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Biomedical subjects

J G Zimmer

Publications and source records attributed to J G Zimmer.

31 records · Page 2Linked to original sources
PubMed1982

Off-hour telephone calls to a geriatric home care team.

This is a study of off-hour telephone calls to a physician/nurse practitioner/social worker team available on a round-the-clock basis to a population, averaging 54 in number, of chronically or terminally ill home-bound elderly patients. Most calls could reasonably be considered urgent and appropriate, and only about three per month necessitated immediate home visits: the off-hours time demand is not excessive and can be managed with appropriate practice organization and provider-patient understanding.

Aged↗
PubMed1979

Appropriateness of vitamin and mineral prescription orders for residents of health related facilities.

A study was made of the medical charts of 433 elderly patients admitted to four Health Related Facilities in upper New York State, to determine whether the respective prescription orders for vitamins and minerals were appropriate to the given diagnoses and, if not, identify the variables correlated with inappropriateness. For 11.1 percent of the patients, vitamins or minerals were prescribed when there was no specific diagnostic indication, or they were not prescribed when the medical diagnosis indicated that they should have been. Women and medicaid patients were more likely than men and self-paying patients to be treated inappropriately with respect to vitamins and minerals, but the differences were not satistically significant.

Aged↗
PubMed1979

Medical care evaluation studies in long-term care facilities.

This report describes the selection, design, conduct, analysis, and application of medical care evaluation studies in long-term care facilities (skilled nursing homes) in a regional program in the Rochester region of upstate New York. Eight examples are presented to highlight methodologic approaches and problems. They are classified under four general headings: Administration Audits, Diagnosis-specific Studies, Care Modality-specific Studies, and General Outcome Indicators. The implementation of results and recommendations from the studies is discussed and an application of "tracer" methodology for assessing the components of care activities in long-term facilities is described. Problems and challenges in long-term quality care are outlined.

Catheters, Indwelling↗
PubMed1978

Discrepancies between admission and discharge diagnoses in a university hospital.

Admission screening and certification systems for utilization review are based on acceptance of attending physicians' admitting diagnosis. This study was conducted to: 1) determine the consistency of admission diagnosis as compared to discharge diagnosis: i) identify the characteristics of patients and diagnoses subject to higher rates of diagnostic discrepancy; and 3) analyze the apparent reasons for such discrepancies. The following methods were used: direct comparison of admission and discharge diagnosis on a sample (n = 955) of university hospital patients using a rating scale to measure the degree of change in specificity and category of diagnosis; analysis of diagnostic change by hospital service, demographic characteristics of patients, length of stay, and source of payment; review of charts with the greatest diagnostic discrepancy. Diagnostic changes were found in 26.8 per cent of all admissions (n = 230) and were most frequent in neurological, medical and pediatric patients. The rate of change varied with patient age and length of stay and was lowest in Medicaid patients. Changes were usually from general to more specific diagnosis in related categories, with 4.3 per cent being discharged undiagnosed and 2.9 per cent with unrelated diagnosis. Major causes for discrepancies were related to clinical and laboratory findings. No evidence was found for deliberate diagnostic manipulation to gain admission or to improve financial coverage.

Adolescent↗
PubMed1978

Spectrum of severity and control of diabetes mellitus in skilled nursing facilities.

A descriptive and quality assessment study was made of 359 elderly patients with a diagnosis of diabetes mellitus in 39 Skilled Nursing Facilities (SNF) in upstate New York. The diagnostic prevalence of diabetes was about 12 percent--similar to that in a National Health Survey of nursing homes, but higher than that reported for the non-institutional elderly. Greater frequency and severity were observed among the females, but the median age for all the diabetic patients was about the same as that for the general SNF population. Several of the other disorders believed to be associated with diabetes were found to be of greater frequency in the SNF diabetic group, but some were not; also, inadequate control of diabetes was associated with some, but not all of these disorders. The severity of diabetes in this elderly SNF population with adult-onset diabetes was usually mild, with a low frequency of complications and of poor control. Problems arose with respect to the ascertainment and recording of diagnostic and control data, most often related to the responsibilities of the attending physicians. There were also problems of uncertainty as to the cause-and-effect relationship between thecontrol of blood glucose levels and treatment outcomes. The establishment of criteria and standards for medical care evaluation studies is discussed.

Aged↗
PubMed1975

An epidemiological model of the natural history of a disease within a multilevel care system.

Detailed epidemiological data on the entire course and treatment of illnesses requiring a variety of forms of management and various levels of institutionalization are scarce, probably due to the difficulty of assembling such data from a multiplicity of sources, particularly within complex and fragmented health care delivery systems. This paper described several analytic approaches to, and applications of, such a body of data, taken from a retrospective cohort study of 552 fractured hip cases incident in one year in an upstate New York county. Examples of six analytic applications of the data are presented, and emphasis is placed on the potential for practical use of some of the results.

Adolescent↗
PubMed1975

Characteristics of patients and care provided in health-related and skilled nursing facilities.

This survey study of 433 admissions to four health-related facilities and 738 admissions to 40 skilled nursing facilities in the Rochester region describes the reasons for placement, the patients' physical, mental, and functional characteristics and their personal, nursing, and other care requirements in the institutional setting. The differences and similarities between the two levels of care and between the four HRF's are analyzed in the light of national data; the appropriateness of placement is evaluated and the implications for regulatory systems are discussed.

Activities of Daily Living↗
PubMedDate not supplied

Description of a computerized health maintenance tracking system for primary care practice.

This article describes the development of a computerized health maintenance tracking system for primary care practice and its features. Research has shown existing computerized health maintenance tracking systems are unsatisfactory for the average practitioner for these reasons: (1) Data entry is slow or requires duplication of entries for billing purposes; (2) the system is linked to a totally computerized medical record that is expensive and complex to maintain; (3) health maintenance status options are limited to "YES/NO" and do not inform the practitioner of the full range of possible situations; (4) physician reminders are created only for patients with an appointment; (5) patient reminders are not generated on a regular basis regardless of appointment status; (6) it is difficult to change individual and global health maintenance schedules. The system described here downloads demographic and health maintenance data from the practice's billing system. Six health maintenance status options are available: D = done and normal, X = done but abnormal, N = not indicated, R = patient refused, E = done elsewhere, I = abnormal but inactive. A health maintenance status report is created for both the patient and provider once a year, in the month of the patient's birth unless an alternate month has been designated, regardless of the patient's appointment status. Patients are encouraged to make an appointment for overdue health maintenance procedures, unless already scheduled.

Appointments and Schedules↗