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Author: John L. Adams Publisher: ISBN: Category : Languages : en Pages :
Book Description
This technical report describes the methods and sensitivity analyses used by the authors in an article published in the New England Journal of Medicine. Purchasers are experimenting with a variety of approaches to control health care costs, including limiting network contracts to lower-cost physicians and offering patients differential copayments to encourage them to visit "high-performance" (i.e., higher-quality, lower-cost) physicians. These approaches require a method for analyzing physicians' costs and a classification system for determining which physicians have lower relative costs. There has been little analysis of the reliability of such methods. Reliability is determined by three factors: the number of observations, the variation between physicians in their use of resources, and random variation in the scores. A study of claims data from four Massachusetts health plans demonstrates that, according to the current methods of physician cost profiling, the majority of physicians did not have cost profiles that met common reliability thresholds and, importantly, reliability varied significantly by specialty. Low reliability results in a substantial chance that a given physician will be misclassified as lower-cost when he or she is not, or vice versa. Such findings raise concerns about the use of cost profiling tools and the utility of their results.
Author: John L. Adams Publisher: ISBN: Category : Languages : en Pages :
Book Description
This technical report describes the methods and sensitivity analyses used by the authors in an article published in the New England Journal of Medicine. Purchasers are experimenting with a variety of approaches to control health care costs, including limiting network contracts to lower-cost physicians and offering patients differential copayments to encourage them to visit "high-performance" (i.e., higher-quality, lower-cost) physicians. These approaches require a method for analyzing physicians' costs and a classification system for determining which physicians have lower relative costs. There has been little analysis of the reliability of such methods. Reliability is determined by three factors: the number of observations, the variation between physicians in their use of resources, and random variation in the scores. A study of claims data from four Massachusetts health plans demonstrates that, according to the current methods of physician cost profiling, the majority of physicians did not have cost profiles that met common reliability thresholds and, importantly, reliability varied significantly by specialty. Low reliability results in a substantial chance that a given physician will be misclassified as lower-cost when he or she is not, or vice versa. Such findings raise concerns about the use of cost profiling tools and the utility of their results.
Author: John L. Adams Publisher: ISBN: Category : Outcome assessment (Medical care) Languages : en Pages :
Book Description
This technical report explains the relationship between reliability measurement and misclassification for physician quality and cost measures in health care. It provides details and a practical method to calculate reliability and misclassification from the data typically available to health plans. This report builds on other RAND work on reliability and misclassification and has two main goals. First, it can serve as a tutorial for measuring reliability and misclassification. Second, it will describe the likelihood of misclassification in a situation not addressed in our prior work in which physicians are categorized using statistical testing. For any newly proposed system, the methods presented here should enable an evaluator to calculate the reliabilities and, consequently, the misclassification probabilities. It is our hope that knowing these misclassification probabilities will increase transparency about profiling methods and stimulate an informed debate about the costs and benefits of alternative profiling systems. The appendixes provide more technical detail on how to measure reliability with related program code as well as a set of lookup tables that can be used to obtain the rate of misclassification associated with a reliability estimate under various scenarios.
Author: Jean-Louis Vincent Publisher: Elsevier Health Sciences ISBN: 0323759300 Category : Medical Languages : en Pages : 2078
Book Description
Bridging the gap between medical and surgical specialties in critical care, Textbook of Critical Care, 8th Edition, offers a practical, multidisciplinary approach to the effective management of adult and pediatric patients in the ICU. An outstanding editorial team, led by world-renowned intensivist Dr. Jean-Louis Vincent, assisted by Dr. Frederick A. Moore and new editors Drs. Rinaldo Bellomo and John J. Marini, provides the evidence-based guidance you need to overcome a full range of practice challenges. A full-color art program, relevant basic science and key summary points in every chapter, and expert contributing authors from all over the world make this an indispensable resource for every member of the critical care team. Provides a concise, readable understanding of the pathophysiology of critical illness and new therapeutic approaches to critical care. Addresses both medical and surgical aspects in critical care for adult and pediatric patients in one comprehensive, easy-to-use reference. Shares the knowledge and expertise of the most recognized and trusted leaders in the field, with more international contributing authors than in previous editions. Covers new information on procedural and diagnostic ultrasound, prone positioning, ECMO, and VADs. Discusses key topics such as organ support, telemedicine, echocardiography, antibiotic stewardship, antiviral agents, coagulation and anti-coagulation, and more. Features a wealth of tables, boxes, algorithms, diagnostic images, and key points that clarify important concepts and streamline complex information for quick reference. Includes companion videos and exclusive chapters online that cover commonly performed procedures. Takes a multidisciplinary approach to critical care, with contributions from experts in anesthesia, surgery, pulmonary medicine, and pediatrics.
Author: Justin B. Dimick Publisher: Springer Nature ISBN: 3030283577 Category : Medical Languages : en Pages : 365
Book Description
This updated volume provides insight into health services research, as well as the emerging areas of research and the tools required to perform scientific work. The book covers topics related to performance assessment, quality improvement, health care policy, and career development. New chapters on the evaluation of non-technical skills in surgery, methods of enhancing causal inference in observational studies, and writing scientific manuscripts are also included. Health Services Research aims to give advice on how to obtain National Institutes of Health funding and other grants, as well as breaking through the barriers to developing a career in academic surgery. This book is relevant to surgical residents and young surgical faculty, as well as anyone undertaking a career in academic surgery.
Author: Jerome Groopman Publisher: Penguin Books ISBN: 014312224X Category : Health & Fitness Languages : en Pages : 322
Book Description
Drs. Groopman and Hartzband reveal a clear path for making the right medical choices. Such factors as authority figures, statistics, other patients' stories, technology, and natural healing are key factors that shape choices.
Author: Gerald F. Kominski Publisher: John Wiley & Sons ISBN: 1118416406 Category : Medical Languages : en Pages : 737
Book Description
The Fourth Edition of Changing the U.S. Health Care System addresses the key topics in health care policy and management, presenting evidence-based views of current issues. Each chapter is written by an expert in the field who integrates evidence to explain the current condition and presents support for needed change. The book examines all the levers in the setting and implementation of health policy, and includes extensive coverage of impact of the Affordable Care Act, particularly on Medicare, Medicaid, and large and small group insurance markets. Also new to this edition is expanded coverage of nursing, disease management, mental health, women's health, children's health, and care for the homeless.
Author: Arnold R. Eiser Publisher: Lexington Books ISBN: 0739181815 Category : Philosophy Languages : en Pages : 219
Book Description
Has postmodern American culture so altered the terrain of medical care that moral confusion and deflated morale multiply faster than both technological advancements and ethical resolutions? The Ethos of Medicine in Postmodern America is an attempt to examine this question with reference to the cultural touchstones of our postmodern era: consumerism, computerization, corporatization, and destruction of meta-narratives. The cultural insights of postmodern thinkers—such as such as Foucault, Deleuze and Guattari, Lyotard, Baudrillard, Bauman, and Levinas—help elucidate the changes in healthcare delivery that are occurring early in the twenty-first century. Although only Foucault among this group actually focused his critique on medical care itself, their combined analysis provides a valuable perspective for gaining understanding of contemporary changes in healthcare delivery. It is often difficult to envision what is happening in the psychosocial, cultural dynamic of an epoch as you experience it. Therefore it is useful to have a technique for refracting those observations through the lens of another system of thought. The prism of postmodern thought offers such a device with which to “view the eclipse” of changing medical practice. Any professional practice is always thoroughly embedded in the social and cultural matrix of its society, and the medical profession in America is no exception. In drawing upon of the insights of key Continental thinkers such and American scholars, this book does not necessarily endorse the views of postmodernism but trusts that much can be learned from their insight. Furthermore, its analysis is informed by empirical information from health services research and the sociology of medicine. Arnold R. Eiser develops a new understanding of healthcare delivery in the twenty-first century and suggests positive developments that might be nurtured to avoid the barren “Silicon Cage” of corporate, bureaucratized medical practice. Central to this analysis are current healthcare issues such as the patient-centered medical home, clinical practice guidelines, and electronic health records. This interdisciplinary examination reveals insights valuable to anyone working in postmodern thought, medical sociology, bioethics, or health services research.
Author: Mitchell P. Fink Publisher: Elsevier Health Sciences ISBN: 0323461069 Category : Medical Languages : en Pages : 1826
Book Description
Comprehensive, concise, and readable, Textbook of Critical Care, 7th Edition, brings you fully up to date with the effective management of critically ill patients, providing the evidence-based guidance you need to overcome a full range of practice challenges. Drs. Jean-Louis Vincent, Edward Abraham, Frederick A. Moore, Patrick Kochanek, and Mitchell P. Fink are joined by other international experts who offer a multidisciplinary approach to critical care, sharing expertise in anesthesia, surgery, pulmonary medicine, and pediatrics. This highly acclaimed text offers ICU clinicians a new understanding of the pathophysiology of critical illness and new therapeutic approaches to critical care. - Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. - Features a wealth of tables, boxes, algorithms, diagnostic images, and key points that clarify important concepts and streamline complex information for quick reference. - Includes many new chapters on echocardiography, antibiotic stewardship, antiviral agents, coagulation and anti-coagulation, , telemedicine, extracorporeal membrane oxygenation (ECMO), and more. - Offers new coverage of biomarkers, bedside ultrasound, and the management of increasingly complex critically ill patients. - Provides new approaches to sepsis, acute kidney injury, and management of acute respiratory distress syndrome (ARDS), and other forms of respiratory failure.
Author: Aasma Shaukat Publisher: Springer ISBN: 1493923331 Category : Medical Languages : en Pages : 210
Book Description
This volume provides a comprehensive overview of quality metrics and methods used to improve quality for all major modalities of CRC screening. It introduces the readers to the evidence of effectiveness behind various CRC screening modalities: stool-based tests (Fecal Occult Blood, Fecal Immunochemical and Fecal DNA tests), flexible sigmoidoscopy, colonoscopy and CT colonography. In-depth chapters review the latest guidelines for CRC screening, compare differences among the five major national guidelines, and highlight the need for valid quality and cost indicators. While the main focus of this volume is on colonoscopy, since most quality indicators and analyses have focused on this modality of screening and surveillance, one chapter is devoted to quality indicators of other screening modalities. Differences between process and outcome measures are also highlighted and a small but valid set of recommended national measures are listed. Written by experts in the field, Colorectal Cancer Screening: Quality and Benchmarks is an important and useful resource written for gastroenterologists, primary care physicians, general and colorectal surgeons, family physicians, and investigators with research focus in screening and quality metrics.
Author: John L. Adams
Author: John L. Adams
Author: John L. Adams
Author: David H. Chestnut
Author: Jean-Louis Vincent
Author: Justin B. Dimick
Author: Jerome Groopman
Author: Gerald F. Kominski
Author: Arnold R. Eiser
Author: Mitchell P. Fink
Author: Aasma Shaukat