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Biomedical subjects

M R Chassin

Publications and source records attributed to M R Chassin.

66 records · Page 4Linked to original sources
PubMed1982

Costs and outcomes of medical intensive care.

Survival, functional status and total six-month medical care costs were measured for 489 consecutive medical intensive care patients. In addition, the study sought to determine if it was possible from data available on admission to identify subgroups of patients with extremely low survival rates. Of the study patients, 86 per cent survived the initial admission, and 72 per cent survived six months. Daily intensive care unit (ICU) charges averaged $1,120 per patient, while total six-month charges per patient averaged $14,577. Age, initial systolic blood pressure, preadmission functional status and diagnosis were all significantly and independently associated with survival. The subgroup with the lowest six-month survival rate (14 per cent) comprised cancer patients with poor preadmission functional status. This study did not identify a subgroup of patients with a survival rate low enough to justify systematic exclusion from intensive care. Controlling ICU costs by excluding patients with very low expected survival may not be possible.

Adolescent↗
PubMed1975

Dilantin-induced disseminated intravascular coagulation with purpura fulminans. A case report.

A patient developed disseminated intravascular coagulation with purpura fulminans 1 month after starting Dilantin therapy for a seizure disorder. In addition, the patient developed exfoliative dermatitis, hepatitis, cutaneous vasculitis, and microangiopathic hemolytic anemia. She was successfully treated with adrenal steroids and heparin for her purpura fulminans. The hepatitic dermatologic, along with hemorrhagic, complications of Dilantin are reviewed, and the possible origin of the vasculitis and disseminated intravascular coagulation is discussed.

Adolescent↗
PubMedDate not supplied

Improving quality, minimizing error: making it happen.

Medical errors and the quality problems to which they lead harm millions of Americans each year. If we are to reduce errors and improve quality substantially, we must create systems and care processes that anticipate inevitable human errors and either prevent them or compensate for them before they cause harm. Formidable barriers now stand in the way of progress. Success will require a multifaceted strategy, including public education, government investment and regulation, payment system restructuring, and leadership from within the delivery system.

Cross-Sectional Studies↗
PubMedDate not supplied

Improving the quality of health care: who will lead?

National interest in the quality of American health care increased dramatically in 1999. The press, the Institute of Medicine, legislators, physicians, and hospitals joined in a vigorous policy discussion. But a similar debate occurred in 1988, following reports from four public agencies that detailed their concerns about health care quality. In the intervening decade, research has not documented much improvement. In this paper we outline the quality problems in U.S. health care, review some of their most prominent causes, consider the biggest obstacles to bringing about major improvement, and discuss the vital role of leadership in achieving this goal.

Health Planning↗
PubMedDate not supplied

A randomized trial of medical quality assurance. Improving physicians' use of pelvimetry.

The capacity of educational programs to improve physician performance remains doubtful despite many evaluative efforts. This is especially true for programs sponsored by the federal government. We tested the efficacy of an educational program conducted by Professional Standards Review Organizations in reducing the inappropriate use of x-ray pelvimetry. This procedure may cause harm to the fetus, and there is little evidence that it is efficacious. We randomly assigned 120 hospitals in six Professional Standards Review Organizations to study and control groups. Physicians with delivery privileges at each study hospital participated in an educational program that discussed acceptable indications for x-ray pelvimetry. Pelvimetry use was similar in study and control hospitals before the program. However, after the program, pelvimetry was performed by physicians at study hospitals less than one third as often as by physicians at control hospitals. We conclude that educational programs can improve physician performance substantially and that such programs can be effectively conducted by federally sponsored physician organizations.

Education, Medical, Continuing↗
PubMedDate not supplied

Coronary angiography and bypass surgery in Manitoba and the United States: a first comparison.

OBJECTIVE: To compare the appropriateness of use of coronary angiography (CA) and bypass surgery (CABS) in the early 1980s in one Canadian hospital and several American hospitals using explicit case-based criteria. Procedure rates were much lower in Canada during this period. SUBJECTS: Canadian subjects, 502 Manitoba residents undergoing CA at one hospital in 1981-82 were tracked forward to determine whether and when they underwent CABS. CA comparisons were made with 351 Canadian patients aged 55 years or older; 1677 American CA patients aged 65 years or older and were drawn in 1981 from three hospitals. Two hundred and forty-five patients undergoing CABS within 12 months of CA made up the Canadian sample. American CABS patients were sampled from three hospitals during 1979-82. Manitoba patients assigned to medical treatment after CA were also appraised. METHODS: Criteria were derived by an American panel of clinicians following a Delphi process; indications were rated appropriate, equivocal and inappropriate. A trained abstractor reviewed charts and assigned ratings. Results of exercise electrocardiograms were not available in the Manitoba data set, hence sensitivity analyses were performed to determine how differing proportions of positive exercise electrocardiograms might affect the Manitoba results. RESULTS: Even assuming only 50% of treadmill tests were positive in the Manitoba sample, the proportion of inappropriate CA was lower in Manitoba than for the American hospitals: 9% versus 15 to 18%. For CABS, only one of the three comparison American hospitals approached the Manitoba hospital level of appropriateness. CONCLUSIONS: In the early 1980s, there was more appropriate use of CA and CABS in a Manitoba hospital compared with several American hospitals. Many Canadian patients undergoing CA and treated medically met American indications for appropriate use of CABS. Whether this represents underprovision of necessary care remains uncertain.

Aged↗