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PubMed1995

[Excess mortality of severely handicapped patients in mandatory health insurance].

The introduction of compulsory long term care insurance as of 1.1. 1995 has temporarily brought to an end a whole range of controversial discussions, which have been strongly coloured by party political interests. The originally planned expenditure figure of at least DM 30 billion represents an enormous outlay in these time of economic recession. It is already abundantly clear that the premium payments will not be sufficient in the long run, nor will it be possible to increase these premiums arbitrarily. This therefore elicits the question as to whether it is possible to calculate in advance the cost of treatment for those "in serious need of nursing care" on the basis of various factors such as age, sex, underlying illness, therapy and social integration. Up to now, there has been very little statistical analysis of these parameters. For this reason, the company MDK has carried out a preliminary survey (which so far has only looked at a limited number of cases) in order to obtain a general idea of the variations in the period required for long term care. This survey has shown that there are two main groups of cases requiring care, which can be differently assessed on the basis of age and sex. On the one hand, there are those in serious need of nursing care, who, due to a life-threatening disease or as a result of an acute deterioration of an existing chronic condition (e.g. severe KHK, cirrhosis of the liver, decompensated renal insufficiency) die a relatively short time after the application for care is made.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Excess mortality in small dialysis centers. The result of dialyzing high-risk patients.

End Stage Renal Disease Network 12 regularly collects information describing the Medicare dialysis population within its boundaries (Iowa, Nebraska, Missouri, and Kansas). Hoping to foster a regional quality improvement program, Network 12 began calculating provider specific mortality rates in 1988. These rates were extremely variable, but small dialysis units (< or = 30 patients) generally had higher mortality rates than their larger counterparts. To determine why mortality rates were inversely proportional to the number of patients treated within the center, we undertook a more intensive statistical review of patient mortality rate within the network. Actual and expected mortality rates were derived for each Network 12 dialysis center. Forty-eight percent of dialysis centers served 30 or fewer patients (small centers), and 40% had an expected mortality rate < or = 5 deaths per year. In 1989 and 1990, the crude mortality rate for dialysis centers enrolling 30 or fewer patients exceeded that of larger dialysis centers (p = 0.02). When Standardized Mortality Ratios were analyzed, this relationship disappeared (p = 0.83). Statistical review of dialysis providers is a complex process. Adjusting mortality rates for patient characteristics known to influence survival obviated the relation of dialysis unit size to patient mortality rate within Network 12. This suggests that patients were not randomly assigned to dialysis units and that small providers enrolled a disproportionate number of high risk patients. Adjusting mortality rates for endemic patient characteristics did not reduce the extreme variability noted in small mortality rates. This uncertainty, embedded in probability theory, cannot be eliminated from the statistical analysis of small samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodialysis Units, Hospital↗
PubMedDate not supplied

Reovirus associated with excessive mortality in young bobwhite quail.

Multiple submissions of bobwhite quail (Colinus virginianus) were received for diagnosis from a commercial-size quail operation. The history and clinical signs included respiratory distress, lethargy, and substantial mortality. Reovirus was recovered from quail in the first submission, and both reovirus and adenovirus were isolated from later submissions. To determine the pathogenicity of the isolated reovirus, the initial isolate was inoculated into young quail from a different source. Those inoculated by the subcutaneous route became lethargic, and more than half died during the 2 weeks of the trial. Reovirus was recovered from a high percentage of those inoculated by this route. To the authors' knowledge, the isolation of reovirus from quail has rarely been reported, and reovirus has never before been suggested as a pathogen in this species.

Animals↗