Can the psro's be cost effective? A study of the effect of the Commonwealth Health Agencies monitoring program on the length of stay of Medicaid patients in Massachusetts.

To analyze the effect of the Commonwealth Health Agencies Monitoring Program on the length of stay of a sample of Massachusetts Medicaid patients, we compared their experience with that of non-Medicaid patients. We found a consistently decreasing trend in the length of stay of Medicaid patients during the 2 1/2-year period studied. The average length of stay of Medicaid patients decreased by 11.9 per cent relative to the norm, whereas the non-Medicaid length of stay decreased by only 6.6 per cent. We infer that the Program may be credited within the 5.3 per cent differential decrease. The consistency and reliability of the data suggest that similar results may be extrapolated to the hospitals not sampled. We conclude that Professional Standards Review Organizations, of which this program was a precursor, can be cost effective, given an expanded review mandate and the application of suibable evaluative processes.

Cerebellar gliomas in children.

We studied the relationship of histologic features to survival in a population of 132 children with cerebellar gliomas (excluding medulloblastomas). These children had their initial tumor operation at The Children's Hospital Medical Center of Boston between 1l927 and 1968. A classification system that accentuates differences in survival was derived on the basis of clustering of histologic features and survival. This division was supported by the existence of differentially distributed symptoms and signs and by differences in resectability. The two major subgroups of cerebellar gliomas had different patterns of clinical characteristics. Cerebellar glioma A had any of the four histologic features of microcyst, leptomeningeal deposit, Rosenthal fiber, or focus of oligodendroglia; children with glioma A had a 10-year survival rate of 94%. Glioma B, encompassing the histologic features of perivascular pseudorosette, high cell density, necrosis, mitosis, and calcification, was clearly defined but histologically less uniform; children with glioma B had a 10-year survival rate of 29%. These two groups accounted for 90% of the cerebellar gliomas in childhood.

Secular trends of cerebellar gliomas in children.

Temporal changes in the histologic composition of cerebellar gliomas were examined in a population of 132 children operated on between 1927 and 1968 at The Children's Hospital Medical Center of Boston. Linear trends with time were examined for clinical features, histologic features, and tumor types. We found evidence of an increasing occurrence of glioma A and its associated features during the 41-year study period. This tumor type is associated with a good prognosis and is histologically well defined. Glioma B, a tumor type associated with a poor prognosis, was relatively stable with respect to time and, therefore, differed markedly from glioma A. Foci of oligodendroglia, a glioma A feature, clustered by year of surgery within a relatively short time span. This feature had a survival rate and a male sex proportion quite different from those of the other histologic features investigated.

Histologic features and observational variation in cerebellar gliomas in children.

Variation existed in the recognition of histologic features commonly used in the evaluation of cerebellar gliomas of childhood. Some histologic features (e.g., perivascular pseudorosettes, leptomeningeal deposits, and calcification) were more reliably observed than were others (e.g., Rosenthal fibers, cell density, and hypervascularity). Knowledge of which features tend to have greater observational variation may lead to improved definitions, less reliance of these features in clinical decisions, further studies of the potential sources of the variation, and guidelines for minimizing observational variation.