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Biomedical subjects

M J Long

Publications and source records attributed to M J Long.

43 records · Page 3Linked to original sources
PubMedDate not supplied

Variation in outpatient procedure rates in Canadian teaching hospitals.

OBJECTIVE: To determine the variation in the rate at which specific procedures are performed on an outpatient basis in Canadian teaching hospitals. DESIGN: An index of outpatient activity was developed using the ratio of expected-to-actual performance, with the expected performance representing empirical, exogenous criteria. SETTING: Canadian teaching hospitals. RESULTS: The index indicated whether the hospital, or group of hospitals, of interest is equally, more, or less active than the comparison group. The results show that Canadian teaching hospitals were 3% less active than Canadian nonteaching hospitals and Alberta teaching hospitals were 22% less active than all Canadian teaching hospitals. Individual teaching hospitals in Alberta were 21% more, 40% less, 9% less, 44% less, 8% less, 39% less, 20% less, and 2% less active than all other Alberta teaching hospitals. CONCLUSIONS: If variation in the use of less costly treatment modalities represents variation in quality as in Donabedian's unifying model, the results show considerable variation in quality across the generally accepted leaders in the medical care field. By comparing teaching hospitals with other teaching hospitals the difference in the patient severity level is minimized. The decision regarding the delivery modality represents only one decision in the complex decision matrix faced by physicians in the treatment episode. Given the considerable variation demonstrated in this study, the task of developing protocol, standards, or guidelines in order to reduce variation over the total treatment episode will be enormous.

Ambulatory Care↗
PubMedDate not supplied

Case management of the elderly in a health maintenance organization: the implications for program administration under managed care.

Kaiser Permanente initiated a two-year demonstration ambulatory case management program in its Ohio region to evaluate five outcomes: perceived health status, functional status, and satisfaction with care, service use, and service costs. Expected results were not consistently obtained for the five outcome measures. Treatment group members did not, however, experience the functional status impairments or decline in health status perceptions reported by the control group during the study period. The unexpected finding that costs were not affected may be attributed to the type of case management intervention used in the demonstration program. This study is broadly applicable to managed care settings facing the challenge of developing programs to minimize the risk for bearing the costs of the Medicare beneficiaries' overall health when all services are not covered. Managed care administrators should be favorably disposed to implementing a case management model with the potential for affecting functional status, the most significant predictor of expensive continuing care for this cohort of Medicare beneficiaries, while working to develop more effective protocols and resource control strategies.

Aged↗
PubMedDate not supplied

Spectrophotometric and liquid chromatographic identification of 3,4-methylenedioxyphenylisopropylamine and its N-methyl and N-ethyl homologs.

3,4-Methylenedioxyphenylisopropylamine (MDA) is an hallucinogenic drug that somewhat resembles lysergic acid diethylamide (LSD) in its effects. Recently, widespread abuse of the N-methyl homolog (MDMA) of MDA has led to federal control. This article reports on the synthesis of the N-ethyl homolog (MDEA) of MDA as well as spectrophotometric and chromatographic methods for identification of the 3 homologs.

3,4-Methylenedioxyamphetamine↗
PubMedDate not supplied

Minimum optimum scale of federally qualified health maintenance organizations.

From a policy standpoint it is important to identify the level of output at which average cost per unit is at its lowest. If minimum optimum scale is achieved at a very high output level, it would suggest that monopoly conditions should be allowed to prevail. If, however, minimum optimum scale is achieved at a low level of output, more organizations would be able to survive, allowing for competition in the marketplace. Using data published by the Office of Health Maintenance Organizations, the relationship between size and average cost was examined in federally qualified staff, group, and Independent Practice Association (IPA) health maintenance organizations (HMOs) and minimum optimum scale was identified for each organization. The findings support the hypothesis that least cost size is achieved at the lowest level of output in IPA HMOs. The hypothesis that minimum optimum scale would be achieved at a lower level of output in group rather than in staff HMOs was not supported. This may be due to the practice of some staff HMOs of employing part-time, salaried providers and purchasing unique services from other providers.

Health Maintenance Organizations↗