Biomedical subjects
Publications and source records attributed to J J May.
Value management is a method of delivering high quality products at a reasonable price. To produce quality products efficiently, healthcare managers must develop a strategic plan that takes into account competition, market needs, and their own organizational goals.
Health care is entering into the era of value management--delivering high quality products and services at a reasonable price. This concept of delivery will have a definite effect on an organization's management strategies and tactics, especially in the area of information systems. Much re-evaluation of an organization's requirements for its information systems wil happen. As a result, a value-managed organization will place a greater demand on its information systems.
This article addresses the future of the diagnosis-related group-based prospective payment system currently used by the Health Care Financing Administration to pay hospitals for care of Medicare patients. Criticisms of the present system are discussed from the standpoint of the quality of the classification system itself, the process by which rates are set using it, and the behavior of providers as a result of the system. Based upon this discussion, the conclusion is reached that it is unlikely that extensions of case-mix based payment for physicians' care and for other non-hospital-based services are feasible. Capitation is an alternative payment mechanism, already in place in some settings and proving increasingly popular.
This report discusses the incentives that a payment system based on diagnosis related groups (DRGs) imposes on hospitals and physicians and presents the author's view of current trends with respect to the extension of DRG-based payment to areas of medical and institutional care beyond the acute general hospital. It examines the impact of prospective payment based on DRGs in New Jersey, a state with more than 4 years of experience with this payment approach. In New Jersey, the system includes all payors, not just Medicare, and as a result, responses to the system in the form of organizational change, modifications in the practice of medicine and hospital/physician interactions have been unusually visible and marked. The report also examines some of the changes that have occurred and are occurring in the way medical records are kept, the internal strictures placed on physicians by hospitals and other factors which relate to the observed trends. Empirical data on changes in length of stay, number of admissions, and so forth, are presented and preliminary explanations of the changes are offered, relating them to both payment rates and to organizational strategies on the part of hospitals.
The effects of split virus influenza vaccine on the pharmacokinetics of theophylline and the in vivo and in vitro induction of interferon were studied in 23 volunteers. No effect on the total body clearance, half-life, or mean residence time of theophylline was found as a result of influenza virus vaccine. Additionally, no interferon activity was detected in vivo for as long as 24 h after vaccination. Finally, no production of interferon occurred in tonsil or peripheral lymphocyte cultures inoculated with split virus vaccine. We conclude that split virus influenza vaccine does not affect theophylline pharmacokinetics. In addition, we find no evidence that split virus influenza vaccine functions as an interferon inducer in humans.
UNLABELLED: All bronchoscopies in our institution are performed by physician-respiratory therapist teams. The therapist instructs the patient, anesthetizes him, does the biopsies, and prepares specimens for laboratory testing. METHODS: We undertook a retrospective study of our performance to evaluate the safety, yield, and cost of this system. RESULTS: Of 216 procedures evaluated, therapist-performed biopsies provided a specific diagnosis in 55%. When a tumor-like mass was seen directly, biopsies were positive 95.7% of the time. No procedure was associated with death. Complications included fever in about 9%, hoarseness in 2%, hemoptysis in 1%, and pneumothorax in one procedure (0.5%). Our institutional costs for flexible fiberoptic bronchoscopy by a physician-respiratory therapist team were only 34% of what they would have been if the same procedures had been performed in the operating room. RESULTS performed were comparable to all others reported in the literature. CONCLUSION: This study clearly demonstrates that respiratory therapists can provide high quality, low cost, safe bronchoscopic assistance to pulmonary internists.
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A 26-yr-old woman with bilateral staphylococcal pneumonia developed respiratory failure. Conventional ventilation failed and high-frequency jet ventilation (HFJV) was successfully instituted. Bronchopleural fistulas required prolonged (73 days) support with HFJV. A bronchoscopy performed after 37 days of mechanical support showed no abnormalities. Computed tomography (CT) of the chest demonstrated severe cystic abnormalities. Pulmonary function tests performed 1 and 6 months after recovery showed small-airway dysfunction. HFJV proved safe for prolonged use.
After briefly describing the New Jersey Diagnosis-Related Group (DRG) system and comparing/contrasting it with the Medicare prospective payment plan, selected findings from an evaluation of the New Jersey DRG experience are presented. The discussion highlights the system's effect on ways in which hospitals are organized and managed, and its preliminary economic and financial impact.
Circulating immune complexes (CIC) have been documented in patients with tuberculosis. Like most other disease-related CIC, the composition of CIC in tuberculosis is unknown. Using the new technique of conglutinin affinity chromatography, we isolated and purified CIC from 6 patients with mycobacterial disease and compared these with CIC from 6 patients with other disorders. The CIC material from both groups was found by Ouchterlony analysis to be similar, containing IgG, IgA, and variable amounts of Clq, C3, and C4. Relative purity was confirmed by the absence of other serum components such as fibrinogen, alpha 1-antiprotease, alpha 2-macroglobulin, and transferrin; trace amounts of albumen were present in all samples. On sucrose density ultracentrifugation, CIC material from both groups demonstrated a well-defined major peak in the 9S to 12S range and a much smaller peak at 7S. After dissociation of CIC at pH 2.8, only a broad band in the 7S region was noted. Ouchterlony analysis demonstrated a positive precipitation reaction between CIC and rabbit anti-BCG in 5 of 6 patients with tuberculosis and 1 of 6 patients without tuberculosis. Anti-BCG activity was demonstrated by precipitation inhibition in 5 of 6 tuberculous and 2 of 6 nontuberculous samples. In all but one of the tuberculous samples tested, these reactions were confined to the 9S to 12S fraction. We conclude that some of the CIC found in patients with tuberculosis are composed of immunoglobulin, complement, and antigen derived from Mycobacterium tuberculosis.
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With federal funding for health planning on the decline, local efforts are under way to replace the health planning structure being dismantled at the federal level. The next generation of health planning will be shaped by the federal government's desire for homogeneity in planning efforts, the inseparability of planning and regulation, the likely diminution of the current anti-regulatory fervor, and the need for individual institutions and their leadership to bear more risk than they have in the past.
We sought to explore immunological factors in patients who died with rapidly fatal fibrosing lung diseases (Hamman-Rich syndrome). A retrospective review of cases of interstitial lung disease showed 12 recent deaths from Hamman-Rich syndrome. The mean age was 62, men outnumbering women 3 : 1. Five patients had proved collagen vascular disease (rheumatoid arthritis three, lupus two). Four others had a history of allergic disorders, syphilis, chronic eosinophilia, or hypersensitivity reactions. One patient showed disappearance of immunofluorescence as fibrosis advanced, which has not previously been reported. The study suggests a possible aetiological link between disorders of immunity and Hamman-Rich syndrome. The evidence also supports the notion that Hamman-Rich syndrome is an accelerated variant of the more indolent interstitial pneumonias.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.