "feedback-loop" system to a more accurate assessment of patient outcomes. There is a major controversy at the foundation of the process that is pitting the opinions from consensus panels of experts against the inability of individual physicians to accurately estimate the outcomes of different options through implicit systems. In many instances, the quality of medical evidence is poor. Many groups within organized medicine are attempting to write guidelines, and at least four major challenges must be confronted before guidelines are widely adopted by clinicians. A new federal agency may provide the necessary resources to focus the debate on guidelines. Guidelines may eventually enhance the quality of medical care.

Health Services↗
PubMed1989

Quality assurance and utilization review in a health insuring organization. The HealthPASS example.

HealthPASS is a Philadelphia-based health insurance organization (HIO), owned and operated by the Penn Health Corporation, a subsidiary of Maxicare, the large for-profit health maintenance organization (HMO) company based in California. In a contractual agreement with the Pennsylvania Department of Public Welfare (DPW), Maxicare contracts primary care physician services on a capitated basis, and other services on a fee basis, to about 96,000 Medicaid enrollees in certain zip codes in Philadelphia. Although HealthPASS does not provide care directly, it contracts with providers for these medical services. HealthPASS serves a primarily poor, minority, and inner city population with high rates of drug abuse, alcoholism, and mental illness. Currently, the enrollees are served by a network of providers including more than 40 participating hospitals and over 500 primary care providers (PCPs) in the community. HealthPASS is unique as previous HIOs in Kentucky and Arizona both failed. This paper describes the quality assurance and utilization review (QA-UR) system implemented by HealthPASS with specific examples of case discussions and a detailed look at the structure and function of the internal review process. Before outlining the QA-UR system, a brief history is provided of the recent controversial trend toward managed care for Medicaid recipients, as there have been marked failures in this arena nationally. The HealthPASS system is described--what it is, how it is staffed, who it serves, and the health services it offers.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Maintenance Organizations↗
PubMed1988

Corporately managed health care and the new role of physicians.

The roles described are not all-inclusive, since a small proportion of physicians, as in times past, will continue to pursue diverse careers outside of an tangential to health care. Neither are the roles mutually exclusive, as physician-managers are also organizational employees, as independently contracting professionals may also be partly fee for service, as physician entrepreneurs may be fee for service practitioners or contracting professionals, and so forth. The point is, that as the delivery of health care becomes a more complex and formalized process, and as large organizations delivering and insuring health care become more predominant, the various roles of physicians are becoming more distinctly obvious. What are the implications of this trend toward greater internal segmentation of the medical profession? At this juncture, they are not entirely clear. It could mean that some groups of physicians will achieve higher status and more rewards than other groups, which might result in greater conflicts within the medical profession. Undoubtedly, the emergence of corporately managed health care and the development of new (and possibly divergent) roles for physicians confronts the medical profession and its members with the gnawing questions of who they really are and what do they really want to be? Ultimately, the greatest challenge may be in finding a common set of commitments and values which transcend our many different roles, and which provide physicians with a clear and continuing sense of ourselves as medical professionals.

Commerce↗
PubMed1988

Privilege delineation in a demanding new environment.

The delineation of clinical privileges is one of the most important means for hospitals to ensure high-quality care. Competition, cost control, and public accountability have created the need for hospitals to assure effective privilege delineation processes. Hospitals should focus on issues of practice variation, continuity of care, volume of services provided and planned, and the integration of ethical considerations into clinical decisions. How information is obtained, verified, and acted upon is reviewed within the organizational framework of the hospital. Several leaders within the hospital, such as the clinical department chairs and members of the medical staff executive committee, have important functions in the clinical privilege delineation process. Granting clinical privileges is a critical hospital function that requires a commitment by the governing body, management, and medical staff leaders.

Clinical Competence↗
PubMed1987

The physician-executive: Part 1. The younger doctor. Growing demand for an emergency subspecialty.

Changes in the health care system have fostered the need for a new, evolving specialty: the physician-executive. The author, who foresees medical administration as a board-certified subspecialty within five years, describes this position as a liaison between the administrative and the clinical personnel of a hospital or prepaid health plan. It is particularly suitable for young physicians who are newly certified in internal medicine. Consideration is given to the advantages of a medical degree for such an executive, and the various management training programs currently available are described. An MBA is recommended for anyone who expects to become a full-time physician-executive. The core curriculum of the Wharton Business School's MBA in health administration is cited as a model program.

Career Choice↗