Measuring Value in Primary Care: Enhancing Quality or Checking the Box?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109581/1/hesr12256-sup-0001-AuthorMatrix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/109581/2/hesr12256.pd

The Church of San Francisco in Mexico City as Lieux de Memoire

San Francisco, memory, lieux de memoir

Costs of liver transplantation: Primum non obfuscare

The costs and benefits of liver transplantation in adult patients at the University of Pittsburgh were reviewed for the period from 1981 through 1984. Indirect costs such as those to support the surgical and hepatology programs, the operating rooms and the clinical pathology department were ignored, and only those costs generated by the liver transplant program were considered in this analysis. Benefits to the patients are survival itself. Over 8.5% of those who leave the hospital return to full-time employment or other useful activity, including normal, albeit complicated, pregnancies. Most deaths occur during the first 3 months, after which there is a slow decline during the first year. Costs to the patient and/or the third party payers are enormous, and include evaluation as a transplant candidate, procurement of the donor liver, the transplantation itself and lifelong medical-surgical follow-up and immunosuppression plus the management of the undesirable consequences of the whole procedure. Laboratory tests alone average over $52,000 per patient. The consumption of blood and blood products is great and averages 30 units per patient. Duration of hospital admissions averaged about 55 days per patient, of which about 10 were in intensive care units. Total dollar costs were not calculated, however. The benefits to medicine are considerable in the acquisition of new knowledge and skills applicable to other disorders and other patients. The authors conclude that with further experience, the costs will decrease and the benefits will increase.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38330/1/1840060643_ftp.pd

HIV infection is an independent risk factor for decreased 6-minute walk test distance.

BackgroundAmbulatory function predicts morbidity and mortality and may be influenced by cardiopulmonary dysfunction. Persons living with HIV (PLWH) suffer from a high prevalence of cardiac and pulmonary comorbidities that may contribute to higher risk of ambulatory dysfunction as measured by 6-minute walk test distance (6-MWD). We investigated the effect of HIV on 6-MWD.MethodsPLWH and HIV-uninfected individuals were enrolled from 2 clinical centers and completed a 6-MWD, spirometry, diffusing capacity for carbon monoxide (DLCO) and St. George's Respiratory Questionnaire (SGRQ). Results of 6-MWD were compared between PLWH and uninfected individuals after adjusting for confounders. Multivariable linear regression analysis was used to determine predictors of 6-MWD.ResultsMean 6-MWD in PLWH was 431 meters versus 462 in 130 HIV-uninfected individuals (p = 0.0001). Older age, lower forced expiratory volume (FEV1)% or lower forced vital capacity (FVC)%, and smoking were significant predictors of decreased 6-MWD in PLWH, but not HIV-uninfected individuals. Lower DLCO% and higher SGRQ were associated with lower 6-MWD in both groups. In a combined model, HIV status remained an independent predictor of decreased 6-MWD (Mean difference = -19.9 meters, p = 0.005).ConclusionsHIV infection was associated with decreased ambulatory function. Airflow limitation and impaired diffusion capacity can partially explain this effect. Subjective assessments of respiratory symptoms may identify individuals at risk for impaired physical function who may benefit from early intervention

A Pilot Study of the Association of Low Plasma Adiponectin and Barrett's Esophagus

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72851/1/j.1572-0241.2008.01823.x.pd

Under Pressure: Financial Effect of the Hospital‐Acquired Conditions Initiative–A Statewide Analysis of Pressure Ulcer Development and Payment

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112254/1/jgs13475.pd

Small area analysis of hospital discharges for musculoskeletal diseases in Michigan: The influence of socioeconomic factors,

The rise in health care costs has occasioned a number of initiatives in an attempt to reduce the rate of increase. Despite the growth of health maintenance organizations and preferred provider organizations and the introduction of Medicare's prospective payment system, health care costs have continued to increase. Coincident with these efforts, a number of researchers have shown that there exists wide variation in age-adjusted hospital discharge rates, which translate into significant variation in per capita expenditures. Much of the focus on the reasons for hospital admission variability has been on physician practice variation. If most of the variation in hospital discharge rates is due to physician practice style, then payment systems can be developed (e.g., capitation) that limit physician practice variation without harming patients. We examined socioeconomic factors in Michigan communities to assess their association with hospital discharge rates for patients with musculoskeletal diseases. Data on hospital discharges from 1980 and 1987 were taken from the Michigan Inpatient Data Base. All admissions from the major diagnostic category 8, diagnosisrelated group (DRG) 209-256 were included. Zip code-specific hospitalization data were grouped into small geographic areas or hospital market communities (HMCs). Discharge rates were calculated, and profiles of the socioeconomic characteristics of each of the HMCs were developed. A Poisson regression model with an extrasystematic component of variance was used to analyze the association of HMC socioeconomic characteristics with age-adjusted hospital use. We found that four socioeconomic variables, average annual income per capita, percent of the population with four years of college, percent of the population living in an urban area, and percent of families with incomes below the poverty line, explained 26.6% (R2) of the variation in overall hospital discharge rates (p Socioeconomic factors play a significant role in explaining the observed variation in hospital discharge rates for musculoskeletal diseases. Models utilizing only physician practice variation to account for the populationbased differences in discharge rates are overly simplistic. In order to ensure that vulnerable subsets of the population are not harmed by the introduction of cost-containment strategies based on simplistic models, more attention must be paid to the socioeconomic and epidemiologic factors related to hospital use.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29190/1/0000243.pd