The New England journal of medicine
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The objective of clinical prediction rules is to reduce the uncertainty inherent in medical practice by defining how to use clinical findings to make predictions. Clinical prediction rules are derived from systematic clinical observations. They can help physicians identify patients who require diagnostic tests, treatment, or hospitalization. ⋯ We applied these standards to 33 reports of prediction rules; 42 per cent of the reports contained an adequate description of the prediction rules, the patients, and the clinical setting. The misclassification rate of the rule was measured in only 34 per cent of reports, and the effects of the rule on patient care were described in only 6 per cent of reports. If the objectives of clinical prediction rules are to be fully achieved, authors and readers need to pay close attention to basic principles of study design.
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DRG-based reimbursement for inpatient services is an option currently being considered by federal policy makers, but little is known about how physician DRGs might work. We performed simulations of potential impacts, using Medicare claims from four states. Although physician-related inpatient costs associated with surgical DRGs were quite homogeneous, those associated with medical admissions varied dramatically. ⋯ Potential gains and losses were also found to be systematically related to the specialty of the attending physician. General practitioners and ophthalmologists would gain financially on average, whereas medical specialists and some surgical specialists would incur net losses. These differences may be due to the triaging of more seriously ill patients within a given DRG to certain specialists.