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Biomedical subjects

E C Nelson

Publications and source records attributed to E C Nelson.

At least 73 records · Page 4Linked to original sources
PubMed1993

Patients' good and bad surprises: how do they relate to overall patient satisfaction?

The literature documents little research regarding patients' good and bad surprises in the hospital. Such experiences may inform a patient's future decisions about recommending or returning to the hospital. Utilizing a database of survey respondents, the authors conducted qualitative and quantitative analyses of patients' self-reported surprises about their hospital stay and the relationship between those surprise experiences and their overall feelings of satisfaction. Analysis of these data shows that patients do experience surprises during their hospital stays, that specific events are associated with these surprises, and that these surprises influence patient satisfaction. These results suggest that in order for health care providers to continuously improve and meet patients' needs and expectations, providers must determine steps to take to delight their patients, to avoid patient disappointments, and to meet patients' basic expectations.

Adolescent↗
PubMed1993

Patient-based quality measurement systems.

Continual improvement of health care can be accelerated and evaluated by the development of patient-based measurement systems. This article provides (1) design principles to guide the development of patient-based measurement systems; (2) a specific, yet flexible method for designing and testing patient-based measurement systems; and (3) real-world examples of patient-based systems that offer a glimpse of the future. These systems can provide direct measures of successes and failures, strengths and weaknesses, and improvements and declines in the provider's capacity to produce desired health outcomes at a cost that represents value.

Data Collection↗
PubMed1992

Differences in the mix of patients among medical specialties and systems of care. Results from the medical outcomes study.

OBJECTIVE: To determine differences in the mix of patients among medical specialties and among organizational systems of care. STUDY DESIGN: Cross-sectional analysis of 20,158 adults (greater than or equal to 18 years of age) who visited providers' offices during 9-day screening periods in 1986. Patient and physician information was obtained by self-administered, standardized questionnaires. SETTING: Offices of 349 physicians practicing family medicine, internal medicine, endocrinology, and cardiology within health maintenance organizations, large multispecialty groups, and solo or small single-specialty group practices in three major US cities. OUTCOME MEASURES: Demographic characteristics, prevalence of chronic disease, disease-specific severity of illness, and functional status and well-being. RESULTS: Among patients with selected physician-reported chronic illnesses (diabetes, hypertension, recent myocardial infarction, or congestive heart failure), increasing levels of severity were associated with decreasing levels of functional status and well-being and with increased hospitalizations, more physician visits, and higher numbers of prescription drugs. Compared with patients of general internists, patients of cardiologists were older (56 vs 47 years, P less than .01), had worse functional status and well-being scores (P less than .01), and carried more chronic diagnoses (mean 1.32 vs 1.02, P less than .01); patients of family practitioners were younger (40 vs 47 years, P less than .01) and more functional (P less than .01), carried fewer chronic diagnoses (0.70 vs 1.02, P less than .01), and (among diabetic patients only) had lower disease-specific severity scores (2.06 vs 2.30 on a five-point scale, P less than .01). Compared with patients in health maintenance organizations, patients visiting solo practitioners under fee-for-service payment were older (50 vs 45 years, P less than .01) and sicker (had worse physical functioning) and had a higher mean number of chronic diagnoses (1.10 vs 0.93, P less than .01). CONCLUSION: Patient mix is related to utilization and differs significantly across medical specialties and systems of care. These differences must be taken into account when interpreting variations in utilization and outcomes across specialties and systems, and when considering alternative policies for payment.

Activities of Daily Living↗
PubMed1992

Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study.

OBJECTIVE: To examine whether specialty and system of care exert independent effects on resource utilization. STUDY DESIGN: Cross-sectional analysis of just over 20,000 patients (greater than or equal to 18 years of age) who visited providers' offices during 9-day periods in 1986. Patient- and physician-provided information was obtained by self-administered questionnaires. SETTING: Offices of 349 physicians practicing family medicine, internal medicine, endocrinology, and cardiology within health maintenance organizations, large multispecialty groups, and solo practices or small single-specialty group practices in three major US cities. OUTCOME MEASURES: Indicators of the intensity of resource utilization were examined among four medical specialties (family practice, general internal medicine, cardiology, and endocrinology) and five systems of care (health maintenance organization, multispecialty group-fee-for-service, multispecialty group-prepaid; solo practice and single-specialty group-fee-for-service, and solo practice and single-specialty group-prepaid) before and after controlling for the mix of patients seen in these offices. The indicators of resource utilization were hospitalizations, annual office visits, prescription drugs, and common tests and procedures, with rates estimated on both a per-visit and per-year basis. RESULTS: Variation in patient mix was a major determinant of the large variations in resource use. However, increased utilization was also independently related to specialty (cardiology and endocrinology), fee-for-service payment plan, and solo and single-specialty group practice arrangements. After adjusting for patient mix, solo practice/single-specialty groups-fee-for-service had 41% more hospitalizations than health maintenance organizations. General internists had utilization rates somewhat greater than family physicians on some indicators. CONCLUSION: Although variations in patient mix should be a major determinant of variations in resource use, the independent effects of specialty training, payment system, and practice organization on utilization rates need further explication. The 2- and 4-year outcomes now being analyzed will provide information critical to interpretation of the variations reported herein.

Adult↗
PubMed1992

Do the pictures influence scores on the Dartmouth COOP Charts?

OBJECTIVE: To determine the effect of illustrations on COOP Chart responses. STUDY DESIGN: Randomized split-half design of 177 patients discharged from a medical centre during a 3 month interval. Patient responses were obtained. However, there are benefits from the use of illustrations. Further research measures. Demographic characteristics and health status. RESULTS: No response differences were observed between patients who received COOP Chart illustrations and those who did not receive illustrations. CONCLUSION: Pictures do not appear to affect responses to COOP Charts. However there are benefits of the use of illustrations. Also, further research should be conducted with other patient populations and other COOP Charts before conclusive statements can be made regarding the use of illustrations with the COOP Charts.

Activities of Daily Living↗
PubMed1992

The physician and employee judgment system: reliability and validity of a hospital quality measurement method.

Hospitals engaged in quality improvement must measure and assess customer perceptions of hospital services. Hospital customers are either "external"--patients, their families, and payers--or "internal"--physicians and hospital employees. This article describes two measurement systems designed to gather information from internal customers about the quality of hospital services. One system targets physicians, the other hospital employees. This article describes how these systems were developed and pilot-tested, and how the results were analyzed. Analysis of results showed the systems to be reliable, valid, and representative. The article also addresses limitations of the research (focus on general acute-care hospitals), interesting findings and implications (the correlation between physicians' and employees' ratings of hospital quality), and uses of these measures in corporate-level and hospital-level quality improvement (measuring trends and identifying specific opportunities for improvement).

Attitude of Health Personnel↗
PubMed1992

Recent developments and future issues in the use of health status assessment measures in clinical settings.

This paper provides a broad overview of the assessment of health status in clinical practice in three parts. Yesterday: The nation has undergone a paradigm shift in health-related thinking. The former paradigm emphasized only disease; the new emphasizes health, functioning, well-being, and disease. Measures of health and disease have evolved to reflect the new paradigm. Many are designed for clinical settings, based on measurement science, and are relatively brief. These newer measures have been used to document the natural history of disease, evaluate treatment effectiveness, and improve clinical case management. Today: Two barriers block full-scale use in clinical settings. The first barrier involves the meaning and interpretation of health status scores. Patients' scores are influenced by several types of patient mix variables and the timing of measurements. Interpretation is enhanced by valid normative data displaying the variability in health status among homogenous patient groups. The second barrier is utilization and mainstreaming. It involves all of the issues associated with changing the day-to-day behavior of clinicians and providers' routine processes to facilitate routine use of health status measures in clinical settings. Tomorrow: In the next decade, the nation will attempt to overhaul the health care system. As it does so, it will struggle with many issues: 1) clarifying the true aim of health care; 2) standardizing measures of health across patients, providers, and settings to evaluate benefit; 3) establishing cause and effect among structural-input factors, care delivery processes, and health outcomes valued by society; and 4) determining if and when cost containment actions have adverse effects on health outcomes. In this context, the importance of interpreting change in health status has a central role.

Activities of Daily Living↗
PubMed1992

Do patient perceptions of quality relate to hospital financial performance?

Analysis confirms that patient perceptions of quality are associated with hospital financial performance. Multivariate analysis involving more than 15,000 patients discharged from 51 medical/surgical hospitals shows that discrete dimensions of hospital quality (i.e., medical and billing systems and discharge processes) explain approximately 17%-27% of the variation in financial measures such as hospital earnings, net revenue, and return on assets. The findings suggest that measurable improvements in patients' judgments of hospital quality might translate into better financial performance. The implications of these results and the limitations of the study are discussed.

Data Collection↗
PubMed1992

Summary of the WONCA/COOP International Health Assessment Field Trial. The Dartmouth COOP Primary Care Network.

This paper describes an international clinical feasibility trial conducted by WONCA in seven countries with the basic objective of increasing understanding of patient health. It was found that the Charts were understood by most patients and doctors found them useful. They produced good discrimination and different profiles for different conditions. Significant variations were noted among participating countries, probably reflecting doctor and patient selection as well as true cultural or ethnic differences.

Culture↗
PubMed1991

The patient comment card: a system to gather customer feedback.

Continuous patient feedback can give important information to hospitals about the quality of care they provide. The Patient Comment Card (PCC), a brief form that can be used to gather open-ended comments from patients and to measure quality, was developed during a two-year period and was extensively evaluated in a series of three pilot tests involving more than 2,000 patients discharged from five hospitals. Evaluation results demonstrate that the questionnaire elicits useful comments from patients and can generate statistically reliable scores and valid quality measures. However, in a field trial in four hospitals, low response rates (15%-27%) reflected, first, lack of follow-up of non-respondents, and second, the fact that most of the PCC quality scores were upwardly biased; these inflated scores were likely to reflect the low response rate. Tools such as the PCC should be used judiciously, given the possible abuses and misinterpretations of hospital quality scores.

Bias↗
PubMed1991

Gaining customer knowledge: obtaining and using customer judgments for hospitalwide quality improvement.

Customer knowledge is an essential feature of hospitalwide quality improvement. All systems and processes have customers. The aim is to use customer knowledge and voice of the customer measurement to plan, design, improve, and monitor these systems and processes continuously. In this way, the hospital stands the best chance of meeting customers' needs and, hopefully, delivering services that are so outstanding that customers will be surprised and delighted. There are many methods, both soft and hard, that can be used to increase customer knowledge. One useful strategy is to use a family of quality measures that reflect the voice of the customer. These measures can generate practical and powerful customer knowledge information that is essential to performing strategic planning, deploying quality policy, designing new services, finding targets for improvements, and monitoring those continuous improvements based on customers' judgments.

Consumer Behavior↗
PubMed1991

Chronic bile duct cannulation in laboratory rats.

To our knowledge this is the first report of rat bile duct cannulations in which the distal cannula is hemisected but extends to the sphincter of Oddi. It is minimally invasive and requires only about 45 minutes preparation time. In contrast to studies described in the literature, enterohepatic recirculation remains intact but bile can always be separated from pancreatic secretions at investigator discretion in the model. In addition, biliary flow and pressure can be measured without compromise. Acute biliary secretory pressure, under anesthesia, was 17 cm water. Bile flow, averaging 9.6 microliters/min/100 g was measured in unanesthetized rats surviving for 2 weeks (60% of animals monitored). Gross necropsy findings indicated that animals dying in less than 7 days usually suffered bile peritonitis subsequent to catheter rupture of the bile duct or loss from the ligature restraint. Deaths after 2 weeks were usually related to cholestasis due to blockage of the catheter with mineral debris and/or duct tissue. A detailed literature review of bile duct cannulation in rats has been made.

Animals↗
PubMed1991

Early genital naming.

To evaluate the clinical impression that young girls are given little or confusing information about their genitals, a sample of 117 mothers with 1- to 4-year-old children were asked which words for genitals, if any, they used with their children. The ethnically and socioeconomically heterogeneous sample was composed of 63 girls and 54 boys, with the average ages of 26 and 29 months, respectively. Neither boys nor girls were likely to be given a standard anatomical genital term, although many children received colorful colloquial expressions. However, girls were less likely than boys to receive a term for their genitals. Receiving names for genitals was related to certain family circumstances, such as higher parental education, exposure to adult male nudity, having a sibling of the opposite sex, and cosleeping. Pediatric health professionals have the opportunity to contribute to early sex education by conveying accurate information regarding genital terms in the course of routine physical examinations.

Child Language↗