Medical care
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To develop and validate a new risk adjustment index-the Burden of Illness Score for Elderly Persons (BISEP)-which integrates multiple domains, including diseases, physiologic abnormalities, and functional impairments. RESEARCH DESIGN SUBJECTS: The index was developed in a prospective cohort of 525 patients aged > or = 70 years from the medicine service of a university hospital. The index was validated in a cohort of 1246 patients aged > or = 65 years from 27 hospitals. The outcome was 1-year mortality. ⋯ BISEP provides a useful new risk adjustment system for hospitalized older persons. Although index performance using different data sources has been evaluated, the full BISEP model, incorporating disease, laboratory, and functional impairment information, demonstrates the best performance.
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Comparative Study
Development of a model for case-mix adjustment of pressure ulcer prevalence rates.
Acute care hospitals participating in the Dutch national pressure ulcer prevalence survey use the results of this survey to compare their outcomes and assess their quality of care regarding pressure ulcer prevention. The development of a model for case-mix adjustment is essential for the use of these prevalence rates as an outcome measure. ⋯ The data of the national pressure ulcer prevalence survey can be used to develop a valid model for case-mix adjustment. Conclusions about the quality of care were influenced by the use of case-mix adjusted outcomes as a measure of this quality.
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Health care information systems in use today frequently fall short of what is needed to meet the demands for data and reporting on performance. Many observers believe substantial improvements in information systems will be necessary if the potential of a national quality measurement and reporting system (NQMRS) is to be realized. A shared vision will facilitate progress in improving information systems. ⋯ A shared national measurement framework is essential because the data systems that health care delivery organizations use are not static. A long-term vision can guide the growth of a data system over time. An NQMRS can be the vehicle that provides the needed vision.
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To examine the changes in licensed nursing staff in Pennsylvania hospitals from 1991 to 1997, and to assess the relationship of licensed nursing staff with patient adverse events in hospitals. ⋯ This study suggests that licensed nurses' patient load began increasing in the 1990s. Adequate licensed nurse staffing is important in minimizing the incidence of adverse events in hospitals. Ensuring adequate licensed nurse staffing should be an area of major concern to hospital management. Improved measures of nurse staffing and patient outcomes, and further studies are suggested.
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To examine the association of primary care availability, HMO enrollment, and other person and location variables with potentially preventable hospitalization for adults in New York State, compared with other types of hospitalization. ⋯ A key policy-relevant result is the negative association of primary care physicians per capita with the likelihood of ACS admissions, without an offsetting association with resource costs via referral-sensitive admissions. The method allowed for examining the possible effects of personal and area variables on one type of hospital admission (ACS) by contrast with other specific types of admissions. This type of analysis could be strengthened in several ways for a defined population when better data on individual patients and several time periods are used.