Estimating hospital admission patterns using Medicare data.

It is often necessary in health services research and strategic planning to simultaneously describe the geographic pattern of admissions to multiple hospitals. Obtaining the data necessary to accomplish this can often be problematic. In some states discharge abstract data on all admissions to all hospitals in the state are compiled and maintained by a government agency, but in 23 states these data are not available. Furthermore, problems arise when a substantial fraction of admissions cross state borders, such that data from more than one state is required for description of 'patient flows'. Individual hospitals typically maintain data on the geographic source of their own admissions, but are not likely to have access to such data regarding other hospitals in their area. Patient flow data on Medicare admissions are available for all states and are readily accessible, but heretofore it has not been known how closely the admission patterns of Medicare patients approximate those of other types of patients. We examine the accuracy of using data on Medicare admissions to estimate, at the hospital level, the admission patterns of other types of patients. Using zip code-to-hospital patient flow data for all non-federal hospitals in California, we calculated the correlation between Medicare admission patterns and those of three other groups of patients (other adults, pediatrics and obstetrics) for each hospital. For the majority of hospitals, Medicare data predict the admissions of other adults quite well, and the admissions of pediatric and obstetric admissions moderately well.(ABSTRACT TRUNCATED AT 250 WORDS)

Internists' practices in health promotion and disease prevention. A survey.

OBJECTIVE: To estimate internists' use of disease prevention and health promotion activities, and to explore demographic, professional, behavioral, psychological, cognitive, and organizational factors associated with the use of such practices. DESIGN: Mail survey. SETTING AND SUBJECTS: A sample of 2610 members and fellows of the American College of Physicians (ACP) participated in the study. They engaged in patient care activities more than 20 hours per week and were stratified by gender and region. They lived in four geographic areas of the United States (Northeast, Southeast, Central, and West), comprising 21 ACP regions. MEASUREMENTS: A questionnaire requesting background information as well as information about personal health; record keeping; use of immunizations (pneumococcal, influenza, tetanus, hepatitis B); use of screening tests and procedures for detecting cancer (breast examination, Papanicolaou smear, stool occult blood test) and other diseases (electrocardiograms, cholesterol level tests, chest radiographs); and behavioral counseling to promote health (in the areas of smoking, exercise, and alcohol and seat belt use). MAIN RESULTS: Internists used effective preventive interventions less frequently and ineffective practices more frequently than experts recommend. Internists' use of health promotion and disease prevention activities is associated with habit, attitude, and a lack of adequate knowledge. Younger physician age, general internal medicine practice, and personal health promotion and disease prevention practices were strongly associated with more appropriate use of recommended practices (P less than 0.01). CONCLUSIONS: Internists' use of disease prevention and health promotion activities falls short of expert recommendations. Programs to improve the delivery of preventive services might be aimed at improving physicians' personal health practices, might be directed toward patients, and might include the development of effective systems to remind physicians.

The appropriate use of high-cost, high-risk technologies: the case of total parenteral nutrition.

An assessment of total parenteral nutrition (TPN), a high-cost, high-risk technology, is used to illustrate the importance of technology assessment to quality assessment. A review of the literature suggests that TPN is only sometimes effective and that it actually produces measurable harm by increasing complication rates in certain groups of patients. However, there are strong advocates for its use. The economic and ethical implications of TPN for the quality of care are also discussed at the levels both of the individual and of society. Continuous assessment of health care technologies, particularly those that are high-cost and high-risk, is critical to the overall quality of health care.

Privilege delineation in a demanding new environment.

The delineation of clinical privileges is one of the most important means for hospitals to ensure high-quality care. Competition, cost control, and public accountability have created the need for hospitals to assure effective privilege delineation processes. Hospitals should focus on issues of practice variation, continuity of care, volume of services provided and planned, and the integration of ethical considerations into clinical decisions. How information is obtained, verified, and acted upon is reviewed within the organizational framework of the hospital. Several leaders within the hospital, such as the clinical department chairs and members of the medical staff executive committee, have important functions in the clinical privilege delineation process. Granting clinical privileges is a critical hospital function that requires a commitment by the governing body, management, and medical staff leaders.

Reuse and reprocessing of disposable medical devices. Legal liability issues.

Reuse and reprocessing of disposable medical devices raises issues of legal liability, especially among physicians, hospitals, and device manufacturers. The practice of reuse has been, at least informally, reported to be fairly widespread. However, the medical risks associated with reuse are unresolved in most cases, which may lead to circumstances conducive to litigation. In this paper, the characteristics of reuse pertaining to legal liability, the parties potentially subject to civil liability suits as a result of reuse, the legal theories underlying claims of injury, and the legal implications of possible policy actions will be examined.