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At least 811 records · Page 45Linked to original sources
PubMed1988

Age and the allocation of medical resources.

How are we to decide where our scarce medical resources are most effectively spent? The notion of a quality-adjusted-life-year has been proposed as a way of doing this. Some economists appear to think that this can be done without making ethical assumptions. We examine the application of this notion to the treatment of premature newborns, and especially to comparisons between the value of medical care for newborns, and the value of medical care for older people. We find that some highly questionable ethical assumptions are involved in such comparisons.

Aged↗
PubMed2005

Patterns of diagnoses in hospital admissions in a multistate cohort of HIV-positive adults in 2001.

BACKGROUND: Admissions for AIDS-related illnesses decreased soon after the introduction of highly active antiretroviral therapy (HAART), but it is unclear if the trends have continued in the current HAART era. An understanding of healthcare utilization patterns is important for optimization of care and resource allocation. We examined the diagnoses for hospitalizations of patients with HIV in 2001. METHODS: Demographic and healthcare data were collected for 8376 patients from 6 U.S. HIV care sites in 2001. We categorized diagnoses into 18 disease groups and used Poisson regression to analyze the number of admissions for each of the 4 most common groups. We also compared patients with admissions for AIDS-defining illnesses (ADI) with patients admitted for other diagnoses. RESULTS: Twenty-one percent of patients had at least 1 hospitalization. Among patients hospitalized at least once, 28% were hospitalized for an ADI. Comparing diagnosis categories, the most common hospitalizations were AIDS-defining illnesses (21.6%), gastrointestinal (GI) diseases (9.5%), mental illnesses (9.0%), and circulatory diseases (7.4%). In multivariate analysis, women had higher hospitalization rates than men for ADI (incidence rate ratio [IRR], 1.50; 95% confidence interval [CI], 1.25-1.79) and GI diseases (IRR, 1.52; 95% CI, 1.15-2.00). Compared with whites, blacks had higher admission rates for mental illnesses (IRR, 1.70; 95% CI, 1.22-2.36), but not for ADI. As expected, CD4 count and viral load were associated with ADI admission rates; CD4 counts were also related to hospitalizations for GI and circulatory conditions. CONCLUSIONS: Five years after the introduction of HAART, AIDS-defining illnesses continue to have the highest hospitalization rate among the diagnosis categories examined. This result emphasizes the importance of vaccination for pneumonia and influenza, as well as prophylaxis for Pneumocystis jiroveci pneumonia. The relatively large number of mental illness admissions highlights the need for comanagement of psychiatric disease, substance abuse, and HIV. Overall, the majority of patients were hospitalized for reasons other than ADI, illustrating the importance of managing comorbid conditions in this population. Data from this cohort of patients with HIV may help guide the allocation of healthcare resources by enhancing our understanding of factors associated with variation in inpatient utilization rates.

AIDS-Related Opportunistic Infections↗
PubMed1986

Priorities in the allocation of scarce resources.

The authors report and comment on student reactions to a clinical example of moral choice in the microallocation of scarce resources. Four patients require dialysis simultaneously, but only one kidney machine is available. What moral, as opposed to clinical, criteria are available to determine who should have priority?

Decision Making↗
PubMed1988

Age as a basis for allocating lifesaving medical resources: an ethical analysis.

In light of the growing prominence of an age criterion in patient selection, it is essential to scrutinize the ethical legitimacy of arguments being offered both for and against using age as a criterion. Accordingly, the present study first explores the primary justifications for an age criterion, then examines the criterion's weaknesses. Weaknesses are grouped into two areas: deficiencies in the justifications of the criterion, and overarching critiques. Finally, a way forward in the midst of the present controversy is suggested. The study's conclusion is that an age criterion per se is unjustified, though age may play a carefully defined role in medical assessments relevant to patient selection.

Age Factors↗
PubMed1994

The patient-physician relationship and the allocation of scarce resources: a law and economics approach.

Patients with insufficient financial resources place physicians in a conflict of interest between the patients' needs and the financial interests of the physician, other patients, and society. Not only must physicians act ethically, but they must avoid liability for violating their legal duties to their patients. The traditional rules of contract and malpractice law that govern the patient-physician relationship do not provide satisfactory guidelines. Better answers are found in the rules of fiduciary law, but only with regard to direct conflicts between patients and physicians and only at the risk of reducing patient access to care. Certain types of legislative action can resolve these conflicts by altering the traditional legal rules, but care must be taken to preserve patient-physician trust, which the legal rules were designed to enhance.

Conflict of Interest↗
PubMed1998

The influence of ill-health experience on the valuation of health.

Social valuations for health states are potentially useful both in clinical decision-making and in health-resource allocation, but there is some evidence that the experience of illness may affect such valuations. This article compares valuations of hypothetical health states obtained from a sample of chronically ill patients, with valuations obtained from a sample of relatively healthy individuals. The instrument used to obtain these values was the EuroQOL 5D questionnaire (EQ-5D). We found that the EQ-5D values of chronically ill patients differed significantly from the values obtained from healthier individuals, particularly in the case of the more severe health states. Healthy individuals assigned negative values to some hypothetical health states, indicating that they consider them to be worse than death, whereas chronically ill patients assigned positive values to all health states. These results raise difficult questions about whose values should count when health-status measures are incorporated in clinical and economic evaluation, and in particular when deciding upon the allocation of scarce resources.

Activities of Daily Living↗
PubMedDate not supplied

Governance in multihospital systems: an assessment of decision-making responsibility.

This study examines decision-making responsibility in multihospital system governance. The investigation focuses on the division of decision-making authority between local (hospital) and corporate boards. Fifteen decision areas were considered, including strategic planning, allocation of financial resources, appointment and evaluation of hospital CEOs, and controlling medical staff privileges. Results suggest moderately high levels of corporate (centralized) decision making in multihospital systems. Findings also indicate that type of decision determines whether control is centralized or decentralized. Most centralized decisions were related to resource allocation, formation of new companies, and changes in by-laws of a system hospital. Most decentralized decisions were related to medical staff privileges, service changes, and hospital strategic planning.

Analysis of Variance↗
PubMed2001

Pupillary responses and processing resources on the visual backward masking task.

Task-evoked pupillary responses were recorded during a visual backward masking task as an index of resource allocation. Increased pupillary dilation indicates increased allocation of processing resources to the task. Consistent with numerous studies, detection accuracy increased with longer interstimulus intervals and approximated no-mask accuracy in the 300-ms condition. Pupillary dilation responses were significantly greater during task performance (cognitive load) than during a passive stimulus viewing condition (no-load) and were significantly greater in the 300-ms condition than the no-mask condition. Consistent with models of early visual information processing, the results suggest that the mask demanded extra processing resources when it followed the target by more than 100 ms. Pupillography methods may be useful in evaluating the contribution and timing of resource-demanding processes during early visual information processing.

Adult↗