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T A Marciniak

Publications and source records attributed to T A Marciniak.

26 records · Page 2Linked to original sources
PubMed1997

Quality improvement activity directed at the national level: examples from the Health Care Financing Administration.

Quality improvement projects coordinated by the Health Care Financing Administration (HCFA) are currently underway to improve the care provided to Medicare beneficiaries. We describe five national quality improvement projects, the End Stage Renal Disease Core Indicators Project, the National Anemia Cooperative Project, the Ambulatory Care Quality Improvement Project, and the Cooperative Cardiovascular Project. We outline the types of intervention strategies employed and compare the approaches used for fee-for-service sites and for managed care plans.

Ambulatory Care↗
PubMedDate not supplied

Influencing care in acute myocardial infarction: a randomized trial comparing 2 types of intervention.

The purpose of this study was to evaluate performance feedback delivered by on-site presentations compared to mailed feedback on improving acute myocardial infarction (AMI) care. We used a randomized trial including 18 hospitals nested within the Cooperative Cardiovascular Project. Patients comprised AMI Medicare patients admitted before (n = 929, 1994 and 1995) and after intervention (n = 438, 1996). Control hospitals received written feedback by mail. The experimental intervention group received a presentation led by a cardiologist and a quality improvement specialist. We assessed the proportion of patients receiving appropriate AMI care before and after the intervention. Both univariate and multivariate analyses demonstrated no effect of the intervention in increasing the proportion of patients who received reperfusion, aspirin, beta-blockers, or angiotensin-converting enzyme inhibitors. On-site feedback presentations were not associated with a larger improvement in AMI care compared to the mailed feedback. Other interventions, such as opinion leaders and patient-directed interventions, may be necessary in order to improve the care of AMI patients.

Aged↗
PubMedDate not supplied

Performance of the '100 top hospitals': what does the report card report?

We examine whether Medicare patients with acute myocardial infarction (AMI) admitted to one of HCIA-Mercer's "100 top hospitals" received better care or had better outcomes than patients treated in other hospitals. Among four hospital peer groups, the top 100 hospitals had similar thirty-day mortality and use of aspirin, beta-blockers, and reperfusion compared with their peers, but lower lengths-of-stay and in-hospital costs, with similar or lower readmission rates. Our findings suggest that the 100 Top Hospitals study may be better suited for identifying hospitals with higher performance on financial and operating measures than superior clinical performance in treating elderly AMI patients. However, there was no evidence that quality was sacrificed for increased financial efficiency among the top 100 hospitals.

Aged↗
PubMedDate not supplied

Accessing NCI's SEER cancer data base with SeerQuery and CD-ROM.

The National Cancer Institute operates the Surveillance, Epidemiology, and End Results (SEER) cancer data base. SEER data are obtained from participating population-based registries that monitor cancer incidence and patient survival in a representative 10 percent sample of the general population. The data cover all cancers (except superficial skin cancers) in the defined regional populations. SeerQuery is a personal computer program for accessing that data on IBM-compatible personal computer compact diskettes in read-only memory (CD-ROM) form. SeerQuery facilitates rapid access to cancer data at minimal cost and effort to the user. SeerQuery is menu-driven, enabling physicians and other health care professionals to query the data base directly. They can use the data to determine cancer frequency, perform cross-tabulation, determine incidence, and calculate survival using such variables as primary cancer site, histologic type, stage, sex, age, and race. The comprehensive data base lacks many selection biases that are inherent in data reported from other sources. SeerQuery has applications in professional education and in cancer control program planning and resource allocation.

Adult↗