Showing papers in "Health Services Research in 1975"

A "desperation-reaction" model of medical diffusion.

Abstract: Knowledge about the adoption and diffusion of innovations is briefly reviewed. A model is then proposed to explain how certain innovations, intended to address dire medical problems, might diffuse in a manner not previously reported, with extensive diffusion occurring during what would be a period of small-scale experimentation and limited adoption in the conventional innovation-diffusion environment. The model is illustrated with findings from a case study of the diffusion of drug therapies for four types of leukemia. Possible implications of "desperation-reaction" diffusion are suggested.

A decision theory approach to measuring severity in illness.

Abstract: The purpose of this study was to evaluate the applicability of a multiattribute utility model for measuring the severity of a patient's illness. A single medical problem (an analysis of the costs and benefits of different burn care systems) was used to test the model. Physicians estimated the relative importance of and severity functions for criteria influencing severity. The model's estimates of severity were compared with survival rates of more than 6000 actual patients and with physicians' rankings of hypothetical patients. Although continued validation is needed, the multiattribute utility model appears to have potential as an index for illness severity and, possibly, health status.

Predicting demand for publicly dispatched ambulances in a metropolitan area.

Abstract: A model to predict demand for publicly dispatched emergency ambulance service in Los Angeles County is constructed using 1970 census tract and land usage data and 1973 population and utilization data. Although data were not available for many communities within the county, results indicate that the mode, which uses four socioeconomic variables, can accurately explain actual variations in ambulance demand for individual communities in Los Angeles County and for larger regions within the county.

Successive intervals analysis of preference measures in a health status index.

Abstract: The method of successive intervals, a procedure for obtaining equal intervals from category data, is applied to social preference data for a health status index. Several innovations are employed, including an approximate analysis of variance test for determining whether the intervals are of equal width, a regression model for estimating the width of the end intervals in finite scales, and a transformation to equalize interval widths and estimate item locations on the new scale. A computer program has been developed to process large data sets with a larger number of categories than previous programs.

Patient referral differences among specialties.

Abstract: Data from the Seventh Periodic Survey of Physicians are examined for differences in referral rates among five major medical specialties. Referral rates for each specialty are regressed against physician-related and patient-related predictor variables. On the basis of Freidson's distinction between "colleague-dependent" and "client-dependent" specialties, the hypothesis tested is that physician-related variables explain more of the variance in referral rates of colleague-dependent than of client-dependent specialists. Although this use of Freidson's classification is not strongly supported by the results, the variables found to correlate with referral differences suggest that public policies aimed to increase access to care may produce a reduction in continuity of care as an unintended second-order effect.

Impact of expanded-duty assistants on cost and productivity in dental care delivery.

Abstract: Data from an experimental dental program are used to develop a linear programming model of dental care delivery that the authors use to examine the economic implications of introducing expanded-duty dental assistants (EDDA's) in three types of dental practices. The authors examine the changes in productivity and profitability that result from hiring one or more EDDAs and conclude that a dentist in solo practice can more than double his net revenue by hiring one EDDA but will not increase his productivity further by hiring additional EDDAs. Two- and three-dentist groups also can increase revenue by hiring EDDAs, but, beyond a certain point, an inverse relationship exists between the number of auxiliaries hired and net revenue generated.

The inverse Gaussian distribution as a model of hospital stay.

Abstract: Properties of the inverse gaussian distribution are presented with comments on fitting the distribution to lentgh-of-stay data. A conceptual framework for the hospitalization process is described; it suggests that the inverse gaussian distribution has considerable potential as both a descriptive and prescriptive model of length of stay, especially in the setting of psychiatric hospitals.

Effect of population and health care environment on hospital utilization.

Abstract: A path analytic test of a causal model linking a county population's demographic and socioeconomic characteristics, the way its hospital services are delivered, and the health care resources available to it with its rate of short-term general hospital utilization is performed using data from 56 New York State counties. The results generally support the model and point to the central importance of an area's hospital bed supply for an understanding of its hospitalization rates. The path analysis reveals the patterns of direct and indirect effects of population and health care environment variables on hospitalization rates and supports the contention that health care environment characteristics intervene between population and hospitalization. The practical implications of these results for those in the health care field are discussed.

Costs of providing dental services for children in public and private practices.

Abstract: This study compares the costs of providing children's dental services in three practice settings: private practices, public mobile clinics, and public fixed clinics. Some 15,000 children were provided comprehensive dental care over a three-year period. Results indicate that costs per visit and per child were lowest in mobile clinics and highest in private practices. The differential was partially explained by differences in productivity but mostly by the fact that the price of services in public practices represented costs of production, whereas in private practices they represented market values.

Determinants of hospital utilization in the Netherlands.

Abstract: Hospital use in the Netherlands is examined in a cross-section analysis of 1969 and 1971 data for 120 service regions. Elasticities of admissions with respect to bed supply and supply of general practitioners are calculated, and the substitutability of first level care (by general practitioners) for hospital care is considered. Substitution effects found indicate that the Dutch government's plan to reduce the ratio of hospital beds to population is feasible.

Enfranchisement and rationing: effects of Medicare on discretionary hospital use.

Abstract: This study examines the effects of Medicare on hospital output using an economic model in which market demand for hospital care is treated as the sum of demands in separable markets. Results indicate that Medicare affected utilization patterns by the elderly, but in terms of an increased level of admissions and increased lengths of stay, not in terms of case mix or (apparently) in the level of the nondiscretionary component of care. However, the results also show the Medicare resulted in rationing of hospital services to patients under 65 years of age: case-specific lengths of stay declined, and there appears to have been a distinct decline in the degree of discretionary hospital use by this patient group.

Accuracy of a health interview survey in measuring chronic illness prevalence.

Abstract: The accuracy of a household health interview survey in measuring the prevalence of chronic illness was tested by comparing survey responses with the same respondents' medical records. Results indicate that the survey is far from a perfect discriminator of recorded medical status. The false-positive rate was 25 percent, and the rate of false negatives was nearly 40 percent. False positives were greater for Mexican-Americans and other nonwhites than for white respondents. The household health interview survey is nonetheless an important planning tool since it reflects respondents' perceived health levels, which may be used to predict utilization of primary medical services.

Input-output analysis and the hospital budgeting process.

Abstract: Two hospitals budget systems, a conventional budget and an input-output budget, are compared to determine how they affect management decisions in pricing, output, planning, and cost control. Analysis of data from a 210-bed not-for-profit hospital indicates that adoption of the input-output budget could cause substantial changes in posted hospital rates in individual departments but probably would have no impact on hospital output determination. The input-output approach promises to be a more accurate system for cost control and planning because, unlike the conventional approach, it generates objective signals for investigating variances of expenses from budgeted levels.

Forecasting patient tray census for hospital food service.

Abstract: Five computerized forecasting models were tested with data on daily patient tray demand in a large medical center food service, and results were compared with intuitive forecasts made by the food service supervisor. All five models gave more accurate results than the intuitive procedure; an adaptive exponential smoothing model was most accurate. The effects of model complexity and data storage requirements are discussed, and simple exponential smoothing is suggested for forecasting patient tray demand in this setting.

Analysis and control of nurse staffing.

Abstract: An information and reporting system based on a regression analysis of historical nurse staffing data is described. The system provides a concise monthly report from which administrators can evaluate the efficiency of scheduling procedures used by nurse supervisors to meet varying patient loads.

Regional planning of maternity services.

Abstract: Analysis of utilization data from maternity units in a ten-county region in New York indicates that more small rural maternity units exist in that region than are needed. A mathematical model is used to ascertain optimal unit sizes, and criteria are developed by which units could be combined for more efficient use of facilities.

Classification of community hospitals.

Abstract: This articles describes the methodology, results, and potential applications of a study conducted by the authors to classify the nation's community hospitals. The classification system is offered as a preferable alternative to the system presently used by the Social Security Administration to implement Section 223 of the Social Security Amendments of 1972 (P.L. 92-603).

Livelihood benefits of small improvements in the life table.

Abstract: This article proposes and illustrates a new lower bound on the economic benefits of reducing the number of deaths due to a particular cause and specifies the underlying economic and demographic assumptions. Unlike previous estimates of the increase in a population's output due to the extension of working lives, this new bound includes the present value to the existing population of avoiding future deaths from the cause. The estimated lower bound of $20 billion benefit from eliminating U.S. male deaths due to kidney and related diseases exceeds by an order of magnitude a previous estimate that considers only current deaths.

Quality of medical care: a factor analysis approach using medical records.

Abstract: A relatively inexpensive, reliable, and unobtrusive method is described for measuring the content of medical care. Factor analysis of the content of the records of more than 11,000 physician-patient encounters from six different health insurance plans extracted four main factors or dimensions that together explained 42 percent of the variance in record content. Appropriate names for these dimensions appear to be: "prevention," "rationality," "verification," and "continuity." The method is tested by scoring the six insurance plans on the four factors.

Internal properties of the CASH nursing care evaluation instrument.

Abstract: This article reports an analysis of the internal properties of an instrument that has been widely used to measure the quality of nursing care. Three-fourths of the 106 questions in the instrument failed to meet minimum standard psychometric test criteria. The better questions dealt with housekeeping rather than nursing duties; the instrument would appear to be reliable as a measure of cleanliness and orderliness, but not of actual nursing care.

Empirical designation of health service areas.

Abstract: A method for identifying viable health service areas for a state is described. A computer program was developed that evaluates combinations of contiguous counties using a set of 56 variables strategic to the construction of health planning areas and the spatial context of health care delivery, in keeping with the structural requirements of the National Health Planning and Resources Development Act of 1974. The objective of the evaluation is to minimize differences among planning regions and between planning regions and the state.