Harold S Luft
Datos Biográficos
| ID | 233799 |
|---|---|
| NOMBRE | Harold S Luft |
| NOMBRES | Harold S |
| APELLIDO | Luft |
| FIRMA | LUFT H S |
| AFILIACIONES | University of California, San Francisco |
| ORCID | 0000-0002-4696-2745 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 33 |
| TOTAL DE CITAS | 21 |
| TOTAL COMO AUTOR | 33 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1975 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2017 |
| ÍNDICE H | 3 |
Evaluating the healthiness of chain-restaurant menu items using crowdsourcing
Objective To develop a technology-based method for evaluating the nutritional quality of chain-restaurant menus to increase the efficiency and lower the cost of large-scale data analysis of food items. Design Using a Modified Nutrient Profiling Index (MNPI), we assessed chain-restaurant items from the MenuStat database with a process involving three steps: (i) testing ‘extreme’ scores; (ii) crowdsourcing to analyse fruit, nut and vegetable (FNV) …
Patients’ Body Mass Index and Blood Pressure Over Time
BACKGROUND: A national strategic framework to address multiple chronic conditions has called for further research on disease trajectories of patients with comorbidities. METHODS: An observational study using multilevel models to analyze electronic health record data from a multispecialty practice from 2003 to 2010 to examine disease trajectories of patients with at least 2 of 3 common chronic conditions: overweight/obese, hypertension, and depres…
Assignment, Attribution, and Accountability
The Patient Protection and Affordable Care Act of 2010 (ACA) includes important features that are likely to change how medicine is delivered in the United States. The Supreme Court will rule this summer on various aspects of the act's constitutionality, especially the individual mandate provisions, but it is unlikely to strike down the entire act. In section 3022 of the act, the Secretary of Health and Human Services is authorized to recognize ar…
Commentary
Comparative effectiveness research is sometimes best done using routinely collected data from multiple real world settings. This raises important issues with respect to the authorizations to use the data, dealing with the multiple IRBs that may have oversight authority, and protecting it from breaches. Careful delineation of what is quality improvement vs. research-driven interventions can help with IRB reviews, especially for low-risk projects. …
Reducing Racial/Ethnic Disparities in Female Breast Cancer
Objectives. We assessed whether population rates of mammography screening, and their changes over time, were associated with improvements in breast cancer stage at diagnosis and whether the strength of this association varied by race/ethnicity. Methods. We analyzed state cancer registry data linked to socioeconomic characteristics of patients’ areas of residence for 1990–1998 time trends in the likelihood of early stage diagnosis. We appended eac…
Assessing Risk-Adjustment Approaches under Non-Random Selection
Various approaches have been proposed to adjust for differences in enrollee risk in health plans. Because risk-selection strategies may have different effects on enrollment, we simulated three types of selection--dumping, skimming, and stinting. Concurrent diagnosis-based risk adjustment, and a hybrid using concurrent adjustment for about 8% of the cases and prospective adjustment for the rest, perform markedly better than prospective or demograp…
From Observing the Relationship Between Volume and Outcome to Making Policy Recommendations
From the Institute for Health Policy Studies, and the Division of General Internal Medicine, University of California San Francisco, San Francisco, California. Address correspondence and reprint requests to: Harold S. Luft, PhD, Caldwell B. Esselstyn Professor of Health Policy and Health Economics, Director, Institute for Health Policy Studies, University of California San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118. E-m…
The Best of Both Worlds
BACKGROUND: There remains considerable uncertainty about whether prospective or concurrent risk adjustment (RA) is preferable. Although concurrent models have better predictive power than prospective models, the large payments associated with concurrent RA create incentives for fraudulent coding. A hybrid strategy--in which prospective payments were used for patients with low expected costs and concurrent payments were available upon the diagnosi…
Managed Care and Children
This article lays the foundation for the other articles in this journal issue, which examine the effect of managed health care arrangements on a particular population: children. Although managed care has been used to finance and deliver health care services for decades, the meaning of this term often has been unclear to health care consumers and practitioners because new forms of managed care have evolved rapidly. The one consistent and unifying …
The Costs and Outcomes of Restricting Public Access to Poison Control Centers
OBJECTIVES: The authors examined the costs and outcomes resulting from a natural experiment during which direct public access to poison control centers was restricted and then restored. METHODS: Both societal and health care purchaser perspectives were used. Probability data were obtained from a natural experiment during which public callers from a large county in California were electronically blocked from directly accessing the poison control c…
The Association of Hospital Volumes of Percutaneous Transluminal Coronary Angioplasty With Adverse Outcomes, Length of Stay, and Charges in California
The objective of this study was to examine whether hospital volumes of percutaneous transluminal coronary angioplasty (PTCA) are associated with adverse outcomes (coronary artery bypass graft surgery after PTCA and/or in-hospital mortality), post-PTCA length of stay (LOS), and hospital charges. Discharge data for 24,856 patients undergoing PTCA in 1989 from 110 California hospitals were analyzed. Regression analysis was used to adjust patient dis…
Costing Medical Care
This paper describes how the PORTS are using data from the Medicare administrative records systems to study the medical care costs of specific conditions. The general strengths and weaknesses of the Medicare databases for studying cost related issues are discussed, and the relevant data elements are examined in detail. Changes in the nature of the data collected over time are noted. Information is provided on how the PORTS are using these data to…
Health Plan Switching in Anticipation of Increased Medical Care Utilization
We compare rates and days of maternity and nonmaternity hospital admission for the years 1981 through 1984 for three groups of employees and dependents from a large private employer: those continuously enrolled in a fee-for-service (FFS) plan (N = 147,700), those continuously enrolled in a health maintenance organization (HMO) (N = 30,957), and those switching from the FFS plan to the HMO (N = 2,144). The rate of maternity admissions for plan swi…
Estimating hospital admission patterns using Medicare data
Border crossing for hospital care and its implications for the use of statewide data
Hospital Volume and Patient Outcomes
Patients achieve better outcomes at hospitals that treat larger numbers of patients with certain diagnoses or who are undergoing particular procedures. However, the causal direction underlying this relationship is less well understood. Do patients treated at institutions with higher volumes of patients achieve better outcomes because the hospital staff and physicians have gained expertise by practice (the "practice makes perfect" hypothesis)? Do …
Changes in patient characteristics and surgical outcomes for coronary artery bypass surgery 1972-82
Data from a national sample of hospitals were used to explore reasons for improved in-hospital survival rate for coronary artery bypass graft (CABG) surgery between 1972 and 1982. Increases in annual volumes of surgery explain a large fraction of the decline in death rates. The residual can be attributed to improved techniques, experience, and other factors, even though more operations were done on older patients and women in 1982 than 1972
Effects of Surgeon Volume and Hospital Volume on Quality of Care in Hospitals
A growing body of evidence indicates that certain surgical procedures exhibit a "volume-outcome" relationship in which a higher volume of patients undergoing a particular procedure at a hospital is associated with better outcomes for those patients. The proportion of a hospital's patients operated on by low-volume or less experienced surgeons also may be associated with poor patient outcomes and thus contribute to the hospital "volume-outcome" re…
Selecting Categories of Patients for Regionalization
A growing number of researchers have demonstrated an inverse relation between the number of patients treated with specific diagnoses or procedures in a hospital and subsequent adverse outcomes. Such findings support the notion that policies should be explored to concentrate patients in selected hospitals to reduce preventable patient mortality or morbidity. The authors used data from 15 diagnoses and procedures demonstrating an inverse relation b…
Regionalization of medical care
Regionalization of medical care. H S LuftCopyRight https://doi.org/10.2105/AJPH.75.2.125 Published Online: August 29, 2011
Competition and Regulation
From the Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, California
Insuring the Nation??s Health
Associate Professor of Health Economics Institute for Health Policy Studies University of California San Francisco
Health Maintenance Organizations
Health Maintenance Organizations
This book is a must for physicians and other persons who have special interests in health maintenance organizations (HMOs) as practitioners, administrators, regulators, or researchers. It is a comprehensive review of what is known and what is not known about HMOs and their performance. Crammed into the 468 pages are references to more than 900 published works and numerous charts and tables. (There are no lists of charts and tables, which would ha…
Diverging Trends in Hospitalization
It has been noticed recently that hospital use by Blue Cross enrollees has fallen substantially in the last decade and that this decline is in marked contrast to relatively stable utilization reported by hospitals. The trends in length of stay in the two data sources are almost identical--all the differential is attributable to differing trends in admission rates: a sharp increase for all persons under 65 years of age in contrast to a moderate de…
Managed Care and Children
This article lays the foundation for the other articles in this journal issue, which examine the effect of managed health care arrangements on a particular population: children. Although managed care has been used to finance and deliver health care services for decades, the meaning of this term often has been unclear to health care consumers and practitioners because new forms of managed care have evolved rapidly. The one consistent and unifying …
Regionalization of medical care
Regionalization of medical care. H S LuftCopyRight https://doi.org/10.2105/AJPH.75.2.125 Published Online: August 29, 2011
Reducing Racial/Ethnic Disparities in Female Breast Cancer
Objectives. We assessed whether population rates of mammography screening, and their changes over time, were associated with improvements in breast cancer stage at diagnosis and whether the strength of this association varied by race/ethnicity. Methods. We analyzed state cancer registry data linked to socioeconomic characteristics of patients’ areas of residence for 1990–1998 time trends in the likelihood of early stage diagnosis. We appended eac…
Estimating hospital admission patterns using Medicare data
Border crossing for hospital care and its implications for the use of statewide data
Changes in patient characteristics and surgical outcomes for coronary artery bypass surgery 1972-82
Data from a national sample of hospitals were used to explore reasons for improved in-hospital survival rate for coronary artery bypass graft (CABG) surgery between 1972 and 1982. Increases in annual volumes of surgery explain a large fraction of the decline in death rates. The residual can be attributed to improved techniques, experience, and other factors, even though more operations were done on older patients and women in 1982 than 1972
Factors affecting the use of physician services in a rural community
This paper examines the relative importance of various independent variables for predicting five separate measures of physician utilization in a rural community. The independent variables include socioeconomic, demographic, attitudinal, and health status factors. The results are comparable to those of national studies which find that health status is the primary determinant of utilization. Income, price measures, and travel time are notable for t…
The Impact of Poor Health on Earnings
T HE overall impact of poor health on earnings is large the average disabled man aged 18 to 64 years suffers a 37% reduction in yearly earnings. This loss is the result of the effects of poor health on all the components of earnings: labor force participation, weeks worked per year, hours worked per week, and earnings per hour. In each case there is a substantial effect of health, not just when a comparison is made between well and sick persons, …
Making Sense Out of Utilization Data
Health care utilization studies often reach conflicting conclusions about the appropriate measures of utilization and the relationships between such measures and the explanatory variables. The purpose of this paper is to demonstrate why such ambiguities exist, provide empirical tests of different models, and suggest an appropriate analytical framework. A household survey of a rural California community was used to collect both family and individu…
Factors affecting the use of physician services in a rural community
This paper examines the relative importance of various independent variables for predicting five separate measures of physician utilization in a rural community. The independent variables include socioeconomic, demographic, attitudinal, and health status factors. The results are comparable to those of national studies which find that health status is the primary determinant of utilization. Income, price measures, and travel time are notable for t…
Should Operations Be Regionalized?
This study examines mortality rates for 12 surgical procedures of varying complexity in 1498 hospitals to determine whether there is a relation between a hospital's surgical volume and its surgical mortality. The mortality of open-heart surgery, vascular surgery, transurethral resection of the prostate, and coronary bypass decreased with increasing number of operations. Hospitals in which 200 or more of these operations were done annually had dea…
Poverty and Health
Poverty and Health
The Relation Between Surgical Volume and Mortality
A previous study of 12 procedures of varying complexity in 1,498 hospitals identified a strong negative curvilinear relationship between the volume of a particular operation and postoperative mortality. The current study uses multiple regression techniques to explore the role of other potentially important variable and alternative interpretations of the volume-mortality relationship. The dependent variable is the difference between the hospital's…
Trends in Medical Care Costs
Total medical care expenses are generally lower for HMO enrollees than for comparable persons with other coverage. However, a rarely addressed question is whether HMO enrollees also experience a slower rate of growth in costs. This paper examines data from several sources (Federal Employees Health Benefits Program, California State Employees, and Kaiser-Oregon) to compare trends in utilization and costs for HMO enrollees and comparison groups ove…
Diverging Trends in Hospitalization
It has been noticed recently that hospital use by Blue Cross enrollees has fallen substantially in the last decade and that this decline is in marked contrast to relatively stable utilization reported by hospitals. The trends in length of stay in the two data sources are almost identical--all the differential is attributable to differing trends in admission rates: a sharp increase for all persons under 65 years of age in contrast to a moderate de…
Health Maintenance Organizations
Health Maintenance Organizations
This book is a must for physicians and other persons who have special interests in health maintenance organizations (HMOs) as practitioners, administrators, regulators, or researchers. It is a comprehensive review of what is known and what is not known about HMOs and their performance. Crammed into the 468 pages are references to more than 900 published works and numerous charts and tables. (There are no lists of charts and tables, which would ha…
Insuring the Nation??s Health
Associate Professor of Health Economics Institute for Health Policy Studies University of California San Francisco
Regionalization of medical care
Regionalization of medical care. H S LuftCopyRight https://doi.org/10.2105/AJPH.75.2.125 Published Online: August 29, 2011
Competition and Regulation
From the Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, California
Selecting Categories of Patients for Regionalization
A growing number of researchers have demonstrated an inverse relation between the number of patients treated with specific diagnoses or procedures in a hospital and subsequent adverse outcomes. Such findings support the notion that policies should be explored to concentrate patients in selected hospitals to reduce preventable patient mortality or morbidity. The authors used data from 15 diagnoses and procedures demonstrating an inverse relation b…
Changes in patient characteristics and surgical outcomes for coronary artery bypass surgery 1972-82
Data from a national sample of hospitals were used to explore reasons for improved in-hospital survival rate for coronary artery bypass graft (CABG) surgery between 1972 and 1982. Increases in annual volumes of surgery explain a large fraction of the decline in death rates. The residual can be attributed to improved techniques, experience, and other factors, even though more operations were done on older patients and women in 1982 than 1972
Effects of Surgeon Volume and Hospital Volume on Quality of Care in Hospitals
A growing body of evidence indicates that certain surgical procedures exhibit a "volume-outcome" relationship in which a higher volume of patients undergoing a particular procedure at a hospital is associated with better outcomes for those patients. The proportion of a hospital's patients operated on by low-volume or less experienced surgeons also may be associated with poor patient outcomes and thus contribute to the hospital "volume-outcome" re…
Hospital Volume and Patient Outcomes
Patients achieve better outcomes at hospitals that treat larger numbers of patients with certain diagnoses or who are undergoing particular procedures. However, the causal direction underlying this relationship is less well understood. Do patients treated at institutions with higher volumes of patients achieve better outcomes because the hospital staff and physicians have gained expertise by practice (the "practice makes perfect" hypothesis)? Do …
Health Plan Switching in Anticipation of Increased Medical Care Utilization
We compare rates and days of maternity and nonmaternity hospital admission for the years 1981 through 1984 for three groups of employees and dependents from a large private employer: those continuously enrolled in a fee-for-service (FFS) plan (N = 147,700), those continuously enrolled in a health maintenance organization (HMO) (N = 30,957), and those switching from the FFS plan to the HMO (N = 2,144). The rate of maternity admissions for plan swi…
Estimating hospital admission patterns using Medicare data
Border crossing for hospital care and its implications for the use of statewide data
Costing Medical Care
This paper describes how the PORTS are using data from the Medicare administrative records systems to study the medical care costs of specific conditions. The general strengths and weaknesses of the Medicare databases for studying cost related issues are discussed, and the relevant data elements are examined in detail. Changes in the nature of the data collected over time are noted. Information is provided on how the PORTS are using these data to…
The Association of Hospital Volumes of Percutaneous Transluminal Coronary Angioplasty With Adverse Outcomes, Length of Stay, and Charges in California
The objective of this study was to examine whether hospital volumes of percutaneous transluminal coronary angioplasty (PTCA) are associated with adverse outcomes (coronary artery bypass graft surgery after PTCA and/or in-hospital mortality), post-PTCA length of stay (LOS), and hospital charges. Discharge data for 24,856 patients undergoing PTCA in 1989 from 110 California hospitals were analyzed. Regression analysis was used to adjust patient dis…
Managed Care and Children
This article lays the foundation for the other articles in this journal issue, which examine the effect of managed health care arrangements on a particular population: children. Although managed care has been used to finance and deliver health care services for decades, the meaning of this term often has been unclear to health care consumers and practitioners because new forms of managed care have evolved rapidly. The one consistent and unifying …
The Costs and Outcomes of Restricting Public Access to Poison Control Centers
OBJECTIVES: The authors examined the costs and outcomes resulting from a natural experiment during which direct public access to poison control centers was restricted and then restored. METHODS: Both societal and health care purchaser perspectives were used. Probability data were obtained from a natural experiment during which public callers from a large county in California were electronically blocked from directly accessing the poison control c…
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