An Occurence at owl Creek Bridge by Ambrose Bierce Essay Example for Free

An Occurence at owl Creek Bridge by Ambrose Bierce Essay An Occurrence at Owl Creek Bridge, is one of the best American short stories and is considered Ambrose Bierces greatest work. First published in Bierces short story collection Tales of Soldiers and Civilians in 1891, this story is about Peyton Farquhar, a southern farmer who is about to be hanged by the Union Army for trying to set the railroad bridge at Owl Creek on fire. While Farquhar is standing on the bridge with a rope around his neck, Bierce leads the reader to think that the rope snaps and he falls into the river, and then makes an amazing escape and finally returns to his farm, to be reunited with his wife. However the ending of the story is totally different, in fact, Farquhar is hanged and these imaginings take place seconds before his death. Ambrose Bierces trick ending succeeds because of the way he manipulated the text by changing the narrative point of view from one type to another. An Occurrence at Owl Creek Bridge is divided into three sections, with each section having a different narrative form. In the first section, the author uses dramatic narration: the story is told by no one. With the disappearance of the narrator, the reader is now the direct and immediate witness to the unfolding drama. The reader views the work from the outside. In the beginning of this story the readers are informed of all the preparations for a man about to be hanged: the set up for the hanging, the characters involved and the surroundings. The narrator gives an incredible and beautiful snapshot of the scene describing the water, the guards, and his restraints. Vertical in front of the left shoulder, the hammer rested on the forearm thrown strait across the chest- a formal and unnatural position (Bierce pg. 90, line 10). This type of narration is the least personal and the reader receives the least information on the characters thoughts and feelings. Although the author describes details, the reader has to fill the blanks as to what actions and events lead up to the situation. The reason for this type of narration in the first section of the story is to get the readers curiosity going. One wonders what Peyton Farquhar could have done to be hanged; was he alone in what he did, why is he involved in a military issue when he is a civilian? In paragraph six and seven and through the second section, the author changes his point of view to one which is third person omniscient: all knowing. The  omniscient narrator is not a character in the story and is not involved with what happens. He imposes his presence between the reader and the story and controls all the events. From an outside point of view, the narrator provides enough information to summarize, interpret and wonder. As the story evolves, the reader begins to read thoughts of the characters: Farquhar, his wife and the soldiers. The reader becomes involved in Farquhars life as the narrator summarizes his situation. The reader is told of him being a planter and owning slaves, that he is a secessionist and devoted to the Southern cause. Nevertheless, the narrator leads the reader to believe Farquhar and his wife are kind people, she fetched the water for the soldier to drink with her own white hands (Bierce pg.92, line 15) instead of ordering one on her colored slaves to do it. Farquhars principles and devotion towards the south is explained in this section and the reader gets to know who he really is. This makes the reader feel sympathetic towards him and his wife. The purpose of the omniscient narrator in the 2nd section is to give information of the characters and to get a glimpse into Farquhars life. The reader finds out how devoted his wife is to her husband. The reader can now relate to Farqhuar and understand how and why he got caught trying to destroy the bridge. Section three is intended to create suspense. Bierce wants the reader to believe that what is being described actually happens. In order for the reader to believe that what is being described is actually happening, the story must be narrated from the characters point of view (limited omniscient point of view). With a limited omniscient point of view, the narrator limits his or her ability to penetrate the mind of a single character. The reader may be shown the characters voice, feelings and thoughts through dialogue, monologue or stream of consciousness. As a result, the reader becomes more and more directly involved in interpreting the story. By using this point of view all of what Farquhar is experiencing seems so real. The advantages of the limited omniscient point of view are the tightness of focus and control that it provides. If the third section was told in an omniscient point of view, the author would have not been able to fool the reader, for he would have seen what was really happening. Seeing the whole action and knowing the soldiers thoughts would have given away the ending. An Occurrence at Owl Creek Bridge was written in three different sections, with each having a different narrative form. The first, using dramatic point of view, describes where the action takes place. The second, omniscient point of view lets the reader comprehend the victims thoughts and actions. And finally, the third section, limited omniscient point of view creates suspense by being only in one mind. With the ability to switch from one form to another, Bierce was able to create a tale of intrigue, captivation and a twist-ending.

Researching the Asian American Culture Essay -- Cultural Identity Essay

Researching the Asian American Culture There are fundamental differences between Eastern and Western cultures and the meeting of these cultures has had several effects, both in Asia and here in the US. Overseas, you can see the juxtaposition of American pop culture on the older modes of Asian thought and society. Here, New Age religions find new excuses in Asian religions and philosophies and Anime is appears regularly on Saturday morning cartoons. Often, this juxtaposition becomes turbulent as the younger generations are caught between two seemingly opposing cultures. As a result, crime rates rise with the integration of Western ideals and culture into Asian society. This is true here in America too as the first generation of Asian-Americans are born and brought up by Asian parents, with Asian thinking, in American society and culture. This conflict manifests itself in our history as a nation as well as in modern universities and businesses. Historically, the United States has not been kind to Asian immigrants and until as late as 1965, legal discrimination against Asians has been an accepted part of American culture. In the mid-nineteenth century, Chinese immigrants began to come to the United States in response to the gold rush in California. By 1852, over 20,000 Chinese had emigrated to the United States. Many of these would end up working on the Transcontinental Railroad as contract laborers. Local groups demanded, however, that the flow of emigration be stopped and in 1858, a law was passed that barred the Chinese from entering. This began a series of laws and treaties with China and Japan that would govern Asian emigration to the US. In 1868, Chinese emigration is reopened as a result of the Burlingame... ...ginning to result in more and more first and second generation Americans in the business and professional world. More and more Asian doctors, always a popular profession, can be seen today. The recent dot com craze similarly resulted in a disproportionate number of Asians heading up companies, although this has yet to manifest itself in the larger corporations. (no hard data on this, but I could probably find some if you need) However, Asians are rapidly becoming a greater force in American culture as the proportion of educated Asian-Americans rises. Despite small numbers, they begin to have more and more influence in the business and professional worlds as well as academics. They are an interesting group, however, caught between two extremely different cultures as they seek to strike a balance between the ideals of their parents and the world they live in.

Functionalist, conflict and the integrationist theories of education Essay

The functionalist theory looks more into the ways that universal education serves the needs of the society. On the other hand, the conflict theory focuses on the function of education as perpetuating inequality on the social aspect of life and boosting the power of those who are dominant within the society. The interactionist’s theory limits its analysis on education to what happens directly in a classroom setup, as it looks into the teacher’s expectation from the learner and how it affects the learner’s performance, attitude and perception (Rappa 1976). The relationship of each theory to education Functionalist theory; According to this theory, the latent role of education is that it brings people together. In other words it enhances socialization within the society among the different people from diverse cultures, languages, color, age and interests. Through the interactions, people get to learn from one another through the exchange of ideas and views regarding different areas of discussion. The other role of education is that it plays the role of passing down core values and social control within the society. Read more:Â  Functionalist Perspective on Social Institutions The conflict theory experts further insist on getting rid of modern exams, as according to them all tests contain a knowledge base which is always culturally sensitive. On the other hand, the Conflict theorists look at education not as a social benefit or opportunity, but as a powerful means of maintaining power structures and creating a docile work force for capitalism. The interactionists’ theory is relative to education in the sense that a teacher has more influence on the students within a classroom set up; therefore the performance of a student is majorly based on the teacher judgment and effort (Brubacher 1962) The perspective of each theory The functionalists see education as a means of transmitting or perpetuating the core educational values from one generation to another. Additionally, they consider education as an important factor in separating the learners putting the basis of this distinction as merit. The conflict theorists on the other hand see the educational system as perpetuating the status quo by dulling the lower classes into being obedient workers to the higher classes. The interactionists on the other hand, focus on the influence of the expectations of the teacher on the learner’s performance (Rappa 1976) Expectations of education from each theory The functionalists expect that universal education should serve the society by unifying the people within a society, and helping in transmitting the core values of the society. The conflict theorists expect that education will maintain inequality within the society, by preserving the power of those who are dominating the society. The interactionists’ expectations are that the teacher’s anticipation from the students should have an impact on their performance, regardless of its positive or negative nature (Rappa 1976). Comparison The functionalist and conflict theorists concur on that education is a tool to be used for sorting out the different learners. Further, the functionalists argue that schools sort students based on merit, while the conflict theorists argue that schools sort out students along class and tribal lines (Schon, 1983). The conflict theory puts more focus on competition between groups, while the functionalist theorists focus on balance and stability within a social system. Additionally, conflict theorists focus on society as made up of social relations characterized by inequality and change. Functionalism perceives the society as a complex phenomenon or system of interrelated parts working together to maintain the desired stability (Brubacher 1962) Analysis of personal selected philosophy and philosopher Aristotle; His philosophy is education for producing quality citizens who are virtuous. He further put consideration on human nature, habit and reason as the vital forces to be expected from and through education. For instance, he considered repetition to be a key tool towards the development of good habits; from the teacher’s systematic guidance of the different students (Schon, 1983). Aristotle put more weight on balancing the theoretical and practical aspects of the subjects taught. Additionally, he argues that the explicitly important subjects include reading, writing and mathematics. Based on the discussion, it can thus be considered that Aristotle’s thinking fits into the ideas of the functionalist theory (Rappa 1976). Conclusion Having discussed the different educational theories, it can be argued that these educational theoretical models are paramount as far as education is concerned, as they bring about an understanding of how different people perceive education. Further, it is through these differences that different people come together and reason towards reaching a solid conclusion, which contributes to an advancement in the field of education because trough discussions new ideas are established. Additionally, these theories help the members of society realize diversity in their thinking and perception of things. References Brubacher, S. (1962). Modem Philosophies of Education. New York: Mc Graw Hill Book Co. Pg 114 Rappa, S. (1976). Education in a Free Society: An American History. Philadelphia: David McKay Company Inc. pp 59 Schon, D. (1983). The reflective practitioner. New York: Basic Books.

A Comprehensive Case Management Program - Free Essay Example

Sample details Pages: 8 Words: 2464 Downloads: 9 Date added: 2017/09/22 Category Advertising Essay Type Narrative essay Did you like this example? JOURNAL OF PALLIATIVE MEDICINE Volume 12, Number 9, 2009 ? Mary Ann Liebert, Inc. DOI: 10. 1089=jpm. 2009. 0089 Original Article A Comprehensive Case Management Program To Improve Palliative Care 1 1 Claire M. Spettell, Ph. D. , Wayne S. Rawlins, M. D. , M. B. A. ,2 Randall Krakauer, M. D. ,3 Joaquim Fernandes, M. S. , 2 2 2 Mary E. S. Breton, B. S. , J. D. , Wayne Gowdy, B. S. , Sharon Brodeur, R. N. , B. S. , M. P. A. , Maureen MacCoy, B. S. N. , M. B. A. ,2 and Troyen A. Brennan, M. D. , M. P. H. 4 Abstract Objective: The objective of this study was to evaluate the impact of comprehensive case management (CM) and expanded insurance bene? s on use of hospice and acute health care services among enrollees in a national health plan. Study Design: Retrospective cohort design with three intervention groups, each matched to a historical control group. Methods: Intervention groups were health plan enrollees who died after 2004: 3491 commercial enrollees with CM; 387 commercial en rollees with CM and expanded hospice bene? ts; and 447 Medicare enrollees with CM. Control groups consisted of enrollees who died in 2004 prior to the start of the palliative care CM program. The main outcomes measured were the proportion using hospice, mean number of hospice days, and number of inpatient days measured through medical claims. Results: Hospice use increased for all groups receiving CM compared to the respective control groups: from 30. 8% to 71. 7% ( p 0. 0001) for commercial members with CM and from 27. 9% to 69. 8% ( p 0. 0001) for Commercial members with CM and enhanced hospice bene? ts. Mean hospice days increased from 15. 9 to 28. 6 days ( p . 0001) and from 21. 4 to 36. 7 days ( p 0. 0001) for these groups, respectively. Inpatient stays were lower for all groups receiving CM services compared to their respective control groups. Conclusions: Comprehensive health plan CM and more liberal hospice bene? t design may help to break down barriers to hospice use; bene? ts might be liberalized within the context of such case management programs without adverse impact on total costs. Introduction ospice care helps to meet the needs of patients with advanced illness by providing effective pain and symptom management and support for the emotional and spiritual needs of patients and their caregivers. Such care allows patients to achieve a sense of control over dying, many of whom would prefer to die at home. Hospice utilization among Medicare decedents increased dramatically in the last decade, to approximately 40% in 2005. 1 However, the current rate is considered less than ideal to fully meet the needs of those with advanced illness, and there is substantial variation in the use of hospice by age, race, diagnosis and geographic location. 2–5 Many individuals enter hospice shortly before death, substantially limiting the bene? t they might obtain 1 2 H from hospice services. In 2006, the median length of stay in hospice was 20. 6 days, down from 26. 0 days in 2005, and little changed from the 2001 rate of 20. 5 days. 6 Among Medicare decedents, the median length of stay was 15 days in 2005. 1 Barriers to election of hospice care include preferences for aggressive curative treatment among patients, families, and physicians, physician’s discomfort and dif? culty in initiating conversations about advanced illness choices, Medicare regulations requiring the patient’s physician to certify that the patient has a life expectancy of 6 months or less, limits on hospice bene? s, and the need to forego curative medical treatment in order to qualify for hospice. 7,8 In 2004, a national health plan launched a comprehensive case management (CM) program targeted speci? cally to patients with advanced illness and their families. The health Aetna Informatics, Aetna, Blue Bell, Pennsylvania. Aetna Government Health Plan, Aetna, Hartford, Connecticut. 3 National Care Management, Aetna, Hartford, Connecticut. 4 CVS Caremark, Woonsocket, Rhode Island. 827 828 plan also piloted a bene? t design change among 13 large employers that liberalized hospice and respite bene? s for seriously ill patients and families. The purpose of this article is to describe the impacts of the case management program and the liberalization of bene? ts on use of hospice and acute health care services in commercially insured and Medicare Advantage populations. Methods Program description A comprehensive case management program termed the ‘‘Compassionate Care Program’’ was launched at the end of 2004 and included comprehensive case management services provided by health plan nurse case managers who received extensive training in palliative care. This specialized case management program supplemented the traditional case management services available to all health plan members. Members were identi? ed as candidates for the program through the health plan’s process of concurrent revi ew of inpatient admissions, physician referral, self-referral, and monthly use of a proprietary predictive model examining medical and pharmacy claims to identify individuals whose claims history suggested a terminal illness. Case management services were available to all eligible members and few individuals declined these services. Physicians in the health plan network were noti? ed of the program at the time it was implemented via an article in the physician newsletter sent out by the health plan. Case managers reached out by telephone to identi? ed members and conducted a comprehensive assessment of their needs and developed individual plans of care that addressed the members’ needs and preferences. The number and frequency of contacts with the member was established with the member=caregiver during the initial outreach. The case manager assisted the member and family by addressing issues such as the need for education of the disease process for member and family=car egiver, understanding of advanced directives and assistance with obtaining these documents, understanding their preferences for care, identifying community resources for member and caregiver support, social work support, pain control, medication management, and home or respite care. The case manager worked with the member’s physician to coordinate care and with the hospice agency if hospice was in place. The case manager handled an average caseload of 40–45 health plan members, all in various stages of need for support. Members with advanced illness made up a small percentage of that caseload at any given time. The internal cost for a nurse case manager to manage a member with advanced illness was approximately $400. In January 2005, a pilot program was launched for 13 large employers whereby, in addition to the provision for case management support, insurance bene? ts for hospice and respite were expanded. The expansion included extending the durational de? niti on of terminal illness from 6 months to 12 months; continued receipt of curative treatment while also receiving hospice services; removal of length of stay for inpatient hospice and maximum dollar limits for outpatient hospice; provision of 15 days per year of respite bene? ts for family members; and availability of bereavement services through employer assistance programs. Study design and population SPETTELL ET AL. The study was a retrospective cohort design using matched historical control groups. Data for the analysis came from the health plan’s eligibility, claims and utilization management systems. Members who died during 2005, 2006, and the ? rst quarter of 2007 were identi? ed through the health plan case management database. These members comprised three groups: 1. Case Management (CM) Group (n ? 3491): Commercially insured members with usual hospice bene? ts who received comprehensive case management (CM) services. 2. Enhanced Bene? ts CM Group (n ? 387): Commerc ially insured members whose bene? s were provided by one of the 13 large employers participating in the pilot program for which hospice and respite bene? ts were liberalized. These members also received the comprehensive CM services. 3. Medicare CM Group (n ? 447): Medicare Advantage members with Centers for Medicare Medicaid Services (CMS)-de? ned hospice bene? ts who received comprehensive CM services. Control groups Historical control groups were created for each of the groups above. Health plan members who died in 2004 were identi? ed from the Social Security Death Index ? es by matching on Social Security Number and two of the following: date of birth, gender and full name. 9 Control group members had been eligible for the health plan’s usual case management services in place prior to the specialzed training program in palliative care. Each member receiving CM was matched to a control group member on age, severity of illness score, presence of health plan pharmacy bene? ts, and diagnosis using information available in the health plan’s claims and eligibility systems. Severity of illness of each member was quanti? d using the Ingenix Episode Risk GroupO (ERGO) Score software. 10 This score was derived from weights assigned from a normative insurance claims database for each diagnosis group found in medical episodes constructed from medical and pharmacy claims data. Study period The date of enrollment in the CM program was determined for each member and the number of days between this index date and the person’s death was calculated. The number of days prior to death was used as the observation period for each matched pair. Primary outcome measures The primary outcome measures were rates of hospice use and mean number of days in hospice, which were expected to be higher in the groups receiving case management and expanded hospice bene? ts compared to the control groups. Hospice use measures were calculated from health plan claims da ta for the commercial members and included the proportion of members using hospice in both inpatient and outpatient settings and the length of service in hospice. For the Medicare CM Group for whom hospice claims were paid directly by CMS, hospice use was calculated based on an CASE MANAGEMENT TO IMPROVE PALLIATIVE CARE indicator ? ag on the CMS Monthly Member Eligibility Files. The number of days in hospice was not available from this source. The ? ag indicating hospice in the health plan utilization management system was not available for the Medicare control group, thus, the hospice use rate was not calculated for this group. Secondary outcome measures The acute care utilization measures were calculated from health plan claims data, and included the proportion of members with acute care hospital admissions, the rate of acute hospital inpatient days per 1000 members, proportion of members with an intensive care unit (ICU) stay during an acute hospitalization, proportion of m embers with emergency visits, the rate of emergency department visits per 1000 members, and rate of primary care and specialist vists per member. No directional hypotheses were made for these measures. Measures expressed as days per 1000 members were calculated as the number of days divided by the number of members in the CM Group multiplied by 1000. Statistical analysis Generalized linear models were used to compare outcome variables between groups with a subject effect variable to adjust for the paired nature of the data. McNemar’s test was used for comparing proportions. A generalized linear model assuming a two parameter Poisson probability distribution was employed for comparing rates represented as counts per thousand. The two-parameter Poisson was chosen for the response probability distribution so that the scale parameter 829 could model the overdispersion in the data. Kaplan-Meier methods were used to estimate the number of days between hospice enrollment and d eath, and group differences were tested using a two-sided log rank test. All models included a variable for the geographical region where the member resided to adjust for regional differences in hospice use. Results of statistical tests yielding p values 0. 5 were considered statistically signi? cant. All analyses were done using SAS v. 9. 0 (SAS Institute, Cary, NC). Results Table 1 shows sociodemographic characteristics of each CM group compared to its control group. There were no statistically signi? cant differences on the variables used in the matching process. Table 2 lists the top 15 diagnoses for each group. Within each cohort, the CM and Control groups varied in the geographic distribution of members; therefore, geographic region was used as an adjustor in the analyses of outcomes. Table 3 presents the use of health care services by the Enhanced Bene? ts CM Group, the CM Group and the Medicare CM Groups compared to their respective control groups, adjusted for differenc es in geographic region. The average number of days in the CM program was 42. 3 days (Enhanced Bene? ts CM Group), 39. 6 days (CM), and 56. 7 days (Medicare CM). For each group receiving CM, the percentage of members using hospice more than doubled compared to its control group (Enhanced Bene? ts CM 69. 8% versus 27. 9%, p 0. 0001; CM 71. 7% versus 30. %, p 0. 0001). The mean number of days with hospice increased from 21. 4 days to 36. 7 days ( p 0. 0001) for the Enhanced Bene? ts CM group, and from Table 1. Characteristics of Case Management (CM) Groups Enhanced Bene? ts CM Study group 387 59. 47 18. 19 18. 1% 74. 4% 61. 5% 96. 6% 9. 8% 20. 9% 4. 1% 9. 8% 39. 3% 8. 3% 7. 8% Control group 387 59. 04 17. 76 18. 1% 74. 4% 55. 8% 98. 2% 10. 3% 22. 0% 9. 3% 9. 8% 19. 4% 8. 8% 20. 4% Study group 3491 56. 52 19. 79 62. 4% 80. 7% 49. 7% 65. 1% 20. 3% 16. 4% 12. 7% 24. 7% 10. 3% 9. 8% 5. % CM Control group 3491 56. 87 19. 65 62. 4% 80. 7% 48. 1% 74. 9% 14. 9% 16. 6% 14. 0% 14. 4% 12. 1% 10. 0% 17. 9% Study group 447 77. 14 24. 83 100% 57. 5% 44. 5% 0% 47. 9% . 2% 48. 5% . 2% 0% 3. 1% 0% Medicare CM Control group 447 77. 36 24. 17 100% 57. 5% 44. 5% 0% 43. 0% 0% 34. 7% 0% 0% 22. 4% 0% n Matching variables Mean age Comorbidity risk scorea Health plan pharmacy Bene? t % with cancer as terminal condition Descriptive variables % Female % PPO Health plan geographic Region Mid-Atlantic North Central Northeast Southeast Southwest West Unknown a value 0. 45 0. 5582 1. 00 1. 00 0. 1086 p value 0. 1266 0. 5824 1. 00 1. 00 0. 1880 p value 0. 6588 0. 4181 1. 00 1. 00 1. 00 Episode Risk GroupO Score. PPO, preferred provider organization. 830 Table 2. Top Fifteen Conditions by Case Management Group Enhanced case management Lung cancer Gastrointestinal cancer Colorectal cancer Neoplasms—other Brain cancer Breast cancer Gynecologic cancer Neurologic disorders Hodgkin’s lymphoma COPD Hepatobiliary disorders Head and neck cancer Heart failure Malignant melanoma Sepsis 1 5. % 10. 6% 9. 0% 7. 2% 6. 2% 6. 2% 5. 2% 3. 9% 3. 1% 2. 6% 1. 8% 1. 6% 1. 3% 1. 3% 1. 0% Commercial case management Lung cancer Gastrointestinal cancer Breast cancer Neoplasms—other Colorectal cancer Gynecologic cancer Brain cancer Hodgkin’s lymphoma Hematologic cancer Hepatobiliary disorders Head and neck cancer Prostate cancer COPD Respiratory failure Malignant melanoma 20. 1% 12. 7% 9. 2% 7. 9% 7. 5% 5. 0% 3. 8% 2. 2% 2. 1% 1. 8% 1. 5% 1. 5% 1. 4% 1. 3% 1. 2% SPETTELL ET AL. Medicare case management Lung cancer Gastrointestinal cancer Congestive heart failure Neoplasms—Other COPD Colorectal cancer Breast cancer Prostate cancer Chronic renal failure Diabetes mellitus Respiratory failure Cerebrovascular disease Hematologic cancer Pneumonia Hypertension 19. 5% 9. 6% 6. 7% 6. 5% 6. 0% 4. 9% 3. 4% 3. 1% 2. 9% 2. 9% 2. 9% 2. 2% 2. 2% 1. 6% 1. 6% 15. 9 days to 28. 6 days ( p 0. 0001) for the CM group. The rate of use of hospice in the Medicare CM Group was 62. 9%. The percentages of members with an acute inpatient stay after program enrollment were reduced for the Enhanced Bene? ts CM Group (16. % versus 40. 3%, p 0. 0001), CM group (22. 7% versus 42. 9%, p 0. 0001), and Medicare CM group (30. 0% versus 88. 4%, p 0. 0001) compared to their respective control groups. The number of acute inpatient days was reduced for the Enhanced Bene? ts CM group (1549 versus 3986 days per thousand members, p 0. 0001), CM Group (2311 versus 3858 days per thousand members, p 0. 0001), and Medicare CM Group (2309 versus 15,217 per thousand members, p 0. 0001) compared to their respective control groups. The proportion of members with ICU stays during an acute inpatient admission was signi? antly lower for all of the groups receiving CM compared to their respective control groups, as was ICU days per thousand member (Enhanced Bene? ts CM Group 899 versus 2542, p 0. 0001, CM Group 1356 versus 2162, p 0. 0001, Medicare CM Group; 1189 versus 9840, p 0. 0001) compared to the control groups. Table 3. Adjusted Utilization of Health Care Servicesa Enhanced Bene? ts CMb Pilot Group Study group Average days in 42. 3 CM program Percent Using 69. 8% Hospice Mean days from hospice 36. 7 claim and death Hospice inpatient 1,424. days=1000 Hospice outpatient 14,607. 0 days=1000 Percent with acute 16. 8% inpatient stay Average Length of 5. 84 Stay Inpatient Percent With Emergency Visit 9. 8% Percent With ICU Stay 9. 6% Acute inpatient days=1000 1,549. 4 Emergency visits=1000 94. 4 ICU days=1000 898. 8 Primary care physician 0. 53 visits per Member Specialist visits per Member 1. 44 a c b CM Group Study group 39. 6 Control group p value Medicare CM Group Study group 56. 7 Control group p value Control group p value 27. 9% 21. 4 601. 2 3,914. 5 40. 3% 6. 91 15. 2% 23. 0% 3,986. 4 159. 3 2,541. 6 1. 00 2. 09 Don’t waste time! Our writers will create an original "A Comprehensive Case Management Program" essay for you Create order