Dwain L. Harper

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CONTEXT Little is known regarding outcomes after intravenous tissue-type plasminogen activator (IV tPA) therapy for acute ischemic stroke outside a trial setting. OBJECTIVE To assess the rate of IV tPA use, the incidence of symptomatic intracerebral hemorrhage (ICH), and in-hospital patient outcomes throughout a large urban community. DESIGN Historical(More)
CONTEXT Hospitals and health plans are often ranked on rates of cesarean delivery, under the assumption that lower rates reflect more appropriate, more efficient care. However, most rankings do not account for patient factors that affect the likelihood of cesarean delivery. OBJECTIVE To compare hospital cesarean delivery rates before and after adjusting(More)
Objective: To examine the reliability of birth certificate data and determine if reliability differs between teaching and nonteaching hospitals. Methods: We compared information from birth certificates and medical records in 33,616 women admitted for labor and delivery in 1993–95 to 20 hospitals in Northeast Ohio. Analyses determined the agreement for 36(More)
OBJECTIVE To assess the association between race and insurance and Cesarean delivery rates after adjusting for clinical risk factors that increase the likelihood of cesarean delivery. DESIGN Retrospective cohort study in 21 hospitals in northeast Ohio. SUBJECTS 25,697 women without prior cesarean deliveries admitted for labor and delivery January 1993(More)
BACKGROUND The impact of upper endoscopy in patients with upper gastrointestinal hemorrhage treated in community practice is unknown. Thus we examined the effectiveness of endoscopy performed within 24 hours of admission (early endoscopy). METHODS Medical records of 909 consecutive hospitalized patients with upper gastrointestinal hemorrhage who underwent(More)
STUDY OBJECTIVES To examine the applicability of a previously developed intensive care prognostic measure to a community-based sample of hospitals, and assess variations in severity-adjusted mortality across a major metropolitan region. DESIGN Retrospective cohort study. SETTING Twenty-eight hospitals with 38 ICUs participating in a community-wide(More)
BACKGROUND Little is known about the accuracy of diagnostic and procedural codes for common gastrointestinal (GI) conditions and endoscopic procedures. METHODS Eight hundred eighty-two patients with upper GI hemorrhage admitted in 1994 to 1 of 13 regional hospitals were studied. Based on endoscopy reports, the source of hemorrhage, performance of upper(More)
OBJECTIVE To examine the relationship of in-hospital and 30-day mortality rates and the association between in-hospital mortality and hospital discharge practices. DATA SOURCES/STUDY SETTING A secondary analysis of data for 13,834 patients with congestive heart failure who were admitted to 30 hospitals in northeast Ohio in 1992-1994. DESIGN A(More)
To determine changes in hospital mortality that occurred in association with the dissemination of data by a regional initiative to profile hospital performance, we conducted a retrospective cohort study of patients admitted before and subsequent to dissemination of comparative data in 1992. The analysis included 101,060 consecutive eligible discharges from(More)
BACKGROUND Cleveland Health Quality Choice is a regional initiative to assess hospital performance which was implemented in 1989. The project developed and validated CHOICE, a severity adjustment system that includes diagnosis-specific models for medical, surgical, and obstetrical patients which are based on clinical data abstracted from patients' medical(More)