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Biomedical subjects

M Chassin

Publications and source records attributed to M Chassin.

8 recordsLinked to original sources
PubMed1998

Engaging clinicians in a quality improvement strategy for early-stage breast cancer treatment.

Physicians are skeptical of quality improvement and obtaining their enthusiastic participation continues to be a challenge. We designed and initiated a clinician-driven quality improvement project to improve the provision of efficacious breast cancer treatments among women presenting to an academic medical center for their initial treatment of early-stage breast cancer. All 156 identified physicians agreed to participate in the project and provided access to their office records or specific medical information.

Academic Medical Centers↗
PubMed1995

Can experts agree when to hospitalize adolescents?

OBJECTIVE: Rates of psychiatric hospitalization and lengths of stay for adolescents have been a focus of recent controversy. With the advent of managed care, hospital systems and third-party payers are looking for ways to decide when hospitalization is indicated. The authors sought to determine whether experts could agree on the appropriateness of putative indicators for hospitalization of adolescents for conduct disorder or substance abuse. METHOD: Using a methodology developed at the Rand Corporation and previously applied to procedures in medicine and surgery, the authors developed a list of possible indications for hospitalization of adolescents with conduct disorder and/or substance abuse. A nine-member panel of experts in these areas, balanced by geography, academics/clinical practice, and whether the expert was in charge of a hospital unit, then rated the appropriateness of each indication twice under a modified Delphi procedure. RESULTS: Using prespecified definitions for agreement, after the initial rating the panel had low levels of disagreement (11%) and moderate levels of agreement (28%) on more than 1,900 possible indications for hospitalization. Despite an expanded number of indications, the panel reduced disagreement to less than 5% and increased agreement to more than 55% after the second round of ratings. CONCLUSIONS: The consensus achieved compared favorably with the results of similar panels judging the appropriateness of procedures in medicine and surgery. The methodology is applicable to studies of the appropriateness of pharmacological or psychotherapeutic interventions in both child and adult psychiatry. The results of such studies can form the basis for rational utilization review and treatment authorization decisions.

Adolescent↗
PubMed1984

Consensus methods: characteristics and guidelines for use.

Consensus methods are being used increasingly to solve problems in medicine and health. Their main purpose is to define levels of agreement on controversial subjects. Advocates suggest that, when properly employed, consensus strategies can create structured environments in which experts are given the best available information, allowing their solutions to problems to be more justifiable and credible than otherwise. This paper surveys the characteristics of several major methods (Delphi, Nominal Group, and models developed by the National Institutes of Health and Glaser) and provides guidelines for those who want to use the techniques. Among the concerns these guidelines address are selecting problems, choosing members for consensus panels, specifying acceptable levels of agreement, properly using empirical data, obtaining professional and political support, and disseminating results.

Decision Making↗
PubMedDate not supplied

Developing good medical standards we all can live with.

Although additional research is needed to find the most reliable, valid and efficient way to create standards, now is the time to begin the large task of reviewing medical practices and creating usable standards for physicians.

Health Services Research↗
PubMedDate not supplied

The appropriateness of performing coronary artery bypass surgery.

Information about how appropriately procedures are performed is vital to the understanding of the impact of technology and to the success of efforts to channel its use appropriately. While the efficacy of coronary artery bypass surgery has been addressed in several large-scale, randomized trials, there is little information about how appropriately the procedure is actually being used in the community. We determined the appropriateness of coronary artery bypass surgeries performed in three randomly chosen hospitals in a western state. We determined appropriateness by comparing data obtained from a detailed medical record review with a list of 488 indications. This list, developed by a national panel of physicians, covered all possible reasons for performing the procedure. Three hundred eighty-six cases from the years 1979, 1980, and 1982 were examined. Fifty-six percent of the surgeries were performed for appropriate reasons, 30% for equivocal reasons, and 14% for inappropriate reasons. The percentage of appropriate surgeries varied by hospital, from 37% to 78%, but did not vary by patient age. Eliminating the performance of inappropriate procedures may lead to reductions in health care expenditures or to improved patient outcomes.

Age Factors↗