Cancer of the breast, colon, ovary, and testis in the United States: rates 1970-78 from a hospital reporting system

We have explored the use of data from the Commission on Professional and Hospital Activities-Professional Activity Study ( CPHA -PAS) for ascertaining information on cancer incidence, with regional breakdowns. Extirpative surgical procedures were linked with discharge diagnoses to provide estimates of numbers of incident cases. We calculated incidence rates for four cancers: breast, colon, ovary, and testis. CPHA -PAS inferred rates corresponded closely to those of other reporting systems for breast cancer in most age groups, and for colonic and testicular cancer in some age groups. Ovarian cancer rates were consistently underestimated. We conclude that a cancer incidence reporting scheme based on hospital discharge data can work for certain cancers, and be very inexpensive and efficient. It must, however, be used with care.

The Professional Activity Study of the Commission on Professional and Hospital Activities

Health Data Sources is an ongoing series talking about data sources useful to health services researchers. Contributors have included Ross Mullner, Peter Kralovec, Edward Kobrinski and Jack Hadley. Each piece begins with a description of the data base and is followed by evaluative comments from a recent user.

Three case-type classifications: suitability for use in reimbursing hospitals

This study compared three case-type classifications--the cross-classification of the Commission on Professional and Hospital Activities, Diagnosis-Related Groups (DRGs) and Staging--with respect to per cent of variance in total patient charges accounted for. The purpose was to assess the relative usefulness of the classifications for application in hospital reimbursement schemes. The sample consisted of 50 hospitals. A nested analysis of variance was performed with case type nested within hospital. Per cent of variance accounted for was calculated for each of three data sets: the full data set, a truncated version of that set and a logarithmically transformed version. Results support the contention that none of the currently available classifications accounts for enough variance to permit straightforward use of case-type standard costs in a reimbursement mechanism. New developments in case-type classification may result in a classification that is more suitable for this use.

Hospital information systems and the development of a national health information system

Hospitals require information to support medical quality assurance, cost containment, productivity improvement, utilization analysis, program planning and evaluation, research, and education. Although hospitals could benefit from participation in a national health information system, many would be reluctant to participate particularly if participation were federally mandated. Incentives to participation should include funding of developmental costs, standardized computer software, guarantees of system stability, and prompt reporting back to participating hospitals.

Hospital medical staff organization and quality of care: results for myocardial infarction and appendectomy

This article examines the relationships among hospital structural characteristics, individual physician characteristics, medical staff organization characteristics and quality of care for two conditions: acute myocardial infarction and appendicitis. Using data obtained from the Commission on Professional and Hospital Activities (CPHA), approximately 50,000 acute myocardial infarction cases and 8,183 appendectomy cases collected from 96 hospitals in the East North Central Region of the country (Illinois, Indiana, Michigan, Ohio and Wisconsin) were examined. These data were merged with medical staff organization and related data on hospital characteristics obtained from the American Hospital Association. The results indicate that such medical staff organization factors as involvement of the medical staff president with the hospital governing board, overall physician participation in hospital decision making, frequency of medical staff committee meetings and percentage of active staff physicians on contract are positively associated with higher quality-of-care outcomes, independent of the effects of hospital and physician characteristics. Further, the medical staff organization factors appear to be somewhat more strongly associated with higher quality-of-care outcomes than the hospital and physician characteristics. For acute myocardial infarction, higher volume of patients treated per family practitioner and internist and presence of a coronary care unit were also associated with better outcomes. Given the restricted number of conditions studied, the geographically limited sample and the fact that specific variables were not consistently related to quality of care for both conditions, the results area viewed as preliminary. However, they are consistent with and extend other developing findings in this area. They also suggest that more attention needs to be given to the organization of the hospital medical staff and its articulation with the overall hospital decision-making structure and process in attempts to improve outcomes of hospitalization.

Health care information: is PAS the answer to the problems of HAA?

PAS--Professional Activity Study--is a patient care information system for short-stay patients, based in the USA, which is 'clinically rich'. By contrast the British, DHSS-sponsored system, HAA (Hospital ACtivity Analysis) is 'clinically impoverished'. This was the comparison drawn by Dr Brain Moores, of the University of Manchester Institute of Science and Technology, in an article which followed a visit he made last year to the headquarters of the Commission on Professional and Hospital Activities (CPHA) at Ann Arbor, Michigan (Journal, 5 December, 1980). Recently, senior officials of CPHA flew to Britain to discuss PAS with an invited audience of British statisticians, administrators, doctors and other information specialists at a two-day seminar in Manchester. It now seems likely that some British health authorities may want to experiment with the PAS approach as an alternative, or a supplement, to HAA. On the other hand, some participants felt that HAA could, potentially, do anything PAS can do.

An audit of chloramphenicol use in a large community hospital

In a large community hospital during a six-month period, 238 of 19,670 hospitalized patients (1.2%) received chloramphenicol. The drug was administered exclusively by the intravenous route in 98% of these patients. In 78% of the patients, chloramphenicol was used for an appropriate indication, whereas in 22%, its use was inappropriate. Serious toxic effects and unexpected clinical failures were not observed.

Pelvic inflammatory disease in the United States. Epidemiology and trends among hospitalized women

The Hospital Discharge Survey, conducted by the National Center for Health Statistics (Rockville, Md.), provides national estimates for conditions causing hospitalization in short-stay hospitals in the United States. The venereal Disease Control Division of the Centers for Disease Control (Atlanta, Ga.) obtained survey data for 1970-1975 and analyzed the epidemiology of pelvic inflammatory disease (PID) in women hospitalized for this disease. An average of greater than 211,000 female patients older than 10 years of age were hospitalized annually for PID. Acute salpingitis occurred predominantly in women younger than 30 years of age. Women of all races other than white had a PID rate 3.3 times greater than that of white women. Data obtained from the Commission on Professional and Hospital Activities were used for determination of the trend in hospitalizations for PID. In all races other than white, the trend appears stable; however the trend among white women is increasing.

Neurosurgery in the United States: a log-diary study

The Division of Research in Medical Education and of the University of Southern California, with the cooperation and assistance of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, has conducted a national study of the professional activities of neurological surgeons in the United States. One of a series of 24 surveys of medical and surgical specialties, the survey obtained information on patient workloads, the allocation of physician time, the characteristics of patients and the circumstances under which they were seen, patient diagnoses, and the care that was provided--including whether an operation was performed. This paper provides a selection of the findings deemed most relevant to manpower issues in neurosurgery. A later paper will examine regional differences in patient care, including the frequency with which selected surgical procedures are used for different clinical conditions.

Determinants of hospital casemix complexity

Using the Commission on Professional and Hospital Activities' Resource Need Index as a measure of casemix complexity, this paper examines the relative contributions of teaching commitment and other hospital characteristics, hospital service and insurer distributions, and area characteristics to variations in casemix complexity. The empirical estimates indicate that all three types of independent variables have a substantial influence. These results are discussed in light of recent casemix research as well as current policy implications.

Professional activity study: crunching the numbers across the Atlantic

It is particularly appropriate in 'International Health Record Year' that Dr Brian Moores, of Manchester University Institute of Science, should examine what professional activity studies have to offer. Here he looks at this American system of monitoring and compares it with HAA, which in contrast he describes as 'clinically impoverished'

An assessment of productivity in health care

The measurement, improvement, and ongoing monitoring of hopitals' efficiency in the delivery of health care is a formidable but necessary task in view of current demands for both cost containment and high-quality care.

[The professional and familial status of female physicians in Switzerland]

A questionnaire on professional and family life was sent to all women doctors in Switzerland (N=2570). 70% were returned, 80% of the respondents are exercising their profession, though only 50% in full time jobs. The most important reason for not working is the presence of small children, mainly in doctors aged 30-40.