Mary Jane Alexander

An Alternative to DRGs: A Clinically Meaningful and Cost-reducing Approach

A statistical methodology based on the Cox proportional hazards model (a survival time analysis method), an alternative to the approach underlying DRGs, is presented. The method is used to obtain an estimate of the length-of-stay (LOS) distribution of a patient incorporating either patient-specific or hospital variables. A percentile of the distribution chosen to minimize prediction error serves as the assigned LOS. Absolute deviation is used as the loss function both to determine the choice of a predicted LOS and to examine how well the scheme works. Multiple assignment schemes may also be developed from this approach. The results of the method, tested on a national probability sample of 4,608 psychiatric patients treated in psychiatric units of general hospitals, suggest that with respect to average absolute deviation, the proposed methodology may provide a scheme that is superior to the present DRG scheme. For the sample, the average percent improvement obtained using the median of the estimated LOS distribution as the predicted LOS over the sample mean of the DRG group is 19%. A two assignment strategy results in average improvements over DRGs of 43%.

The current systems assessment and the clinical care process: A tool for clinical supervision and the design of clinical information systems

A side benefit of a current systems assessment carried out prior to automation was the development of a systematic picture of the clinical care system as captured in the system flow chart. The results of this assessment provided clinical administrators with ablueprint identifying the current systems strengths and weaknesses, which could be used both to introduce improvements and to measure the effect of such changes totally apart from the initial question of automation.

Effects of Compliance on Outcome Independent of Pharmacological Efficacy in the Treatment of Opioid Dependence: A Post Hoc Regression Analysis

In this double-blind controlled study, 143 opioid-dependent male subjects were detoxified and randomly assigned to etrafon (amitriptyline 25 mg and perphenazine 2 tng), methadone, or placebo. Subjects were treated, monitored, and evaluated frequently for 1 year. Reported here are assessments carried out at 3-month intervals after hospital discharge. Treatment effectiveness was defined in terms of improvement of clinical symptoms, employment, and reduction in drug abuse. Data were analyzed on subjects who remained in treatment for at least 3 months (73%)- Data analysis used a random regression model. Overall, type of treatment did not significantly affect outcome. An unexpected but significant effect on outcome seemed due to adherence to drug regimen. Those who adhered to their medication, whether etrafon, methadone, or placebo, improved more than noncompliers on most outcome measures regardless of type of drug treatment.