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dc.creatorShowstack, Jonathanen
dc.creatorKatz, Patricia P.en
dc.creatorLake, John R.en
dc.creatorBrown, Robert S.en
dc.creatorDudley, R. Adamsen
dc.creatorBelle, Stevenen
dc.creatorWiesner, Russell H.en
dc.creatorZetterman, Rowen K.en
dc.creatorEverhart, Jamesen
dc.date.accessioned2015-05-05T19:04:23Zen
dc.date.available2015-05-05T19:04:23Zen
dc.date.created1999-04-21en
dc.date.issued1999-04-21en
dc.identifier10.1097/00132586-200002000-00016en
dc.identifier.bibliographicCitationJAMA. 1999 Apr 21; 281(15): 1381-1386.en
dc.identifier.issn0098-7484en
dc.identifier.urihttp://worldcatlibraries.org/registry/gateway?version=1.0&url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&atitle=Resource+Utilization+in+Liver+Transplantation:+Effects+of+Patient+characteristics+and+Clinical+Practice&title=JAMA.++&volume=281&issue=15&pages=1381-1386&date=1999&au=Showstack,+Jonathanen
dc.identifier.urihttp://dx.doi.org/10.1097/00132586-200002000-00016en
dc.identifier.urihttp://hdl.handle.net/10822/755096en
dc.description.abstractCONTEXT: Liver transplantation is among the most costly of medical services, yet few studies have addressed the relationship between the resources utilized for this procedure and specific patient characteristics and clinical practices. OBJECTIVE: To assess the association of pretransplant patient characteristics and clinical practices with hospital resource utilization. DESIGN: Prospective cohort of patients who received liver transplants between January 1991 and July 1994. SETTING: University of California, San Francisco; Mayo Clinic, Rochester, Minn; and the University of Nebraska, Omaha. PATIENTS: Seven hundred eleven patients who received single-organ liver transplants, were at least 16 years old, and had nonfulminant liver disease. MAIN OUTCOME MEASURE: Standardized resource utilization derived from a database created by matching all services to a single price list. RESULTS: Higher adjusted resource utilization was associated with donor age of 60 years or older (28% [$53813] greater mean resource utilization; P=.005); recipient age of 60 years or older (17% [$32795]; P=.01); alcoholic liver disease (26% [$49596]; P=.002); Child-Pugh class C (41% [$67 658]; P less than .001); care from the intensive care unit at time of transplant (42% [$77833]; P less than .001); death in the hospital (35% [$67 076]; P less than .001); and having multiple liver transplants during the index hospitalization (154% increase [$474 740 vs $186 726 for 1 transplant]; P less than .001). Adjusted length of stay and resource utilization also differed significantly among transplant centers. CONCLUSIONS: Clinical, economic, and ethical dilemmas in liver transplantation are highlighted by these findings. Recipients who were older, had alcoholic liver disease, or were severely ill were the most expensive to treat; this suggests that organ allocation criteria may affect transplant costs. Clinical practices and resource utilization varied considerably among transplant centers; methods to reduce variation in practice patterns, such as clinical guidelines, might lower costs while maintaining quality of care.en
dc.formatArticleen
dc.languageenen
dc.publisherNational Institute of Diabetes and Digestive and Kidney Diseases. Liver Transplantation Database Groupen
dc.sourceBRL:MEDKIE/99231405en
dc.subjectAdultsen
dc.subjectAge Factorsen
dc.subjectAlcohol Abuseen
dc.subjectBiomedical Technologiesen
dc.subjectComparative Studiesen
dc.subjectDeathen
dc.subjectDiseaseen
dc.subjectEconomicsen
dc.subjectEvaluationen
dc.subjectGuidelinesen
dc.subjectHealthen
dc.subjectHealth Careen
dc.subjectHospitalsen
dc.subjectIntensive Care Unitsen
dc.subjectIllnessen
dc.subjectLiversen
dc.subjectLiver Transplantationen
dc.subjectMethodsen
dc.subjectOrgan Transplantationen
dc.subjectPatientsen
dc.subjectResource Allocationen
dc.subjectReviewen
dc.subjectSelection for Treatmenten
dc.subjectTissue Transplantationen
dc.subjectTransplant Recipientsen
dc.subjectTransplantationen
dc.titleResource Utilization in Liver Transplantation: Effects of Patient Characteristics and Clinical Practiceen
dc.provenanceDigital citation created by the National Reference Center for Bioethics Literature at Georgetown University for the BIOETHICSLINE database, part of the Kennedy Institute of Ethics' Bioethics Information Retrieval Project funded by the United States National Library of Medicine.en
dc.provenanceDigital citation migrated from OpenText LiveLink Discovery Server database named NBIO hosted by the Bioethics Research Library to the DSpace collection BioethicsLine hosted by Georgetown University.en


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