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Biomedical subjects

R J Lagoe

Publications and source records attributed to R J Lagoe.

At least 19 recordsLinked to original sources
PubMed2000

Hospital readmissions at the communitywide level: implications for case management.

This study describes the development of information concerning the distribution of hospital readmissions by diagnosis in seven different United States metropolitan areas. The data demonstrated that circulatory disorders were associated with the largest number of communitywide readmissions in all of the communities. It also showed that circulatory, respiratory, and digestive disorders accounted for a majority of readmissions in all of the areas. This information suggested that case management efforts to reduce readmissions can focus on a limited range of clinical diagnoses. This approach should enable the process to function effectively within resource constraints.

California↗
PubMed1999

Analyzing hospital readmissions using statewide discharge databases.

Hospital readmissions are an important indicator of the outcomes of care as well as a source of unnecessary health care expenditures. This study focused on development of a uniform algorithm for identification of hospital readmission data. It involved development of a uniform definition of readmissions which could be applied to multiple statewide computer databases. Through this approach, comparable readmit data were generated for use in benchmarking and quality improvement activities.

California↗
PubMed1999

Health care data and their sources.

This article outlines the types of health care data currently available from internal and external sources. It describes utilization, outcomes, and financial data. It focuses on information available through computer abstract hospital databases. It provides information concerning the sources and content of these databases.

Ambulatory Care Facilities↗
PubMed1999

Analyzing hospital admission rates at the community level.

This article describes the importance of hospital admission rates as utilization indicators and provides guidance on the development of related data. It identifies categories for analysis of hospital admission rates, including inpatient services, age groups, and geographic units. It describes how resident hospital admission rates can be developed from computer abstract data and contains examples of this information.

Age Factors↗
PubMed1999

Using data to reduce hospital readmissions.

This article describes the importance and the development of data concerning hospital readmissions as an outcomes indicator. It emphasizes the need for consistent definition of readmissions according to time intervals and diagnostic categories. It describes the development of readmission information using computer abstract databases to ensure consistency of indicators. It also provides examples of data developed through this approach.

Data Interpretation, Statistical↗
PubMed1999

Using health care data to improve utilization and outcomes. Introduction.

This article suggests that the information age has generated extensive amounts of additional health care data, but has not provided the tools to access this information. It identifies principles for development and use of health care data including clarity of sources, validity and consistency, importance and relevance, accessibility, and the human element.

Data Collection↗
PubMed1997

Development and implementation of clinical pathways for stroke on a multihospital basis.

This study describes the development and implementation of clinical pathways for stroke on a cooperative basis by three hospitals in the same community. The participating institutions developed separate pathways which met their respective organizational needs. This process occurred within separate hospital management structures with coordination among the institutions. They employed a common set of length of stay, quality and resource variables to evaluate the impact of the pathways.

Cerebrovascular Disorders↗
PubMed1996

Enlisting physician support for practice guidelines in hospitals.

Available experience indicates that physician support is crucial if clinical pathways are to support quality of care while reducing lengths of stay and resource use. Enlisting such support requires understanding of physician perspectives concerning the quality and delivery of health care. It also requires the development of data systems as a means of communication with physicians.

Attitude of Health Personnel↗
PubMed1995

Development and implementation of a program to reduce hospital stays and manage resources on a community-wide basis.

The study describes an effort to reduce hospital stays and limit the use of expensive resources in the metropolitan area of Syracuse, New York. The program included the implementation of clinical pathways for a number of surgical procedures and medical diagnoses. The effort involved the identification of specific resource variables in a wide range of clinical disciplines. The program was important because it focused on cooperative efforts at length of stay and resource reduction by the staffs of all of the hospitals within a common service area.

Critical Pathways↗
PubMed1995

The evaluation of hospital stays for total hip replacement.

The purpose of this study is to present four care experiments developed in the Netherlands and New York State that aim to reduce mean hospital stays for total hip replacement and thus increase efficiency of hospital utilization without adversely influencing quality of care. The major components of the programs and their impact on lengths of stay are described.

Aged↗
PubMed1995

Excess acute care bed capacity and its causes: the experience of New York State.

OBJECTIVE: The study was developed to identify numbers of excess hospital medical-surgical and pediatric bed capacity and the variables that produce them in the counties of New York State. DATA SOURCES/STUDY SETTING: Data were collected from New York's Statewide Planning and Research Cooperative System (SPARCS) for 1991. This system includes data for all hospital discharges in New York State by county. The counties of New York State include a full range of urban, suburban, and rural settings. STUDY DESIGN: A methodology was developed for projecting excess numbers of acute medical-surgical and pediatric beds. The impact of utilization variables (such as hospital discharge rates and lengths of stay) on bed levels were analyzed, as well as the effects of demographic, social, and health care resource availability. DATA COLLECTION/EXTRACTION METHODS: Data were collected through discharge abstracts provided by hospitals in New York State. PRINCIPAL FINDINGS: The data demonstrated that hospital discharges and lengths of stay contributed to excess utilization at different levels in New York State counties. The data also identified relationships between lower incomes and educational levels, as well as larger supplies of physicians and high-variation discharges, and excess beds. CONCLUSIONS: The causes of excess hospital beds varied considerably among communities in New York State; each community must develop its own approach to this problem.

Adolescent↗
PubMed1994

Adding nursing facility beds: impact on hospital nonacute care.

The study evaluated the impact of admitting 235 nonacute patients who had been backed up in hospitals to new nursing facility beds in the metropolitan area of Syracuse, New York, during a 12-month period. The data indicated that these admissions reduced the hospital nonacute census by 53 percent and produced substantial declines in numbers of nonacute patients with postacute stays longer than one month and with Medicaid as principal payer. Numbers of patients waiting for Medicaid eligibility were not affected by admissions to the new beds. The data also indicated that substantial numbers of new admissions were required to generate these changes.

Bed Occupancy↗
PubMed1991

Long-term care patients in acute care beds: a community-based analysis.

This paper describes an analysis of hospital utilization by alternate care patients, those who receive long-term care in hospital beds because postdischarge services are not available. During a 3-year period, the number of hospital beds occupied by these patients in Syracuse, New York reached 184, or 14% of the area's medical-surgical capacity. These patients were heterogeneous with respect to disposition, age, functional ability, and payor status. For this reason, the control of hospital alternate care should involve the management of admissions to nursing homes, home care, and elderly housing in a focused manner.

Aged↗
PubMed1990

Relieving overcrowded emergency departments through ambulance diversion.

One city's solution to overcrowded emergency departments and a shortage of beds was the installation of an ambulance-diversion system, whereby ambulances carrying patients with relatively minor injuries were diverted, when necessary, from the city's busy emergency departments to less crowded ones in neighboring counties.

Ambulances↗
PubMed1990

Changes in ambulatory surgery utilization 1983-88: a community-based analysis.

Changes in ambulatory surgery utilization in the metropolitan area of Syracuse, New York 1983-88 were identified. Total ambulatory surgery utilization rose from 12,479 to 24, 643 procedures. Approximately 69 percent of the increase was generated by freestanding surgery centers. Operations responsible for the largest additional volumes included lens procedures, certain cervical procedures, hernias, and excision of skin and breast lesions.

Ambulatory Surgical Procedures↗
PubMed1989

A community-wide effort to reduce hospital utilization by patients requiring nursing home placement.

Described is an effort by health care providers to reduce hospital utilization by increasing admissions to skilled nursing facilities from hospitals. For a 6-month period, there were increased admissions from hospitals to nursing homes and a reduced number of hospital nonacute patients who required long-term care placement. Eventually, however, the nursing homes shifted their admission patterns to accept more persons from non-hospital settings. As a result, admissions from hospitals declined and the number of nonacute patients in hospitals increased.

Aged↗
PubMed1988

Hospital mortality for otolaryngologic disorders in New York State.

Hospital mortality in New York State during 1983, 1984, and 1985 for diagnosis related groups (DRGs) that addressed principal diagnoses of otolaryngologic disorders was evaluated. Inpatient data from 291 acute care hospitals in the state indicated that 66.6% of hospital mortality for these conditions was produced in a single category, DRG 64--Ear, Nose, and Throat Malignancy (treated medically). Other otolaryngologic DRGs that were sources of hospital mortality in New York State addressed otitis media and upper respiratory tract infections for elderly persons and patients with complications who were treated medically, a wide range of ear, nose, and throat diagnoses that were treated medically, major head and neck surgical procedures, and a wide range of other surgical procedures for malignant neoplasms. This information should contribute to the evaluation of disease trends that cause mortality in individual hospitals, statewide and nationwide, as well as to efforts at evaluation of quality of care in otolaryngology.

Adolescent↗