Mortality of Medicare hospital patients in New York State, 1983-1985.
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Aged↗
Biomedical subjects
R J Lagoe
Publications and source records attributed to R J Lagoe.
Mastectomies for malignancy: a DRG-based hospital utilization analysis.
The study identified hospital utilization patterns by diagnosis-related group (DRG) produced by mastectomies for malignancy in Sacramento, California, and Syracuse, New York, for the years 1981-1984. A total of 3,449 discharges were included. Total and subtotal mastectomy discharges per capita increased in both areas. The proportion of mastectomy discharges attributed to total mastectomies increased in Sacramento and decreased in Syracuse. Mean stays for mastectomy DRGs declined by 13.72 to 56.38%. In 1984 mean stays ranged from 4.79 to 7.49 days for total mastectomies and 1.88 to 5.44 days for subtotal mastectomies. A major problem identified by the study was the lack of DRG sensitivity to differences in types of procedures. Under DRGs, radical and simple mastectomies are combined in one type of category, while subtotal mastectomies, quadrant resections, and breast biopsies are combined in another.
Breast Neoplasms↗
Hospital stays by diagnosis related group for neurologic patients treated medically.
We analyzed differences in hospital stays by diagnosis related group for neurologic patients treated medically in Sacramento, CA, and Syracuse, NY, between 1981 and 1984. Differences between stays were highest for DRGs with large proportions of elderly discharges, especially those with cerebrovascular disorders. Length of stay variability was also higher for DRGs with large proportions of elderly. These results suggest that extended hospital stays for neurology patients result from approaches to patient management, rather than demographic patterns, availability of hospital or long-term care beds, or the extent of health maintenance organization activity.
Age Factors↗
Ambulatory surgery utilization by age level.
We compared ambulatory and inpatient surgery utilization by age level for procedures known to be frequently performed on an ambulatory basis. Our scope of data was the Crouse Irving Memorial Hospital in Syracuse, New York during 1984. The hospital operates one of the largest freestanding ambulatory surgery programs in the United States. The study included 8,348 ambulatory procedures, 42 per cent of all operations performed under the aegis of this institution. At the aggregate, the inpatient surgery included a somewhat lower proportion of young adults and a higher proportion of individuals aged 65 and over did outpatient surgery. For specific procedures, however, age distributions differed. Ambulatory procedures included lower percentages of elderly than did inpatient utilization for inguinal hernia repair, carpal tunnel release, destruction of larynx lesions, hernia repairs, destruction of skin lesions, and other operations, while ambulatory utilization for lens procedures included higher percentages of elderly patients than did inpatient utilization. Physician practice patterns also appeared to influence the setting of certain procedures. The study data suggested that persons involved in health planning should evaluate ambulatory surgery use on an age and procedure-specific basis, and utilization review should evaluate procedures on a case-by-case basis.
Adolescent↗
Patterns of otolaryngologic surgery utilization in Syracuse, NY.
Utilization of otolaryngologic surgical procedures performed in Syracuse, NY, during 1983 and 1984 was evaluated. Both inpatient and outpatient procedures were included; classification was according to diagnosis related groups. The system-wide portion of the analysis demonstrated that 62.5% of otolaryngologic operations carried out during the study were performed in outpatient settings. Total utilization was highest for myringotomies, tonsillectomies, and adenoidectomies, over 80% of which were performed on an outpatient basis. The program-specific portion of the analysis indicated that the highest volumes for these procedures were produced by a free-standing ambulatory surgery program with dedicated facilities and staff. However, a hospital-integrated program, which made use of inpatient resources, also served a majority of total hospital cases for several types of procedures.
Adenoidectomy↗
Total cholecystectomy utilization by diagnosis related group.
Utilization rates for total cholecystectomy by diagnosis related group in Sacramento, Calif, and Syracuse, NY, between 1981 and 1984 were studied. The two areas had similar hospital discharge rates and bed supplies. The data included 8989 discharges. Discharge rates for the combined cholecystectomy diagnosis related groups differed by only 1% to 3%. Syracuse mean stays for these categories exceeded those of Sacramento by 34% to 38% and were the principal cause of differences in hospital utilization for the procedure. These differences were related to more conservative community-wide physician practice patterns in Syracuse rather than to differences in the composition of the samples by age and payor status, or to the impact of length of stay variability. In the future, shorter stays for cholecystectomy, such as those of Sacramento, may become the norm for the entire nation.
Adult↗
Obstetric hospital stays by diagnosis related groups: a community-based analysis.
The study analyzed obstetric inpatient hospital stays by diagnosis related group in Sacramento, California, and Syracuse, New York, two areas with similar admission rates, between 1981 and 1984. The sample included 123,308 hospital discharges. The data indicated that aggregate obstetric stays in Syracuse were 32.9% longer than those in Sacramento, which was typical of differences between these stays in the western and northeastern United States. Obstetric stays in both areas declined between 1981 and 1984; however, the rate of decline in Sacramento (6.1%) was substantially higher than that of Syracuse (3.5%). Variability of obstetric stays was substantially lower in Syracuse for most diagnosis related groups, including those with the largest caseloads. These results suggest that community and regional differences in obstetric hospital stays may be produced by system-wide consumer preferences and physician practice patterns, more than by hospital bed availability, health maintenance organization activity, or other factors.
California↗
Differences in hospital discharge rates. A community-based analysis.
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California↗
A community-based analysis of ambulatory surgery utilization.
We conducted a study to determine the utilization level for ambulatory surgery and the proportions of specific procedures which could be performed in certain ambulatory settings in one community, Syracuse, New York, which has used this service extensively. It was estimated that, in 1983, 26.9 surgery cases per 1,000 population in Syracuse were performed in ambulatory settings. This level amounted to approximately 37 per cent of hospital-based surgery in the area. Analysis of surgery utilization in two hospital-integrated and freestanding ambulatory surgery facilities indicated that more than 95 per cent of myringotomies, tonsillectomies, and adenoidectomies as well as substantial proportions of carpal tunnel releases, lens extractions, sterilizations, circumcisions, and inguinal hernia repairs in these two facilities were performed in ambulatory settings. The availability of dedicated facilities and full-time staff produced higher utilization for these procedures in freestanding facilities. The utilization levels for individual procedures identified in the study can be employed in the planning of hospital-integrated and freestanding programs.
Adenoidectomy↗
The impact of outpatient surgery on hospitalization.
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Ambulatory Surgical Procedures↗
A community-based analysis of regional differences in hospital stays by diagnosis related group.
Most research on regional differences in hospital stays focuses on systemwide influences, the relative availability of hospital beds, and utilization control mechanisms. In this study, we used a different approach to account for utilization differences between Sacramento, California, and Syracuse, New York: by comparing hospital mean stays at the aggregate level and by diagnosis related groups. We conclude that the shorter mean stays in Sacramento, at both the aggregate and the DRG-specific levels, were produced by a complex variety of factors rather than by systemwide differences in demographics, institutional bed availability, or health maintenance organization penetration. We also found that the largest differences between stays in the two areas were associated with DRGs containing large numbers of elderly, nonsurgical patients.
Adult↗
Impact of selected diagnosis-related groups on regional neonatal care.
The evaluation and reimbursement of hospital use by means of diagnosis-related groups (DRGs) may have a major impact on the utilization of regional neonatal care. Medicare has already implemented the DRG system and other payors, including Medicaid, Blue Cross, and commercial insurance, are also considering adopting it. Under this approach, neonates are assigned to one of seven DRGs, each of which is reimbursed at a relatively fixed rate. An evaluation of hospital utilization by neonates focused on three of these DRGs in four regional neonatal systems located in Upstate New York. Calendar year 1983 data indicated that Level III, II, and I neonatal facilities generated substantially different mean stays for these DRGs in the four regions. The ranges of mean stays between Level III and Level I facilities were greatest for DRGs involving neonates who died or were transferred and those with extreme immaturity and/or respiratory distress syndrome. Federal length of stay and cost standards for these categories failed to address the different utilization experience of these levels of care. The analysis suggests that, as additional payors adopt DRGs, the standards relating to neonatal care must be modified.
Catchment Area, Health↗
Community based analysis of Medicare inpatient utilization: DRG 468.
This study of Medicare inpatients in Syracuse, New York; demonstrated that most DRG 468 discharges were produced by a limited range of procedures and diagnoses. It also showed that patients were assigned to DRG 468 because of procedures wholly unrelated to the principal diagnoses, procedures that resulted from systemic difficulties, and procedures clinically unrelated to principal diagnoses which were assigned to different MDCs by DRG logic.
Catchment Area, Health↗
Stroke hospitalization under prospective payments: analysis of diagnosis related group 14.
Development of a hospital prospective payment system (PPS) for Medicare patients based on diagnosis related groups (DRGs) should generate renewed interest in acute care utilization by stroke patients. Within the PPS, these patients are classified as DRG 14--specific cerebrovascular disorders except transient ischemic attacks. Hospitals are paid a relatively fixed rate for each Medicare patient within this category. In order to investigate patterns of inpatient care for this DRG, hospital utilization patterns in four United States metropolitan areas with a variety of acute and long-term care utilization characteristics were compared. The study involved a total of 4,593 discharges in DRG 14. Hospital discharge and admission rates and mean stays of the four sample populations were evaluated. Data demonstrated that discharge and admission rates of the four areas in this DRG were similar. However, the results also indicated that mean stays for DRG 14 varied by over 100%. These differences could not be explained by differences in age level and payor status of sample populations. Some variations appeared to be related to limitations in the availability of nursing home beds for posthospital care stroke patients. These results suggest that efforts to improve the efficiency of hospital care for stroke patients under DRGs must increasingly focus on long-term care services.
Adolescent↗
Diagnosis-related groups analysis of medical care in four American cities.
The introduction of diagnosis-related groups (DRGs) into American medical care is having a considerable impact on hospital finance and utilization. Patterns of patient care for individual physicians will also be assessable with this system. We evaluated a one-year sample of data on hospital admissions for ear, nose, and throat disorders in four comparable American cities for length of stay variations. The trends from city to city included a wide variation in rates of admission per population of 100,000, especially in the major head and neck surgery category. Patterns of disease, specifically with regard to dysequilibrium and childhood salivary glands, may be a potentially unknown problem for the communities involved. Even though the present DRG system may be an oversimplified method of describing medical care, it does provide useful information for otolaryngologists-head and neck surgeons.
Costs and Cost Analysis↗
Hospital care gridlock: one community's experience.
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Acute Disease↗
Benchmarking hospital lengths of stay using histograms.
The authors demonstrated that length of stay histograms can provide considerably more benchmark information concerning hospital lengths of stay than numerical benchmarks. Examples of histograms described the complete distribution of hospital stays, as well as levels of outliers, rather than simple numerical averages. Gathering such data led to a clearer understanding of the significant LOS impact of certain DRG outliers in the two different hospitals in Syracuse, NY. Given that the other two communities represented, Seattle, Washington and San Diego, California, were more influenced by extensive managed care penetration, variations in histogram data were less in evidence there. Histograms were designed with bars to show LOS distributions at the 50th, 75th, and 90th percentiles for each of the above DRGs. The greatest variations could be shown when comparing the 1997 LOS data on the various DRGs at the two Syracuse hospitals. At both hospitals the presence of a large contingent of outliers (for different types of mostly medical patients) could be seen as the major factor in driving up their overall LOS.
Benchmarking↗
Combined benchmarking of hospital outcomes and utilization.
A strong case is made for developing quantitative benchmarks for hospital outcomes as well as utilization that includes both acute care re-admissions and lengths of stay. A number of hospitals in two distinctly different geographic health care environments [CA and NY] are studied as to the differences in outcomes and utilization for three of the most common high-cost DRGs. Unscheduled hospital readmissions (within 30 days of initial discharge) were employed as outcome indicators because they reflect both the quality of acute care and the need for case management in the post-discharge period. Benchmark targets were established for patients with a diagnosis of congestive heart failure, acute MI treated medically, or COPD using scattergrams that showed each hospital's mean acute LOS on the x axis and the re-admission rates on the y axis. "Benchmarks were identified as those points with the lowest values for both indicators, as demonstrated by points that were closest to the intersection of the two axes."
Benchmarking↗