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Using 1986 AHA hospital survey data, we analyzed hospital-HMO contract provisions, hospital operating characteristics, and market conditions for a national sample of 801 hospitals with HMO contracts to determine the [...]

Institutional alternatives to the rural hospital Introduction In June 1988, the Montana Hospital Research and Education Foundation (affiliated with the Montana Hospital Association) received a 1-year planning grant from the [...]

EXECUTIVE SUMMARY Few studies have systematically examined the influence of physician, patient, and practice characteristics on physician-directed use of resources within the overall environment of medical group practices and none [...]

To the Editor.—Hypophosphatemia is a serious consequence of many common clinical entities. Despite the recent emphasis on the consequences and treatment of hypophosphatemia,1 few clinicians recognize the potential toxicity of oral phosphate therapy. The following reports a case of hypocalcemia from hyperphosphatemia induced by oral phosphate replacement therapy.Report of a Case.—A 98-year-old man was hospitalized for a left lower lobe pneumonia. His family had noted progressive deterioration of his mental status, increasing shortness of breath, and poor dietary intake during the week before. There was no history of renal impairment. The temperature was 38.3 °C; pulse rate, 90 per minute; blood pressure, 120/70 mm Hg; and respiratory rate, 28 per minute. Examination showed a lethargic, disoriented, elderly man with bibasilar rales. Admission laboratory findings disclosed the following values: normal electrolytes, creatine, 0.9 mg/dL; BUN, 7 mg/dL; serum calcium, 9.0 mg/dL; phosphate, 1.9 mg/dL; and albumin, 2.8 mg/dL.