Search PubMed⌕ Search

Biomedical subjects

J R Griffith

Publications and source records attributed to J R Griffith.

At least 37 records · Page 2Linked to original sources
PubMed1990

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↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

Principles of the well-managed community hospital.

Management of a community hospital must relate an exceptionally complicated organization to a dynamic and demanding environment. To do so requires a structure that guides decision processes. The author argues that five principles comprise this structure that is in place among today's successful hospitals. They are: (1) Success is measured by market shares at a satisfactory financial margin and an acceptable level of quality. (2) The business of a hospital is medical care, and doctors must be its allies. (3) Planning and budgeting decisions are the arena where trustees, executives, clinical professionals, and managers have their most frequent and meaningful collaboration. (4) Facts, and therefore information systems, are the key to successful planning and budgeting decisions. (5) Rewards are routine and generous to members of the hospital team who contribute to overall success.

Financial Management, Hospital↗
PubMed1989

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↗
PubMed1988

Voluntary hospitals: are trustees the solution?

Many of the criticisms of American hospitals are implicitly charges of governing board failures. Boards cannot solve all the problems, but they can accept a mandate to guarantee quality and act more effectively to control costs. To succeed, they must stiffen their willpower (perhaps by better selection of their own members), broaden their knowledge base, and improve their decision processes. A clearer, more specific mission is a good start, backed by more reliance on the CEO, more collaborative relations with the medical staff, and more rigorous processes for planning and budgeting.

Cost Control↗
PubMed1988

The mission of the well-managed community hospital.

The well-managed community hospital as an organization is in dynamic equilibrium with its geographic community and with other communities providing finance, physicians, nurses, other professionals and resources necessary to meet local health care needs. The hospital is "well-managed" when it develops an equilibrium that permits all of its various constituencies to be satisfied. Growth in market share results from good management. The hospital's ability to attract and satisfy the needs of health care professionals while simultaneously meeting the needs of patients and their families at competitive prices allows it to flourish. Its financial success allows it to reward its medical staff and employees in ways that attract the best of each work group. A central problem in achieving good management is communication. Hospitals must communicate their goals convincingly to a large number of doctors and employees. "The Well-Managed Community Hospital," winner of the James A. Hamilton Hospital Administration Book Award, argues that a well-structured mission statement is the essential first step in the communications process. According to the book, final responsibility for the mission statement lies with the governing board and is one of five non-delegable functions of the board. The nature of the mission setting function as described in the book follows.

Community-Institutional Relations↗
PubMed1985

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↗
PubMed1985

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↗
PubMed1984

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↗
PubMed1983

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↗