Groups of neonates who are usually treated at hospitals that provide specialized pediatric care are not adequately classified by the use of diagnosis-related groups (DRGs). Therefore, a set of revised DRGs, pediatric modified DRGs (PM-DRGs), have been developed. Use of PM-DRGs substantially improves the classification of neonates in the following ways: a single pediatric modified major diagnostic category has been defined to include only and all neonates (patients younger than 29 days of age when admitted to the hospital); deaths and transfers of newborns are no longer combined into a single group; birth weight (rather than diagnosis) is used as the primary variable to differentiate categories of neonates; and duration of mechanical ventilation, presence of major problems, and surgery are used to define specific PM-DRGs. A total of 46 PM-DRGs have been developed to replace the 7 DRGs for neonates. Based on a sample of discharged patients from 13 children's hospitals, the overall variance reduction in duration of stay for neonates using PM-DRGs was 38.7% compared with 20.4% for DRGs. Variance reduction for PM-DRGs was 45.9% compared with 16.3% for DRGs when operating cost per case was used instead of duration of stay. After removing outliers at 150 days, the duration of stay variance reduction was 53.3% vs 23.6%, respectively, and the operating cost variance reduction was 58.8% vs 17.8%, respectively.

Birth Weight↗

PubMed1987

An open letter to Georgetown.

Explore the source record for details and available documents.

District of Columbia↗

PubMed1982

Primary malignant melanoma arising in an ovarian dermoid cyst.

Explore the source record for details and available documents.

Dermoid Cyst↗

PubMed1981

The praxeology of the office dilatation and curettage.

Studies establishing the validity, safety, acceptability, and cost-effectiveness of dilatation and curettage (D&C) performed in the office have been published for 60 years. Major obstacles to office D&Cs have been third-party payers, congressional action and governmental regulations, social mores, medicolegal practices, and specialization. Analysis of 310 offices D&Cs in a private gynecologic practice reveals a 300% reduction of patient short-term disability, 90% patient acceptability, 98% diagnostic accuracy, 450% improved physician time, approximately 450% cost reduction, and improved cost savings and income to patient and physician. The gynecologist has the substantial role in medical care decision-making. However, we must not lose sight of the fact that these very personal and individualized decisions must involve the patient as well. In order to maintain the most beneficial perspective and medical care decision-making, a hierarchy of values is presented: quality medical care, patient and physician satisfaction, economies of cost, and replicability. It is suggested that this praxeologic approach to the office D&C can be applied to other medical care decisions.

Ambulatory Surgical Procedures↗

PubMed1978