Showing papers in "Journal for Healthcare Quality in 1984"

Linking Financial Analysis And Quality Assurance Using

Abstract: EDITOR’S NOTE: One of the presentations giuen at the annual conference of the National Association of Quality Assurance Professionals focused on the deuelopment and application of Patient Management Categories. Patient Management Categories are a patient classification that is a substitutable alternatiue to the DRGs (Diagnosis Related Groups) used in the Medicare Prospective Payment System. This article prouides highlights of the presentation made by Dr. Wanda W . Young, uice president of research at Blue Cross of Western Pennsylvania. The measurement of hospital case mix has been recognized for some time as a critical ingredient not only for achieving more equitable reimbursement but for improving hospital management through institutional planning and quality assurance. There has been some question, however, whether one measure can be used effectively for these multiple applications. The answer to this question depends, for the most part, on the basis of the case-mix measure being used, that is, the patient classification. The way in which patients are categorized for payment and/or review is critical to an effective hospital program which links financial analysis and quality assurance. This link between payment and quality assurance cannot be made effective using most existing patient classifications. This is primarily because the individual patient categories in these classification systems are not clinically specific enough to be both interpretable by physicians (in terms of similar clinical management) and useful in predicting total resource use or hospital costs. This article presents a description of how Patient Management Categories a patient classification developed by researchers at Blue Cross of Western Pennsylvania with a six-year grant from the Health Care Financing Administration’ can be an effective tool for making this linkage. The usefulness of Patient Management Categories in a quality assurance program is based on two unique characteristics of this case mix system. First, each patient category was defined to be clinically specific enough to enable physicians to infer similar clinical management for the patients who are assigned to that category. Second, for each Patient Management Category, physicians went on to explicitly specify types and quantities of services required for the effective management of a typical patient in that category. With this state-of-the-art technology available specifically, computerized Patient Management Categories and a physician specified management strategy for each category profiles of care can be developed for two purposes:

Education Improved Use of Prophylactic Antibiotics

Abstract: Antibiotics are among the most commonly used drugs in hospitalized patients. About 45 percent of surgery patients receive antibiotics to prevent postoperative infection.’ Several studies have reported that prophylactic antibiotics are often used inappropriately. 2-5 Little is known about the effectiveness of educational programs to improve this use in pediatric patients. The objective of this study was to assess the changes in the use of preoperative antibiotics in pediatric surgery patients prior to start and after completion of an educational program.

THE VALIDITY OF DIAGNOSIS RELATED GROUPS (DRGs)

Abstract: INTRODUCTION The most frequently cited problem confronting the health care industry is rapidly rising costs, particularly the costs of hospital care. During 1982, America’s medical bill climbed by 12.5% to $322 billion, or more than one-tenth of the gross national product (GNP). This marked the first time that medical costs exceeded 10% of the nation’s GNP. Inflation in the hospital sector increased three times faster than the overall rate of inflation in 1982 (1). These increases in the cost of hospital care have serious implications for the federal government as a purchaser of hospital services. In 1983, Medicare outlays for hospital services will exceed $37 billion, as compared to only $3.2 billion in 1967 (1). Medicare expenditures for hospital services have increased 19.2% annually between 1979 and 1982. In 1982 when inflation was 5%, hospital costs rose 15.5%. The per diem cost of a hospital stay has risen from $40 in 1967 to $144 in 1978 to $304 in 1983. At the current rate of growth, expenditures for Medicare beneficiaries are expected to reach $110 billion by 1987, with approximately 70% going to the hospital sector (2). If these levels are reached, the Medicare Hospital Insurance Trust Fund outlays will exceed income and the Fund would become insolvent.