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Robert A Lowe

Publications and source records attributed to Robert A Lowe.

At least 19 recordsLinked to original sources
PubMed2006

Ambulance diversion and lost hospital revenues.

STUDY OBJECTIVE: We estimate ambulance revenues lost from each hour spent on ambulance diversion at an urban teaching hospital's emergency department (ED) and examine the financial impact of increased ICU capacity, which reduced diversion hours by 63%. METHODS: This was a secondary analysis of administrative data to determine the time and date of ambulance arrivals, as well as the insurance status and revenues from each ED patient arriving by ambulance between January 1, 2002, and December 31, 2003. The primary outcome measure was hourly revenues (ie, payments to the hospital) for ambulance patients. RESULTS: Ten thousand three hundred one adult, non-trauma-system ED patients arrived by ambulance in 2002 and 2003, with average hospital revenues of 4,492 dollars. Each hour spent on diversion was associated with 1,086 dollars (95% confidence interval 611 dollars to 1,461 dollars) in forgone hospital revenues from ambulance patients. In August 2002, the study hospital increased its staffed ICU beds from 47 to 67, and diversion decreased from an average of 307 to 114 hours per month. In association with the reduction in diversion, the hospital received more patients by ambulance, which translated into approximately 175,000 dollars in additional monthly revenues from ambulance patients. However, these gains were relatively small in relation to total ambulance revenues and to their large monthly variance. CONCLUSION: Ambulance patients generated substantial revenues for hospital services. Decreasing diversion time led to improved revenues. The potential for increased revenues may provide some incentive for hospitals to take greater efforts to reduce ambulance diversion.

Adult↗
PubMed2006

Changes in access to primary care for Medicaid beneficiaries and the uninsured: the emergency department perspective.

Reductions in scope of benefits and stricter premium and co-payment policies in the Oregon Health Plan (OHP) led to a large drop in OHP enrollment. Outpatient psychiatric benefits were eliminated for approximately 25% of enrollees. One measure of access to care is ED use. We used administrative data from our ED from August 1, 2001, through June 30, 2004, comparing ED use before vs after the March 1, 2003, cutbacks. Before the cutbacks, 38% of ED visits were by OHP beneficiaries, falling to 32% afterward. Visits by the uninsured rose from 18% before to 22% afterward. The proportion of visits for psychiatric conditions covered by OHP fell from 41% [corrected] to 31% [corrected], although the proportion by uninsured patients rose from 16% to 23%. These findings suggest a worrisome reduction in access to medical care for uninsured Oregonians and unstable access for OHP enrollees, especially for behavioral health conditions.

Cohort Studies↗
PubMed2006

EMTALA, two decades later: a descriptive review of fiscal year 2000 violations.

PURPOSE: To determine to what extent cases sanctioned under the Emergency Medical Treatment and Active Labor Act (EMTALA) reflect willful refusal of screening or stabilization. BASIC PROCEDURES: The Centers for Medicare and Medicaid Services were petitioned for all confirmed EMTALA citations from year 2000. Each citation was classified into one of three categories: (1) willful refusal to perform a screening exam or to stabilize; (2) possible refusal to screen or stabilize; or (3) no evidence of refusal to screen or stabilize. Citations were reviewed to determine the presence of 10 other characteristics. Three investigators independently reviewed a subset of data to verify acceptable inter-rater reliability. FINDINGS: We received 157 (53%) of the 294 records requested. Of the 131 involving ED personnel, 44 (34%) demonstrated willful refusal of screening or stabilization. Thirty-two (24%) were possible refusals of service, and 55 (42%) contained no evidence of refusal. PRINCIPAL CONCLUSION: Emergency department willful refusal of screening and stabilization still occurs despite enforcement of EMTALA.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Thinking big.

Explore the source record for details and available documents.

Adolescent↗
PubMed2006

Pressure ulcers among elderly patients early in the hospital stay.

BACKGROUND: Pressure ulcers among elderly hospital patients diminish quality of life and increase the cost of hospital care. Evidence suggests that pressure ulcers can arise after only a few hours of immobility. The goals of this study were to estimate the incidence of hospital-acquired pressure ulcers in the first 2 days of the hospital stay and to identify patient characteristics associated with higher incidence. METHODS: A prospective cohort study was performed between 1998 and 2001. A total of 3233 patients 65 years old or older admitted through the Emergency Department to the inpatient Medical Service at two study hospitals were examined by a research nurse on the third day of hospitalization. Pressure ulcers were ascertained using standard criteria and were classified as either preexisting, possibly hospital-acquired, or definitely hospital-acquired. RESULTS: There were 201 patients with one or more possibly or definitely hospital-acquired pressure ulcers for a cumulative incidence of 6.2% (95% confidence interval, 5.4%-7.1%). Most of the pressure ulcers were stage 2, and the majority were in the sacral area or on the heels. In multivariable analysis, pressure ulcer incidence was significantly associated with increasing age, male gender, dry skin, urinary and fecal incontinence, difficulty turning in bed, nursing home residence prior to admission, recent hospitalization, and poor nutritional status. CONCLUSIONS: A small but significant proportion of elderly emergently admitted hospital patients acquire pressure ulcers soon after their admission. New models of care may be required to ensure that preventive interventions are provided very early in the elderly person's hospital stay.

Aged↗
PubMed2006

Clinical use of the Er,Cr: YSGG laser for osseous crown lengthening: redefining the standard of care.

UNLABELLED: To design the optimal outcome for a patient during aesthetic enhancement, the restorative dentist must seek to create a symmetrical and harmonious relationship between the lips, gingival architecture, and the positions of the natural dentate forms. In the author's experience, the Er,Cr: YSGG laser has been a useful adjunct for performing aesthetic surgical crown lengthening procedures. This article will highlight the associated biological principles and demonstrate techniques for the application of this laser in closed and open crown lengthening procedures. LEARNING OBJECTIVES: This article demonstrates the use of the Er,Cr: YSGG laser for osseous crown lengthening . Upon reading this article, the reader should have: Enhanced awareness of criteria for developing a biologically stable free gingival margin. Greater familiarity with the open and closed crown lengthening procedures, including case selection and surgical approaches.

Alveolar Process↗
PubMed2005

Effect of increased ICU capacity on emergency department length of stay and ambulance diversion.

STUDY OBJECTIVE: Lack of inpatient bed availability has been identified as a major contributor to emergency department (ED) crowding. Our objective is to determine the changes in ED length of stay and ambulance diversion occurring in an urban, academic medical center after an increase in adult ICU beds. METHODS: This was a secondary analysis of 2 years of hospital administrative data, capitalizing on a natural experiment in which the number of adult ICU beds in the study hospital increased from 47 to 67 (total beds 411 to 431). We analyzed changes in ED length of stay for adults admitted to ICU, telemetry beds, and ward beds and adults discharged home. We also analyzed changes in hours per day spent on 3 types of ambulance diversion: complete diversion (all ambulances), critical care diversion (ambulances carrying patients requiring ICU beds), and diversion of ambulances carrying trauma patients. RESULTS: The average hours per day on complete ambulance diversion decreased from 3.8 hours to 1.4 hours (66% decrease). Critical care and trauma diversion showed similar decreases. Average ED length of stay for patients admitted to the ICU decreased by 25 minutes (257 to 232 minutes). Average ED length of stay did not significantly decrease for other admitted patients and increased for discharged patients. CONCLUSION: The most notable change after ICU expansion was a decrease in time spent on ambulance diversion. Increasing ICU beds appears to have shortened ED length of stay for ICU patients but has less effect on other admitted patients and apparently no effect on patients discharged home.

Academic Medical Centers↗
PubMed2005

Association between primary care practice characteristics and emergency department use in a medicaid managed care organization.

BACKGROUND: Many patients use emergency departments (EDs) for primary care. Previous studies have found that patient characteristics affect ED utilization. However, such studies have led to few policy changes. OBJECTIVES: We sought to determine whether Medicaid patients' ED use is associated with characteristics of their primary care practices. RESEARCH DESIGN: This was a cohort study. SUBJECTS: A total of 57,850 patients, assigned to 353 primary care practices affiliated with a Medicaid HMO, were included. MEASURES: Predictor variables were characteristics of primary care practices, which were measured by visiting each practice. The outcome variable was ED use adjusted for patient characteristics. RESULTS: On average, patients made 0.80 ED visits/person/yr. Patients from practices with more than 12 evening hours/wk used the ED 20% less than patients from practices without evening hours. A higher ratio of the number of active patients per clinician-hour of practice time was associated with more ED use. When more Medicaid patients were in a practice, these patients used the ED more frequently. Other factors associated with ED use included equipment for the care of asthma and presence of nurse practitioners and physician assistants. DISCUSSION: Modifiable characteristics of primary care practices were associated with ED use. Because the observational design of this study does not allow definitive conclusions about causality, future studies should include intervention trials to determine whether changing practice characteristics can reduce ED use. CONCLUSIONS: Improving primary care access and scope of services may reduce ED use. Focusing on systems issues rather than patient characteristics may be a more productive strategy to improve appropriate use of emergency medical care.

Adolescent↗
PubMed2005

How primary care practice affects Medicaid patients' use of emergency services.

The use of emergency departments (EDs) in the U.S. continues to rise. Some of these ED visits may reflect limited access to primary care, even among patients with a primary care provider. Payers and policymakers have tried to restrain ED use, because of concern over high charges and discontinuity of care. But most of these attempts have involved erecting financial and administrative barriers to going to the ED, rather than expanding access to primary care. Is it possible to reduce excessive use of EDs by making primary care practices more "user-friendly"? This Issue Brief summarizes research that identifies primary care characteristics associated with ED use in a Medicaid managed care population. It suggests a strategy to simultaneously improve access to primary care and reduce costs of ED care.

Emergency Service, Hospital↗
PubMed2004

Drivers of accident preparedness and safety: evidence from the RMP Rule.

This paper provides an overview of recent results derived from the accident history data collected under 112(r) of the Clean Air Act Amendments (the Risk Management Program (RMP) Rule) covering the period 1994-2000, together with a preliminary assessment of the effectiveness of the RMP Rule as a form of Management System Regulation. These were undertaken at the University of Pennsylvania by a multi-disciplinary team of economists, statisticians and epidemiologists with the support of the US Environmental Protection Agency and its Office of Emergency Prevention, Preparedness and Response (OEPPR, formerly CEPPO). Section 112(r) of the Clean Air Act Amendments of 1990 requires that chemical facilities in the US that had on premises more than specified quantities of toxic or flammable chemicals file a 5-year history of accidents. The initial data reported under the RMP Rule covered roughly the period from mid-1994 through mid-2000, and provided details on economic, environmental and acute health affects resulting from accidents at some 15,000 US chemical facilities for this period. This paper reviews research based on this data. The research is in the form of a retrospective cohort study that considers the statistical associations between accident frequency and accident severity at covered facilities (the outcome variables of interest) and a number of facility characteristics (the available predictor variables provided by the RMP Rule), the latter including such facility characteristics as size, hazardousness, financial characteristics of parent company-owners of the facility, regulatory programs in force at the facility, and host community characteristics for the surrounding county in which the facility was located, as captured in the 1990 Census. Among the findings reviewed are: (1) positive associations with (a measure of) facility hazardousness and accident, injury and economic costs of accidents; (2) positive (resp., negative) associations between accident propensity and debt-equity ratios (resp., sales) of parent companies; (3) several interrelated associations between accident propensity and regulatory programs in force; and (4) strong associations between facility hazardousness, facility locations decisions, observed accident frequencies and community demographics.

Air Pollutants↗
PubMed2003

Factors affecting decisions to seek treatment for sick children in Kerala, India.

The purpose of this study was to measure the effects of social and economic variables, disease-related variables, and child gender on the decisions of parents in Kerala, India, to seek care for their children and on their choice of providers in the allopathic vs. the alternative system. A case-control analysis was done using data from the Kerala section of the 1996 Indian National Family Health Survey, a cross-sectional survey of a probability sample of households conducted by trained interviewers with a close-ended questionnaire. Of the 469 children who were eligible for this study because they had at least one common symptom suggestive of acute respiratory illness or diarrhea during the 2 weeks before the interview, 78 (17%) did not receive medical care, while the remaining 391 (83%) received medical care. Of the 391 children who received medical care, 342 (88%) received allopathic medical care, and 48 (12%) received alternative medical care. In multivariable analyses, parents chose not to seek medical care for their children significantly more often when the illness was mild, the child had a specific diagnosis, the mother had previously made fewer antenatal visits, and the family had a higher economic status. When parents sought medical care for their children, care was sought significantly more often in the alternative provider system when the child was a boy, the family lived in a rural area, and the family had a lower social class. We conclude that, in Kerala, disease severity and economic status predict whether children with acute respiratory infection or diarrhea are taken to medical providers. In contrast, most studies of this issue carried out in other populations have identified economic status as the primary predictor of medical system utilization. Also in Kerala, the gender of the child did not influence whether or not the child was taken for treatment but did influence whether care was sought in the alternative or the allopathic system.

Acute Disease↗
PubMed2003

Accident epidemiology and the U.S. chemical industry: accident history and worst-case data from RMP*Info.

This article reports on the data collected on one of the most ambitious government-sponsored environmental data acquisition projects of all time, the Risk Management Plan (RMP) data collected under section 112(r) of the Clean Air Act Amendments of 1990. This RMP Rule 112(r) was triggered by the Bhopal accident in 1984 and led to the requirement that each qualifying facility develop and file with the U.S. Environmental Protection Agency a Risk Management Plan (RMP) as well as accident history data for the five-year period preceding the filing of the RMP. These data were collected in 1999-2001 on more than 15,000 facilities in the United States that store or use listed toxic or flammable chemicals believed to be a hazard to the environment or to human health of facility employees or off-site residents of host communities. The resulting database, RMP*Info, has become a key resource for regulators and researchers concerned with the frequency and severity of accidents, and the underlying facility-specific factors that are statistically associated with accident and injury rates. This article analyzes which facilities actually filed under the Rule and presents results on accident frequencies and severities available from the RMP*Info database. This article also presents summaries of related results from RMP*Info on Offsite Consequence Analysis (OCA), an analytical estimate of the potential consequences of hypothetical worst-case and alternative accidental releases on the public and environment around the facility. The OCA data have become a key input in the evaluation of site security assessment and mitigation policies for both government planners as well as facility managers and their insurers. Following the survey of the RMP*Info data, we discuss the rich set of policy decisions that may be informed by research based on these data.

Accidents↗