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Biomedical subjects

S C Stearns

Publications and source records attributed to S C Stearns.

46 records · Page 3Linked to original sources
PubMed1992

Physician responses to fee-for-service and capitation payment.

The ability to achieve reductions in health care costs is determined in part by physician payment mechanisms. This study observes the response to a change in the reimbursement mechanism by a group of physicians who participated in a fee-for-service plan and then formed an IPA using capitation payment for primary care physicians and a reduced fee schedule for specialists. Patient benefits were similar under the two plans. Analyses of data for a group of continuous enrollees show that the change in the physician payment mechanism was associated with a reduction in hospitalizations but increases in length of hospital stay and number of ambulatory visits. These increases may have occurred because capitation for primary care physicians and a reduced fee schedule for specialists led to a greater number of referrals with no incentive in place for reductions in length of stay for specialty admissions.

Ambulatory Care↗
PubMed1991

Hospital discharge decisions, health outcomes, and the use of unobserved information on case-mix severity.

Although implementation of the Medicare prospective payment system has been accompanied by significant decreases in hospital length of stay, the early discharge of some patients may lead to worse health outcomes, particularly if sufficient aftercare services following hospitalization are not available. This article develops an empirical model of the relationship between the choice of length of stay and patient outcome. The model incorporates information on the severity of a patient's medical condition known by the physician who chooses length of stay for a patient but generally not known by a researcher interested in the factors that affect length of stay and health outcome. Joint estimation of equations for length of stay and health outcome controls for unmeasured aspects of case severity that affect both variables. The ratio of nursing home beds to Medicare enrollees in the county is included as an exogenous variable in both equations to assess whether variation in nursing home bed availability is correlated with length of stay or health outcome. The model is estimated using billing data for Medicare patients admitted with congestive heart failure to New Jersey hospitals during 1982 and 1983. Two measures of outcome are used: (1) a discrete measure of survival time following admission, and (2) a categorical measure of whether or not the patient was discharged dead or died within six months after discharge. Empirical results show no evidence that longer lengths of stay for congestive heart failure patients lead to lower postadmission mortality. However, greater availability of nursing home beds may reduce length of stay and may shift the provision of terminal care away from a hospital setting. Therefore, policies to expand the nursing home bed supply may enable further decreases in hospital length of stay without deleterious effect on patient outcome.

Aged↗
PubMed1987

The selection-arena hypothesis.

The selection arena hypothesis offers one answer to a puzzling question. Why do some organisms produce many more fertilized zygotes than are actually reared to hatching, birth, or release-then neglect, discard, resorb, or eat some of them, or allow them to eat each other? It makes four assumptions: (1) zygotes are cheap; (2) after conception the investment of parental time, energy, or risk into offspring continues; (3) offspring vary in fitness; (4) variation in offspring fitness can be identified by the mother at an early stage of the life cycle. If these assumptions hold, then one general prediction follows: the parent should overproduce zygotes, identify those with lower expected fitness, then either kill and reabsorb them, let them be eaten by sibs, or simply stop feeding them in order to invest in more promising offspring. The explanation appears to apply to a wide range of phenomena whose common cause had not previously been appreciated. These include: (1) polyovulation in some bats, tenrecs, the plains viscacha, and the pronghorn antelope; (2) cases of recurrent, consecutive, spontaneous abortions in humans; (3) some cases of surplus flower production and fruit abortion; (4) sex-ratio adjustment in red deer, mice, and coypus; (5) some types of cannibalism, including possible cases in mice, sharks, and wasps. Some cases that might be explained by the selection arena hypothesis are also plausibly explained by other causes, including bet-hedging reproductive investment in the face of unpredictable food supplies, and inter-specific or inter-familial aggression as an alternative to parent-offspring or sib-sib cannibalism.

Animals↗
PubMed1982

On inference in ecology and evolutionary biology: the problem of multiple causes.

If one investigates a process that has several causes but assumes that it has only one cause, one risks ruling out important causal factors. Three mechanisms account for this mistake: either the significance of the single cause under test is masked by noise contributed by the unsuspected and uncontrolled factors, or the process appears only when two or more causes interact, or the process appears when there are present any of a number of sufficient causes which are not mutually exclusive. In ecology and evolutionary biology, experiments usually test single factor hypotheses, and many scientists apparently believe that hypotheses incorporating several factors are so much more difficult to test that to do so would not be practical. We discuss several areas in ecology and evolutionary biology in which the presupposition of simple causation has apparently impeded progress. We also examine a more mature field, the study of atherosclerosis, in which single factor studies did significantly delay progress towards understanding what now appears to be a multifactor process. The problem has three solutions: either factorial experiments, dynamic models that make quantitative predictions, response-surface methods, or all three. In choosing a definition for 'cause', we make a presupposition that profoundly influences subsequent observations and experimental designs. Alternative definitions of causation should be considered as contributing to potential cures for research problems.

Aging↗
PubMed1976

Life-history tactics: a review of the ideas.

This review organizes ideas on the evolution of life histories. The key life-history traits are brood size, size of young, the age distribution of reproductive effort, the interaction of reproductive effort with adult mortality, and the variation in these traits among an individual's progeny. The general theoretical problem is to predict which combinations of traits will evolve in organisms living in specified circumstances. First consider single traits. Theorists have made the following predictions: (1) Where adult exceeds juvenile mortality, the organism should reproduce only once in its lifetime. Where juvenile exceeds adult mortality, the organism should reproduce several times. (2) Brood size should macimize the number of young surviving to maturity, summed over the lifetime of the parent. But when optimum brood-size unpredictably in time, smaller broods should be favored because they decrease the chances of total failure on a given attempt. (3) In expanding populations, selection should minimize age at maturity. In stable populations, when reproductive success depends on size, age, or social status, or when adult exceeds juvenile mortality, then maturation should be delayed, as it should be in declining populations. (4) Young should increase in size at birth with increased predation risk, and decrease in size with increased resource availability. Theorists have also predicted that only particular combinations of traits should occur in specified circumstances. (5) In growing populations, age at maturity should be minimized, reproductive effort concentrated early in life, and brood size increased. (6) One view holds that in stable environments, late maturity, broods, a few, large young, parental care, and small reproductive efforts should be favored (K-selection). In fluctuating environments, early maturity, many small young, reduced parental care, and large reproductive efforts should be favored (r-selection). (7) But another view holds that when juvenile mortality fluctuates more than adult mortality, the traits associated with stable and fluctuating environments should be reversed. We need experiments that test the assumptions and predictions reviewed here, more comprehensive theory that makes more readily falsifiable predictions, and examination of different definitions of fitness.

Age Factors↗
PubMedDate not supplied

The experimental evolution of aging in fruitflies.

The evolutionary theory of aging suggests that the level of repair will evolve to an intermediate optimum that permits the accumulation of random damage to cells. This, in turn, causes a decline in essential functions during the life span of an organism. The central claim of the life history theory of aging is that intrinsic mortality rates evolve in response to changes in extrinsic mortality rates. To prove this central claim, it must be evaluated experimentally. Experimental evolution is an approach that has been yielding interesting results from both a variety of questions posed and organisms examined. In this article the organism chosen for study is the fruitfly (Drosophilia melanogaster) in which the evolutionary effects of high and low adult mortality rates are compared. It has been found that higher extrinsic mortality rates lead to the evolution of higher intrinsic mortality rates and a shorter life span. This is the first clear experimental demonstration of the central claim of the evolutionary theory of aging.

Aging↗
PubMedDate not supplied

Premium increases and disenrollment from state risk pools.

State risk pools exist primarily for persons who want to buy health insurance, but are either medically uninsurable or are only able to find a policy at considerably higher cost than the rate for a standard insured person. While some people enroll in state risk pools for extended periods, many enroll only for a limited time. This study analyzes duration of enrollment in eight state risk pools using data from 1988 through 1991. A discrete time hazard model provides estimates of the relationship between voluntary disenrollment and enrollee and plan characteristics. Among other findings, the regressions provide evidence of substantial increases in disenrollment in most states in response to premium increases that either were implemented by the plan or occurred as enrollees aged into higher risk categories.

Adolescent↗