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Biomedical subjects

J D Restuccia

Publications and source records attributed to J D Restuccia.

28 records · Page 2Linked to original sources
PubMed1984

Obtaining information on patient satisfaction with hospital care: mail versus telephone.

Many objectives of the study examined here were to develop a questionnaire useful in eliciting the perceptions of patients regarding their hospital care, to compare the methodologic and substantive differences between a mail survey and a telephone survey of patients done approximately a week post discharge, and to develop methods allowing the questionnaire to be administered by an organization other than the hospital. Two independent surveys were conducted at the same hospital--a telephone survey with a telephone follow-up, and a mail survey with a telephone follow-up. The study demonstrated that an organization external to the hospital can economically conduct a patient satisfaction survey of a representative patient sample while ensuring confidentiality and producing potentially useful results. The mail survey was preferred over the telephone survey due to lower cost, lower chance of biased responses, and complete assurance of confidentiality. The aspects of hospital care most influencing patient satisfaction related to nursing services.

Confidentiality↗
PubMed1982

The effect of concurrent feedback in reducing inappropriate hospital utilization.

This study conducted in four general hospitals, evaluates the effectiveness of feedback from utilization review coordinators in reducing the number of inappropriate hospital days. Experimental control was exerted over the type of feedback provided in the utilization review process to produce four treatment groups (including a control group) that vary according to 1) the channel used to inform an attending physician of a probable inappropriately located patient and 2) the amount of discretion permitted the nurse coordinator in deciding whether, when and to whom this information is provided. The results of the study indicate that physician and hospital performance in utilization review, measured both by inappropriate patient days and length of stay, are affected by the feedback strategy employed. For patients inappropriately located for a portion of their hospital stay, provision of concurrent feedback resulted in reduction of approximately two thirds of an inappropriate day and two and one half total days, compared with patients for whom no feedback was provided or for whom physician advisor involvement was required. In addition, the effect of reasons causing patients to be inappropriately located (barriers) was assessed. Barriers outside the realm of influence of the hospital or the physician were found to impede the effectiveness of the utilization review systems.

California↗
PubMed1982

Methods of control for hospital quality assurance systems.

The major failure of hospital quality assurance systems is the failure to influence physicians' therapeutic decision making in a way that will ensure their ordering necessary and only necessary services. The primary reason for this is insufficient recognition of the "intensive" technology used to treat acute patients, a technology characterized by the interdependence of therapeutic services and the patient's response to these services. In such situations, the appropriate method of achieving quality control is to provide performance feedback to the physician on a regular basis. To the extent that there is uncertainty about the impact of therapeutic services on the patient's response, the physician should be allowed discretion over the therapeutic process. In contrast, when process-outcome relations in the therapeutic process are relatively certain, feedback should be reinforced with sanctions.

Feedback↗
PubMed1981

The appropriateness evaluation protocol: a technique for assessing unnecessary days of hospital care.

A major national health policy objective is to improve the efficiency of hospital utilization. To evaluate programmatic interventions with this objective, such as the Professional Standards Review Organization program, measures of appropriate use are a fundamental need. This report represents the results of two developmental trials of a new technique, labeled the Appropriateness Evaluation Protocol (AEP), for assessing potentially unnecessary hospital days of care. Twenty-seven objective criteria items related to medical services, nursing/life support services and patient condition factors were incorporated in the protocol. If any one of the criteria was met, the day was deemed "appropriate," and if none was met, the day was deemed "inappropriate" at an acute hospital level of care. A reviewer could override the objective criteria in either direction in reaching a final judgment. Three reviewers, two nurses and one physician each reviewed 200 charts at a teaching hospital. After correcting for a small number of abstracting errors, overall agreement rates between pairs of reviewers ranged from 92 to 94 per cent, levels significant p less than 0.0001. Of all cases judged inappropriate by at least one of the reviewers, specific agreement rates for the reviewer pairs on which days were inappropriate ranged from 73 to 79 per cent. These overall agreement rates and specific agreement rates on days of care judged as inappropriate are higher than those of any previously reported assessment methods. A parallel study of the appropriateness of admissions in these same cases, using purely subjective reviewer judgments, found overall agreement rates averaging 90 per cent, but rates of specific agreement on inappropriate admissions were less than 40 per cent between pairs of reviewers. Along with comparisons to other, more subjective, assessment techniques, this finding suggests that objective criteria are a vital element in developing methodologically sound techniques for assessing appropriate hospital use.

Health Services Misuse↗
PubMed1981

Measuring community hospital service in Michigan.

Using discharge abstracts from Michigan hospitals, we divided the state into hospital use communities with measured populations. We constructed population-based rates measuring use, cost, and some aspects of quality. The results cover 54 communities comprising 90 percent of the Michigan population and ranging in size from Detroit (population 600,000) to very small (population less than 25,000) communities. Age-adjusted patient days per 1,000 population, length of stay, cost per person per year, hospitalization rates for surgery, trauma and vascular disease, and childbirth problems show large variations, generally ranging from 2 to 1. High values usually are positively associated with each other and with population size. Patient days per 1,000 (mean 1,114, range 600-1,700) and cost per person(mean +223, range +110-+290) are distributed such that almost 75 percent of communities are below the mean. We believe this information will be useful to community hospital trustees, physicians, and administrators.

Cardiovascular Diseases↗
PubMed1976

Barriers to appropriate utilization of an acute facility.

Professional Standards Review Organizations (PSROs) have been mandated to assure appropriate utilization of health resources. In order to meet this objective, PSROs must be able to determine when and why health resources are misutilized so that corrective action may be taken. This paper describes a study designed to identify and measure the significance of factors causing the misutilization of beds at one hospital. Using explicit Medicare levels of care criteria, a utilization review nurse coordinator determined the appropriate location (hospital, skilled nursing facility, home health care, home with outpatient or no care) or a sample of hospital patients. When a patient was judged inappropriately located on a particular day the nurse coordinator identified the barrier(s) to appropriate utilization, i.e., the reason(s) the patient remained in the hospital. Approximately 10 per cent of the 1,902 patient days were judged inappropriate at a hospital level of care. The most significant barriers to appropriate utilization were 1) the unavailability of skilled nursing facilities with the necessary amount of nursing services, and 2) the attending physician's conservative medical management of the patient. The implications for reduction of hospital misutilization are discussed.

Classification↗
PubMed1976

Development of hospital levels of care criteria.

A modification of the Nominal Group/Delphi Technique can be applied to the problem of developing among physicians levels-of-care criteria for use in "concurrent review" activities. UR requirements can be rationalized through a process that uses physicians' scarce time effectively, allows for cyclical feedback on their peers' views, and insures input from both dominant and reticent individuals.

Asthma↗