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PubMed2002

Regional variation in medical systems data: influences on upcoding.

Attempts to minimize over-reimbursement to health care providers have resulted in highly publicized prosecution of health care providers and provider organizations. Such prosecution has led many to propose that upcoding influences exerted upon health care information managers would largely disappear, both within and external to the provider organization. This study seeks to examine the degree of both intra- and extraorganizational influences on reimbursement optimizing practices through a national survey of accredited health information managers. Results suggest that significant upcoding influence continues to occur within organizations, despite the risk of severe counterfraud penalties designed to eliminate such practices. We examine variation in intra- and extraorganizational optimizing influences, finding such influence was found to exist both within and external to the provider organization. We also examine how optimization influences vary across demographic, practice setting, and market characteristics. We find significant variation in influence across practice settings and managed care markets. Ramifications for reimbursement assessment are discussed.

Abstracting and Indexing↗
PubMed1993

Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system.

BACKGROUND: Previous studies have found racial differences in the use of invasive cardiovascular procedures, which may be due in part to the greater financial incentives to perform such procedures in white patients. In Department of Veterans Affairs hospitals, direct financial incentives affecting use of the procedures are minimized for both patients and physicians. METHODS: We conducted a retrospective analysis of the use of cardiovascular procedures among black and white male veterans discharged from Veterans Affairs hospitals with primary diagnoses of cardiovascular disease or chest pain during fiscal years 1987 through 1991. We used coded discharge data to determine whether cardiac catheterization, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting was performed during or immediately after such admissions. We used logistic-regression analysis to adjust for the primary discharge diagnosis, the presence of coexisting conditions, age, marital status, type of eligibility to receive care at Veterans Affairs hospitals, geographic region, and whether the hospital was equipped to perform bypass surgery. We classified the primary diagnosis as myocardial infarction, unstable angina, angina, chronic ischemia, chest pain, or "other" cardiovascular diagnosis. RESULTS: After we adjusted for all the potential confounders, we found that white veterans were more likely than black veterans to undergo cardiac catheterization (odds ratio, 1.38; 95 percent confidence interval, 1.34 to 1.42), angioplasty (odds ratio, 1.50; 95 percent confidence interval, 1.38 to 1.64), and coronary artery bypass surgery (odds ratio, 2.22; 95 percent confidence interval, 2.09 to 2.36). CONCLUSIONS: Even when financial incentives are absent, whites are more likely than blacks to undergo invasive cardiac procedures. These findings suggest that social or clinical factors affect the use of these procedures in blacks and whites.

Adult↗
PubMed1998

Integrating population health concepts, clinical guidelines, and ambulatory medical systems to improve diabetes care.

The integration of clinical guidelines with office systems has great potential to improve population health. This article shows how simple office systems can be developed and applied to expand the impact of clinical guidelines on the health of populations of patients enrolled in managed care organizations, using diabetes as an example. The basic tools needed to improve population health include (1) clinical guidelines that clearly articulate important and specific health goals; (2) a clinical database that can identify patients who are eligible for guideline-recommended care, monitor this group of patients, and classify patients who need different levels of intervention; and (3) clinics that are organized in a way that facilitates provision of guideline-directed clinical care based on cues from the clinical database. This article illustrates a successful application of this strategy to improve the care of a population of patients with diabetes enrolled in health maintenance organization-owned clinics.

Ambulatory Care Information Systems↗
PubMed2006

Corneal toxicity from topical ocular and systemic medications.

PURPOSE: To review what is known about the adverse effects on the cornea from various classes of medications. New data from previously unreported cases of drug-related corneal toxicity are included. METHODS: Data are garnered from a Medline literature review and from case reports collected by the World Health Organization, the Food and Drug Administration, and the National Registry of Drug-Induced Ocular Side Effects. RESULTS: Aminoglycosides, bisphosphonates, chemotherapeutic medications, cyclooxygenase-2 inhibitors, fluoroquinolones, glaucoma eye drops, topical iodine, nonsteroidal anti-inflammatory eye drops, preservatives in eye drops, retinoids, topical anesthetics, topical steroids, and some herbal medications can cause corneal toxicity in some patients. CONCLUSION: Ophthalmologists need to be aware of potential corneal toxicities that can arise from commonly prescribed medications.

Cornea↗
PubMed1982

Wound healing: a review. IV. Systemic medications affecting wound healing.

Physicians performing dermatologic surgery should include a thorough drug history in their preoperative assessments of patients. Such information may allow for the discontinuation, if desired, of drugs that negatively influence the wound-healing process. In some instances, the surgeon may find it useful, during the perioperative period, to substitute a drug known to impede wound healing with another possessing no untoward effects. In other situations, as in the treatment of keloids, physicians may wish to introduce drugs known to reduce scar formation into the biologic environment in which wound healing ensues.

Adrenal Cortex Hormones↗