Community disasters: Primary prevention and treatment in a health maintenance organization.

Several prominent cases have recently highlighted tension between the interests of individuals and those of the broader population in gaining access to health care resources. The care of Helga Wanglie, an elderly woman whose family insisted on continuing life support long after she had lapsed into a persistent vegetative state (PVS), cost approximately $750,000, the majority of which was paid by a Medi-gap policy purchased from a health maintenance organization (HMO). Similarly, Baby K was an anencephalic infant whose mother, believing that all life is precious regardless of its quality, insisted that the hospital where her daughter was born provide mechanical ventilation, including intensive care, whenever respiratory distress threatened her life. Over the hospital's objections, courts ruled that aggressive care must be provided. Much of Baby K's care was covered by her mother's HMO policy. In the 1993 case of Fox v. HealthNet, a jury awarded $89 million to the family of a woman whose HMO had refused, as experimental, coverage for autologous bone marrow transplant in treating her advanced breast cancer.

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Use of health services by children of smokers and nonsmokers in a health maintenance organization.

American Journal of Public Health ◽

10.2105/ajph.88.6.897 ◽

1998 ◽

Vol 88 (6) ◽

pp. 897-902 ◽

Cited By ~ 17

Author(s):

C M McBride ◽

P Lozano ◽

S J Curry ◽

D Rosner ◽

L C Grothaus

Keyword(s):

Health Services ◽

Health Maintenance Organization ◽

Health Maintenance ◽

Use Of Health Services

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Extracting and analyzing ejection fraction values from electronic echocardiography reports in a large health maintenance organization

Health Informatics Journal ◽

10.1177/1460458216651917 ◽

2016 ◽

Vol 23 (4) ◽

pp. 319-328 ◽

Cited By ~ 6

Author(s):

Fagen Xie ◽

Chengyi Zheng ◽

Albert Yuh-Jer Shen ◽

Wansu Chen

Keyword(s):

Heart Disease ◽

Ejection Fraction ◽

Health Maintenance Organization ◽

Prognostic Indicator ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Free Text ◽

Ventricular Ejection Fraction ◽

Health Maintenance ◽

Systolic Left Ventricular Function

The left ventricular ejection fraction value is an important prognostic indicator of cardiovascular outcomes including morbidity and mortality and is often used clinically to indicate severity of heart disease. However, it is usually reported in free-text echocardiography reports. We developed and validated a computerized algorithm to extract ejection fraction values from echocardiography reports and applied the algorithm to a large volume of unstructured echocardiography reports between 1995 and 2011 in a large health maintenance organization. A total of 621,856 echocardiography reports with a description of ejection fraction values or systolic functions were identified, of which 70 percent contained numeric ejection fraction values and the rest (30%) were text descriptions explicitly indicating the systolic left ventricular function. The 12.1 percent (16.0% for male and 8.4% for female) of these extracted ejection fraction values are <45 percent. Validation conducted based on a random sample of 200 reports yielded 95.0 percent sensitivity and 96.9 percent positive predictive value.

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