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At least 19 recordsLinked to original sources
PubMed1994

Work placement and worker fitness. Implications of the Americans with Disabilities Act for pulmonary medicine.

Pulmonary physicians have a significant role in assessing the ability of individuals with respiratory impairments to be placed in jobs or retain current jobs. The Americans with Disabilities Act mandates a high level of rational thought and justification for any recommendation against placement or work retention. This article reviews criteria for determining if an individual with a respiratory impairment or disability can currently and safely perform a job and if there is substantial direct threat of future risk. In addition, methods of modifying the workplace to accommodate individuals with respiratory disabilities are discussed.

Persons with Disabilities↗
PubMed1988

DRG prospective, "all payor systems," financial risk, and hospital cost in pulmonary medicine non CC stratified DRGs.

Previous work by our group had suggested that some pulmonary medicine diagnosis-related group (DRGs) did not adequately compensate for patients with multiple complications and comorbidities. Congress has recommended no major changes to pulmonary medicine DRGs along these lines. The purpose of this study was to analyze resource consumption in any of the seven noncomplicating conditions (CC), stratified pulmonary medicine DRGs using the new DRG prospective "all payor system" in effect at our hospital. Analysis of 858 pulmonary medicine patients by payor (Medicare, Medicaid, Blue Cross, and commercial insurance) in these non-CC stratified pulmonary medicine DRGs for a three-year period demonstrated that patients with more CCs per DRG for each payor generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under DRG payment, more outliers, and a higher mortality, compared to patients in these same DRGs with fewer CCs. Both hospital length of stay and total cost per patient (adjusted for DRG weight index) increased with CCs. Financial risk per patient under DRGs also increased as CCs accumulated. These findings suggest that new prospective DRG "all payor systems" may be inequitable to certain groups of patients or types of hospitals vis-a-vis the non-CC stratified pulmonary medicine DRGs. Many pulmonary medicine DRGs should be stratified by the numbers and types of CCs to more equitably reimburse hospitals under DRG all-payor systems.

Academic Medical Centers↗
PubMed1988

Costs of pulmonary medicine and DRGS. Access and quality of care for the future.

Many changes are under way for the payment of physician and hospital care of patients in medicine and the medical subspecialties, i.e., the hospitalized pulmonary medicine patient. The purpose of this study was to characterize hospital resource consumption and outcome by age for pulmonary patients. All pulmonary medicine admissions treated at a large academic medical center from January 1, 1985 through December 31, 1986 were analyzed using the Diagnostic Related Group (DRG) format. Total costs (exclusive of physician fees) for the 2,647 pulmonary patients studied were $19,751,192. Mean hospital cost per patient, hospital length of stay, percentage of outliers, and mortality increased with age. Under the DRG reimbursement mechanism (i.e., All Payor System), a loss was incurred for all patients 45 yr of age and older, which led to an overall fiscal deficit for pulmonary medicine admissions. Medicare patients (n = 930) demonstrated a stronger expression of these trends. DRG case-mix index and the mean number of diagnoses per patient increased steadily with age. Emergency admissions were highest for the young (i.e., 18 to 35 yr of age), for some middle-aged (i.e., 45 to 65 yr of age), and for the very old (80 yr of age). Utilization of the intensive care unit and blood transfusions was higher for older patients; utilization of plasma products showed a more variable pattern, although older patients had greater consumption than their younger cohorts. This study demonstrated several trends with regard to resource utilization and age for pulmonary patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1998

Methodologic standards for diagnostic test research in pulmonary medicine.

STUDY OBJECTIVES: To determine conformance with methodologic standards in the evaluation of diagnostic tests. DATA SOURCES: MEDLINE database search (1992 to 1997) of nine prominent general medicine and six subspecialty journals for articles that report discriminative properties of diagnostic tests in pulmonary medicine. STUDY SELECTION: Articles were eligible if they reported discriminative properties of diagnostic tests in humans, diagnostic tests were intended for the detection of existing conditions, and the target disorder was relevant to pulmonary medicine. DATA EXTRACTION: Each study was critically reviewed independently by two observers. DATA SYNTHESIS: Of the 1,029 retrieved articles, 41 met study inclusion criteria. The median number of the 12 major standards for design fulfilled by study articles was 6 (range, 1 to 12, 25th to 75th percentile, 5.0 to 8.5) and only 2 articles fulfilled all 12 standards. Seven (17%) articles did not report any standard measures of diagnostic accuracy and 7 (17%) provided data only for sensitivity and specificity. Only 4 of 17 articles (24%) that compared different tests used standard statistical methods. CONCLUSION: These results indicate that greater methodologic rigor is needed for studies that evaluate diagnostic tests in pulmonary medicine. Existing deficiencies in methodology risk the introduction of invalid tests into clinical practice.

Area Under Curve↗
PubMed1988

Financial risk, hospital cost, and complications and comorbidities (CCs) in the non-CC-stratified pulmonary medicine diagnostic-related group Medicare hospital payment system.

The purpose of this study was to analyze hospital resource consumption in the 8 noncomplicating condition-stratified pulmonary medicine diagnostic-related groups (DRGs). We analyzed 427 Medicare patients treated during a 2-yr period in these 8 noncomplicating condition-stratified DRGs. Patients with a greater number of complicating conditions (CCs) had higher total hospital costs, a longer hospital length of stay, more procedures per patient, increasing financial risk under DRGs, a larger number of outliers, and a higher mortality than did patients in these same DRGs with a fewer number of CCs. These findings raise the question of the equity of DRG reimbursement at our hospital vis-à-vis the non-CC-stratified pulmonary medicine DRGs. If these findings are generalizable at other teaching hospitals, the current DRG system may provide financial incentives to not treat certain types of pulmonary medicine patients likely to have many CCs, and potentially effect these patient's access and quality of care in the future.

Diagnosis-Related Groups↗
PubMed1986

Factors in the choice of academic or practice careers in pulmonary medicine.

The characteristics, motives, and sources of job satisfaction were compared between persons choosing a research career in academic pulmonary medicine and those choosing a career in the practice of pulmonary medicine. In a first study, established practitioners and academic researchers were asked what the main influences were on their career decisions, from what they obtained job satisfaction, and why they did or did not choose academic medicine. After these results were obtained a second questionnaire was sent to all pulmonary fellows in U.S. programs asking them their future career plans, reasons for their career choices, factors in their job satisfaction, and attitudes toward an academic career. Both current and future researchers desired intellectual challenge, continued learning, and an opportunity to investigate, whereas established and future practitioners derived more satisfaction from patient care. The opportunity to be creative, the chance to work fixed hours, and to gain national recognition were more important to future academic researchers. The prospective practitioners rated helping people, freedom from bureaucracy, and income level as the major determinants of their career choice. In addition to the personal qualities, many environmental factors, such as participating in a successful research project and encouragement from faculty, were important in leading a pulmonary fellow to select a research career.

Career Choice↗
PubMed2004

[Endoscopic ultrasound-guided fine-needle aspiration in pulmonary medicine].

Endoscopic ultrasound-guided fine-needle aspiration has significantly increased the capacity of pulmonary diagnostic procedures. Since this method was introduced, 1212 examinations have been performed at two centres of pulmonary medicine. Data on indications, procedures, findings, diagnostic yield and complications have been recorded. This paper describes the experiences thus gained regarding the possibilities and limitations of the method and assesses the current significance of the technique in pulmonary medicine according to previous studies. In primary diagnosis of mediastinal tissue alterations and in staging of malignant diseases the method offers a low-complication diagnostic measure which has a seminal impact on therapy in many cases, even though in daily practise the diagnostic accuracy of published studies is not always attained.

Biopsy, Fine-Needle↗
PubMed1998

[Decentralized special training in pulmonary medicine. A project using telemedicine].

In arctic Norway, where there is a lack of specialists in pulmonary medicine two postgraduate students, already qualified as specialists in internal medicine at Tromsø Regional Hospital, applied to continue their training at their respective local hospitals. The regional hospital in Tromsø has a long tradition of telemedicine, with network links to local hospitals in the region, and is equipped for interactive consultation and the bilateral transmission of x-rays and video recordings, and digital transmission of x-rays. Accordingly, supported by their supervisor, the two postgraduate students applied to the committee for postgraduate education in pulmonary medicine to have a year's work at their respective local hospitals, supervised via the telemedicine facilities, accepted as equivalent to a six-month module of the normal syllabus. The project was approved and executed as planned. The registrars, who were responsible for pulmonary service at their local hospitals, served four days a month at the regional hospital, and their supervisor visited the local hospitals one day each month. All internal education at the regional hospital was made available by means of a weekly interactive televised link-up, x-rays being displayed on screen as transmitted digitally; bronchoscopies were shown by video, and ad hoc tutorials arranged as needed. Evaluated by the national committee, the project was found satisfactory, and the registrars were duly qualified.

Arctic Regions↗
PubMed1987

Computer-based instruction in clinical medical education: a pulmonary medicine self-assessment.

This computer assisted teaching program was designed to provide a comprehensive review of pulmonary medicine in the form of a self-assessment. The program consisted of 30 questions including multiple choice, true or false and matching questions. The questions were based on the respiratory chapter from a standard textbook of medicine. Forty students taking their mandatory medicine rotation at a major university teaching hospital used the program. Their scores ranged from 46.7% to 93.3% with a mean of 68.1%. The format enabled the student to answer the questions, to quickly determine which ones he got right and wrong and then he was provided with the correct answer and a reference in the respiratory chapter of the standard textbook of medicine on which the assessment was based. A score was given to each individual so that each student could be his own judge as to how well he did. After reading the references for the questions missed, the learner would decide for himself what area of pulmonary medicine deserved further study.

Computer-Assisted Instruction↗
PubMed1989

Health care financing policy for hospitalized pulmonary medicine patients.

Several federal bodies provide ongoing analyses of the Medicare DRG prospective hospital payment system. Many states are using DRG prospective "all payor systems" for hospital reimbursement (based on the federal model). In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers pay by the DRG mode; New York State has been All Payor since 1/1/88. This study simulated DRG All Payor methods on a large sample (n = 1,662) of pulmonary medicine patients for a two-year period using both federal and New York DRG reimbursement now in effect at our hospital. Medicare patients had (on average) a longer hospital length of stay and total hospital cost compared to patients from Medicaid, Blue Cross, and other commercial payors. Medicare patients also had a greater severity of illness compared to patients from Blue Cross Medicaid or other payors. All payors, however, (Medicaid, Blue Cross, Medicare and commercial insurers) generated significant financial risk under the DRG All Payor scheme. These data suggest that federal, state, and private payors may be underreimbursing for the care of the hospitalized pulmonary medicine patients using the DRG prospective hospital payment scheme. Health care financing policy, as demonstrated in this study, may limit both the access and quality of care for many pulmonary medicine patients in the future.

Aged↗