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Biomedical subjects

D Wilkerson

Publications and source records attributed to D Wilkerson.

10 recordsLinked to original sources
PubMed1997

Impact of a function-based payment model on the financial performance of acute inpatient medical rehabilitation providers: a simulation analysis.

OBJECTIVES: To operationalize research findings about a medical rehabilitation classification and payment model by building a prototype of a prospective payment system, and to determine whether this prototype model promotes payment equity. This latter objective is accomplished by identifying whether any facility or payment model characteristics are systematically associated with financial performance. DESIGN: This study was conducted in two phases. In Phase 1 the components of a diagnosis-related group (DRG)-like payment system, including a base rate, function-related group (FRG) weights, and adjusters, were identified and estimated using hospital cost functions. Phase 2 consisted of a simulation analysis in which each facility's financial performance was modeled, based on its 1990-1991 case mix. A multivariate regression equation was conducted to assess the extent to which characteristics of 42 rehabilitation facilities contribute toward determining financial performance under the present Medicare payment system as well as under the hypothetical model developed. PARTICIPANTS: Phase 1 (model development) included 61 rehabilitation hospitals. Approximately 59% were rehabilitation units within a general hospital and 48% were teaching facilities. The number of rehabilitation beds averaged 52. Phase 2 of the stimulation analysis included 42 rehabilitation facilities, subscribers to UDS in 1990-1991. Of these, 69% were rehabilitation units and 52% were teaching facilities. The number of rehabilitation beds averaged 48. MAIN OUTCOME MEASURE: Financial performance, as measured by the ratio of reimbursement to average costs. RESULTS: Case-mix index is the primary determinant of financial performance under the present Medicare payment system. None of the facility characteristics included in this analysis were associated with financial performance under the hypothetical FRG payment model. CONCLUSIONS: The most notable impact of an FRG-based payment model would be to create a stronger link between resource intensity and level of reimbursement, resulting in greater equity in the reimbursement of inpatient medical rehabilitation hospitals.

Health Services Research↗
PubMed1996

Function-based payment model for inpatient medical rehabilitation: an evaluation.

OBJECTIVE: To describe the components of a function-based prospective payment model for inpatient medical rehabilitation that parallels diagnosis-related groups (DRGs), to evaluate this model in relation to stakeholder objectives, and to detail the components of a quality of care incentive program that, when combined with this payment model, creates an incentive for provides to maximize functional outcomes. DATA SOURCES: This article describes a conceptual model, involving no data collection or data synthesis. DATA SYNTHESIS: The basic payment model described parallels DRGs. Information on the potential impact of this model on medical rehabilitation is gleaned from the literature evaluating the impact of DRGs. The conceptual model described is evaluated against the results of a Delphi Survey of rehabilitation providers, consumers, policymakers, and researchers previously conducted by members of the research team. CONCLUSIONS: The major shortcoming of a function-based prospective payment model for inpatient medical rehabilitation is that it contains no inherent incentive to maximize functional outcomes. Linkage of reimbursement to outcomes, however, by withholding a fixed proportion of the standard FRG payment amount, placing that amount in a "quality of care" pool, and distributing that pool annually among providers whose predesignated, facility-level, case-mix-adjusted outcomes are attained, may be one strategy for maximizing outcome goals.

Activities of Daily Living↗
PubMed1996

Linking data from national trauma and rehabilitation registries.

OBJECTIVE: To evaluate te feasibility of retrospectively creating a data base useful in trauma systems evaluations. MATERIALS AND METHODS: Records for 375 patients in both the Major Trauma Outcome Study and the Uniform Data System for Medical Rehabilitation were linked to create an injury-through-rehabilitation data base, including patients from four impairment groups: traumatic brain injury (TBI); spinal cord injury --paraplegic complete (SCI-PARA) and quadriplegic complete (SCI-QUAD); and hip fracture (HIP-FX). MEASUREMENTS AND MAIN RESULTS: The average ages (25.1 years SCI-QUAD, 72.6 years HIP-FX); Injury Severity Score (10.2 HIP-FX, 31.7 SCI-PARA); Revised Trauma Score (5.9 TBI, 7.8 HIP-FX); and acute care lengths of stay (13.3 days HIP-FX, 24.2 days TBI) varied substantially over the four groups. On average, patients spent from approximately 20 days (HIP-FX) to nearly 100 days (SCI-QUAD) in rehabilitation. Functional gains during rehabilitation were primarily in motor skills, but TBI patients also made substantial cognitive gains. Nearly 90% of TBI and SCI patients were discharged to their homes; the percentage of HIP-FX patients discharged to their homes, however, was lower (74%). Across all impairment groups, more patients lived with their relatives after rather than before injury. The correlation between a summary Major Trauma Outcome Study-Functional Independence Measure assessed at acute care discharge and the complete Uniform Data System for Medical Rehabilitation-Functional Independence Measure assessed on admission to rehabilitation was significant for all study patients and for each impairment group except SCI_PARA. CONCLUSIONS: Linking records to create the study data base was arduous and could not be practically accomplished on a large scale or on a continuing basis. Because of the growing emphases on trauma system evaluations and outcomes beyond survival at acute care discharge, we recommend the routine inclusion of rehabilitation data in hospital-based trauma registries.

Activities of Daily Living↗
PubMed1995

Criteria for selection of a payment method for inpatient medical rehabilitation.

This article presents the results of a 3-stage Delphi survey designed to identify the policy criteria that should govern the evaluation of alternative payment methods and guide the selection of a payment method for inpatient medical rehabilitation. The Delphi survey (n = 85) included four groups of participants: consumers (n = 8), providers (n = 35), payers (n = 15), and health services researchers (n = 27). The Delphi survey uncovered 16 evaluation criteria. Delphi participants evaluated each criterion on a 10-point scale (1 = not important; 10 = greatest importance). Respondents value maximize patient/family outcome, maximize access, and maximize efficiency as the three most important criteria. Respondents report that minimize financial risk is the least important criterion. The results from both stage 2 and stage 3 (response rate = 85%) indicate a high level of consensus across the four respondent groups.

Delphi Technique↗
PubMed1993

In-vitro assessment of the behavior of magnetic resonance angiography in the presence of constrictions.

RATIONALE AND OBJECTIVES: Time-of-flight magnetic resonance angiography (TOF/MRA) is increasingly used to assess the nature and severity of stenotic blood vessels. Flow artifacts associated with high flows and/or narrow constrictions may confuse the interpretation of these studies. Accurate TOF/MRA evaluations demand an understanding of the nature of these flow effects. METHODS: A two-dimensional TOF pulse sequence was used to acquire images of five smoothly constricted phantoms at various flows. Analysis included assessment of phantom appearance and quantification of apparent constriction diameter and signal variations. RESULTS: Most notable flow phenomena were a cone-shaped region of high signal, a region of signal void, and signal preservation along the wall. When visible, constriction diameter was accurately measured. CONCLUSIONS: The behavior observed in TOF/MRA images can be understood by considering the contributing mechanisms of phase dispersion, turbulence, poststenotic flow eddies, flow reversal, and flow separation.

Blood Vessels↗
PubMed1991

Interleaved magnetic resonance and ultrasound by electronic synchronization.

Increasing attention has been directed toward using magnetic resonance imaging (MRI) to assess blood flow velocity. Complete acceptance of this application requires validation of MRI-derived flow measurements against an accepted flow measurement technique such as Doppler ultrasound in an in vivo situation. To provide an accurate correlation in the presence of rapid changes in blood flow, the MR acquisition should be made nearly simultaneously with the ultrasonic measurements. Unfortunately, standard ultrasound equipment generates radio frequency signal which interferes with MRI. Near-simultaneous acquisition of MR data and ultrasonic blood flow data should be possible if the two measurements are properly synchronized. In the technique presented, ultrasound is made to peacefully coexist with MRI by gating the ultrasound so that it is disabled during the time of MR data acquisition. Phantom and animal experiments confirm the use of this procedure. Although we did not specifically test new fast-scan MR techniques, our technique is completely general and should work equally well with spin-echo as well as newer fast scanning MRI techniques.

Animals↗
PubMed1975

Institutional tour effects on attitudes related to mental retardation.

The effects of an institutional tour on college students' attitudes toward the mentally retarded child, mentally retarded adult, state school for mentally retarded persons, and ward attendant at a state school for mentally retarded persons were investigated. Four separate Semantic Differential Scales were administered to 179 subjects prior to being given the alternative of touring a state school for mentally retarded persons (72 subjects took the tour). Pretest responses were used to divide subjects into initially positive or negative attitude groups. Posttest scores for each concept were then analyzed by a two-way classification mixed-models analysis of variance for unequal Ns. Results indicated significant positive effects on attitudes toward mental retardation as a function of the institutional tour.

Age Factors↗
PubMedDate not supplied

Implementing outcomes.

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Data Collection↗