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Biomedical subjects

E F Hughes

Publications and source records attributed to E F Hughes.

At least 19 recordsLinked to original sources
PubMed1992

Regional variation in Medicare hospital mortality.

This study examines variation in severity-adjusted Medicare hospital mortality rates across nine U.S. census regions. The extent to which regional variation is reduced by controlling for differences in hospital resources and structure, county-level population characteristics, and the level of federal SuperPRO-identified hospital quality problems is estimated. Hospital resources, population characteristics, and SuperPro process quality scores are significant predictors of hospital mortality rates, but they do not explain the important, highly significant regional differences observed after controlling for hospital case-mix severity.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Response to treatment with antihistamines in a family with myotonia congenita.

In a family in which myotonia congenita was found in five generations, both great-grandparents of the index case were affected. In subsequent generations mild and severely affected cases were clearly segregated down parallel lines of this family. The grandmother of the index case had noted improvement with an antihistamine. When the index case was prescribed trimeprazine, she showed a striking reduction in severity of symptoms. Antihistamines seem to deserve further evaluation as a safe and effective treatment for myotonia congenita.

Adult↗
PubMed1990

Training house officers to be cost conscious. Effects of an educational intervention on charges and length of stay.

Two annual cost-containment educational programs, featuring involvement of respected senior physicians, lectures, comparative feedback, chart reviews, and small group discussions, were designed to reduce interns' generated costs in a private and a VA university hospital affiliated with Northwestern University Medical School. To evaluate the impact of this randomized educational intervention, hospital data on inpatient charges and length of stay (LOS) were collected for 12 common medical diagnoses and adjusted by the Severity of Illness Index. Interns who were randomized to the program were found to have significantly lower per patient costs and LOS than control group interns at both hospitals. These reductions in resource use and LOS were not associated with differences in patients' residual impairment on discharge, the incidence of inpatient complications, or the percentage of deaths and readmissions within 30 days. Our results suggest that the current hospital cost-containment environment may be far more conducive to physician cost-containment education than indicated by the earlier literature.

Chicago↗
PubMed1988

The effects of regulation, competition, and ownership on mortality rates among hospital inpatients.

We examined the influence of the regulation of hospital rates, state certificate-of-need programs, competition, and hospital ownership on mortality rates among inpatients receiving care under Medicare for 16 selected clinical conditions that were studied as a group. Data were obtained from the records of 214,839 patients who received care in 981 hospitals in 45 states from July 1, 1983, through June 30, 1984. We found significant associations between higher mortality rates among inpatients and the stringency of state programs to review hospital rates (P less than or equal to 0.05), the stringency of certificate-of-need legislation (P less than or equal to 0.01), and the intensity of competition in the marketplace, as measured by enrollment in health maintenance organizations (P less than or equal to 0.05). Hospitals in the states with the most stringent review procedures for hospital rates had ratios of actual to predicted death rates that were 6 to 10 percent higher than those of hospitals in states with less stringent rate-review programs (P less than or equal to 0.001). Hospitals in the states with the most stringent procedures for reviewing applications for certificates of need had ratios of actual to predicted death rates that were 5 to 6 percent higher than those of hospitals in states with less stringent certificate-of-need procedures (P less than or equal to 0.05). There was no statistically significant association between mortality rates among inpatients and either the type of hospital ownership or the number of hospitals competing in the market area. Additional analyses, which examined alternative explanations for these findings, failed to change the results. These findings raise serious concerns about the welfare of patients who are admitted to hospitals in highly regulated areas and those admitted to hospitals in relatively competitive markets. They suggest that it is important to incorporate quality-assurance procedures and systems to monitor patients' outcomes into public and private programs designed to contain costs or promote competition, or both.

Aged↗
PubMed1986

Medicare beneficiary decision making about health insurance. Implications for a voucher system.

A two-phase study involving focus group interviews and a survey of 2,016 Medicare beneficiaries was conducted to examine beneficiary decision making about health insurance under a hypothetical Medicare voucher program. Some of the major findings were that: beneficiaries lack important information about Medicare and health insurance in general; plans with physician restrictions, no restrictions on hospitals, and benefits for custodial long-term care at home or in nursing homes are most preferred when prices are roughly equal to actuarial costs; plan features often interact rather than combined additively to affect choices; price sensitivity is small in comparison with sensitivity to other plan features; price sensitivity is particularly small for plans with custodial long-term care benefits; Medicare would not experience substantial selection bias in a voluntary system containing a wide range of plans preferred by beneficiaries; physician-restricted plans would experience favorable selection; plans with long-term custodial care benefits would experience some adverse selection which might be handled by modest price adjustments in view of the relatively low price elasticity of preferences.

Community Participation↗
PubMed1984

Cleavage of growth hormone by rabbit liver plasmalemma enhances binding.

Several studies have shown that proteolytic cleavage can enhance the biological activity of the growth hormone (GH) molecule. It seemed possible, therefore, that proteolytic modification of GH might be a normal function of GH-target tissues. Plasmalemma-enriched fractions isolated from rabbit liver were found to contain a proteinase(s) which cleaves the large disulfide loop of human and rat GH. The proteolytic activity was specific to plasmalemma-enriched fractions in that much lower activities were observed in microsomal-enriched fractions prepared from the same livers. The plasmalemmal proteinase(s) may be a trypsin-like enzyme because proteolytic activity was decreased by two serine proteinase inhibitors. Inhibition by unlabeled human GH of 125I-GH binding to receptors did not prevent cleavage of the tracer; therefore, hormone-receptor interaction was not required for cleavage of the GH molecule. In binding studies, cleaved GH associated more readily than did intact hormone with rabbit liver receptors. These studies suggest that plasmalemma-enriched fractions prepared from rabbit liver contain a proteinase which cleaves the GH molecule in a highly specific manner. Moreover, it is unlikely that inactivation of GH is the function of this limited proteolysis because cleaved hormone is bound preferentially by at least a subset of receptors in rabbit liver.

Animals↗
PubMed1984

A synopsis of federal-state sponsored preventive child health.

This synopsis presents data on the impact of services and evaluation issues for the nation's largest preventive child health program, the Early and Periodic Screening, Diagnosis and Treatment program (EPSDT). The information is drawn from a series of six EPSDT demonstration/evaluation (D/E) projects sponsored by the Health Care Financing Administration between 1972 and 1979. These projects were implemented in order to learn how to provide preventive services for children participating in the Medicaid program. The results of D/E activities are revised in a methodological framework as defined by principles of epidemiology and evaluation research. Consideration of the major threats to valid interpretation of the D/E findings shows self-selection to be the most serious methodological problem. Data pertaining to the history of use of preventive services, number of children found to have problems in screening, the treatment status and subjective seriousness of these problems, and the resolution of conditions referred to diagnosis and treatment are presented within the context of this methodological critique. The information thus assembled also provides the basis for further, more rigorous assessments of EPSDT program accountability.

Child↗
PubMed1983

Surgical utilization statistics: some methodologic considerations.

This article considers variations in the recording and counting protocols used in the generation of surgical utilization data. A single raw data source was manipulated to reproduce several common protocols to illustrate the statistically significant differences that can result in the volume of surgical utilization considered for both individual procedures and groups of procedures. The results suggest that if recording or counting protocols differ in the samples under consideration, comparison of the statistics and inferences drawn as to utilization therein may be confounded. It is quite possible, therefore, that some of the results of earlier surgical utilization studies may be confounded by such differences in protocols. While there may be valid differences in surgical utilization across different settings, our findings suggest that until methods used in previous work are investigated and reconciled, caution should be exercised in the utilization of this research in public policy making.

Female↗
PubMed1982

Effects of glycogen depletion and pedaling speed on "anaerobic threshold".

Nine male subjects performed continuous incremental exercise on a bicycle ergometer pedaling at 50 and 90 rpm in a normal glycogen state (NG) and at 50 rpm in a glycogen-depleted state (GD) to determine if alterations in pedaling frequency and muscle glycogen content would affect their "anaerobic thresholds." Ventilatory [T(vent)] and lactate [T(lac)] thresholds were identified as the points after which expired minute volume and blood lactate began to increase nonlinearly as a function of work rate. The GD protocol elicited a significant divergence between the two thresholds shifting the T(vent) to a lesser and the T(lac) to a greater work rate relative to the NG state. When the pedaling frequency was increased to 90 rpm in the NG condition, the T(lac) was shifted to a lesser work rate relative to the 50-rpm NG condition. A correlation of only 0.71 was obtained between subjects' T(vent) and T(lac). In subjects of less than 70 kg body wt, the T(lac) came at a work rate 400 kg.m.min-1 less than in subjects of greater than 80 kg body wt despite equivalent O2 uptake. The observation that the T(vent) and T(lac) could be manipulated independently of each other reveals limitations in using the T(vent) to estimate the so-called anaerobic threshold.

3-Hydroxybutyric Acid↗
PubMed1980

A comparison of surgical assisting in a prepaid group practice and a community hospital.

Previous studies of the work loads and time utilization of general surgeons in two different practice settings suggested that paraprofessional surgical assistants (SAs) could reduce surgeon assisting time and perhaps increase productivity. In order to further assess the potential advantage of using SAs as surgical assistants, the present study examines assisting patterns in a prepaid group practice where SAs are used and in a community hospital where only physicians are available to assist. In the prepaid group practice, 87 per cent of general surgical procedures were performed with an assistant; in the c ommunity hospital, 67 per cent of general surgical procedures were performed with an assistant. General practitioners also were found to assist in the community hospital; family practice residents, medical students and "others" also assisted in prepaid group. In both settings, the propensity to use an assistant was positively correlated with operative complexity. On operations of greatest complexity, surgeons were most likely to act as first assistants. The use of SAs was not usually associated with operative sessions longer than when surgeons assisted, except on operations of high complexity. In the prepaid group, SAs also frequently assisted on orthopedic surgery, neurosurgery and obstetrics-gynecology, only occasionally on otolaryngology and plastic surgery, and never on ophthalmology. It appears that in organizations such as a prepaid group practice, where mechanisms for sharing resources exist and incentives are provided to minimize the total cost of surgery, the utilization of SAs might be associated with cost savings. At present, organizational and financial barriers exist to the introduction of paraprofessionals as surgical assistants. It is difficult to advocate the modification of these barriers to facilitate the training and large-scale introduction of this new group of paraprofessionals in the current surgical market where there may already be an excess supply of surgeons.

General Surgery↗
PubMed1977

"The study on surgical services for the United States": a valid prescription for American surgery?

The overall approach of SOSSUS to the study of surgical services, the interpretation of findings, and policy recommendations are rightly called into question. But singular concern with the consequences of monopolistic control by the profession is no substitute for analysis of the dynamics among demand, production, and supply of surgery. Any delivery system--and many models are feasible--involving consumers, providers, and payers is a market in which multidimensional behavior must be anticipated.

Clinical Competence↗
PubMed1976

Time utilization of a population of general surgeons in a prepaid group practice.

Seven general surgeons in a prepaid group practice previously shown to have a mean operative work load of 9.2 hernia equivalents (HE) per week were found to have a standardized mean daytime working week of 56.2 hours, exclusive of evening activities of which 50.7 hours were devoted to professional activities. The surgeons also devoted a mean of 6.7 evening hours per week to professional activities for a mean net professional week of 57.4 hours. Comparisons with a population of previously studied community surgeons revealed that the prepaid group surgeons were able to produce a surgical output more than double that of the community surgeons while devoting only one and a half as much time to professional activities. Economies in the utilization of surgical manpower in the prepaid group appear to stem from: 1) restriction of practice setting to a single geographic location, 2) restriction of patients to surgical patients, 3) reduced surgeon waiting time in the office, and 4) the utilization of paraprofessional personnel for selected operative assisting. These economies were achieved while the prepaid group surgeons were observed to average more time per patient visit both on rounds and in the office than the community surgeons.

Adult↗