We conducted depth of penetration experiments into grout and concrete targets with ogive-nose steel projectiles. Powder guns launched 0.064 kg, 12.9 mm diameter projectiles into grout targets with ...unconfined compressive strengths of 13.5 M Pa (2.0 ksi) and 21.6 MPa (3.1 ksi). For the concrete targets, powder guns launched projectiles with length-to-diameter ratios of 10; a 0.48 kg, 20.3 mm diameter rod, and a 1.60 kg, 30.5 mm diameter rod. Concrete targets had unconfined compressive strength of 62.8 M Pa (9.1 ksi) for the 0.48 kg rods and unconfined compressive strength of 51.0 MPa (7.4 ksi) for the 1.60 kg rods. For these experiments, penetration depth increased as striking velocity increased until nose erosion became excessive. Thus, we determined experimentally the striking velocities corresponding to maximum penetration depths. Predictions from a previously published model are in good agreement with data until nose erosion becomes excessive.
Algorithms designed to precisely identify disease severity for a given patient within a managed care population are helpful in organizing targeted interventions. These algorithms are also attracting ...considerable attention within the medical research community. Several health risk screening instruments have been developed; however, these involve survey methodologies and have several shortcomings. We present a valid and efficient method for predicting healthcare resource utilization among asthmatics in an Health Maintenance Organization (HMO) population. First, various diagnosis, procedure and pharmacy billing codes were used to identify the asthmatics within the database. The screening algorithm awards points each time one of these codes is identified for an HMO member. By varying the number of points necessary to consider a patient asthmatic, the sensitivity, specificity, positive and negative predictive values of the algorithm can be adjusted. Once identified as asthmatic, subjects were then stratified into severity levels based on pharmacy data. Severity stratification was validated directly by measuring asthma-related bed days utilized during the 12 months following the date of stratification. Our identification algorithm estimated an asthma prevalence of 3·84% within the studied population, with age-specific prevalence estimates that closely mirrored previously published survey data. There was a monotonic relationship between pharmacy severity levels and inpatient resource utilization. For example, asthmatics in severity level 1 used only 92 hospital days per 1000 asthmatics in the year following characterization, while those in levels 2–5 used 133, 156,277 and 1168 hospital days (
P < 0·001), respectively. Results from this model can be used as adjusters in other predictive models or stand alone to represent a patient's severity of illness.
In Memoriam Robert Buttel (1923–2023) Hanchak, Peter; Serio, John N; Bates, Milton J ...
The Wallace Stevens journal,
01/2023, Letnik:
47, Številka:
2
Journal Article, Book Review
Recenzirano
Below we would like to honor him with four personal testimonies by Wallace Stevens’s grandson, Peter Hanchak, our Honorary Editor John Serio, fellow Board Member Milton Bates, and former Book Review ...Editor and Board Member George Lensing. In the world of Stevens criticism, Bob’s name is remembered especially for two major books that have continued to be used by subsequent generations: his monograph Wallace Stevens: The Making of Harmonium (Princeton UP, 1967), whose title we will italicize in its entirety below to make for easier reading; and a volume of essays, edited together with Frank Doggett, Wallace Stevens: A Celebration (Princeton UP, 1980), which not only showcased the work of a range of stellar critics at the time but also included important personal recollections by Holly Stevens and a variety of previously unpublished poetic and prose writings by Stevens himself. MLA complied with my request to provide an additional session, and the two seminars ran consecutively from 7:15 PM to 10:30 PM on a cold wintry evening at the Palmer House in late December. Since the word “harmonium” contained the letters “i,” “r,” “o,” and “n,” the author argued, Harmonium alluded to Elsie’s ironing.
The 1990s is truly the era of increased accountability in the practice of medicine. Through the methods of cost and quality measurement and the introduction of a manager (i.e., the MCO), society as a ...whole will benefit from a medical delivery system that focuses on linking the outcomes of care delivered to the processes of the care provided. Report cards serve an important tool by which information about quality and costs can be quantified and shared with the purchasers and users of the medical delivery system. Purchasers and patients are asking for greater accountability from payers and providers. The increased accountability of physicians to health plans, IDSs, hospitals, and patients with whom they interact has major implications on the definition of success in the managed medical delivery system of today. The theme of accountability has been described by the examples of the HEDIS Quality Report Card for health plans and Quality Report Cards for hospitals, PCPs, and specialists. Physicians must provide high-quality care to each patient they see but must also develop the mindset and structures to manage an entire population of patients. The expectations of each of the entities with whom they interact must be understood, and physicians need to develop the skills and infrastructure to put total quality management and information technology to work to help them facilitate the delivery of high-quality care in a cost-effective manner. Everyone involved in the health care system--from purchasers to payers to consumers--shares the same goals as physicians: provide the highest-quality care and achieve the best possible outcomes in the most cost-effective manner.
To compare outpatients' understanding of medication dosing instructions written in terms of daily frequency with patients' understanding of instructions specifying hourly intervals.
Prospective ...cohort study involving patient interviews.
A university hospital outpatient pharmacy.
Five hundred patients presenting new and refill prescriptions to the hospital outpatient pharmacy.
Patients were interviewed using a standardised questionnaire.
Of the 71 patients with prescriptions specifying dosing instructions in hourly intervals (e.g., q6h), 55 (77%) misinterpreted the recommended frequency of dosage compared with only 4 (0.99%) of the 429 patients with dosing instructions specifying daily frequency (e.g., qid) (relative risk 83; 95% confidence interval 31-200). This difference remained when patient subgroups were evaluated by education level, new versus refill prescriptions, and analgesic versus nonanalgesic medications.
This study indicates that the intended dosing regimen is frequently misunderstood when the physician writes outpatient prescriptions in hourly intervals. To promote optimal patient compliance, the outpatient prescription label should state the number of times a day a medication is to be taken.
To evaluate (a) the relationship between mammogram interpretation and diagnosis of new breast cancer and (b) interprovider variation in mammogram interpretation.
Interpretations of screening ...mammograms (133,668 mammograms in 114,899 women) acquired during 21 months in a large health maintenance organization were categorized (categories 1-5) with use of a standard format. During 1 year after mammography, new breast cancer was identified with use of claims data. Interprovider variation in the categories read was evaluated, and percentages of these categories were correlated with breast cancer detection.
Over the 21 months, 1,018 mammograms were followed by a diagnosis of new breast cancer. The category of mammogram interpretation was strongly associated with the diagnosis of new breast cancer; in 47.5% cases of category 5 mammograms, breast cancer was diagnosed. There was substantial interprovider variation in the percentages of category 3, 4, or 5 mammograms read. The percentage of category 4 and 5 mammograms read correlated inversely with the likelihood of cancer detection (Pearson correlation coefficient r = -.4778 after log-log transformation, P < .001).
A strong correlation existed between a mammographic abnormality suggestive of cancer and its detection; however, substantial interprovider variation in the reading of category 3, 4, and 5 mammograms and their positive predictive values existed. Reduction of interprovider variation should improve quality of care because the number of false-negative and false-positive mammograms should decrease.
The patterns of treatment for newly diagnosed breast carcinomas in older women aged 65 years or more have not been well studied, particularly in relation to screening mammography performed for the ...early detection of breast cancer. Therefore, the present study was performed to determine the patterns of treatment for newly diagnosed breast carcinomas in older women aged 65 years or more and to determine the impact of screening mammography on these patterns of treatment. The study population consisted of 130 women aged 65 years or more with newly diagnosed breast carcinoma from 1993 through 1994 enrolled in a large health maintenance organization. The medical records of these 130 patients were reviewed. The breast cancers detected in women who had undergone mammographic screening were more often eligible for breast-conservation treatment than the breast cancers detected in women who had not undergone mammographic screening (79% vs. 48%, respectively; p = 0.0044). For the breast cancers that were eligible for breast-conservation treatment, breast-conservation treatment was used more often for the women who had undergone mammographic screening than for the women who had not undergone mammographic screening (70% vs. 27%, respectively; p = 0.0077). Definitive radiation therapy was delivered after breast-conservation surgery in 89% (55/62) of the patients. Medical oncology consultation was obtained more commonly for more advanced staged breast cancers. Clinical management was altered in 9% (12/130) of the patients because of older patient age, comorbid medical conditions, or both. These findings have documented the patterns of treatment for older women aged 65 years or more with newly diagnosed breast cancer. Screening mammography had a significant impact on the patterns of breast cancer management, as demonstrated by the association of screening mammography with an increased eligibility for breast-conservation treatment and an increased use of breast-conservation treatment for eligible patients.
The Medicare-HMO Revolving Door Josephson, D G; Grana, J R; Hanchak, N A
The New England journal of medicine,
12/1997, Letnik:
337, Številka:
25
Journal Article
Recenzirano
To the Editor:
We have major questions about the methods and conclusions of Morgan et al. (July 17 issue)
1
in their study of the Medicare–health maintenance organization (HMO) revolving door. The ...authors admit that the study area, southern Florida, is unique, having “more Medicare beneficiaries than each of 35 states, one of the nation's highest per capita health care costs, and the nation's second highest Medicare capitated rate.” Nevertheless, the authors generalize their results to the whole nation without reservation or qualification — a serious leap of faith and lapse of judgment.
In addition, the authors excluded Medicare recipients who . . .
To present results with a radiology performance report to help evaluate utilization of radiologic examinations by primary-care practices (family practice, internal medicine, or pediatrics) in an ...independent practice association health maintenance organization (HMO).
Utilization reports for primary-care-physician practices (n = 5,000) over a 12-month period (July 1, 1993 through June 30, 1994) were derived from administrative data collected from claim and encounter forms submitted by radiologic practices. Data were divided into 22 measures to help define practice utilization. five overall measures helped evaluate procedures performed by HMO member or nonmember practices per 1,000 members. Twelve specific measures helped evaluate patterns of use of frequently ordered imaging procedures (eg, computed tomography, magnetic resonance imaging, bone scanning, cardiovascular nuclear imaging, nonobstetric ultrasound, and plain radiography). Five quality measures helped evaluate utilization of screening mammography in women aged 50-64 years (as a percentage of all women in the HMO aged 50-64 years) and of low-yield examinations (ie, sinus, rib, and skull radiography per 1,000 adult members).
Individual practice utilisation mean results were compared with overall HMO mean results adjusted for practice type and age and sex of members.
Utilization data are an integral part of evaluation of HMOs and their providers, and these results helped establish a baseline level of performance.
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