bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concurrent Prediction of Hospital Mortality and Length of Stay from Risk Factors on Admission
Authors: Clark David E. , Ryan Louise M. 
Published: March 2003

Objective. To develop a method for predicting concurrently both hospital survival and length of stay (LOS) for seriously ill or injured patients, with particular attention to the competing risks of death or discharge alive as determinants of LOS.Data Sources. Previously collected 1995–1996 registry data on 2,646 cases of injured patients from three trauma centers in Maine.Study Design. Time intervals were determined for which the rates of discharge or death were relatively constant. Poisson regression was used to develop a model for each type of terminal event, with risk factors on admission contributing proportionately to the subsequent rates for each outcome in each interval. Mean LOS and cumulative survival were calculated from a combination of the resulting piecewise exponential models.Principal Findings. Age, Glasgow Coma Scale, Abbreviated Injury Scores, and specific mechanisms of injury were significant predictors of the rates of death and discharge, with effects that were variable in different time intervals. Predicted probability of survival and mean LOS from the model were similar to actual values for categorized patient groups.Conclusions. Piecewise exponential models may be useful in predicting LOS, especially if determinants of mortality are separated from determinants of discharge alive.
Agreement between Self‐reported and Routinely Collected Health‐care Utilization Data among Seniors
Authors: Raina Parminder , Torrance‐Rynard Vicki , Wong Micheline , Woodward Christel 
Published: March 2003

Objective. To examine the agreement between self‐reported and routinely collected administrative health‐care utilization data, and the factors associated with agreement between these two data sources.Data Sources/Study Setting. A representative sample of seniors living in an Ontario county within Canada was identified using the Ontario Ministry of Health's Registered Persons Data Base in 1992. Health professional billing information and hospitalization data were obtained from the Ontario Ministry of Health and Long‐Term Care (OMH) and the Ontario Health Insurance Plan (OHIP).Study Design. A cross‐sectional survey was carried out to assess any contact and frequency of contacts with health professionals and hospital admissions. Similar information was obtained from routinely collected administrative data. The level of agreement was assessed using the proportion of absolute agreement, Cohen's kappa statistic (), and the intraclass correlation coefficient (ICC). Logistic and linear regressions were used to identify factors that were associated with the magnitude and direction of disagreement respectively.Data Collection/Extraction Methods. Telephone interviews were conducted on 1,054 seniors, and complete data were available for 1,038 seniors. Each respondent's personal health number was used to electronically link survey data with health professional billing and hospitalization databases.Principal Findings. Substantial to almost perfect agreement was found for the contact utilization measures, while agreement on volume utilization measures varied from poor to almost perfect. In surveys, seniors overreported contact with general practitioners and physiotherapists or chiropractors, and underreported contact with other medical specialists. Seniors also underreported the number of contacts with general practitioners and other medical specialists. The odds of agreement decreased if respondents were male, aged 75 years and older, had incomes of less than $25,000, had poor/fair/good self‐assessed health status, or had two or more chronic conditions.Conclusion. The findings of this study indicate that there are substantial discrepancies between self‐reported and administrative data among older adults. Researchers seeking to examine health‐care use among older adults need to consider these discrepancies in the interpretation of their results. Failure to recognize these discrepancies between survey and administrative data among older adults may lead to the establishment of inappropriate health‐care policies.
Medical Expenditures during the Last Year of Life: Findings from the 1992–1996 Medicare Current Beneficiary Survey
Authors: Hoover Donald R , Crystal Stephen , Kumar Rizie , Sambamoorthi Usha , Cantor Joel C 
Published: March 2003

Objective. To compare medical expenditures for the elderly (65 years old) over the last year of life with those for nonterminal years.Data Source. From the 1992–1996 Medicare Current Beneficiary Survey (MCBS) data from about ten thousand elderly persons each year.Study Design. Medical expenditures for the last year of life and nonterminal years by source of payment and type of care were estimated using robust covariance linear model approaches applied to MCBS data.Data Collection. The MCBS is a panel survey of a complex weighted multilevel random sample of Medicare beneficiaries. A structured questionnaire is administered at four‐month intervals to collect all medical costs by payer and service. Medicare costs are validated by claims records.Principal Findings. From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years. Mean total last‐year‐of‐life expenditures did not differ greatly by age at death. However, non‐Medicare last‐year‐of‐life expenditures were higher and Medicare last‐year‐of‐life expenditures were lower for those dying at older ages. Last‐year‐of‐life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non‐Medicare expenditures, and 25 percent of Medicaid expenditures.Conclusions. While health services delivered near the end of life will continue to consume large portions of medical dollars, the portion paid by non‐Medicare sources will likely rise as the population ages. Policies promoting improved allocation of resources for end‐of‐life care may not affect non‐Medicare expenditures, which disproportionately support chronic and custodial care.
Measuring Preferences for Health Care Interventions Using Conjoint Analysis: An Application to HIV Testing
Authors: Phillips Kathryn A , Maddala Tara , Johnson F. Reed 
Published: March 2003

Objective. To examine preferences for HIV test methods using conjoint analysis, a method used to measure economic preferences (utilities).Data Sources. Self‐administered surveys at four publicly funded HIV testing locations in San Francisco, California, between November 1999 and February 2000 (n=365, 96 percent response rate).Study Design. We defined six important attributes of HIV tests and their levels (location, price, ease of collection, timeliness/accuracy, privacy/anonymity, and counseling). A fractional factorial design was used to develop scenarios that consisted of combinations of attribute levels. Respondents were asked 11 questions about whether they would choose “Test A or B” based on these scenarios.Data Analysis. We used random effects probit models to estimate utilities for testing attributes. Since price was included as an attribute, we were able to estimate willingness to pay, which provides a standardized measure for use in economic evaluations. We used extensive analyses to examine the reliability and validity of the results, including analyses of: (1) preference consistency, (2) willingness to trade among attributes, and (3) consistency with theoretical predictions.Principal Findings. Respondents most preferred tests that were accurate/timely and private/anonymous, whereas they had relatively lower preferences for in‐person counseling. Respondents were willing to pay an additional $35 for immediate, highly accurate results; however, they had a strong disutility for receiving immediate but less accurate results. By using conjoint analysis to analyze new combinations of attributes, we found that respondents would most prefer instant, highly accurate home tests, even though they are not currently available in the U.S. Respondents were willing to pay $39 for a highly accurate, instant home test.Conclusions. The method of conjoint analysis enabled us to estimate utilities for specific attributes of HIV tests as well as the overall utility obtained from various HIV tests, including tests that are under consideration but not yet available. Conjoint analysis offers an approach that can be useful for measuring and understanding the value of other health care goods, services, and interventions.
Discrepancies Between Explicit and Implicit Review: Physician and Nurse Assessments of Complications and Quality
Authors: Weingart Saul N. , Davis Roger B. , Palmer R. Heather , Michael Cahalane  , Beth Hamel Mary , Mukamal Kenneth , Phillips Russell S. , Davies Donald T. , Iezzoni Lisa I. 
Published: March 2003

Objective. To identify and characterize discrepancies between explicit and implicit medical record review of complications and quality of care.Setting. Forty‐two acute‐care hospitals in California and Connecticut in 1994.Study Design. In a retrospective chart review of 1,025 Medicare beneficiaries age ≥65, we compared explicit (nurse) and implicit (physician) reviews of complications and quality in individual cases. To understand discrepancies, we calculated the kappa statistic and examined physicians' comments.Data Collection. With Medicare discharge abstracts, we used the Complications Screening Program to identify and then select a stratified random sample of cases flagged for 1 of 15 surgical complications, 5 medical complications, and unflagged controls. Peer Review Organization nurses and physicians performed chart reviews.Principal Findings. Agreement about complications was fair ( κ=0.36) among surgical and was moderate ( κ=0.59) among medical cases. In discordant cases, physicians said that complications were insignificant, attributable to a related diagnosis, or present on admission. Agreement about quality was poor among surgical and medical cases ( κ=0.00 and 0.13, respectively). In discordant cases, physicians said that quality problems were unavoidable, small lapses in otherwise satisfactory care, present on admission, or resulted in no adverse outcome.Conclusions. We identified many discrepancies between explicit and implicit review of complications and quality. Physician reviewers may not consider process problems that are ubiquitous in hospitals to represent substandard quality.
The Lack of Effect of Market Structure on Hospice Use
Authors: Iwashyna Theodore J , Chang Virginia W , Zhang James X , Christakis Nicholas A 
Published: March 2003

Objective. To describe the relative importance of health care market structure and county‐level demographics in determining rates of hospice use.Data Sources. Medicare claims data for a cohort of elderly patients newly diagnosed with lung cancer, colon cancer, stroke, or heart attack in 1993, followed for up to five years, and linked to Census and Area Resource File data.Study Design. Variation between markets in rates of hospice use by patients with serious illness was examined after taking into account differences in individual‐level data using hierarchical linear models. The relative explanatory power of market‐level structure and local demographic variables was compared.Data Collection Methods. The cohort was defined within the Medicare hospital claims data using validated algorithms to detect incident cases of disease with a three‐year lookback. Use of hospice was determined by linkage at an individual level to the Standard Analytic Files for Hospice through 1997. Individual‐level data was linked to the Area Resource File using county identifiers present in the Medicare claims.Principal Findings. There is substantial variation in hospice use across markets. This variation is not explained by differences in the major components of health care infrastructure: the availability of hospital, nursing home, or skilled nursing facilities, nor by the availability of HMOs, doctors, or generalists.Conclusions. Intercounty heterogeneity in hospice use is substantial, and may not be related to the set‐up of the medical care system. The important local factors may be local preferences, differences in the particular mix of services provided by local hospices, or differences in community leadership on end of life‐issues; many of these differences may be amenable to educational efforts.
Bourgeoisie Out, Expertoisie In: The New Political Economies at Loggerheads
Authors: Hodges Donald Clark , Lustig Larry 
Published: March 2003

Part I of our paper pinpoints the “political” in the new political economies: first, the distinction between political, public, and civic economies that are almost invariably confused; second, the role of power politics, force, and fraud in determining income differentials in the name of market forces. Part II pinpoints the “new” in twentieth‐century political economies: first, the emergence of a fourth factor of production in addition to labor, capital, and land, whether identified with organization, knowledge, headwork, education, brainpower, management, or information; second, the subordination of capital to this new factor; third, the formation of a new social class based on its ownership; fourth, the struggle between the owners of capital and the new class for control over decision making and for the lion's share in distribution; fifth, the reliance on government to protect and advance the interests of the new class of professionals; and sixth, the eclipse of the old class struggle between bourgeoisie and proletarians by a new class struggle between managers and managed, executives and executants, “knows” and “know‐nots.” Part III pinpoints the “loggerheads” or sources of dissension between the “human capital” and post‐capitalist variants of the new political economies: first, over whether the expertoisie constitute a new social class or a fraction of the bourgeoisie; second, over whether the new economic order constitutes an advanced stage of capitalism or the advent of a post‐capitalist society; and third, whether the “knows” exploit the “know‐nots” through their monopoly of economic and political power.Why “political,” why “new,” and why “at loggerheads”? Our essay divides into three parts our tentative answers to these questions.
Green national income and expenditure
Authors: Cairns Robert D. 
Published: March 2003

Distinguishing between national income and expenditure helps to shed light on some issues in green national accounting, including capital gains. Although their total is the same, different types of depreciation should be defined differently in the income and expenditure accounts. For example, there are two ways to define the depletion of non‐renewable resources. If depletion is defined as the resource rent, the unit value of the resource stock exceeds the current rent. If resource rent is viewed in terms of the resource’s contribution to national income, the stock can be valued at the current rent but depletion is less than resource rent. JEL classification: E20, Q30 Revenus et dépenses nationaux verts. Le fait de distinguer le revenu national et la dépense nationale aide àéclairer certains problèmes dans la comptabilité nationale verte, y compris en ce qui a trait aux gains de capitaux. Même si leur total est le même, différents types d’amortissement devraient être utilisés dans les comptes de revenus et de dépenses. Par exemple, il y a deux manières de définir l’épuisement des ressources non‐renouvelables. Si l’épuisement est défini par la rente sur la ressource, alors la valeur unitaire du stock de ressource est plus grande que la rente courante. Si la rente de la ressource est considérée comme la contribution de la ressource au revenu national, le stock peut être évalué au niveau de la rente courante, mais alors l’épuisement est moins que la rente de la ressource.
Semi‐non‐parametric estimates of substitution for Canadian monetary assets
Authors: Fleissig Adrian R. , Serletis Apostolos 
Published: March 2003

We estimate the dynamic Fourier expenditure system to obtain consistent estimates of short‐run and long‐run Morishima elasticities of substitution for Canadian liquid assets. We argue that the variability of the estimated elasticities and evidence of less than perfect substitution between monetary assets interferes with the successful use of simple‐sum aggregates and traditional log‐linear money‐demand functions. Calibrations semi‐non‐paramétriques de la substitution pour des actifs monétaires canadiens. Les auteurs calibrent le système dynamique de dépenses à la Fourier pour obtenir des estimations cohérentes des élasticités de substitution à la Morishima à court et à long termes pour des actifs monétaires canadiens. Ils suggèrent que la variabilité des élasticités estimées et la constatation que la substitution n’est pas parfaite entre les actifs monétaires rendent difficile un usage heureux des agrégats de simple somme et des fonctions log‐linéaires de demande de monnaie.
Vertical product differentiation and the import demand function: theory and evidence
Authors: Malley Jim , Moutos Thomas 
Published: March 2003

In this paper we use a model of vertical product differentiation to cast doubt on the general validity of the import demand function as specified in macroeconomic models. The empirical importance of our theoretical concerns is then established. According to our first hypothesis, the share of a good’s imports in total imports is non‐increasing in domestic wages if the country has comparative advantage in high‐quality varieties of this good. The second hypothesis states that the share of a good’s imports is increasing in non‐wage domestic income if the country has comparative advantage in high‐quality varieties of this good. JEL Classification: F4, F41 Différenciation verticale des produits et fonction de demande d’importations : théorie et résultats. Dans ce mémoire, les auteurs utilisent un modèle de différenciation verticale des produits pour jeter certains doutes sur la validité générale de la fonction de demande d’importations telle que spécifiée dans les modèles macroéconomiques. L’importance empirique de ces malaises théoriques est étudiée à l’aide de deux hypothèses. La première hypothèse suggère que la part d’un bien dans les importations totales d’un pays ne va pas croître quand les salaires du pays s’accroissent si le pays a un avantage comparatif dans les variétés de haute qualité de ce bien. La seconde hypothèse suggère que la part d’un produit qui provient de l’importation croît quand le revenu intérieur non‐salarial s’accroît si le pays a un avantage comparatif dans les variétés de haute qualité de ce bien. On observe des résultats qui donnent un support empirique ferme à ces deux propositions en analysant les données en provenance de l’Allemagne, du Japon et des Etats‐Unis.
Property rights, labour markets, and efficiency in a transition economy: the case of rural China
Authors: Benjamin Dwayne , Brandt Loren 
Published: March 2003

We investigate the consequences of imperfect factor market development for farm efficiency in North China. We estimate the extent to which an inverse relationship in farm productivity can be attributed to the administrative (as opposed to market) allocation of land, combined with unevenly developed off–farm opportunities. Using a new household survey, we find considerable inefficiency in the use of labour. This inefficiency is alleviated by external labour markets and, to a limited degree, by administrative reallocations. The reallocations do not go far enough, however, which raises important questions about constraints on rental activity and property rights formation more generally. JEL Classification: Q15, O12 Droits de propriété, marchés du travail et efficacité dans une économie en transition : le cas de la Chine rurale. Ce mémoire analyse les conséquences du développement de marchés imparfaits des facteurs de production sur l’efficacité des fermes dans le nord de la Chine. On examine jusqu’à quel point la relation inverse entre la productivité des fermes et leur taille est attribuable à l’allocation administrative de la terre (par opposition à l’allocation par le marché), en combinaison avec le développement inégal des opportunités en dehors de la ferme. Les auteurs utilisent une nouvelle enquête sur les ménages qui révèle une grande inefficacité dans l’utilisation du travail. Cette inefficacité est atténuée par des marchés de travail externes, et, à un moindre degré, par des ré–allocations administratives. Les ré–allocations ne vont pas assez loin cependant. Voilà qui soulève des questions importantes à propos des contraintes sur les activités de location et la formation des droits de propriété en général.
Welfare–maximizing and revenue–maximizing tariffs with a few domestic firms
Authors: Larue Bruno , Gervais Jean–Philippe 
Published: March 2003

In this paper we compare the orthodox optimal tariff formula with the appropriate welfare–maximizing tariff when there are a few producing or importing firms. The welfare–maximizing tariff can be very low, voire negative in some cases, while in others it can even exceed the maximum–revenue tariff. The relationship between the welfare–maximizing tariff and the number of firms need not be monotonically increasing, because the tariff is not strictly used to internalize terms of trade externality. It is also used to manipulate cost asymmetries between producing and importing firms. Welfare–maximizing specific tariffs are never worse than their ad valorem counterparts. JEL Classification F13, L13 Tarif qui maximise le bien être et tarif qui maximise le revenu quand on est en présence de peu de firmes. Nous comparons le tarif optimal orthodoxe au tarif maximisant le bien être lorsqu’il y a peu de firmes productrices ou importatrices. Le tarif qui maximise le bien être est parfois très bas, même négatif, mais il peut excéder le tarif qui maximise le revenu dans d’autres cas. La relation entre le tarif et le nombre de firmes n’est pas nécessairement monotone parce que le tarif n’est pas strictement utilisé pour améliorer les termes d’échange. Il est aussi utilisé pour manipuler les asymétries dans les coûts des firmes productrices et importatrices. Le tarif spécifique n’est jamais dominé par le tarif ad valorem.