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Predicting important patient outcome...

Reiley, Peggy J.

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Predicting important patient outcomes in the hospitalized elderly: How important is functional status?

Record Type:	Language materials, printed : Monograph/item
Title/Author:	Predicting important patient outcomes in the hospitalized elderly: How important is functional status?/
Author:	Reiley, Peggy J.
Description:	193 p.
Notes:	Chairperson: Norman Kurtz.
Contained By:	Dissertation Abstracts International60-02B.
Subject:	Gerontology. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=9920125
ISBN:	9780599195325

Predicting important patient outcomes in the hospitalized elderly: How important is functional status?
Reiley, Peggy J.

Predicting important patient outcomes in the hospitalized elderly: How important is functional status? - 193 p.

Chairperson: Norman Kurtz.

Thesis (Ph.D.)--Brandeis University, The Heller School for Social Policy and Management, 1999.

Projections are that national health spending will reach one trillion dollars in 1995. As health care costs continue to increase, policy makers, consumers, and insurers are questioning the value of the technologically intensive American health care system. In addition, managed care has hit Massachusetts with a vengeance. The goal of managed care is to provide more efficient, cost effective care without adversely affecting patient outcomes. However, there is a danger that the strong economic incentives of managed care to under-treat will have a harmful effect on patients. The need to measure and evaluate the quality of patient care has emerged as the critical issue of the 90's.

ISBN: 9780599195325Subjects--Topical Terms:

533633
Gerontology.

Predicting important patient outcomes in the hospitalized elderly: How important is functional status?
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020 $a 9780599195325
035 $a (UMI)AAI9920125
035 $a AAI9920125
040 $a UMI $c UMI
100 1 $a Reiley, Peggy J. $3 1291506
245 1 0 $a Predicting important patient outcomes in the hospitalized elderly: How important is functional status?
300 $a 193 p.
500 $a Chairperson: Norman Kurtz.
500 $a Source: Dissertation Abstracts International, Volume: 60-02, Section: B, page: 0607.
502 $a Thesis (Ph.D.)--Brandeis University, The Heller School for Social Policy and Management, 1999.
520 $a Projections are that national health spending will reach one trillion dollars in 1995. As health care costs continue to increase, policy makers, consumers, and insurers are questioning the value of the technologically intensive American health care system. In addition, managed care has hit Massachusetts with a vengeance. The goal of managed care is to provide more efficient, cost effective care without adversely affecting patient outcomes. However, there is a danger that the strong economic incentives of managed care to under-treat will have a harmful effect on patients. The need to measure and evaluate the quality of patient care has emerged as the critical issue of the 90's.
520 $a Donabedian has proposed a model of health care quality assessment that links the structure and process of care to patient outcomes. But there are a variety of other factors that may also contribute to the outcomes of care. Demographics such as age, socioeconomic status, marital status and even gender may influence patient outcomes. Severity of illness and functional status also have an effect. Functional status may be a particularly important variable in the elderly. The purpose of this dissertation was to determine what variables, available by computer during the first 24 to 48 hours of admission to the hospital, are important predictors of the following outcomes in elderly patients: (1)�length of hospital stay, (2)�readmission to hospital and (3)�discharge destination. A second study objective was to explore the extent to which functional status is predictive of these outcomes.
520 $a To explore important variables predictive of the outcomes identified, three conditions were studied: (1)�congestive heart failure, (2)�stroke and (3)�community acquired pneumonia. These conditions were selected because of their high prevalence in the elderly.
520 $a The findings from this dissertation add to the body of knowledge currently available regarding risk assessment in two important ways. First, it shows that functional status is an important variable in identifying risk of adverse outcomes. This was true for length of hospital stay and discharge destination for all three study conditions. In predicting length of hospital stay, functional status was as important prognostically as the APACHE-L score, a physiological severity adjuster. In predicting discharge destination, functional status was prognostically more important than the APACHE-L for all three study conditions.
520 $a Second, this dissertation shows that it is possible to develop clinical risk adjusters that are a by-product of a computerized hospital data system. The data generated for this dissertation were part of routine clinical processes of care. The widespread use of these data would require no primary data collection. Such clinically relevant data would allow for enhanced outcomes comparisons with no additional administrative costs for data collection.
590 $a School code: 0541.
650 4 $a Gerontology. $3 533633
650 4 $a Health Sciences, Medicine and Surgery. $3 1017756
650 4 $a Health Sciences, Public Health. $3 1017659
650 4 $a Health Sciences, Recreation. $3 1018003
650 4 $a Health Sciences, Rehabilitation and Therapy. $3 1017926
690 $a 0351
690 $a 0382
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710 2 0 $a Brandeis University, The Heller School for Social Policy and Management. $3 1024624
773 0 $t Dissertation Abstracts International $g 60-02B.
790 $a 0541
790 1 0 $a Kurtz, Norman, $e advisor
791 $a Ph.D.
792 $a 1999
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=9920125