Showing papers by "Lee A. Green published in 1996"

Users' Guides to the Medical Literature: XI. How to Use an Article About a Clinical Utilization Review

Abstract: CLINICAL SCENARIO You are a general internist attending a medical advisory committee meeting as the newly appointed chief of staff in a large community hospital affiliated with a major health maintenance organization. A junior administrator presents data showing that the hospital's utilization of percutaneous transluminal coronary angioplasty (PTCA) is high relative to similar-sized centers with similar numbers of interventional cardiologists. He insinuates that unnecessary PTCAs are being done. The cardiologists present are infuriated, and the meeting degenerates into a shouting match. After the hospital chief executive officer brings the meeting back to order, you and the chief of cardiology agree to research the matter independently and report back in 1 week. THE SEARCH Raw utilization data are insufficient to assess whether cardiologists at your hospital are using PTCA inappropriately. You need to review their practice in light of criteria for deciding whether each application of PTCA was likely, given a

Practical issues in conducting small-area variation analysis.

Abstract: BACKGROUND AND OBJECTIVES This paper provides a detailed examination of the conduct of a small-area variation analysis (SAVA) health services research project to aid other researchers in performing and interpreting such projects. STUDY CONDUCT SAVA was performed on hospital admissions with suspected acute cardiac ischemia in the state of Michigan, and the details of each of the steps are presented. The study team consisted of the principal investigator, a biostatistician, a health economist, a medical geographer, and a systems analyst. Data were obtained from the state hospital association and from a commercial demographics source. Small areas for analysis were defined by a patient origin clustering method. Crude area rates were adjusted for age and gender composition of small areas. Multivariate Poisson regression that included sociodemographic variables was performed on adjusted rates. Issues in interpretation of SAVA and practical barriers to primary care SAVA are discussed.