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Biomedical subjects

J Goldstein

Publications and source records attributed to J Goldstein.

At least 217 records · Page 12Linked to original sources
PubMed1988

Financial risk and hospital cost for elderly patients. Age- and non-age-stratified medical diagnosis related groups.

The purpose of this study was to analyze hospital resource consumption for Medicare patients in non-age- and age-stratified medical diagnosis related groups (DRGs). This study of patients in 74 non-age-stratified DRGs (N = 3643) and 113 age-stratified DRGs (N = 2898) demonstrated that older medical patients (usually greater than or equal to 75 to 80 years of age) had (on average) higher total hospital costs, a longer hospital length of stay, more diagnoses per patient, a greater percentage of outliers, and a higher mortality compared with younger patients in these same DRGs. These findings raise the question of the equity of DRG payment vis-à-vis older Medicare patients in both non-age- and age-stratified medical DRGs. Financial disincentives to treat older medical patients may limit both their access and quality of care in the future.

Aged↗
PubMed1988

Hospital costs, resource characteristics, and the dynamics of death for patients with hypertension.

A great deal of interest has begun to focus on outcome data for hospitals. We analyzed hospital resource consumption for 4289 patients with hypertension by outcome (ie, survivors vs mortalities). The 211 mortalities had a much greater intensity of hospital resource utilization and a substantial financial risk under diagnosis related group (DRG) pricing schemes compared with the 4078 survivors. Only mortalities within one week of admission to the hospital were profitable under DRGs. A long hospital length of stay (LOS) for mortalities was very unprofitable (mortalities with greater than 60-day LOS generated a $40,673 loss per patient). Patients admitted under emergency conditions who died tended to have a shorter hospital LOS and less financial risk under DRGs compared with those who were not emergency admissions and died. Mortalities referred from other clinical services tended to have greater resource utilization and financial risk under DRGs compared with nonreferred mortalities. These data suggest notable inequities in the DRG prospective payment system vis-à-vis patients who died with hypertension. They also demonstrated variables predictive of greater hospital resource utilization for patients who died with hypertension, including longer hospital LOS, nonemergency admission, and referral from another clinical service.

Aged↗
PubMed1988

Surgonomics. Health care financing policy for hospitalized otolaryngology patients.

The Medicare diagnosis related group (DRG) prospective payment model is changing hospital payment. Currently many states are using DRG prospective "All Payor Systems" for hospital reimbursement. In All Payor Systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York State has been All Payor since Jan 1, 1988. This study simulated DRG All Payor methods on a large sample (N = 1074) of adult otolaryngology patients for a two-year period using both federal and New York DRG reimbursement now in effect. Both Medicare and Medicaid patients had (on average) a longer hospital stay and total hospital cost compared with patients from Blue Cross and other commercial payors. Medicare and Medicaid patients also had a greater severity of illness compared with patients from Blue Cross or other payors. All payors (ie, Medicaid, Blue Cross, and commercial insurers), except Medicare, generated financial risk under the DRG All Payor scheme. These data suggest that state and private payors may be underreimbursing for the care of the hospitalized otolaryngology patient using the DRG prospective hospital payment scheme. Health care financing policy described in this study may limit both the access and/or the quality of care for many otolaryngology patients in the future.

Diagnosis-Related Groups↗
PubMed1988

Benign nasopharyngeal lymphoid tumors, lymphoepithelial lesions, and lymphocytic interstitial pneumonitis.

A clinico-pathologic and immunologic case study of a 57-year-old woman who has shown progressive lymphoid proliferations and lymphocyte dysfunction over the course of 10 years is presented. Early in the course of her disease, she presented with recurrent benign nasopharyngeal lymphoid tumors. She subsequently developed benign lymphoepithelial lesions involving both a submandibular and then a parotid salivary gland. She eventually underwent pneumonectomy for lymphocytic interstitial pneumonitis with marked cystic degeneration and lung destruction. Although frank malignancy has not been demonstrated review of her nasopharyngeal biopsies and of her pulmonary pathology shows a tendency toward distinct cellular uniformity with loss of follicles and germinal centers. Concurrently, immunologic studies have demonstrated abnormalities of cell mediated (T cell) function.

Female↗
PubMed1988

Financial risk, hospital cost, and complications and comorbidities in medical non-complications and comorbidity-stratified diagnosis-related groups.

A number of methods are being studied to modify and improve the accuracy of the Medicare Diagnosis-Related Group (DRG) hospital classification system. This study analyzed resource consumption for 2,431 medical Medicare patients in the 53 non-complicating condition-stratified (i.e., non-complication and comorbidity) medical DRGs. Resource consumption per patient increased as the number of complications and comorbidities per patient per DRG increased, as measured by total hospital cost, hospital length of stay, the number of diagnoses and procedures per patient, the percent outliers, and mortality. Patients with more than four complications and comorbidities generated significant financial risk ($5,667 loss per patient) under DRG reimbursement. This study raises the question of the equity of DRG reimbursement for the medical non-complication and comorbidity-stratified DRGs. A method for DRG adjustment based on complications and comorbidities should be implemented by Congress to assure equitable payment for patients in these medical DRGs.

Costs and Cost Analysis↗
PubMed1988

The identifier concept: clinical parameters to stratify hospital patient costs within gynecology diagnosis-related groups.

The purpose of this study was to analyze whether clinical variables could stratify hospital costs within gynecology diagnosis-related groups. We analyzed 3171 gynecologic admissions to a large teaching hospital and found that the parameters of nonemergency and intensive care unit admission and blood or plasma product utilization could stratify hospital costs and outcome within a gynecology diagnosis-related group. Patients with the variables had higher total hospital costs, a longer hospital length of stay, more procedures per patient, a greater proportion of outliers, and a higher mortality than patients without the variables. This study demonstrates that these four clinical variables could be used to focus cost-containment efforts on gynecologic patients incurring higher costs in the coming era of limited resources.

Blood Transfusion↗
PubMed1988

Financial risk, hospital cost, complications and comorbidities (CCc) in non-CC stratified urology diagnostic related groups.

The federal Medicare Diagnosis Related Group payment mechanism is undergoing constant change. Significant interest has been generated at the health policy level regarding reimbursement for patients with complications and comorbidities. The purpose of this study was to analyze hospital resource consumption for patients in the seventeen urology non-complicating condition (CC) stratified Diagnostic Related Groups (DRGs), currently 45 percent of urology DRGs. We analyzed 185 Medicare patients in these non-CC stratified urology DRGs and found that patients with more CCs per patient had higher total hospital costs per patient, financial risk under DRGs, a greater percentage of outliers, and a higher mortality, than patients in these same DRGs with fewer CCs per patient. These findings suggest that the current DRG system is inequitable to some patients and certain hospitals vis-a-vis non-CC stratified urology DRGs. The Health Care Financing Administration has not significantly changed the complicating condition urology DRG classification, as of its recent May, 1988 legislation. Financial disincentives to treat these patients may affect both their access and quality of care in the future.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1988

Access and quality of care for urology patients under diagnostic related group reimbursement.

The Diagnostic Related Group payment mechanism is rapidly changing economic incentives for hospitals. We studied resource consumption and age for a large group of urology patients under Diagnostic Related Group reimbursement. Total hospital costs (exclusive of Diagnostic Related Group reimbursement. Total hospital costs (exclusive of physician fees) for the 1,281 urology patients studied were $8,895,264. Older urological patients consumed a disproportionately larger share of hospital resources. Mean hospital cost per patient, mean number of procedures, hospital length of stay and mortality generally increased with age. Under Diagnostic Related Group reimbursement, financial risk increased with age; patients 75 years and older generated significant financial risk to the hospital. Older patients often had a more intense resource use as measured by emergency or surgical intensive care unit admission, and blood and plasma protein requirements. These findings suggest that the current Diagnostic Related Group payment scheme may provide significant financial disincentives to hospitals vis-à-vis older urology patients and, thus, it could limit the access and quality of care for the older urology patient in the future.

Adult↗
PubMed1988

A study of change in clinical service for general surgical patients.

The department of surgery at Long Island Jewish Medical Center in New York City conducted a study examining resource consumption and quality of care for patients referred to surgery from other hospital services, or "referred patients." Referred patients were compared with "nonreferred" surgery patients using several indicators of resource consumption. A quality assessment was also performed on a random sample from both groups using peer review organization guidelines. The study found that referred patients consumed more resources and may have received poorer quality care than nonreferred patients. Previous studies suggest that some resource utilization by referred patients may be avoidable. Thus, referral to the department of surgery may serve as an indicator for identifying patients in need of ongoing quality and/or utilization monitoring.

Health Resources↗
PubMed1988

Diagnosis related groups, resource utilization, age, and outcome for hospitalized nephrology patients.

Economic incentives are rapidly changing for hospitals under the prospective Diagnosis Related Group (DRG) hospital reimbursement scheme. The purpose of this project was to study resource use, age, and outcome for nephrology admissions to a large academic medical center. Total hospital costs for the 784 nephrology admissions (January 1, 1985 to December 31, 1986) were $5,037,460. Mean hospital cost per patient and mortality generally increased with age. DRG payment for patients in the 13 nephrology DRGs analyzed would have produced an aggregate loss of $483,584; however, all age categories of patients 55 years of age and over generated significant losses (the highest was for patients 85 years and above, $5,343 loss per patient). Diabetic nephrology patients generated greater resource consumption compared with nondiabetic nephrology patients, as well as patients in medical and surgical DRGs with chronic renal failure compared with patients in these same DRGs without chronic renal failure. Older nephrology patients also demonstrated higher emergency and ICU admission and blood requirements than younger patients. This study suggests that the current DRG reimbursement scheme may be inequitable vis a vis older nephrology patients, as well as those with diabetes mellitus and chronic renal failure. Financial disincentives by DRGs may affect both the access and quality of care for groups of nephrology patients in the future.

Adolescent↗
PubMed1988

Health care financing policy for hospitalized nephrology patients.

The Medicare diagnosis-related group (DRG) prospective payment system is now entering its 6th year, with no reported major adverse effects on the health status of the American people. Currently 13 states are using DRG prospective "all-payer systems" for hospital reimbursement; other state may adopt DRG all payer systems. In DRG all-payer systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York state has been all-payer since January 1, 1988. This study simulated DRG all-payer methods on a large sample (n = 558) of adult nephrology patients for a 2-year period using both federal and New York DRG reimbursements now in effect. Both Medicare and Medicaid patients had (on average) longer hospital lengths of stay and higher total hospital costs compared with patients from Blue Cross and other commercial payers. Medicare and Medicaid patients also had greater severity of illness than patients from Blue Cross or other payers. However, all payers (ie, Medicaid, Blue Cross, Medicare, and commercial insurers) generated significant financial risk under our DRG all-payer scheme. These data suggest that federal, state, and private payers may be underreimbursing for the care of hospitalized nephrology patients using the DRG prospective hospital payment scheme. As DRG payment rates are further reduced compared with the real hospital costs of treating patients, both the access to and the quality of care for many nephrology patients may be jeopardized.

Aged↗
PubMed1988

Clinical comparison of the SITE IRAS hand-held interferometer and Haag-Streit Lotmar visometer.

The preoperative testing of retinal acuity was evaluated using two instruments in each of 35 eyes having extracapsular cataract extraction. Retinal acuity was measured using the SITE IRAS hand-held interferometer and the Haag-Streit Lotmar visometer. The postoperative findings are given for comparisons of final acuity, prediction, and instrument evaluation. The results showed predicted acuity to be within two lines of the final acuity in 57.1% of eyes with the Haag-Streit unit and in 42.8% of eyes with the SITE instrument. The instrument differences were more in procedure than in results.

Aged↗
PubMed1988

Financial risk, hospital cost, complications, and comorbidities in surgical noncomplication- and noncomorbidity-stratified diagnostic related groups.

The purpose of this study was to analyze resource consumption in the 147 non-complicating condition-stratified surgical diagnostic related groups (DRGs). Analysis of 2647 surgical patients in these non-CC-stratified surgical DRGs demonstrated that patients with more CCs per DRG generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under DRG payment, more outliers, and a higher mortality rates than patients in these same DRGs with fewer CCs. These findings suggest that the current DRG classification system may be inequitable to certain groups of patients or types of hospitals vis-à-vis the non-CC-stratified surgical DRGs. Financial disincentives to treat these patients may affect both their access and quality of care in the future.

Academic Medical Centers↗
PubMed1988

Effects of serotonin inhibition in air embolism in dogs.

Serotonin can induce pulmonary hypertension, hypoxia and bronchoconstriction, and ketanserin has been shown to reverse these effects on various experimental models of acute respiratory failure. In the present study, the hemodynamic and gasometric effects of ketanserin were studied during acute respiratory failure induced by an air infusion at a rate of 10 ml/min in dogs. During a 60-min air infusion, 10 dogs received 4 mg of ketanserin i.v. and 10 dogs served as control. Ketanserin-treated dogs had similar pulmonary hypertension even though more significant decreases in arterial pressure and systemic vascular resistance characterized the systemic effects of ketanserin. Similarly, a marked increase in hematocrit observed in control dogs (from 36.9 to 43.8%, p less than 0.01) was totally prevented by ketanserin (from 40.3 to 40.4%, NS). Hypoxia was similar, although the increase in pulmonary shunt was attenuated (259 instead of 468%). Therefore, the influence of serotonin is very limited in acute respiratory failure secondary to air embolization. Serotonin might have a more important influence on the systemic than on the pulmonary vasculature in these conditions.

Animals↗
PubMed1988

Financial risk, hospital cost, and complications and comorbidities (CCs) in the non-CC-stratified pulmonary medicine diagnostic-related group Medicare hospital payment system.

The purpose of this study was to analyze hospital resource consumption in the 8 noncomplicating condition-stratified pulmonary medicine diagnostic-related groups (DRGs). We analyzed 427 Medicare patients treated during a 2-yr period in these 8 noncomplicating condition-stratified DRGs. Patients with a greater number of complicating conditions (CCs) had higher total hospital costs, a longer hospital length of stay, more procedures per patient, increasing financial risk under DRGs, a larger number of outliers, and a higher mortality than did patients in these same DRGs with a fewer number of CCs. These findings raise the question of the equity of DRG reimbursement at our hospital vis-à-vis the non-CC-stratified pulmonary medicine DRGs. If these findings are generalizable at other teaching hospitals, the current DRG system may provide financial incentives to not treat certain types of pulmonary medicine patients likely to have many CCs, and potentially effect these patient's access and quality of care in the future.

Diagnosis-Related Groups↗
PubMed1988

DRG prospective, "all payor systems," financial risk, and hospital cost in pulmonary medicine non CC stratified DRGs.

Previous work by our group had suggested that some pulmonary medicine diagnosis-related group (DRGs) did not adequately compensate for patients with multiple complications and comorbidities. Congress has recommended no major changes to pulmonary medicine DRGs along these lines. The purpose of this study was to analyze resource consumption in any of the seven noncomplicating conditions (CC), stratified pulmonary medicine DRGs using the new DRG prospective "all payor system" in effect at our hospital. Analysis of 858 pulmonary medicine patients by payor (Medicare, Medicaid, Blue Cross, and commercial insurance) in these non-CC stratified pulmonary medicine DRGs for a three-year period demonstrated that patients with more CCs per DRG for each payor generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under DRG payment, more outliers, and a higher mortality, compared to patients in these same DRGs with fewer CCs. Both hospital length of stay and total cost per patient (adjusted for DRG weight index) increased with CCs. Financial risk per patient under DRGs also increased as CCs accumulated. These findings suggest that new prospective DRG "all payor systems" may be inequitable to certain groups of patients or types of hospitals vis-a-vis the non-CC stratified pulmonary medicine DRGs. Many pulmonary medicine DRGs should be stratified by the numbers and types of CCs to more equitably reimburse hospitals under DRG all-payor systems.

Academic Medical Centers↗
PubMed1988

Antibody produced against isolated Rh(D) polypeptide reacts with other Rh-related antigens.

Rh(D) antigen-containing polypeptide was prepared by immune precipitation of intact cDE/cDE erythrocytes by using a high-titer preparation of polyclonal anti-D. when isolated Rh(D) polypeptide was administered to rabbits, antibody was produced that was unresponsive toward Rh-positive and -negative cells but reacted strongly with the immunogen in enzyme-linked immunosorbent assay-type immunobinding and Western blot immunostaining assays. Rabbit antibody also immunostains isolated Rh(c) polypeptide as well as the Rh antigen-containing components of sodium dodecyl sulfate-polyacrylamide gel electrophoresis-separated membrane proteins from Rh(D)-positive (cDE/cDE,CDe/CDe), Rh(D)-negative (cde/cde,Cde/Cde), and -D-/-D- cells. It does not react with any membrane protein from Rh-null regulator type cells, thus indicating a specificity for Rh-related proteins. We have also been able to demonstrate that polyclonal and monoclonal anti-D preparations that do not immunostain isolated Rh(D) polypeptide will react with it in our immunobinding assay.

Antibody Specificity↗