Multiparameter scoring system for the prognosis of differentiated thyroid cancer.

UNLABELLED: The AIM of the study was to develop a scoring system consisting of multiple parameters that are significant for prognosis of thyroid cancer. The score was designed to permit a risk stratification with all available information at any time of presentation. PATIENTS, METHODS: A score using 25 parameters was used for 171 patients with differentiated thyroid cancer, who were included in follow up over a mean of 9 (+/- 5) years. The significance of each parameter as well as of a summation outcome score was determined. The result of this scoring system was compared to other scores reported in the literature applied to the same patients' group. Thirty-two out of the 171 patients presented with recurrence during follow up. RESULTS: The summation score was highly significant for prognosis of differentiated thyroid cancer. Out of 25 parameters, 18 showed a significant association with outcome also as individual parameters. In comparison to the scores commonly used, this new system showed the highest significance (p < 0.0001, chi square 90, df 1) to estimate recurrence free survival. At a cutoff of -5.95 the sensitivity and specificity for the distinction between high and low risk patients were 87.5 and 77.0%, respectively. CONCLUSION: With our multiparameter scoring system a reliable prognosis with respect to recurrence free survival is possible in patients suffering from differentiated thyroid cancer. A summation score of all parameters gives the best results. Scoring is also possible, if several important parameters are missing.

Hospital utilization and mortality levels for patients in the Arizona Health Care Cost Containment System.

The primary intent behind Medicaid was to mainstream the poor and enable them to receive the same level and quality of care enjoyed by the middle class. This study compares the hospital utilization (total charges, length of stay, charges per day) and mortality levels among beneficiaries of Arizona's experimental Medicaid program with those of privately insured patients. The analysis is based on 121,874 discharges of patients with 11 different conditions from nonfederal general hospitals in Arizona during 1989 and 1990. After controlling for severity of illness and the specific hospital used, as well as several patient, hospital, and physician factors, we find that AHCCCS patients with medical, surgical, and pediatric diagnoses exhibit few significant differences in utilization and mortality compared to patients with private insurance. However, AHCCCS patients undergoing vaginal delivery exhibit significantly lower charges and length of stay, suggesting they underuse these services. AHCCCS women undergoing cesarean section exhibit higher charges and longer stays. We conclude that Arizona's Medicaid program provides hospital care equivalent to that received by privately-insured patients for many but not all conditions.