Abstract：
OBJECTIVE:To develop and test a new outcome measure, Conditional Length of Stay (CLOS), to assess hospital performance when deaths are rare and complication data are not available. DATA SOURCES:The 1991 and 1992 MedisGroups National Comparative Data Base. STUDY DESIGN:We use engineering reliability theory traditionally applied to estimate mechanical failure rates to construct a CLOS measure. Specifically, we use the Hollander-Proschan statistic to test if LOS distributions display an "extended" pattern of decreasing hazards after a transition point, suggesting that "the longer a patient has stayed in the hospital, the longer a patient will likely stay in the hospital" versus an alternative possibility that "the longer a patient has stayed in the hospital, the faster a patient will likely be discharged from the hospital." DATA COLLECTION/EXTRACTION METHODS:Abstracted records from 7,777 pediatric pneumonia cases and 3,413 pediatric appendectomy cases were available for analysis. PRINCIPAL FINDINGS:For both conditions, the Hollander-Proschan statistic strongly displays an "extended" pattern of LOS by day 3 (p<.0001) associated with declining rates of discharge. This extended pattern coincides with increasing patient complication rates. Worse admission severity and chronic disease contribute to lower rates of discharge after day 3. CONCLUSIONS:Patient stays tend to become prolonged after complications. By studying CLOS, one can determine when the rate of hospital discharge begins to diminish--without the need to directly observe complications. Policymakers looking for an objective outcome measure may find that CLOS aids in the analysis of a hospital's management of complicated patients without requiring complication data, thereby facilitating analyses concerning the management of patients whose care has become complicated.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Silber JH,Rosenbaum PR,Koziol LF,Sutaria N,Marsh RR,Even-Shoshan Okeywords:
subject
Has Abstractpub_date
1999-04-01 00:00:00pages
349-63issue
1 Pt 2eissn
0017-9124issn
1475-6773journal_volume
34pub_type
杂志文章abstract：OBJECTIVE:Pay-for-performance (P4P) is commonly used to improve health care quality in the United States and is expected to be frequently implemented under the Affordable Care Act. However, evidence supporting its use is mixed with few large-scale, rigorous evaluations of P4P. This study tests the effect of P4P on qual...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12035
更新日期：2013-08-01 00:00:00
abstract：OBJECTIVE:To develop novel, scalable, and valid literacy profiles for identifying limited health literacy patients by harnessing natural language processing. DATA SOURCE:With respect to the linguistic content, we analyzed 283 216 secure messages sent by 6941 diabetes patients to physicians within an integrated system'...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13560
更新日期：2020-09-23 00:00:00
abstract：:This article examines the effect of owning long-term care insurance policies on the amount of out-of-pocket costs incurred by the elderly during their nursing home stays, and the importance of different policy features and restrictions. Data were drawn from the 1985 National Nursing Home Survey, and from copies of lon...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1991-02-01 00:00:00
abstract：BACKGROUND:Many states have passed legislation mandating that health plans provide direct access to obstetricians/gynecologists (hereinafter "ob/gyns") for women, limiting the ability of plans to require referrals or otherwise restrict access. One benefit of these laws may be improved preventive screening rates, but no...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2006.00646.x
更新日期：2007-06-01 00:00:00
abstract：OBJECTIVES:To provide updated estimates of narrow- and broad-spectrum antibiotic use among U.S. children. DATA SOURCES:Linked nationally representative data from the 2004-2010 Medical Expenditure Panel Survey Household Component and the 2000 Decennial Census. STUDY DESIGN:Relationships between individual-, family-, a...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12260
更新日期：2015-06-01 00:00:00
abstract：OBJECTIVE:To examine the service experiences and outcomes of low-income Medicaid beneficiaries with disabilities under two different models for organizing home-based personal assistance services: agency-directed and consumer-directed. DATA SOURCE:A survey of a random sample of 1,095 clients, age 18 and over, who recei...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2000-04-01 00:00:00
abstract：:De-hospitalization of cancer treatment, particularly for those with advanced disease, can complicate adjustment and strain the capacity of caregiver networks to meet patients' daily needs. Outpatient staff should be able to recognize patients who need help to meet their daily needs as well as those who are not getting...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1992-08-01 00:00:00
abstract：:The concept of propensity to use ambulatory care is defined as the probability that a utilization occurs in a very small interval of time, given that no utilization has been observed before. With this definition of utilization, survival analysis can be used to assess the effect of a set of predictors on utilization. T...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1988-06-01 00:00:00
abstract：:Previous research has confirmed that desirable hospital attributes as well as increased distance, or travel time, have an impact on hospital choice. These studies have become increasingly sophisticated in modeling choice. This study adds to the existing literature by estimating the effect of both hospital and individu...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1991-12-01 00:00:00
abstract：OBJECTIVE:To examine the relationship of services for post-acute care (PAC) to stroke patient outcomes. DATA SOURCES/STUDY SETTING:Veterans Health Administration (VHA) hospitals from two facility-level surveys and extant data files. STUDY DESIGN:Cross-sectional study of veterans hospitalized with acute stroke during ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2001-02-01 00:00:00
abstract：OBJECTIVE:To examine changes in children's albuterol use and out-of-pocket (OOP) costs in response to increased copayments after the Food and Drug Administration banned inhalers with chlorofluorocarbon (CFC) propellants. SETTING:Four health maintenance organizations (HMOs), two that increased copayments for albuterol ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12615
更新日期：2018-02-01 00:00:00
abstract：:Thresholds for medical decision making are the probabilities of disease at which clinicians choose to initiate testing or therapy. A descriptive analysis of clinicians' decision making can derive their test and test-treatment thresholds and has the potential to explain variations in test utilization. A previously desc...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1986-02-01 00:00:00
abstract：OBJECTIVE:Examine the impact of the 2011 shortage of the drug cytarabine on patient receipt and timeliness of induction treatment for Acute Myeloid Leukemia (AML). STUDY DESIGN:A retrospective cohort was utilized to examine odds of receipt of inpatient induction chemotherapy and time to first dose across major (N = 10...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13028
更新日期：2018-12-01 00:00:00
abstract：OBJECTIVE:To utilize functional status (FS) outcomes to benchmark outpatient therapy clinics. DATA SOURCES:Outpatient therapy data from clinics using Focus on Therapeutic Outcomes (FOTO) assessments. STUDY DESIGN:Retrospective analysis of 538 clinics, involving 2,040 therapists and 90,392 patients admitted July 2006-...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12344
更新日期：2016-04-01 00:00:00
abstract：:This article describes a model development process that represents a useful step in classifying populations in terms of risk of institutionalization (Inst-Risk II). A four-category risk classification system--"High risk, Some risk, Low risk, and Very Low Risk"--was developed, based on combinations of measures of funct...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1988-10-01 00:00:00
abstract：OBJECTIVE:To compare health care utilization between Canadian and U.S. residents. DATA SOURCES:Nationally representative 2007 surveys from the Medical Expenditure Panel Survey for the United States and the Canadian Community Health Survey for Canada. STUDY DESIGN:We use descriptive and multivariate methods to examine...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2012.01466.x
更新日期：2013-04-01 00:00:00
abstract：OBJECTIVE:To examine the benefits of a high-performance work environment (HPWE) for employees, patients, and hospitals. STUDY SETTING:Forty-five adult, medical-surgical units in nine hospitals in upstate New York. STUDY DESIGN:Cross-sectional study. DATA COLLECTION:Surveys were collected from 1,527 unit-based hospit...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2012.01438.x
更新日期：2013-02-01 00:00:00
abstract：OBJECTIVE:To test the hypothesis that health systems provide better care to patients with high needs by comparing differences in quality between system-affiliated and nonaffiliated physician organizations (POs) and to examine variability in quality across health systems. DATA SOURCES:2015 Medicare Data on Provider Pra...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13570
更新日期：2020-12-01 00:00:00
abstract：OBJECTIVES:The Patient Activation Measure (PAM) quantifies the extent to which people are informed about and involved in their health care. Objectives were to determine the psychometric properties of PAM among multimorbid older adults and evaluate a theoretical, four-stage model of patient activation. Methods. A cross-...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2010.01210.x
更新日期：2011-04-01 00:00:00
abstract：OBJECTIVE:This study examines whether parents' reports and ratings of pediatric health care vary by race/ethnicity and language in Medicaid managed care. DATA SOURCES:The data analyzed are from the National Consumer Assessment of Health Plans (CAHPS) Benchmarking Database 1.0 and consist of 9,540 children enrolled in ...
journal_title：Health services research
pub_type： 杂志文章,多中心研究
doi：
更新日期：2001-07-01 00:00:00
abstract：OBJECTIVE:To compare the performance of various risk adjustment models in behavioral health applications such as setting mental health and substance abuse (MH/SA) capitation payments or overall capitation payments for populations including MH/SA users. DATA SOURCES/STUDY DESIGN:The 1991-93 administrative data from the...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2001-08-01 00:00:00
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 an...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1975-04-01 00:00:00
abstract：OBJECTIVE:To summarize the state of the art in quality improvement, review its application to care for children, and define the information that will be needed so that care for children can be further improved. PRINCIPAL FINDINGS:Health services for children exhibit numerous deficiencies in quality of care. The defici...
journal_title：Health services research
pub_type： 杂志文章,评审
doi：
更新日期：1998-10-01 00:00:00
abstract：:This article analyzes three methods used to forecast the transition of long-term care clients through a variety of possible home and facility placements and levels of care. The test population (N = 1,653) is derived from the larger population of clients admitted in 1978 to British Columbia's newly established Long-Ter...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1985-10-01 00:00:00
abstract：:The relationship between income and health is well established: the higher an individual's income, the better his or her health. However, recent research suggests that health may also be affected by the distribution of income within society. We outline the potential mechanisms underlying the so-called relative income ...
journal_title：Health services research
pub_type： 杂志文章,评审
doi：
更新日期：1999-04-01 00:00:00
abstract：OBJECTIVE:To estimate 2012 tax expenditures for employer-sponsored insurance (ESI) in the United States and to explore the sensitivity of estimates to assumptions regarding the incidence of employer premium contributions. DATA SOURCES:Nationally representative Medical Expenditure Panel Survey data from the 2005-2007 H...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12037
更新日期：2013-04-01 00:00:00
abstract：OBJECTIVE:To determine if the availability of public ambulatory clinics affects preventable hospitalization (PH) rates of low-income and elderly populations. DATA SOURCES:PH rates were calculated using elderly and low-income discharges from 1995-97 Virginia hospital discharge data. Other data sources include the 1990 ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2001-06-01 00:00:00
abstract：OBJECTIVE:To compare utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. DATA SOURCES:A nationally representative sample of adults from the Medical Expenditure Panel Survey (2004-2008). STUDY DESIGN:HC patients were defined as those wit...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12178
更新日期：2014-10-01 00:00:00
abstract：OBJECTIVE:To examine implementation of the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs, enacted in 1988. The article summarizes the origin of the QMB and SLMB programs, describes what we have learned about QMB and SLMB enrollment in state Medicaid programs and, des...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2000-04-01 00:00:00
abstract：OBJECTIVE:The study used administrative data to identify the social determinants that have the greatest impact on Medicaid expenditures in adolescence. DATA SOURCES:Data were compiled using the Washington State Department of Social and Health Services Integrated Client Databases, which link data from state systems inc...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13052
更新日期：2019-02-01 00:00:00
