Building bridges, not walls: caring for the adolescent.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
J R Griffith
Publications and source records attributed to J R Griffith.
Continuous improvement of strategic information systems: concepts and issues.
Health care organizations that want to position themselves for the future must develop and continuously improve strategic information systems (SIS). The authors consider several problem areas on the current frontier of SIS development and propose solutions that for the most part are expedient and pragmatic.
Budgets↗
Socioeconomic influence on small area hospital utilization.
Health care policy makers, concerned with the rising cost of health care, have focused on the observed variation in the use of hospitals as a potential area in which to lower health care costs, i.e., if hospital utilization can be decreased, health care costs may also decline. However, it is crucial that the reasons for the observed variation in the current practice be understood or attempts to reduce costs may lead to policies that harm groups of patients and the providers and institutions currently delivering care. Using hospital discharge data from 59 hospital market communities in the lower peninsula of Michigan in 1984-86, the authors examined possible associations between socioeconomic characteristics and the observed small area variation in hospital discharge rates. First, a series of Poisson regressions was used for each of five covariates and 112 modified diagnosis-related groups (DRGs). Then, multiple regressions were examined, utilizing the five socioeconomic characteristics, after excluding statistically influential communities. The results indicate that community characteristics, including education, poverty, and unemployment, have a statistically significant association with the observed small area hospital discharge rate for many DRGs. Moreover, the direction of the effect is consistent across multiple disease categories. In multiple regressions, the five selected socioeconomic variables explained 48% of the variance for medical admissions and 19% for surgical admissions. For most DRGs, high educational levels were associated with lower hospitalization rates. The authors also identified statistically influential communities whose hospital utilization profile was different from that of most communities in Michigan.
Diagnosis-Related Groups↗
Using claims data to monitor hospital utilization.
Controlling provider use is a continuing problem for health care insurers. This paper describes a Blue Cross and Blue Shield of Michigan system that places primary responsibility for inpatient admissions on participating hospitals and uses a dual monitoring approach. Expensive annual samples that review medical records against published criteria constitute the basic test of compliance. An inexpensive indicator is developed quarterly using automated universal claims review. Statistical methodology, costs, and savings for both monitors are described. The claims monitor uses diagnosis related group (DRG) characteristics to estimate the percentage of inappropriate utilization from historical values for the patient group.
Blue Cross Blue Shield Insurance Plans↗
Small-area analysis of gastrointestinal disease hospital discharge variation: are the poor at risk?
Capitation plans may place their enrollees at risk of rationed services if they do not adjust for underlying patient characteristics that dictate differing levels of care. To assess the degree to which population-based socioeconomic characteristics are associated with hospital use, this study explored small-area variation in hospital discharges for gastrointestinal and liver (GI) Diagnosis Related Groups (DRGs). Utilizing a 1980 Michigan database of 1.5 million discharges, we constructed age-adjusted, population-based discharge rates for the GI DRGs. We then evaluated the effect of poverty, defined by the percent of households in a hospital market community below the poverty line. Using regression techniques, we found that poverty explained 27.5% of the variation in GI hospital discharges, with the poor admitted more often (p less than 0.0001). Using cost weighted discharge rates as the dependent variable, we found that poverty explained 20.3% (p = 0.0003) of the variation in cost weighted discharges. These results suggest that poverty explains a significant amount of variation in hospital discharges and has a significant effect on associated small-area hospitalization costs in GI diseases. Practicing gastroenterologists and surgeons need to be aware of factors that influence patients utilizing their services in order to retain their role as patient advocates as changes in payment systems are suggested.
Capitation Fee↗
Micro-area variation in hospital use.
Many recent studies have demonstrated that hospital utilization rates vary widely across small geographic areas. The variation is often attributed to the style of practice of the provider. This study demonstrates that hospital utilization varies widely between "micro" areas within individual hospital market areas. Further, the study demonstrates that hospital utilization rates within a hospital market area are more similar to each other than to rates in "micro" areas within other hospital market areas. After adjustment for available demographic, socioeconomic, and epidemiological factors, the utilization rates within "micro" areas are highly related to the group of hospitals that dominates the market area. After simultaneously adjusting for age and poverty, the market share-dominant group explains 35 percent of the variance in surgical use rates of "micro" areas and 39 percent of the variance in medical use rates.
Adolescent↗
Virginal breast hypertrophy.
Virginal breast hypertrophy is reviewed. The latest advances regarding the etiology, clinical presentation, differential diagnosis, and treatment, both medical and surgical, are discussed.
Adolescent↗
Small-area variation in hospital discharge rates. Do socioeconomic variables matter?
Although numerous studies have been made of the determinants of small-area variation in hospital discharge rates, there is still disagreement about the role of socioeconomic factors. The lack of consensus stems, in part, from the difficulty in comparing results across studies that use different units and methods of analysis. Many of the studies using well-defined hospital service areas did not have the data needed to conduct a controlled analysis of the determinants of hospital utilization. Most of the studies that have performed controlled analyses have relied on larger geopolitical areas, which are not believed to capture self-contained health care systems. The study described here used a consistent set of data, three methods of analysis, and two units of analysis to test the importance of socioeconomic characteristics in explaining the variation in medical and surgical discharge rates in Michigan. Socioeconomic factors are found to be statistically significant determinants of the variation in both medical and surgical discharge rates, whether the method of analysis is simple correlations or multiple regressions, and whether the unit of analysis is the county or a well-designed hospital service area. These results suggest that previous small-area variation studies may have incorrectly concluded that socioeconomic characteristics do not explain differences in utilization rates.
Hospitals↗
Patterns of surgical and nonsurgical hospital use in Michigan communities from 1980 through 1984.
Hospital discharge rates vary substantially among 60 communities in Michigan. (R2 = 90 percent and R2 = 85 percent of the systematic variance is explained by community effects for nonsurgical and surgical discharges, respectively.) The ranking of communities by discharge rates is stable over a five-year period (Spearman rho = 0.78 for nonsurgical discharges and 0.72 for surgical discharges). Surgical discharge rates decreased substantially (4 percent per year) over this time period, while nonsurgical rates showed no consistent pattern. Communities with exceptional discharge rates showed no substantial or significant regression toward the mean through the five-year study.
Adolescent↗
Does race affect hospital use?
Based on 1980 hospital discharges in areas in the State of Michigan, with substantial Black populations, Blacks use approximately 50 per cent more hospital care than Whites, but about half this difference is associated with use in specific communities which affects both White and Black use. Black use is not associated with community size, per cent of Blacks, or available beds and doctors. After controlling for mortality and socioeconomic status, a small statistically non-significant difference in race-specific use remains for 23 Michigan communities. The elimination of race as an explainer of hospital use suggests progress in assuring equal access to hospitals, but differences in poverty, mortality, and some specifics of use remain.
Adolescent↗
Clinical profiles of hospital discharge rates in local communities.
Using comprehensive 1980 data for hospitalization of the 9 million citizens of Michigan's lower peninsula, the authors have previously demonstrated that the discharge rates of local communities differ by a range of 2 to 1. This article seeks to identify differences in the clinical profile of high-use compared to low-use communities. Population-based rates and percentages of total discharges were studied for major clinical activity groups, such as cardiovascular disease, frequent diagnoses, rarely occurring diagnoses, short- and long-stay diagnoses, certain surgical procedures, and major organ groups of the diagnostic classification system. Although high-use communities tend to admit proportionately fewer surgical cases and proportionately more nonsurgical cases, few other such patterns could be demonstrated.
Adolescent↗
Classification of hospital patients as "surgical." Implications of the shift to ICD-9-CM.
Using a nearly complete set of hospital discharge abstracts for Michigan in 1980, the authors offer evidence that the shifts in diagnostic and procedure coding (from HICDA-2 to ICD-9-CM) and associated class definitions may have affected both estimates of surgical/nonsurgical use rates and expected lengths of stay of operated versus nonoperated patients as defined using Commission on Professional and Hospital Activities length-of-stay texts.
Abstracting and Indexing↗
The role of Blue Cross and Blue Shield in the future U.S. health care system.
In a recent speech to Blue Cross and Blue Shield executives and trustees, the author noted that despite the historic success of Blue Cross and Blue Shield Plans, the future contains challenges arising from an aging population, scarce national resources, and evolving technology. To continue to grow and to meet its customers' needs, he urged Blue Cross and Blue Shield to expand its efforts in several directions: emphasize control of services and costs for the customer; restructure the concept of provider participation; and positively reward providers who exceed minimum standards. He advocated joint ventures between Blue Cross and Blue Shield and nonprofit providers, especially in the area of aged care.
Blue Cross Blue Shield Insurance Plans↗
Measuring community hospital service in Michigan.
Using discharge abstracts from Michigan hospitals, we divided the state into hospital use communities with measured populations. We constructed population-based rates measuring use, cost, and some aspects of quality. The results cover 54 communities comprising 90 percent of the Michigan population and ranging in size from Detroit (population 600,000) to very small (population less than 25,000) communities. Age-adjusted patient days per 1,000 population, length of stay, cost per person per year, hospitalization rates for surgery, trauma and vascular disease, and childbirth problems show large variations, generally ranging from 2 to 1. High values usually are positively associated with each other and with population size. Patient days per 1,000 (mean 1,114, range 600-1,700) and cost per person(mean +223, range +110-+290) are distributed such that almost 75 percent of communities are below the mean. We believe this information will be useful to community hospital trustees, physicians, and administrators.
Cardiovascular Diseases↗
A preliminary investigation into a method of producing a bond between glass-ionomer cement and ceramics.
The advantages offered by glass-ionomer cements would be greatly extended if they formed an attachment to ceramic materials.
Adhesiveness↗
Forecasting bed needs and recommending facilities plans for community hospitals: a review of past performance.
A university-based hospital consulting group reviewed six studies of Michigan hospitals retrospectively in 1975. The studies represented all those done between 1967 and 1971 requiring forecasts of acute bed supply and service needs. The original studies developed forecasts using empirical studies of patient origin and rigorously prepared authoritative forecasts of county populations. The 1975 review compared forecasts of population, service population, and bed need against current values and also interviewed clients to assess retrospective satisfaction with the recommendations. Although the consultants strove steadily to minimize the bed supply and base population forecasts were accurate, the studies overestimated bed needs. Further, the clients were often dissatisfied with the original recommendations, and frequently acted to exceed them. Comparing the 1975 actual with what would now be recommended by the consultant indicates that the "error" cost the communities about $50 per person per year.
Bed Occupancy↗
Defining hospital market efficiency--the community's task.
Hospitals must concentrate on both market and productive efficiency to control costs and satisfy customers' health care needs. Local communities can set market efficiency standards using data sets similar to the Michigan study's.
Catchment Area, Health↗