Improved results in acute appendicitis care following areawide review

Diagnosis related groups (DRGs): efficiency and/or quality producing? Some evidence from surgical patients

Hospital charges and length of stay for inguinal hernia and acute appendicitis patients were examined in a university hospital to determine the degree of variation with DRGs. Evidence presented here suggests that DRGs may lead to a reduction in medical care costs without a reduction in patient outcomes. Mode/year DRGs to take account of source of admission and maintaining outliers payments may be desirable to avoid patient selectivity and incentives for lowering quality of care of the most severely ill patients.

Software for health care analysts: a modular approach

The many concerns about the cost and quality of health care suggest the need to facilitate planners' using existing data bases for utilization review, program evaluation, and technology assessment. Despite both the availability of relevant data and widespread improvements in computing power, integrated computer software to permit analyses by nonspecialists has not previously been developed. This paper discusses the features of a health policy information system which aids working with hospital discharge abstracts, medical claims, cancer registries, and vital statistics files. Analyses of small area utilization, length of stay, in-hospital mortality, and readmissions are facilitated by this package. This information system, named the Health Applications System, includes an analysis module, three information management modules, and a set of record linkage modules. The modules were developed using the macroprocessor in the fourth-generation SAS system. Features of the software and their implications for data analysis are discussed.

The influence of age and gender on normal appendicectomy rates

Epidemiological data from a retrospective analysis of 1307 pathology reports of appendicectomy specimens from four Hunter Valley Hospitals, having a 100% tissue audit, showed that there was a significant difference in normal appendicectomy (histologically normal appendix following appendicectomy for suspected acute appendicitis) rates for the young (male and female 0-12 years) and reproductive female (13-50 years) groups when compared with the elderly (over 60 years) and the rest (male 13-59, female 51-59 years) of the population. The overall normal appendicectomy rate was 26%, and the perforation rate 3.6%. These data suggest that suspected acute appendicitis in the Hunter Valley is managed in an appropriate way. The perforation rate was significantly higher in the elderly group, and management of these patients will remain a problem due to delayed and atypical presentation. Continuing audit programmes and area-wide review should contribute to improved accuracy in the diagnosis of acute appendicitis.