Medical care
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The purpose of the study was to determine the basis for nonpsychiatrists' decisions to obtain psychiatric consultations in an emergency department (ED) for patients with transient to moderate psychiatric symptoms. The authors reviewed ED records during July-August 1982 and January-March 1983. Complete data were gathered for 133 of 134 patients with primary or secondary psychiatric discharge diagnoses and scores on the Global Assessment Scale (GAS) such that most clinicians would not think immediate consultation was required. ⋯ Social characteristics also distinguished between patients who received a psychiatric consultation in the ED and patients who did not. It was concluded that nonpsychiatrists base important management decisions on a history of psychiatric treatment for patients with transient to moderate symptoms. Whether this is appropriate needs to be studied.
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Comparative Study
Nursing home patients admitted to a medical intensive care unit.
To investigate admissions from nursing homes to a medical intensive care unit (ICU), the authors detailed the major interventions, costs, and outcomes for such patients (n = 67) over a 3-year period and then compared them with those for ICU patients receiving home care or visiting nurse services (240 patients) before admission and all others older than 65 years of age (949 patients). These three groups comprised 37% of total ICU admissions. ⋯ In-hospital mortality for the nursing home group (28%) was significantly higher than for the home care group (7%) and others older than 65 years of age (7%). Cumulative mortality for the nursing home group reached 66% by 8 months, versus 32% and 26% in the other groups, respectively.
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Burn care treatment is among the costliest yet least studied forms of care. This paper presents estimates of the magnitude and components of burn care costs. It analyzes the extent to which burn care cost is determined by severity of burns or by characteristics of the institution in which the patient is treated, based on patient-specific data from eight hospitals representing different levels of technical sophistication in the delivery of burn care. ⋯ Many patients with small burns are treated in specialized facilities, at much higher costs than patients treated in general care facilities. Among specialized facilities, patient severity accounts for a portion of the variance in costs, but significant cost differences remain after adjusting for severity. These results suggest that cost-control efforts should concentrate on specifying criteria for admission to specialized burn facilities, regional coordination of facilities and institutions, and improved facilities design and management.
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Randomized Controlled Trial Clinical Trial
The role of perceived price in physicians' demand for diagnostic tests.
This research examines the extent of physicians implicit price knowledge and its role in the physicians' demand for diagnostic tests. In particular, it examines the effect of perceived price on the quantity of test ordered. A group of 36 second and third-year residents and 23 clinical faculty members in three family practice centers affiliated with the Family Medicine Department of Wayne State University were randomly assigned to either a control group or an experimental group. ⋯ Physicians' implicit price knowledge was measured by the number of underestimates, overestimates, and correct estimates and correlated with the total number of tests ordered. The results show the following tendencies: 1) physicians generally incorrectly estimate prices; 2) they tend to underestimate rather than overestimate; 3) they tend to underestimate the higher priced tests and overestimate the lower priced tests; 4) the greater the propensity to underestimate, the greater the number of tests ordered; 5) the greater the propensity to overestimate, the fewer the number of tests ordered; and 6) the greater the propensity to correctly estimate, the fewer the number of tests ordered. The results indicate that in the absence of actual prices, perceived prices enter the physicians' demand function and that physicians' demand for diagnostic tests might be categorized as rational.