To compare the length of stay and charges for patients with pneumonia admitted in 1995 to the teaching and nonteaching services of a Northeastern teaching hospital, we reviewed the charts of 237 patients. Patients cared for by hospitalbased generalists working with housestaff (teaching service) were discharged more quickly and with lower or equivalent charges than patients cared for by community-based attending physicians working either with housestaff (private teaching service) or alone (nonteaching service). Academic teaching services staffed by general medicine faculty may provide efficient inpatient pneumonia care. A t a time when managed care contracting has created fiscal pressures at academic centers, hospital stays continue to account for a high proportion of overall patient care costs. Not surprisingly, traditional models of inpatient care at teaching hospitals are being reevaluated. 1 Residency teaching services are thought to be particularly inefficient in providing care. The average cost of hospitalization has been reported to be 30% to 40% higher at academic centers than in nonacademic institutions. 2 Whether this reported difference derives from overutilization of services, differences in severity mix, or a higher intrinsic cost structure remains unclear. Although medical decisionmaking at teaching hospitals is shared between housestaff and attending physicians, at most programs housestaff independently order tests and arrange for consultations, which may accelerate or impede hospital discharge. Again, it has been assumed that housestaff participation adds to the cost of care, and educational programs targeted at unnecessary diagnostic tests by housestaff have been attempted. 3 At Rhode Island Hospital, three models of inpatient care exist, providing the grounds for a natural experiment. Using a single diagnosis, pneumonia, that has a well-defined measure of severity of illness, we compare the economic implications of three models of inpatient care in order to gain insight into practice style differences between housestaff teaching services and a nonteaching service.
Hypertension is a serious health problem for millions of Americans. A small portion of these cases result from renal artery stenosis. Angiography continues to be the gold standard for diagnosing renal vascular disease. However, as a result of the high cost and possible risks associated with this invasive method, duplex sonography has emerged as an inexpensive and noninvasive alternative diagnostic tool that, in many cases, can accurately detect renal vascular disease. According to the literature, there are numerous techniques using Doppler waveforms to show renal artery stenosis. These include renal artery to aortic ratio, acceleration index, acceleration time, end diastolic ratio, and the tardus-parvus waveform. Several studies have been conducted to evaluate duplex sonography as a diagnostic tool for detection of renal artery stenosis and the overall accuracy of ultrasound compared with angiography. The accurcy of duplex ultrasound largely depends on the blood flocriteria being used to evaluate renal vasculature, patient preparation, the time allowed to perform the ultrasound examination, and the technical expertise of the sonographer performing the study.
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