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In response to continuing concerns about escalating health care costs and poor quality care, many health plans have adopted a strategy called 'tiered provider networks.' With TPNs, plans provide financial [...]

Objective. To determine whether additional risk adjustment is necessary in economic profiling of physicians when claims data are already grouped into episodes of care, and to measure effects of risk adjustment on cost efficiency rankings of physicians. Data Sources. Four years of inpatient, outpatient, professional, and pharmacy claims data from a mixed model HMO. Study Design. Claims data were processed through Symmetry Health Data Systems' episode treatment group (ETG) grouper to define episodes of care and Symmetry's episode risk group (ERG) software to define measures of patients' health risk scores. For each episode type (ETG), ETG-mean expected costs were calculated as the mean costs of all episodes of that type, and risk-adjusted expected costs were calculated using three alternative risk model formulations. Data Collection. Within specialties, physicians were ranked from most cost efficient to least cost efficient, based on standardized difference between actual and expected costs. ETG-mean based rankings were compared with risk-adjusted rankings. Analyses were performed for cardiologists, family practitioners, general surgeons, and neurologists. Principal Findings. With all three risk models, risk scores were essentially unrelated to episode costs in approximately three-fourths of episode categories (ETGs). In a sample of ETGs for which risks-costs relationships appeared to exist, split sample validation showed the relationships to be unstable or spurious in all except one ETG. Within specialties, risk-adjusted cost efficiency rankings differ little from ETG-mean adjusted rankings. Conclusions. Depending upon the purpose for which economic profiling is performed, additional risk adjustment, beyond that already provided by episode grouping, may be unnecessary. Additional research may be needed to identify and validate ETG-level relationships between patient risks and episode costs. Key Words. Risk adjustment, economic profiling, health care costs, After the medicare prospective payment system was introduced in the early 1980s, some hospitals--especially teaching institutions--were concerned about inadequate reimbursement for the care they delivered. This concern was prompted by [...]

A study examining the relationship between length of stay (LOS) and quality of care found that longer hospital stays indicate a lower level of quality. Data from Michigan Medicare patients from 1988-1990 were used to create risk models and case-level quality evaluations. For 13 hospital-treated conditions, longer LOSs indicated poor quality. That longer LOSs increase a patient's exposure to quality problems was not considered a factor.

Application of Severity Measurement Systems for Hospital Quality Management Summary As hospitals increasingly emphasize efforts to measure and improve quality of care, the related issue of severity measurement emerges as [...]

Factors influencing readmission risk: Implications for quality monitoring Introduction The release by the Health Care Financing Administration (1987, 1988a) of hospital-specific mortality data for Medicare beneficiaries has highlighted national concerns [...]

To learn more about the metabolic effects of dietary fructose and sucrose, 12 type I and 12 type II diabetic subjects were fed three isocaloric (or isoenergic) diets for eight days each according to a randomized, crossover design. The three diets provided, respectively, 21% of the energy as fructose, 23% of the energy as sucrose, and almost all carbohydrate energy as starch. The fructose diet resulted in significantly lower one- and two-hour postprandial plasma glucose levels, overall mean plasma glucose levels, and urinary glucose excretion in both type I and type II subjects than did the starch diet. There were no significant differences between the sucrose and starch diets in any of the measures of glycemic control in either subject group. The fructose and sucrose diets did not significantly increase serum triglyceride values when compared with the starch diet, but both increased postprandial serum lactate levels. We conclude that short-term replacement of other carbohydrate sources in the diabetic diet with fructose will improve glycemic control, whereas replacement with sucrose will not aggravate glycemic control.(JAMA 1986;256:3241-3246)

Relationships between use of pharmacy computers and performance of selected professional activities were investigated, via a survey of southern Michigan pharmacists. Respondents included users of two major computer systems as well as pharmacists who do not use computers. A net response rate of 65.7 percent (213 usable questionnaires) was achieved. In general, computer users reported encountering more drug-related problems than did nonusers and more frequent contacts with prescribers for drug-therapy problems. Little difference was found between the two groups in regard to patient counseling activities, except that computer users were more likely to use auxiliary labels. When responses from users of the two computer systems were examined separately, results suggested that one of the systems contributed positively to certain aspects of pharmacists' professional activities while the other system had little influence. These results indicate that it may not be possible to state general conclusions about the effect of computers on the professional practice of pharmacy.

INTRODUCTION Modern medicine is founded upon methodical biologic research, careful clinical observation, and a regimen of logical pharmacologic therapy. However, in our plodding search for cancer's panacea the hope within Pandora's box is often less precise, merely a sorcerer's potion which sometimes casts its spurious spell over even the most discerning of our men of science.Those of us (EFL) who are constantly in close clinical contact with cancer sufferers are especially prone to be afflicted by a more benign but somewhat comparable "permanent thorn in the flesh"—an incurable zeal to penetrate the abysmal darkness of malignant disease. Thus, we are often tempted in our eagerness to try the "treasure hunt" technique in cancer research. In his fascinating presidential a d d r e s s entitled "The Nature of Discovery," Blalock2 mentions Newton as having said that "no great discovery was ever made without a bold guess." The