Abstract：
:Uniform hospital discharge abstract data from Maryland were used to examine the homogeneity of trauma-related DRGs with respect to a well-established measure of injury severity, the Injury Severity Score (ISS). Thirty DRGs were identified as including trauma cases with a wide range of severity; for each of these DRGs, ISS explains a significant amount of variation in length of stay. By applying statistical techniques similar to those used to create the original DRG groupings, these 30 DRGs were subdivided by severity and age categories to create a new set of severity-modified DRGs. The potential effects of using DRGs and modified DRGs to pay for inpatient care within the Maryland state regionalized system of trauma care were examined. Payments based on regional averages per DRG and per modified DRG were compared to actual hospital charges regulated by the state's Health Services Cost Review Commission. Using average charges per DRG as a basis of payment, approximately !1.4 million (11 percent of total hospital charges) would be shifted from trauma centers to nontrauma centers. This shift represents an 18 percent loss in revenues to trauma centers and a 30 percent gain in revenues to nontrauma centers. Using a payment system based on severity-modified DRGs, trauma centers would still experience a net loss in revenues and the nontrauma centers a net gain, but the total amount of the shift would be reduced from $11.4 million to $9.8 million. The results argue for the need to explore alternative payment systems not strictly based on current DRGs. Because of DRGs do not adequately reflect severity differences, using them to pay hospitals will create financial incentives that discourage regionalization of trauma care.
journal_name
Health Serv Resjournal_title
Health services researchauthors
MacKenzie EJ,Steinwachs DM,Ramzy AI,Ashworth JW 3rd,Shankar Bsubject
Has Abstractpub_date
1991-04-01 00:00:00pages
5-26issue
1eissn
0017-9124issn
1475-6773journal_volume
26pub_type
杂志文章abstract：OBJECTIVES:To examine the effects of changes in payment and risk adjustment on (1) the annual enrollment and switching behavior of Medicare Advantage (MA) beneficiaries, and (2) the relative costliness of MA enrollees and disenrollees. DATA:From 1999 through 2008 national Medicare claims data from the 5 percent longit...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12006
更新日期：2013-06-01 00:00:00
abstract：OBJECTIVE:To develop and validate a disease-specific automated inpatient mortality risk adjustment system primarily using computerized numerical laboratory data and supplementing them with administrative data. To assess the values of additional manually abstracted data. METHODS:Using 1,271,663 discharges in 2000-2001,...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2010.01126.x
更新日期：2010-12-01 00:00:00
abstract：OBJECTIVE:To investigate disparities in mental health care episodes, aligning our analyses with decisions to start or drop treatment, and choices made during treatment. STUDY DESIGN:We analyzed whites, blacks, and Latinos with probable mental illness from Panels 9-13 of the Medical Expenditure Panel Survey, assessing ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12095
更新日期：2014-02-01 00:00:00
abstract：OBJECTIVE:To assess the relative impact of clinical factors versus nonclinical factors-such as postacute care (PAC) supply-in determining whether patients receive care from skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs) after discharge from acute care. DATA SOURCES AND STUDY SETTING:Me...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2005.00365.x
更新日期：2005-04-01 00:00:00
abstract：OBJECTIVE:We study the association between the timing of the Great Recession (GR) and health spending among uninsured adults distinguishing by citizenship/nativity status and time of U.S. residence. DATA SOURCE:Uninsured U.S. citizens and noncitizens from the 2005-2006 and 2008-2009 Medical Expenditure Panel Survey. ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12193
更新日期：2014-12-01 00:00:00
abstract：:A decision to add a new treatment program has widespread and long-lasting implications for both the patient and the organization. Information about the interactions among the institution, the patient, and the treatment modality are seldom available. Cognitive rehabilitation is a relatively new treatment modality that ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1990-04-01 00:00:00
abstract：:The growth of unionization among hospital workers was sharply accelerated by the 1974 amendments to the National Labor Relations Act covering voluntary hospital workers. With continuing inflationary pressures in the hospital sector, the cost implications of the recent and projected growth of hospital unions is of some...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1984-12-01 00:00:00
abstract：:A location model is used to determine the most efficient (i.e., least-cost) number and location of ambulance facilities in a rural area. The model incorporates response time and service time standards into the analysis and indicates the trade-off between costs and various time standards. The financial feasibility of i...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1977-10-01 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：OBJECTIVES:(1) To examine the association of socioeconomic characteristics (SES) with hospitalization by age group, and when using measures of SES at the community as opposed to the individual level. (2) Thus, to support the inference that socioeconomic factors are important in the analysis of small area utilization da...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1998-06-01 00:00:00
abstract：OBJECTIVE:Assess proxy respondent effects on health care evaluations by Medicare beneficiaries. DATA SOURCE:110,215 respondents from the nationally representative 2001 CAHPS((R)) Medicare Fee-for-Service Survey. STUDY DESIGN/DATA COLLECTION/EXTRACTION METHODS:We compare the effects of both proxy respondents and proxy...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2007.00820.x
更新日期：2008-06-01 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：OBJECTIVE:To assess hospital and geographic variability in 30-day mortality after surgery for CRC and examine the extent to which sociodemographic, area-level, clinical, tumor, treatment, and hospital characteristics were associated with increased likelihood of 30-day mortality in a population-based sample of older CRC...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12171a
更新日期：2014-08-01 00:00:00
abstract：OBJECTIVE:To explore and understand approaches to user engagement through investigating the range of ways in which health care workers and organizations accommodated the introduction of computerized physician order entry (CPOE) and computerized decision support (CDS) for hospital prescribing. STUDY SETTING:Six hospita...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12581
更新日期：2017-10-01 00:00:00
abstract：OBJECTIVE:To analyze hospitalization patterns of persons with AIDS (PWAs) in a multi-state/multi-episode continuous time duration framework. DATA SOURCES:PWAs on Medicaid identified through a match between the state's AIDS Registry and Medicaid eligibility files; hospital admission and discharge dates identified throu...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1999-02-01 00:00:00
abstract：OBJECTIVE:Through a review of the literature, to identify and describe (1) empirical studies of inpatient nursing care quality that evaluate links between nursing care processes and health-related patient outcomes, (2) nursing care processes for which process-outcome links have been established, and (3) important nursi...
journal_title：Health services research
pub_type： 杂志文章,评审
doi：
更新日期：1999-12-01 00:00:00
abstract：OBJECTIVE:To examine the influence of dimensions of service quality on patient experience of primary care. DATA SOURCES/STUDY SETTING:Data from the national GP Patient Survey in England 2014/15, with responses from 858,351 patients registered at 7,918 practices. STUDY DESIGN:Expert panel and principal component analy...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12985
更新日期：2018-12-01 00:00:00
abstract：OBJECTIVE:To describe changes in characteristics of directors of outpatient opioid agonist treatment (OAT) programs, and to examine the association between directors' characteristics and low methadone dosage. DATA SOURCE:Repeated cross-sectional surveys of OAT programs in the United States from 1995 to 2011. STUDY DE...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12558
更新日期：2017-10-01 00:00:00
abstract：:The National Long Term Care Demonstration (channeling) was designed to provide coordinated community-based long-term care services to those older persons at high risk of nursing home placement. A key component of the program was the process established to accomplish this targeting effort. In this article, the outreach...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1988-04-01 00:00:00
abstract：OBJECTIVE:To examine county-level geographic variation in treatment admissions among opioid treatment programs (OTPs) that accept Medicaid in the continental United States. DATA SOURCES/STUDY SETTING:Data come from the 2012 National Survey of Substance Abuse Treatment Services. STUDY DESIGN/DATA COLLECTION:We used lo...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12686
更新日期：2018-02-01 00:00:00
abstract：OBJECTIVE:To test how Certificate of Need laws affect all-cause mortality in the United States. DATA SOURCES:The data of 1992-2011 all-cause mortality are from the Center for Disease Control's Compressed Mortality File; control variables are from the Current Population Survey, Behavioral Risk Factor Surveillance Syste...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12619
更新日期：2018-02-01 00:00:00
abstract：OBJECTIVE:To examine the determinants of postsurgery length of stay (LOS) and inpatient mortality in the United States (California and Massachusetts) and Canada (Manitoba and Quebec). DATA SOURCES/STUDY SETTING:Patient discharge abstracts from the Agency for Health Care Policy and Research Nationwide Inpatient Sample ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2000-03-01 00:00:00
abstract：OBJECTIVE:To explain the association of out-of-pocket (OOP) cost, community-level factors, and individual characteristics on statin therapy nonadherence. DATA SOURCES:BlueCross BlueShield of Texas claims data for the period of 2008-2011. STUDY DESIGN:A retrospective cohort of 49,176 insured patients, aged 18-64 years...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12547
更新日期：2017-08-01 00:00:00
abstract：OBJECTIVE:To evaluate the impact of a locally adapted evidence-based quality improvement (EBQI) approach to implementation of smoking cessation guidelines into routine practice. DATA SOURCES/STUDY SETTING:We used patient questionnaires, practice surveys, and administrative data in Veterans Health Administration (VA) p...
journal_title：Health services research
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.1111/j.1475-6773.2008.00865.x
更新日期：2008-10-01 00:00:00
abstract：OBJECTIVE:To estimate the effects of competition for both Medicare and HMO patients on the quality decisions of hospitals in Southern California. DATA SOURCE:Secondary discharge data from the Office of Statewide Health Planning and Development for the State of California for the period 1989-1993. STUDY DESIGN:Outcome...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2003.00185.x
更新日期：2003-12-01 00:00:00
abstract：OBJECTIVES:(1) To present the Behavioral Model for Vulnerable Populations, a major revision of a leading model of access to care that is particularly applicable to vulnerable populations; and (2) to test the model in a prospective study designed to define and determine predictors of the course of health services utiliz...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2000-02-01 00:00:00
abstract：OBJECTIVE:To determine whether assigning a dedicated general practitioner (GP) to a nursing home reduces hospitalizations and readmissions. DATA SOURCES/STUDY SETTING:Secondary data on hospitalizations and deaths by month for the universe of nursing home residents in Denmark from January 2011 through February 2014. S...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13112
更新日期：2019-06-01 00:00:00
abstract：:The cost of capital for hospitals is a topic of continuing interest as Medicare's new capital payment policy is implemented. This study examines the determinants of tax-exempt revenue bond yields, the primary source of long-term capital for hospitals. Two important methodological issues are addressed. A probit analysi...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1992-12-01 00:00:00
abstract：OBJECTIVE:This study explores the impact of multiple-site practices on the distribution of physician services within a medical service region. DATA SOURCES AND STUDY SETTING:A questionnaire was mailed to all urologists (100 percent response rate) practicing in north central Connecticut (the Hartford medical service ar...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1993-10-01 00:00:00
abstract：OBJECTIVE:To examine the implications of serious and chronic health problems on the willingness of enrollees to switch health plans if they are dissatisfied with their current arrangements. DATA SOURCE:A large (20,283 respondents) survey of employees of three national corporations committed to the model of managed com...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1999-06-01 00:00:00
