Measurement of end-capillary PO2 with positron emission tomography.

The analysis of positron emission tomography measurements of oxygen metabolism has been extended to provide a quantitative estimate of end-capillary PO2. The principle of this extension rests on the idea that the oxygen extraction fraction can be used to calculate the end-capillary oxygen saturation of the blood. The relation between oxygen saturation and PO2 is obtained through the oxygen dissociation curve. Our studies show that in addition to the local oxygen extraction fraction, arterial PO2 and pH values are needed in the calculation, whereas fairly large variations in factors such as PCO2, hematocrit, hemoglobin, and plasma protein levels have little or no effect. Rough estimates of end-capillary PO2 can be made using standard O2 dissociation nomograms. Blood gas and acid-base properties of blood have been known for decades, making it possible to account accurately for individual differences that may be encountered when studying patients. Measurements in nine normal subjects yielded a mean end-capillary PO2 value of 31.2 mm Hg. The ability to make a quantitative visualization of altered patterns of end-capillary PO2 provides an additional dimension to the investigation of stroke disease and tumor metabolism.

Hospitals and physicians work together to manage risk.

The hospitals and physicians who have been successful in the managed care arena are those who hae carefully analyzed the operational implications of managed care contracts. They have worked together to establish mutually beneficial economic incentives and to create organizational structures capable of effectively managing hospital and physician risk.

Managing under managed care: winning strategies.

As managed care contracts grow in number and complexity, financial managers must develop strategies to manage and control them. Managers must gain the cooperation of the medical staff, improve financial controls and forecasting, develop an effective information system, improve case-mix management, and measure and control productivity in the hospital to truly manage managed care. This article is the first of a six-part special report on managing managed care. The strategies presented in this series will illustrate how hospitals are successfully, and sometimes unsuccessfully, dealing with the problems and challenges of managed care.

Niche systems help hospitals manage useful data.

Hospitals often struggle to more effectively manage their information. However, their main problem is not the lack of data to solve problems with, it is the lack of useful data. By incorporating a specialized or "niche" system of information management, hospitals will have specific data they can use for strategic planning without being overwhelmed by repetitive or unneeded information. This is the third article in a special report on managing managed care.

Establishing a physician incentive system.

The increasing complexity of managed care is changing the need for better information on medical costs and utilization. Because most claims systems have limited reporting and analysis capabilities, a better alternative is to transfer the data into the reporting systems described herein, in which a comprehensive analysis is conducted faster and at a lower cost. Virtually any type of analysis is possible.