Search PubMed⌕ Search

Biomedical subjects

J Josephson

Publications and source records attributed to J Josephson.

6 recordsLinked to original sources
PubMed1992

Computer-assisted tracking simulation (CATS).

The tracking technique involves a sender reading consecutive segments from a story and a receiver attempting to repeat each segment verbatim. The reliability and validity of the tracking procedure have been criticized based upon uncontrolled variables such as sender, receiver, and text characteristics. To address these problems, a computer-assisted interactive tracking simulation (CATS) system has been developed in which story segments are presented to the receiver via a video laser disc system and repair strategies are implemented through a computer program.

Communication Devices for People with Disabilities↗
PubMed1990

Physicians' patient load per DRG, the consumption of hospital resources, and the incentives of the DRG prospective payment system.

From 1985 through 1987, the authors assessed the relationship between two main variables at a large academic medical center: (1) the numbers (high or low) of patients per diagnosis-related group (DRG) treated by individual physicians and (2) hospital resource consumption of the patients. The patients were classified according to their routes of admission (emergency or non-emergency); the physicians with eight or more patients per DRG were labeled "high-patient-load physicians" (hereafter called "high-load physicians"), and those with five or fewer patients were labeled "low-patient-load physicians," ("low-load physicians"). The resource variables studied were length of stay (LOS) and total hospital cost. For the non-emergency admissions, the low-load physicians' patients had an average LOS that was 56.2% greater and an average hospital cost that was 58.3% greater than were the LOS and cost of the patients of the high-load physicians. (Both LOS and cost per patient were adjusted for DRG weight index.) This was due in part to a greater severity of illness for the patients (as measured by total ICD-9-CM codes per patient) of the low-load physicians. For the emergency admissions, the low-load physicians' patients had an average LOS that was 9.5% greater and an average hospital cost that was 10.5% greater than the LOS and cost of the patients of the high-load physicians. As in the non-emergency admissions group, severity of illness for the patients of the low-load physicians was greater. The only category of patients that was economically profitable to the hospital was the non-emergency admissions group treated by the high-load physicians. Even though these findings were the result of many factors (discussed in the text), they suggest a relationship between hospital resource consumption and the physicians' patient load per DRG.

Academic Medical Centers↗
PubMed1989

Pediatric patients, DRG hospital payment, and comorbidities.

To determine whether the diagnosis related group (DRG) hospital payment system is causing financial pressure on pediatric hospitals similar to that shown in our previous work in other settings, we analyzed resource consumption for pediatric patients in any of the 251 DRGs not stratified by comorbidities. The new DRG prospective "all payor system" is in effect at our hospital. Analysis of 12,771 pediatric patients by payer (Medicaid and commercial insurance such as Blue Cross) in these DRGs for a 3-year period demonstrated that, as a group, pediatric patients with more comorbidities 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 (expensive patients), and a higher mortality rate than pediatric patients in the same DRGs with fewer comorbidities. This study confirms major inequities in DRG prospective hospital payment for many pediatric patients.

Child↗
PubMed1989

Diagnosis-related groups, costs, and outcome for patients in the intensive care unit.

Our purpose was to analyze hospital cost, resource utilization, and outcome by age for a large group of patients who required intensive care unit (ICU) services. Patients in the ICU (N = 6331) were stratified by age groups. Mean hospital cost per patient generally increased with age. Older patients (65 years of age and older) who were treated in the ICU had longer hospital lengths of stay, higher mortality rates, and a greater percentage of outlier patients, as compared with younger patients (under 65 years of age). Patients in the ICU would have produced a substantial loss for our medical center under a diagnosis-related group (DRG) all payer prospective payment scheme. Although higher mean costs were associated with older patients, every age group of patients in the ICU that we examined demonstrated a loss under DRGs. As a whole for the 3-year period, patients in the ICU would have generated more than +30 million in losses for our medical center. These losses were a result of a variety of factors, including a greater severity of illness and greater hospital resource utilization. The current DRG hospital payment system appears to be inequitable for the patient who receives treatment in the ICU during the hospital stay. As hospital operating margins continue to decline because of federal and state DRG hospital payment systems, additional pressures may be applied for physicians, nurses, and health care professionals to cut expenses for these patients. In this effort to watch the bottom line, physicians and nurses must not sacrifice the quality of or the access to care for patients who require ICU services.

Academic Medical Centers↗
PubMed1979

Primary Pseudomonas maltophilia infection of the lung.

To our knowledge, this is the first reported case of primary Pseudomonas maltophilia pneumonia. Presenting symptoms were fever and chills of two days' duration and a density in the right upper lobe. Sputum culture showed normal flora, and multiple blood cultures were negative. Antibiotic therapy initially with penicillin and then with carbenicillin was unsuccessful. Selective bronchial aspiration yielded pure cultures of P maltophilia. When an appropriate antibiotic, chloramphenicol, was given, a prompt therapeutic response followed.

Aged↗