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D E Detmer

Publications and source records attributed to D E Detmer.

At least 37 records · Page 2Linked to original sources
PubMed1994

Computer-based patient records: a building block for health care reform.

The fundamental need for better information management capabilities in health care is at risk of being overlooked in the proposals for major national changes aimed at providing health security, controlling costs, enhancing quality, and expanding access for citizens. In addition to these proposed macro changes (e.g., universal access, guaranteed benefit package, national health board, regional health alliances), successful reform will require transformation of health care delivery at the micro level. We must overcome provider-dependent variations in clinical practice patterns, in quality of performance, and in costs of services. We must ensure movement toward appropriate care rather than simple rationing. Individual health care professionals and institutions must acquire and use tools that will enable them to provide their services cost-effectively with consistent results. We must be able to assess and ensure value--i.e., appropriateness, effectiveness, and cost--of health services, apply that knowledge in each and every patient encounter, and track the impact of clinical decisions through an analysis of aggregated databases.

Guidelines as Topic↗
PubMed1991

A vision for future patient records.

This article discusses The Computer-based Patient Record: An Essential Technology for Healthcare, the eagerly awaited report from the Institute of Medicine. The report presents the conclusions and recommendations of the multidisciplinary committee convened to explore how patient records could be improved, a project supported in part by AMRA.

Computer Communication Networks↗
PubMed1989

Chronic compartment syndrome. An unusual cause for claudication.

Chronic Compartment Syndrome (CCS) is usually caused by overuse injury in well-conditioned athletes (particularly runners). Less common causes of CCS include blunt trauma, venous insufficiency, and tumor. CCS is clinically manifested as claudication, tightness, and occasional paresthesia. Unlike other forms of overuse injury (tendonitis, stress fracture), CCS does not respond to rest, anti-inflammatory medications, or physical therapy. The diagnosis of this condition is confirmed by elevated compartment pressures (normal less than 15 mmHg; CCS greater than 20 mmHg). The only effective treatment is surgical compartment release. Two hundred nine patients have been surgically treated for CCS, 100 by subcutaneous fasciotomy (group I) and 109 by open fasciectomy (group II). These procedures were usually performed in ambulatory surgery using local anesthesia. Patients treated by open faciectomy instead of subcutaneous fasciotomy had fewer early postoperative wound complications (6% vs. 11%) and fewer late recurrences (2% vs. 11%).

Adult↗
PubMed1989

Chronic compartment syndrome.

Chronic compartment syndrome typically affects young people who are engaged in endurance sports. The primary clinical feature is a sensation of tightness or aching pain in a defined compartment of the affected limb, starting during activity or hours after activity ceases and lasting for varying lengths of time. The diagnosis is based on the history and on measurement of compartmental pressures. Fasciotomy or partial fasciectomy is the definitive treatment.

Adult↗
PubMed1988

Diagnosis related groups (DRGs): efficiency and/or quality producing? Some evidence from surgical patients.

Hospital charges and length of stay for inguinal hernia and acute appendicitis patients were examined in a university hospital to determine the degree of variation with DRGs. Evidence presented here suggests that DRGs may lead to a reduction in medical care costs without a reduction in patient outcomes. Mode/year DRGs to take account of source of admission and maintaining outliers payments may be desirable to avoid patient selectivity and incentives for lowering quality of care of the most severely ill patients.

Appendectomy↗
PubMed1986

Whither primary care in the academic health science center?

Five forces that shape the form and function of the future academic health center are a mandate to decrease health care costs, a surplus of physicians, intense competition for the provision of tertiary medical care, a suboptimal diagnosis-related group (DRG) case mix, and decreasing funding for manpower training and research. All five forces cause the academic health center to be much more in need of strong primary medical care services. This article describes the current relationship between primary care and the academic medical center, new contributions that primary care can make to the academic medical center, and the benefits that would accrue to both the academic medical center and primary care should a closer working relationship develop. These benefits include increased outpatient volume and revenue, a more balanced inpatient case mix, better primary medical care education, an enhanced community reputation, and greater influence by primary care on academic medical center policies. Published and personal case study experiences that show some of the potential problems with a closer working relationship between primary care and the academic medical center are described.

Academic Medical Centers↗
PubMed1984

Improved results in acute appendicitis care following areawide review.

The Wisconsin Professional Review Organization compared acute appendectomies being performed in 1981 to those done in 1978 in 32 Wisconsin hospitals. In both years approximately 75 percent of primary appendectomies were in patients 5 to 30 years of age, one-fourth were in patients 15 to 19 years of age, and the majority were in males. Incidence of normal appendices dropped from 16.1 percent in 1978 to 11.4 percent in 1981 (p less than 0.005). The number of patients with normal appendices who did not meet symptom criteria dropped from 37.3 percent to 9.5 percent (p less than 0.05). Incidence of normal appendices was highest in small hospitals. Severity and ruptures or perforations increased, but not significantly. Postoperative complications and mortality decreased. Average length of stay decreased overall, but increased for patients with complications and ruptures or perforations. These data suggest that areawide reviews assure quality and help contain costs. Physician self-regulation using areawide studies may produce desirable change.

Acute Disease↗
PubMed1984

The economics of surgical signatures.

Identification and analysis of practice patterns for a group of surgeons within the same institution show a significant variation in total hospital charges, length of stay, and ancillary charges for simple uncomplicated hernia repairs and appendectomies. When presented to surgeons, these data can be of immense value in terms of altering practice patterns in order to deliver cost-effective, high-quality health care.

Appendectomy↗
PubMed1984

Policy proposal for correcting the imbalance in general surgical manpower.

The Graduate Medical Education National Advisory Committee's 1980 report on physician manpower estimated that 23,500 general surgeons would be required in 1990 and that there would be a surplus of 11,800 trained general surgeons by then. Using the GMENAC estimates of need and our analysis of supply, we project a surplus of only about half that number. To balance the supply of general surgeons to anticipated needs by the year 2000, it is estimated that the number of physicians beginning their residency training in general surgery between 1984 and 1995 should be reduced by 20% in relation to the number of first-year general surgery residents in 1982-1983.

General Surgery↗