Multi-center evaluation of analytical performance of the Beckman Coulter AU5822 chemistry analyzer.

OBJECTIVES: Our three academic institutions, Indiana University, Northwestern Memorial Hospital, and Wake Forest, were among the first in the United States to implement the Beckman Coulter AU5822 series chemistry analyzers. We undertook this post-hoc multi-center study by merging our data to determine performance characteristics and the impact of methodology changes on analyte measurement. DESIGN AND METHODS: We independently completed performance validation studies including precision, linearity/analytical measurement range, method comparison, and reference range verification. Complete data sets were available from at least one institution for 66 analytes with the following groups: 51 from all three institutions, and 15 from 1 or 2 institutions for a total sample size of 12,064. RESULTS: Precision was similar among institutions. Coefficients of variation (CV) were <10% for 97%. Analytes with CVs >10% included direct bilirubin and digoxin. All analytes exhibited linearity over the analytical measurement range. Method comparison data showed slopes between 0.900-1.100 for 87.9% of the analytes. Slopes for amylase, tobramycin and urine amylase were <0.8; the slope for lipase was >1.5, due to known methodology or standardization differences. Consequently, reference ranges of amylase, urine amylase and lipase required only minor or no modification. CONCLUSION: The four AU5822 analyzers independently evaluated at three sites showed consistent precision, linearity, and correlation results. Since installations, the test results had been well received by clinicians from all three institutions.

Reforming gendered health care: an assessment of change.

Health policy in the United States has changed dramatically over the past three decades, with the main concern shifting from expanded health care coverage to containment of health care costs. The current focus on providing cost-effective health services, reflected in the growth of managed care initiatives, has elevated concern about the quality of health care. The authors contend that quality of health care has always been the key focus in the women's health movement, which evolved in the late 1960s as the first significant challenge to modern medicine. In this article, they apply the analytic lens of gender to develop a fresh perspective on U.S. health care organizations and policies, examining the six broad demands of the feminist consumer model of health care, all of which hinge on the issue of quality care for women, to determine whether women's health needs are now being better addressed. The authors conclude that, despite some notable gains in the roles of women as consumers and providers of health care, many of the new health reforms have replicated and solidified the historical inequities in the health care system.

Gender differences in the early careers of health care managers.

In health care, as in many other fields, women's occupational advancement appears to occur more slowly than men's. Two main theories purport to explain this phenomenon: 1) the "glass ceiling" perspective which focuses on structural arrangements and/or the attitudes of those who make promotion decisions, and 2) "supply side" approaches which argue that characteristics of women themselves explain their relative lack of progress. There is also another view that challenges the glass ceiling, suggesting that it affects predominantly older cohorts of women, and that younger entrants experience few advancement obstacles. This study examines these questions using a population of health administrators who graduated between May, 1984 and May, 1995. Gender comparisons reveal considerable similarity between men and women graduates on a variety of early career outcome variables, disputing supply side arguments and suggesting that barriers to women, if they exist, become important after the early career period.

What we say and what we do: county-level public spending for health care.

The purpose of this study is to examine county-level public spending for health care services in Kansas and to explain variation in spending levels with a model composed of population density, population age and per capita income. Data are abstracted from budget documents for all 105 counties in Kansas for the years 1994, 1995 and 1996. Health care expenditures are defined as county tax revenues spent for ambulance, hospitals, ambulatory care, home health services, nursing homes, and mental health and substance abuse services. Results show that Kansas counties spent between 12.1 percent and 13.6 percent of their budgets to fund local health care services between 1994 and 1996, spending more than $133 million in 1996 alone. In 10 counties, one-quarter to one-third of the budget went for health services. Low population density and relatively high per capita income explained nearly one-third of the variation in how much counties spent and an even greater proportion when analysis was limited to the most rural counties. Findings from this study suggest there may be a significant local commitment in the United States to publicly supported health care services, more support than typically recognized and perhaps more than is estimated in national health care spending data. Future research on the economic effects of the health sector on local communities should take account of local spending for health care, especially at the county level.

Review criteria for stroke rehabilitation outcomes.

OBJECTIVES: To develop review criteria from the Agency for Health Care Policy and Research Stroke Rehabilitation Guidelines, to review chart records from three sites of care, and to evaluate the interrater and intrarater reliability for the chart review. DESIGN: A descriptive cross-sectional study using a convenience sample. SETTING: Charts for abstraction were obtained from three sites of care home health care, nursing facilities, and inpatient rehabilitation centers. PARTICIPANTS: Charts were included in the study from the three sites of care if the following conditions were met: (1) the client's first admission to a rehabilitation setting; (2) the client's care was Medicare reimbursed; (3) the client lived in the community prior to the stroke; and (4) the client was receiving skilled rehabilitation services. MEASURES: Review criteria, developed directly from the AHCPR Stroke Rehabilitation guidelines, consisted of 11 global quality criteria representative of comprehensive multidisciplinary rehabilitative care. There were approximately 150 variables, comprised of specific criteria to measure each of the 11 global quality criteria plus comprehensive demographic and client-specific information. RESULTS: Results of this study suggest that differences exist in documentation of care across the three sites of care. There was difficulty in obtaining adequate numbers of home health charts. Intrarater reliability, using Cohen's Kappa, was .78 and interrater reliability was .64. CONCLUSIONS: Based on chart documentation, there is variability in the process of stroke rehabilitation care across nursing facilities, inpatient rehabilitation facilities, and home health. This variability can be reliably assessed by chart review. This study provides the impetus for future research specifically evaluating the associations between documentation of the processes of care and patient outcomes.

Rural hospitals under PPS: a five-year study.

This research examines the impact of prospective payment (PPS) on the financial performance of Kansas hospitals, which are predominantly rural. Financial ratios are presented and regressed on bed size and year. The data suggest that bed size has the strongest effect on financial viability. There are indications of a delayed effect of PPS on the rural, smallest hospitals (fewer than 25 beds), suggesting that non-operating sources of revenue (local property tax mill levies) are being used to subsidize them in the short term. Small hospitals appear to be delaying all capital and long-term costs to survive. The research suggests that the effect of PPS may be long term.

The health status of the 'old-old': a reconsideration.

This paper questions the universal applicability and utility of age groupings among the elderly and the predictions which result concerning health status and costs as more people live beyond age 75. Comprehensive health data from an elderly population in rural Minnesota show the 'old-old' to be comparable to and in some respects better off than the 'young-old'. Drawing on the notions of "compression of morbidity' and survivorship, this study suggests looking beyond simple age distinctions in order to identify groups with increased risk.