Showing papers in "Journal of Medical Systems in 1999"

Tele-Education in a Telemedicine Environment: Implications for Rural Health Care and Academic Medical Centers

Abstract: Over 50 million people in the United States (about 20% of the population) live in rural areas, but only 9% of the nation's physicians practice in rural communities. It is difficult to recruit and retain rural health care practitioners, partly because of issues relating to professional isolation. New and enhanced telecommunications links between community and academic hospitals show promise for reducing this isolation and enhancing lifelong learning opportunities for rural health care providers. This paper will explore some of the issues involved in using interactive video (telemedicine) networks to transmit continuing medical education programming from an academic center to multiple rural hospitals. Data from a recent University of Iowa survey of the state's health educators will be presented as one approach to assessing the health care marketplace for the deployment of tele-education services.

Using Administrative Databases for Outcomes Research: Select Examples from VA Health Services Research and Development

Abstract: The U.S. Department of Veterans Affairs (VA) operates and maintains one of the largest health care systems under a single management structure in the world. The coordination of administrative and clinical information on veterans served by the VA health care system is a daunting and critical function of the Department. This article provides an overview of VA Health Services Research and Development Service initiatives to assist researchers in using extant VA databases to study patient-centered health care outcomes. As examples, studies using the VA's Patient Treatment File (PTF) and the Beneficiary Identification and Records Locator System (BIRLS) Death File are described.

Estimating Hospital Inefficiency: Does Case Mix Matter?

Abstract: A two-stage approach is used in a stochastic frontier analysis of the factors affecting hospital efficiency. In the first stage, a translog cost-function is used to estimate inefficiency scores. In the second stage, inefficiency scores are regressed against independent variables to test hypotheses that come from X-inefficiency Theory. The study was based on 1989 data for 195 Pennsylvania acute care hospitals. This data base was chosen because of the availability of patient-level severity of illness data, a measure of output that is not available from most data sources. The stochastic frontier analysis models estimated mean inefficiency scores that ranged from 0.075 to 0.180. The addition of the DRG case mix index (CMI) reduced estimated inefficiency by more than 50%. The incremental effect of a severity of illness variable to an equation with CMI was very small. The second-stage results suggest inefficiency and are inversely associated with regulatory pressures and industry concentration.

Secondary Data Bases and Their Use in Outcomes Research: A Review of the Area Resource File and the Healthcare Cost and Utilization Project

Abstract: Secondary data sources are being used more frequently than ever in outcomes research. The speed and relative low cost of these data bases makes them ideal for analyzing outcomes. Today's researcher has numerous secondary data bases available for use. Few publications exist to help researchers locate the ideal data set for their needs. Herein, two national secondary data bases are reviewed: the Area Resource File (ARF) and the Healthcare Cost and Utilization Project (HCUP). These two data sets represent the two types of secondary data: aggregate and individual. ARF represents an aggregate data set and HCUP represents an individual data set. The advantages of each type of secondary data will also be reviewed.

Trends in Hospital Efficiency Among Metropolitan Markets

Abstract: This study evaluates trends in efficiency among American hospital markets. A total of 6010 hospitals were identified for use in the analysis from the American Hospital Association's Annual Surveys for 1989 and 1993. Using data envelopment analysis (DEA), a longitudinal study of hospital efficiency was conducted on all 314 metropolitan markets in the United States. Results suggest that large hospital markets generally demonstrated higher inefficiency. The major inefficiencies exist in the availability of hospital services, the number of operating beds, the utilization of hospital staffing and operating expenses. Consequently, the large hospital market had a significant excess of health manpower that resulted in inefficiency that amounted to approximately d23 billion. From a policy perspective, this study has shed some light on the need to establish more specific policies to address inefficiency in the health care industry.

Analysis of Integrated Healthcare Networks' Performance: A Contingency-Strategic Management Perspective

Abstract: Few empirical analyses have been done in the organizational researches of integrated healthcare networks (IHNs) or integrated healthcare delivery systems. Using a contingency derived context-process-performance model, this study attempts to explore the relationships among an IHN's strategic direction, structural design, and performance. A cross-sectional analysis of 100 IHNs suggests that certain contextual factors such as market competition and network age and tax status have statistically significant effects on the implementation of an IHN's service differentiation strategy, which addresses coordination and control in the market. An IHN's service differentiation strategy is positively related to its integrated structural design, which is characterized as integration of administration, patient care, and information system across different settings. However, no evidence supports that the development of integrated structural design may benefit an IHN's performance in terms of clinical efficiency and financial viability.

The Rate and Risk of Heat-Related Illness in Hospital Emergency Departments During the 1995 Chicago Heat Disaster

Abstract: Objectives: To conduct an Emergency Department (ED)-based treated prevalence study of heat morbidity and to estimate the rate and risk of heat morbid events for all Chicago MSA EDs (N e 95s 2.7 million visits per year). Methods: ED patient log data were compiled from 13 randomly selected hospitals located throughout the Chicago MSA during the 2 weeks of the 1995 heat disaster and from the same 2-week period in 1994 (controls). Measurements included: age, sex, date, and time of ED service, up to three ICD-9 diagnoses, and disposition. Results: Heat morbidity for Chicago MSA hospital EDs was calculated at 4,224 (95%CI e 2964−5488) cases. ED heat morbidity increased significantly 5 days prior to the first heat-related death. In 1995, there was an increase in the estimated relative risk for the city e 3.85 and suburbs e 1.89 over the control year of 1994. Conclusions: Real time ED-based computer automated databanks should be constructed to improve public health response to infectious or noninfectious outbreaks. Rapid area-wide M&M tabulations can be used for advancing the effectiveness of community-based prevention programs, and anticipating hospital ED resource allocation.

International Maternal Mortality Reduction: Outcome of Traditional Birth Attendant Education and Intervention in Angola

Abstract: Background. As a result of war and periodic natural disasters, Angola has among the highest infant and maternal mortality rates in the world. In response to the acute health needs of the population, the International Medical Corps (IMC) developed a traditional birth attendant educational course designed to reduce the preventable causes of maternal and infant mortality. Methods. From 1994 until 1998, Angolan traditional birth attendants (TBAs) participated in an intensive 38-hr training course on prenatal, delivery, and postnatal care. Following the birth of a child, the trained TBAs completed a registration form containing information regarding the health of the mother. Previous studies of Angolan maternal mortality served as historic comparisons. Findings. Complete data including maternal mortality data were available for 19,666 deliveries (83% of total). Fifty five maternal deaths were recorded, which corresponds to a maternal mortality rate of 293 per 100,000 live births. The average historic maternal mortality rate for available comparison groups was 1241 per 100,000 live births. Interpretation. The maternal mortality rate was reduced among women managed by IMC-trained TBAs when compared with historical control data.

Evaluating the Outcome of Two Teaching Methods of Breath Actuated Inhaler in an Inner City Asthma Clinic

Abstract: Objectives: Our objective was to compare two different teaching methods used to educate patients in the use of a breath actuated inhaler (BAI) and to assess the impact of its continued use on their metered-dose inhaler (MDI) technique. Design: Prospective, randomized, controlled trial. Setting: Adult Pulmonary/Asthma clinic of Cook County Hospital, Chicago, IL. Patients: Diagnosed, stable asthmatics. Intervention: The patients were randomized into two groups. The experimental group received verbal instructions and demonstration on breath actuated inhaler technique while the control group received written instructions only on BAI use. The metered dose inhaler technique of both groups of patients was also evaluated. Measures: A checklist evaluating the key aspects of proper BAI and MDI inhalation techniques was used to assess the use of both types of inhalers at entry into the study and upon postintervention follow-up at 8 to 20 weeks. Results: At baseline, 97% of patients in the experimental group and 83% of patients in the control group were initially able to demonstrate BAI inhalation technique correctly. Upon follow-up, 82% of the control group and 68% of the experimental group were able to use the BAI correctly, which was a statistically significant deterioration in the experimental group. In both of these groups, there was a statistically significant improvement in MDI technique. Conclusions: Written instructions alone may be an adequate teaching tool for proper inhalation technique of BAI. Continued BAI use appears not to impact adversely on proper MDI technique.

Computer Assisted Outcomes Research in Orthopedics: Total Joint Replacement

Abstract: Long-term studies are needed to determine clinically relevant outcomes within the practice of orthopedic surgery. Historically, the patient's subjective feelings of quality of life have been largely ignored. However, there has been a strong movement toward measuring perceived quality of life through such instruments as the SF-36. In a large database from an orthopedic practice results are presented. First, computerized data entry using touch screen technology is not only cost effective but user friendly. Second, patients undergoing hip or knee arthroplasty surgeries make statistically significant improvements in seven of the eight domains of the SF-36 in the first 3 months after surgery. Additional statistically significant improvements over the next 6 to 12 months are also seen. The data are presented here in detail to demonstrate the benefits of a patient outcomes program, to enhance the understanding and use of outcomes data and to encourage further work in outcomes measurement in orthopedics.

The Feasibility of Using Automated Data to Assess Guideline-Concordant Care for Schizophrenia

Abstract: This study examines the feasibility of using automated computer data versus written medical record data to identify patients receiving guideline concordant treatment for schizophrenia. Central elements of care derived from published practice guidelines for schizophrenia were examined for a convenience sample of 28 patients who received acute inpatient treatment. The results showed that automated data were superior to medical record data for identifying some elements of guideline-concordant treatment. Not only were the elements of care examined in this study clinically significant and within the current capabilities of the existing computer information system, but they are also likely related to patient outcomes. Implications for clinical care, future research, and health care quality improvement efforts are discussed.

The Public Health Care Planning Problem: A Case Study using Geographic Information Systems

Abstract: We address the problem of designing new networks for the delivery of public health care services in the United States. The paper is based on a case study design conducted with the Fulton County Health Department (Atlanta, GA). The research contribution this paper makes is twofold. First, it presents a planning methodology to deliver health care services through a mix of fixed health centers, satellite facilities, and mobile facilities. Second, it gives insights on how to use geographic information systems to design new health care service networks.

Medical Record Innovations That Can Improve Physician Productivity

Abstract: Medical records are the fulcrum of patient care activities. They represent the primary reference point with respect to the patient's medical status and long-term planning. A significant portion of the patient care dollar is invested in the medical record document and its handling. The most critical part of this process takes place in the physician's examination room during the patient encounter. The use of SmartCharts4 is a way to expedite the chart generation process and improve the quality and consistency of the source information from which all future care and plans are generated. The process removes a substantial portion of the human memory cycle that is needed for chart development and improves the encounter process by exploring the full range of diagnostic signs and symptoms that are associated with a preselected diagnosis or patient problem. The system is designed for stand-alone operation or insertion into an already-functioning electronic medical record system.

Histopathologic Variants of Basal Cell Carcinoma Correlation with Sex, Age and Localization

Abstract: During the 6-year period (January 1,1993 to December 31, 1998) in the Laboratory for Dermatopathology of Department of Dermatovenereology in Clinical Hospital Split, 1616 basal cell carcinomas (BCC) of a total of 323 investigated specimens were diagnosed. The incident rate varies from 92 to 114 BCC per 100,000 inhabitans in the Split region. The sex ratio in material is 1,2:1 in favor of males. The frequence of BCC increases with the advanced age in both sexes with the peak in the age group from 70 to 79 years. The most frequent location in both sexes is the nose followed by cheeks and trunk. Statistic analysis showed a significantly higher occurrence of BCC in temporal region in the males and perioral region in the femaless respectively. The solid variant is the most frequent followed by superficial multicentric and solid-adenoid. Pure variants are found in 83.1% specimens, and mixed variants in 16.9%. Solid and adenoid variants are the most frequent on the nose and cheeks. According to statistics cystic variant is significantly higher on the forehead, and morpheic variant on the nose. Superficial multicentric variant is statisticaly more frequent on the trunk than on other locations. All specimens were reexamined and histopathologic variants were obtained. Over 2000 data are comprised which is a sufficient examination sample. In programs such as SPSS, and Graph master ver 1,12, Win95, MO'97 (Word, Excel, Access) on Pentium II 200 MHz, floppy, 64 MB RAM, HDD 2,1 GB, CD x24, HP LJet 6L, a comprehensive analysis has been performed.

Asthma Outcome Measures

Abstract: Annually, asthma accounts for 10.4 million physician visits, 468,000 hospitalizations, 1.8 million emergency room visits, and 10 million missed school days. According to the Centers for Disease Control and Prevention, the number of asthma deaths has increased progressively since 1978 form 1,800 to 5,400 per year. It is an expensive disease, accounting for about 1% of all health expenditure in the United States in 1990. Asthma has a significant impact on the patient and the community at large and the assessment of the clinical, physiologic, humanistic and economic outcomes will be measured.

Problems and Our Solutions for Implementing Telemedicine Systems

Abstract: There are several problems on the practical use of telemedicine, for example, the difficulties involved in promoting communication between medical facilities, uncooperative clinicians, and the absence of high-speed circuits and high-resolution CRT. From the Japanese point of view, we suggest ways to resolve these problems. We will analyze and propose scenarios for realizing successful communications among medical institutions, medical communication and its characteristics, barriers to the promotion of communications among medical institutions, second-opinion centers, and separate satellites and separate circuits. We also mention the World Wide Web for teleconsultation, provision of assistance to people with data handicaps via a communications satellite, and assistance to programs designed for training telemedicine specialists. Using a communication satellite, we offer programs that explain preventive medicine, support activities for nursing at home, explain the risks of fast food, and support activities for the handicapped and women in a simple manner to computer illiterates.

Object-Oriented Analysis and Design of a Health Care Management Information System

Abstract: We have created a prototype for a universal object-oriented model of a health care system compatible with the object-oriented approach used in version 3.0 of the HL7 standard for communication messages. A set of three models has been developed: (1) the Object Model describes the hierarchical structure of objects in a system—their identity, relationships, attributes, and operationss (2) the Dynamic Model represents the sequence of operations in time as a collection of state diagrams for object classes in the systems and (3) functional Diagram represents the transformation of data within a system by means of data flow diagrams. Within these models, we have defined major object classes of health care participants and their subclasses, associations, attributes and operators, states, and behavioral scenarios. We have also defined the major processes and subprocesses. The top-down design approach allows use, reuse, and cloning of standard components.

The Medical Database as a Tool for Improving Maternal/Infant Continuity of Care

Abstract: Analysis of the Sinai Health System's integrated medical database revealed a serious discontinuity of care, frequently observed in underserved communities, for mothers who delivered at the hospital but failed to return on a timely basis for postpartum visits for themselves and newborn visits for their babies. Since the Sinai Health System (SHS) is a fully integrated health system including community-based primary care, a process improvement project to improve rates of return was initiated. Prior to hospital discharge, a staff member visited each new mother and baby to schedule clinic follow-up appointments. Appointment compliance was monitored using the SHS integrated medical database. Results after the first year showed marked improvement. Eighty percent of mothers returned for postpartum care within 4 months of delivery compared to 46 at baseline. Eighty eight percent of newborns were seen in the clinics within the four month timeframe compared to a baseline of 59%. The integrated medical database not only allowed for identification of this problem but was an essential tool at each point in the intervention.

An Intranet-based System for Quality Assurance in Surgery

Abstract: Quality assurance in surgery relies on precise medical records about surgical procedures and outcomes. Data quality is crucial for statistical evaluations missing values cannot be avoided but must be minimized. The quality assurance system must be accessible from many locations within the clinics given the complex and heterogeneos computing infrastructure this is a technological challenge. Intranet-technology—the application of internet-tools in local networks—can help to solve the technical problems. We designed, implemented and evaluated a generic Intranet-based quality assurance system in surgery. The basic concept is multi-purpose data entry with predefined textblocks, i.e. the same data is used for clinical reports as well as scientific evaluations. Our first instance were reports on laparoscopic cholecystectomies consisting of 41 Items and 132 textelements. Because of the good clinical acceptance of the system it will be expanded to other surgical procedures.

Outcomes of Cataract Surgery: Implications for the Developing World

Abstract: Cataract surgery has virtually eliminated cataract blindness in the developed world. However, in the economically developing areas of the world it is a staggering and escalating problem where it is the leading cause of blindness affecting 16–20 million people. Outcomes research has clearly shown that modern cataract surgery with intraocular lens implantation is a safe and effective means of restoring visual function and improving vision-related quality of life. Several recent developments provide hope in the global fight against cataract blindness: decrease in the cost of modern surgerys available models of infrastructure developments and a global plan for the elimination of avoidable blindness.

Are Electronic Emergency Department Data Predictive of Heat-Related Mortality?

Abstract: The study by Rydman and co-workers analyzes the rate and risk of heat-related illness in hospital emergency departments (ED) during the 1995 heat wave in Chicago. The authors address a significant public health problem that is of increasing public health importance. Based on the data presented the authors suggest that excess emergency department (ED) morbidity was found to be well ahead of the mortality curve. The authors propose that a statistically significant increase in morbidity on the 8th of July was linked to an increase of mortality on the 14th. I think that such an assumption is misleading. In their graph, the authors do not include the heat index, which is a measure of heat and humidity combined. When the heat index is plotted in relation to their data (Fig. 1) it becomes apparent that heat-related morbidity follows the course of the heat index with a 3to 4-day lag. As we had indicated at the time of our investigation in Chicago this graph also suggests that the increase in mortality follows with a lag, the rapid rise of the heat index which peaked on July 13th 1995. The authors had suggested that the increase in morbidity on the 8th was predictive of the peak in mortality on the 15th. However, by including the heat index in the plot, it appears that a better suggestion for these observations is that the peak in mortality on the 15th was a consequence of the extreme peak in the heat index on the 13th. It also appears that this mortality peak is better predicted by the peak in morbidity on the 14th rather than on the 8th. Therefore, it is likely that both mortality and morbidity peaks on the 14th and 15th, respectively, are a consequence of the rapid rise of the heat index on the 13th.

Information Subsystem of the Chemical Coefficients K 1 and K 2 As the Base for the Study of the Ecological Factors That Influence Human Health

Abstract: With regard to the relatively limited water supply in the area of Dalmatia (Southern Croatia), water supply system and health care institutions are especially interested in observing and monitoring the waters, as well as preserving their quality. The ecological need to sum up the work on water quality investigations led us to monitor the environment. Because it is necessary, from the informatical aspect, to organize mass ecological health data into databases, the relational database for the research of chemical analyses (coefficients K1 and K2) as the methodological foundation for the study of the ecological factors that influence human health is defined in this paper. Results used for the prototype implementation subsystem of the chemical water analysis control are based on the investigations of the Water Examination Department of the Public Health Institute of the Split-Dalmatian County (Croatia). Over 2500 data comprised the examination sample. The software used included Win'95, MO'97, and Paradox 4.5, while the hardware used included Pentium II 200 MHz, floppy, 64 MB RAM, HDD 2,1 GB, CD×24, HP Ljet 4L.

Comparison of Two Regimens of β-Adrenergics in Acute Asthma

Abstract: Background and Methods: Inhaled adrenergics and steroids are the main agents used in acute asthma. Dosing recommendations for adrenergics, while generally becoming more aggressive, lack prospective validation. A double blind, randomized trial of two regimens of nebulized metaproterenol was conducted in patients presenting to an Emergency Department with an acute asthma exacerbation. Asthmatics age 16–55, with no other cardio-pulmonary disease, presenting with peak expiratory flow rate (PEFR) <30% of predicted and greater than 80L/m were enrolled. All patients received 125 mg of methylprednisolone and theophylline, if needed, to reach therapeutic levels. The experimental group received 0.3 cc metaproterenol in 2.5 cc of saline at times 0, 20″, 40″, 1′, 2′, 3′, 4′, 5′, 6′, and 7′. The control group received metaproterenol at times 0,1 hr, and hours 3, 5, and 7. Placebo was given to control group patients at 20″, 40″, 2′, 4′, and 6′. PEFR and vital signs were measured 10 min after each treatment. Study end points included discharge upon reaching set criteria or admission if patients were not discharged following the hour 7 treatment. Results: Seventy one patients were enrolled, 40 in experimental group and 31 in the control group. The group characteristics did not differ at entry in any significant way, and the groups began with mean expected PEFR of 23.4% and 24.5%, respectively. There were no significant differences at any point in PEFR outcomes, time to discharge, or admission rate. The experimental group showed a greater increase in pulse rate and a reduced diastolic blood pressure at 20, 40 and 60 min. The experimental group had a 12- and 8-fold increase in the risk of a pulse rate >140 at 40 and 60 min, respectively. This group also had two moderate complications, both near the 60-minute mark. These were an induction of atrial fibrillation in one patient and ischemic electrocardiographic changes in another. Conclusion: Three treatments in the first hour, and hourly thereafter showed no benefit over treatments initially, at one hour, and every other hour in acute, moderate, or severe exacerbation of asthma. Side effects were markedly increased in the control group. Such dosing should not be recommended as routine therapy.

Assessment of Psychosocial Work Environment in Primary Care—Development of a Questionnaire

Abstract: Recent studies have indicated deteriorated working conditions of health care personnel. To have an efficient health care organization requires good working conditions and the well-being of the personnel. Today there are no “gold-standard” assessment tools measuring psychosocial working conditions. The aim of this study was to develop two valid and reliable questionnaires, one generic and one specific, measuring psychosocial working conditions for general practitioners (GPs) and district nurses (DNs) in Sweden, with a special emphasis on organizational changes. The construction of the questionnaires were made after a stepwise developing phase including literature review, interviews, and a pilot study. The pilot study included GPs n e 42 and DNs n e 39. The questionnaires were later on used in a main study (GPs n e 465, DNs n e 465). A factor analysis was carried out and showed that there were fewer items in the main study that had factor loading ≥ 0.40 in more than one factor, compared to the pilot study. The factors from the main study were easier to label and had good correspondence with other studies. After this stepwise development phase good construct validity and internal consistency were established for the questionnaire.

Introducing the Theme in a Qualitative Interview Using a Visual Starter

Abstract: Community involvement implies conscientious citizen engagement, not as passive recipients but active contributors. Insufficient understanding of concepts of health outcome in a socioeconomic deprived context with unemployment as a major feature was identified as a hindrance to intervention. This communication gives a report of a “visual starter” used as a cognitive instrument for qualitative research on concepts of joblessness and health. Health education and behavioral change efforts are often insufficient in reaching empowerment on individual or community levels. It is suggested that understanding different categories of thinking using a phenomenographic method could contribute to strategies for community involvement. The “visual starter” uses pictures to introduce the theme as well as for associative purposes in the interview.

Face and Contents Validity, and Feasibility of Healthometer: A Delphi Study

Abstract: Our recent descriptive report in this journal of “Healthometer,” an interactive instrument for self-mediated health counseling, was well received in the medical systems research and development community. Suitable for paper as well as electronic mediation and covering both screening, processing/storage, and advisory tasks in a positively reinforcing and confidential way, it has on the whole been considered to be an interesting model in the advancing “information society technologies” perspectives however, a closer scientific and operative evaluation is warranted. Because the power of the instrument in addition to the hardware is critically dependent upon the wet- and software quality, the present study aims at examining in the same forefront forum some basic aspects of all these modalities, with emphasis on face and content validity, feasibility, and users' attitudes and opinions. It can be summarized, quite briefly, that all of them were satisfactory.

The Current Quality of Health Plan Report Cards

Abstract: In general, health plan report cards can provide valuable information to consumers, physicians, and health care purchasers regarding plan performance and quality to assist in the selection of a health plan. However, significant limitations of health plan report cards currently exist. It is only with further evolvement and refinement that health plan report cards can live up to their potential and become a distinctive and useful tool in evaluating and selecting among various health plans.

Consumer Opinions with Ancillary Hospital Services: Improving Service Delivery in Turkish Hospitals

Abstract: This article reports the results of 2,045 consumer interviews conducted after discharge from seven major public and private hospitals in the country of Turkey. The direct measurement of consumer-satisfaction and utilization of this information to improve service delivery is a relatively new phenomena for this country. Based on postdischarge consumer interviews information on satisfaction of several ancillary hospital service variables was identified and inclusion for achieving overall consumer satisfaction is emphasized. Two critical areas were examined: ancillary staff and consumer relations and overall impressions of the comfort of the facility. Relationships and percentages within and among these variables are reported. Overall, the majority of the complaints noted by consumers were not related to direct treatment rather they focused on interactions with the hospital's staff and other services provided by the facility (e.g., comfort, cleanliness, parking, etc.). When comparing the different hospitals across these variables significant differences were noted at the .05 level between the seven different hospitals examined. Findings and recommendations from this study are presented to assist in providing a basis for the development of improved consumer satisfaction.

Using Department of Veterans Affairs Administrative Databases To Examine Long Term Care Utilization for Men and Women Veterans

Abstract: We examined long term care (LTC) utilization by male and female veterans using administrative databases maintained by VA. Research questions included: (1) Which LTC services are utilized? (2) Do utilization patterns of older veterans differ from those of elderly persons in the general U.S. population? (3) Do LTC needs of veterans vary by gender? We were unable to track LTC utilization of individuals across administrative databases. Some databases could only provide information at the national level, or alternatively, were available only at local facilities, or only at the patient or program-level data—making it impossible to get a clear picture of all the services received by an individual. Those planning to use administrative databases to conduct research must: (1) take more time than expecteds (2) be flexible/willing to compromise, (3) “ferret out” information, and (4) recognize that because of dynamism inherent in information systems, results may change over time.

A New Approach to Computer Guidance in Orthopedic Surgery Using Real Time Volume Rendering

Abstract: The purpose of this paper was to evaluate the ability of a new real time volume rendering system using raw unprocessed CT data on a four processor Pentium® PC. A CT data set of the pelvic area was used to demonstrate the systems ability to integrate and visualize both data from a CT scan and a tracking system. The computer system consisted of a four processor Pentium® PC and the software tool VGInsight (Volume Graphics GmbH). For study purposes in a laboratory setting a magnetic tracking system (Polemus® Inc.) was used to simulate tracked surgical tools. With this new software tool and the tracking system the exact relative location of a tracked instrument within all structures of the pelvic area, soft tissue as well as bone, could be displayed in 3D and real time without preprocessing of the data set. Until recently real time volume rendering required expensive workstations. With a new software tool on a four processor Pentium® PC the authors were able to introduce a 3D real time processed data supply to the surgeon.