Curriculums must address issues in practice milieu.
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Biomedical subjects
Publications and source records attributed to J D Thompson.
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A system has been developed to generate hospital budgets based on the types of patients served. Several hundred classes of patients are defined according to clinical attributes such as diagnoses and surgical procedures, and for each class a profile of resources consumed is determined. The class definitions are based both on homogeneity of patient care processes as well as resource consumption. These profiles are expressed as revenues generated by charging departments and as costs both direct and indirect for all services. A methodology has been developed to associate all indirect costs with their source for each service included in the profile. From a forecast of patient load by class, budgets can be computed from the cost profiles and revenues determined from the charging profiles. Further analysis thus can include the effect of changes in case mix as well as changes in patient care processes. The effect on revenues of different reimbursement mechanisms can also be projected as a function of the case mix. The system is currently being implemented for demonstration and evaluation of the Yale-New Haven Hospital.
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This paper approaches the design of a regional or statewide hospital rate-setting system as the underpinning of a larger system which permits a regulatory agency to satisfy the requirements of various public laws now on the books or in process. It aims to generate valid interinstitutional monitoring on the three parameters of cost, utilization, and quality review. Such an approach requires the extension of the usual departmental cost and budgeting system to include consideration of the mix of patients treated and the utilization of various resources, including patient days, in the treatment of these patients. A sampling framework for the application of process-based quality studies and the generation of selected performance measurements is also included.
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During a 13 year period ending in July, 1974, 42 obstetric patients with a diagnosis of invasive carcinoma of the cervix were seen. Nine patients were treated with primary radiation therapy; 33 patients were treated with primary surgery. Total hysterectomy with partial vaginectomy was performed in seven patients with Stage I-A, and extensive abdominal hysterectomy with bilateral pelvic lymphadenectomy was performed in 26 patients (14 with Stage I-A, nine with Stage I-B, and three with Stage II-A). Thirty-eight patients are alive and well from three months to 13 years following treatment. Extensive abdominal hysterectomy and pelvic lymphadenectomy can be done in selected obstetric patients with invasive carcinoma of the cervix with an acceptable morbidity and cure rate. Normal ovaries left in place will continue to function normally. Seven patients with a conization diagnosis of Stage I-A had a planned delay in definitive treatment until delivery at term.
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