{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:31:59Z","timestamp":1777681919631,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[1997,11,1]],"date-time":"1997-11-01T00:00:00Z","timestamp":878342400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Serv Manage Res"],"published-print":{"date-parts":[[1997,11]]},"abstract":"<jats:p>This study addresses the question for cholecystectomy patients of whether there is an association among manifesting better health outcomes and the quantity of hospital resources consumed when the appropriateness of this surgery is also considered. 10 043 cholecystectomies performed by 218 surgeons in 43 Pennsylvanian hospitals are analysed using data from an administrative data set. Performance measures are adjusted for admission severity of illness and other patient variables. The results demonstrate a statistically significant positive association between adjusted hospital total charges and adjusted morbidity controlling for whether specified clinical criteria are met that validate the need for a cholecystectomy. This study illustrates a systems quality paradigm wherein performance is examined in terms of health outcomes, appropriateness and resource expenditures, as well as the relationships among these three dimensions.<\/jats:p>","DOI":"10.1177\/095148489701000404","type":"journal-article","created":{"date-parts":[[2017,1,12]],"date-time":"2017-01-12T14:50:09Z","timestamp":1484232609000},"page":"231-244","source":"Crossref","is-referenced-by-count":3,"title":["Toward a Systems Quality Paradigm: Relating Health Outcomes, Resource Expenditures, and Appropriateness of Cholecystectomy Patients"],"prefix":"10.1177","volume":"10","author":[{"given":"R. C.","family":"Bradbury","sequence":"first","affiliation":[{"name":"Master of Health Administration Program, Clark University, Worcester, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. H.","family":"Golec","sequence":"additional","affiliation":[{"name":"Graduate School of Management, Clark University, Worcester, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. M.","family":"Steen","sequence":"additional","affiliation":[{"name":"MediQual Systems, Inc."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[1997,11,1]]},"reference":[{"key":"bibr1-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.13.4.25"},{"key":"bibr2-095148489701000404","volume-title":"Guide to the Health Care Field","author":"American Hospital Association","year":"1990"},{"key":"bibr3-095148489701000404","volume-title":"Directory of Health Care Coalitions in the United States","author":"American Hospital Association","year":"1991"},{"issue":"2","key":"bibr4-095148489701000404","first-page":"211","volume":"40","author":"Arndt M.","year":"1995","journal-title":"Hospital and Health Services Administration"},{"key":"bibr5-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198901053200110"},{"issue":"4","key":"bibr6-095148489701000404","first-page":"37","volume":"1","author":"Bradbury R. C.","year":"1977","journal-title":"American Journal of Health Planning"},{"issue":"3","key":"bibr7-095148489701000404","first-page":"253","volume":"24","author":"Bradbury R. C.","year":"1987","journal-title":"Inquiry"},{"issue":"4","key":"bibr8-095148489701000404","first-page":"407","volume":"26","author":"Bradbury R. C.","year":"1991","journal-title":"Health Services Research"},{"issue":"1","key":"bibr9-095148489701000404","first-page":"87","volume":"28","author":"Bradbury R. C.","year":"1991","journal-title":"Inquiry"},{"issue":"1","key":"bibr10-095148489701000404","first-page":"56","volume":"31","author":"Bradbury R. C.","year":"1994","journal-title":"Inquiry"},{"issue":"4","key":"bibr11-095148489701000404","first-page":"1","volume":"8","author":"Bradbury R. C.","year":"1995","journal-title":"Health Services Management Research"},{"issue":"4","key":"bibr12-095148489701000404","first-page":"377","volume":"22","author":"Brewster A. C.","year":"1985","journal-title":"Inquiry"},{"key":"bibr13-095148489701000404","volume-title":"Hospital Effectiveness Report, Technical Notes","author":"Commonwealth of Pennsylvania","year":"1990"},{"key":"bibr14-095148489701000404","volume-title":"Hospital Charge Adjustment Methodology: Documentation","author":"Corporate Cost Management","year":"1989"},{"key":"bibr15-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.12.suppl_1.24"},{"key":"bibr16-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03520440035033"},{"key":"bibr17-095148489701000404","first-page":"246","volume-title":"Costs, Risks and Benefits of Surgery","author":"Fitzpatrick G.","year":"1977"},{"key":"bibr18-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1177\/107755879004700405"},{"issue":"1","key":"bibr19-095148489701000404","first-page":"29","volume":"28","author":"Fleming S. T.","year":"1991","journal-title":"Inquiry"},{"key":"bibr20-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/5.1.75"},{"key":"bibr21-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198209233071305"},{"key":"bibr22-095148489701000404","volume-title":"Reengineering Health Care, Building on CQI","author":"Griffith J. R.","year":"1995"},{"key":"bibr23-095148489701000404","volume-title":"MEDISGROUPS: A Clinical and Analytic Assessment","author":"Iezzoni L. I.","year":"1987"},{"key":"bibr24-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1001\/jama.260.21.3159"},{"key":"bibr25-095148489701000404","volume-title":"An Introduction to Quality Improvement in Health Care","author":"Joint Commission on Accreditation of Healthcare Organizations","year":"1991"},{"issue":"4","key":"bibr26-095148489701000404","first-page":"557","volume":"38","author":"Johnson K. L.","year":"1993","journal-title":"Hospital and Health Services Administration"},{"issue":"3","key":"bibr27-095148489701000404","first-page":"351","volume":"24","author":"Leape L. L.","year":"1989","journal-title":"Health Services Research"},{"issue":"1","key":"bibr28-095148489701000404","first-page":"72","volume":"26","author":"McLaughlin C. G.","year":"1989","journal-title":"Inquiry"},{"key":"bibr29-095148489701000404","volume-title":"MedisGroups Procedure Monitoring Report Module \u2014 User Documentation","author":"MediQual Systems, Inc","year":"1991"},{"key":"bibr30-095148489701000404","volume-title":"Healthplan Employer Data and Information Set and User's Manual, Version 2.0","author":"National Committee for Quality Assurance","year":"1993"},{"key":"bibr31-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03500080066034"},{"key":"bibr32-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.13.1.147"},{"key":"bibr33-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03520440075041"},{"key":"bibr34-095148489701000404","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-99-2-199"},{"key":"bibr35-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1177\/107755878404100401"},{"key":"bibr36-095148489701000404","volume-title":"Indications for Selected Medical and Surgical Procedures \u2014 A Literature Review and Ratings of Appropriateness: Colecystectomy","author":"Solomon D. H.","year":"1986"},{"issue":"2","key":"bibr37-095148489701000404","first-page":"128","volume":"30","author":"Steen P. M.","year":"1993","journal-title":"Inquiry"},{"issue":"4","key":"bibr38-095148489701000404","first-page":"483","volume":"26","author":"Thomas J. W.","year":"1989","journal-title":"Inquiry"},{"key":"bibr39-095148489701000404","volume-title":"Medical Uses of Statistics","author":"Ware J. H.","year":"1986"},{"key":"bibr40-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.3.2.6"},{"key":"bibr41-095148489701000404","volume-title":"The President's Health Security Plan","author":"White House Domestic Policy Council","year":"1993"},{"key":"bibr42-095148489701000404","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.13.1.9"}],"container-title":["Health Services Management Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/095148489701000404","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/095148489701000404","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:41:23Z","timestamp":1777452083000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/095148489701000404"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1997,11]]},"references-count":42,"journal-issue":{"issue":"4","published-print":{"date-parts":[[1997,11]]}},"alternative-id":["10.1177\/095148489701000404"],"URL":"https:\/\/doi.org\/10.1177\/095148489701000404","relation":{},"ISSN":["0951-4848","1758-1044"],"issn-type":[{"value":"0951-4848","type":"print"},{"value":"1758-1044","type":"electronic"}],"subject":[],"published":{"date-parts":[[1997,11]]}}}