Health services research
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Health services research · Oct 1991
Measuring outcomes of hospital care using multiple risk-adjusted indexes.
Using existing data sources, we developed three risk-adjusted measures of hospital quality: the risk-adjusted mortality index (RAMI), the risk-adjusted readmissions index (RARI), and the risk-adjusted complication index (RACI). We describe the construction and validation of each of these indexes. After these measures were developed, we tested the relationships among the three indexes using a sample of 300 hospitals. ⋯ This result provides some evidence that no measure of quality should be used by itself to represent different aspects of the quality of hospital care. Adequate overall measures of hospital quality will need to include multiple measures in order to be credible and to reflect the complexity of hospital care. The findings suggest that consumers, payers, and policymakers cannot simply choose one hospitalwide measure, such as the mortality rate, to validly represent a hospital's performance: those hospitals with high rankings on their mortality rates do not necessarily rank high on their readmission rates or complication rates.
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Health services research · Oct 1990
Modeling the effect of insurance on health expenditures in the People's Republic of China.
A pilot study was undertaken in two rural counties in Sichuan Province to determine the feasibility of offering health insurance to peasant families. Models of per capital inpatient and outpatient health care expenditures were developed using self-reported utilization from a survey of 880 households, supplemented by cost and utilization data from the providers in the counties. Expenditures at a facility were modeled as a function of level of insurance in three parts: (1) as the product of the probability of any use, (2) the expected number of visits given any use, and (3) the cost per visit at the facility. Output from the model for representative insurance plans is presented.
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Health services research · Aug 1990
Medicare home health utilization as a function of nursing home market factors.
Rapid increases in the size and costs of the home health market, unknown impacts of Medicare's DRG hospital reimbursement on the posthospital market, and general lack of knowledge about factors that explain interstate variation in home health utilization all suggest the importance of developing and testing models of Medicare home health use. This article proposes and tests a model of state home health utilization as a function of the nursing home market. ⋯ Specifically, Medicare home health use in the 1978-1984 period was found to be negatively related to nursing home bed stock, positively related to Medicaid nursing home utilization, and related to several other supply and demand factors, as hypothesized by the model. The further model assumption that home health utilization does not affect the nursing home market could not be tested in this analysis, but will be addressed in future research by the authors.
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Health services research · Apr 1990
The whole is greater than the sum of its parts: the anatomy of the Department of Veterans Affairs Medical District 17 Health Services Research and Development Field Program.
The Medical District 17 Health Services Research and Development (HSR&D) Field Program was funded by the Veterans Administration (now the Department of Veterans Affairs--VA) in January 1983. This article describes the organization, progress, and accomplishments of this field program, and it provides a review of the breadth of health services research that is being conducted in Medical District 17. Overall, the field program has conducted research that addresses significant problems in the delivery of health care within the VA system. ⋯ These collaborations are a major strength of the field program. Primary research priorities of the field program are cost effectiveness of VA services (e.g., patient care technologies, delivery systems), long-term care, and rehabilitation. Investigators, however, are not limited to these topics and explore many other health services research issues of particular interest to them.
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Health services research · Apr 1990
Health Services Research and Development: a tool for hospital management.
Mr. Zamberlan is one of seven major executives in the Department of Veterans Affairs (VA) Veterans Health Services and Research Administration (VHS&RA), directing health care in a five-state region that includes 21 medical centers, 7 outpatient clinics, and 19 veterans outreach centers. ⋯ In this editorial, Mr. Zamberlan outlines his perspective on HSR&D in VA and relates it to the activities of the HSR&D Field Program in the region he directs, which is based at the VA Medical Center in Ann Arbor, MI.