FN Thomson Reuters Web of Science™ VR 1.0 PT J AU Jackson, Y Dietz, WH Sanders, C Kolbe, LJ Whyte, JJ Wechsler, H Schneider, BS McNally, LA Charles-Azure, J Vogel-Taylor, M Starke-Reed, P Hubbard, VS Johnson-Taylor, WL Troiano, RP Donato, K Yanovski, S Kuczmarski, RJ Haverkos, L McMurry, K Wykoff, RF Woo, V Noonan, AS Rowe, J McCarty, K Spain, CB AF Jackson, Y Dietz, WH Sanders, C Kolbe, LJ Whyte, JJ Wechsler, H Schneider, BS McNally, LA Charles-Azure, J Vogel-Taylor, M Starke-Reed, P Hubbard, VS Johnson-Taylor, WL Troiano, RP Donato, K Yanovski, S Kuczmarski, RJ Haverkos, L McMurry, K Wykoff, RF Woo, V Noonan, AS Rowe, J McCarty, K Spain, CB TI Summary of the 2000 Surgeon General's listening session: Toward a national action plan on overweight and obesity SO OBESITY RESEARCH LA English DT Article DE schools; worksites; media; family and community; health care ID UNITED-STATES AB Objective: To provide insight into discussions at the Surgeon General's Listening Session, "Toward a National Action Plan on Overweight and Obesity," and to complement The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. Research Methods and Procedures: On December 7 and 8, 2000, representatives from federal, state, academic, and private sectors attended the Surgeon General's Listening Session and were given an opportunity to recommend what to include in a national plan to address overweight and obesity. The public was invited to comment during a corresponding public comment period. The Surgeon General's Listening Session was also broadcast on the Internet, allowing others to view the deliberations live or access the archived files. Significant discussion points from the Listening Session have been reviewed by representatives of the federal agencies and are the basis of this complementary document. Results: Examples of issues, strategies, and barriers to change are discussed within five thematic areas: schools, health care, family and community, worksite, and media. Suggested cooperative or collaborative actions for preventing and decreasing overweight and obesity are described. An annotated list of some programmatic partnerships is included. Discussion: The Surgeon General's Listening Session provided an opportunity for representatives from family and community groups, schools, the media, the health-care environment, and worksites to become partners and to unite around the common goal of preventing and decreasing overweight and obesity. The combination of approaches from these perspectives offers a rich resource of opportunity to combat the public health epidemic of overweight and obesity. C1 NIH, Div Nutr Res Coordinat, DHHS, Bethesda, MD 20892 USA. Adm Aging, US Dept HHS, Washington, DC USA. Ctr Dis Control & Prevent, Div Nutr & Phys Act, DHHS, Atlanta, GA USA. Ctr Dis Control & Prevent, Div Adolescent & Sch Hlth, DHHS, Atlanta, GA USA. Ctr Medicare & Medicaid Serv, Agcy Healthcare Res & Qual, DHHS, Baltimore, MD USA. US FDA, DHHS, Rockville, MD 20857 USA. US Hlth Resources & Serv Adm, DHHS, Rockville, MD 20857 USA. Indian Hlth Serv, US Dept HHS, Rockville, MD USA. NIH, Off Director, DHHS, Bethesda, MD 20892 USA. NCI, NIH, DHHS, Bethesda, MD 20892 USA. NHLBI, NIH, DHHS, Bethesda, MD 20892 USA. NIDDKD, NIH, DHHS, Bethesda, MD 20892 USA. NICHHD, NIH, DHHS, Bethesda, MD 20892 USA. Off Dis Prevent & Hlth Promot, DHHS, Washington, DC USA. Off Surg Gen, DHHS, Washington, DC USA. Off Womens Hlth, DHHS, Washington, DC USA. Presidents Council Phys Fitness & Sports, Off Publ Hlth & Sci, DHHS, Washington, DC USA. RP Johnson-Taylor, WL (reprint author), NIH, Div Nutr Res Coordinat, DHHS, 2 Democracy Plaza,Room 640,6707 Democracy Blvd,MS, Bethesda, MD 20892 USA. OI Troiano, Richard/0000-0002-6807-989X NR 12 TC 22 Z9 22 U1 0 U2 0 PU NORTH AMER ASSOC STUDY OBESITY PI SILVER SPRING PA 8630 FENTON ST, SUITE 918, SILVER SPRING, MD 20910 USA SN 1071-7323 J9 OBES RES JI Obes. Res. PD DEC PY 2002 VL 10 IS 12 BP 1299 EP 1305 DI 10.1038/oby.2002.176 PG 7 WC Endocrinology & Metabolism; Nutrition & Dietetics SC Endocrinology & Metabolism; Nutrition & Dietetics GA 625MY UT WOS:000179821300014 PM 12490675 ER PT J AU West, JC Pingitore, D Zarin, DA AF West, JC Pingitore, D Zarin, DA TI Characteristics of psychiatric patients for whom financial considerations affect optimal treatment provision SO PSYCHIATRIC SERVICES LA English DT Article ID MENTAL-HEALTH; MANAGED CARE; INSURANCE; SERVICES AB This study assessed characteristics of psychiatric patients for whom financial considerations affected the provision of "optimal" treatment. Psychiatrists reported that for 33.8 percent of 1,228 patients from a national sample, financial considerations such as managed care limitations, the patient's personal finances, and limitations inherent in the public care system adversely affected the provision of optimal treatment. Patients were more likely. to have their treatment adversely affected by financial considerations if they were more severely ill, had more than one behavioral health disorder or a I psychosocial problem, or were receiving treatment under managed care arrangements. Patients for whom financial considerations affect the provision of optimal treatment represent a population for whom access to treatment may be particularly important. C1 Amer Psychiat Inst Res & Educ, Amer Psychiat Pract Res Network, Washington, DC 20005 USA. Univ Calif Berkeley, Ctr Mental Hlth, Serv Res, Berkeley, CA USA. Technol Assessment Program, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP West, JC (reprint author), Amer Psychiat Inst Res & Educ, Amer Psychiat Pract Res Network, 1400 K St NW, Washington, DC 20005 USA. NR 10 TC 2 Z9 2 U1 0 U2 0 PU AMER PSYCHIATRIC PRESS, INC PI WASHINGTON PA 1400 K ST, N W, STE 1101, WASHINGTON, DC 20005 USA SN 1075-2730 J9 PSYCHIATR SERV JI Psychiatr. Serv. PD DEC PY 2002 VL 53 IS 12 BP 1626 EP 1629 DI 10.1176/appi.ps.53.12.1626 PG 4 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychiatry SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychiatry GA 621ZG UT WOS:000179620900023 PM 12461227 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Services Task Force TI Behavioral counseling in primary care to promote physical activity: Recommendations and rationale (Reprinted) SO AMERICAN FAMILY PHYSICIAN LA English DT Reprint ID RANDOMIZED CONTROLLED TRIAL; GENERAL-PRACTICE; HEALTH BEHAVIORS; ADVICE; EXERCISE; ADULTS; RISK C1 US Prevent Serv, Task Force, Rockville, MD 20852 USA. RP Berg, AO (reprint author), Care of Atkins D, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 24 TC 11 Z9 11 U1 1 U2 2 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD NOV 15 PY 2002 VL 66 IS 10 BP 1931 EP 1936 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 618EQ UT WOS:000179406000014 ER PT J AU Farquhar, CM Kofa, EW Slutsky, JR AF Farquhar, CM Kofa, EW Slutsky, JR TI Clinicians' attitudes to clinical practice guidelines: a systematic review SO MEDICAL JOURNAL OF AUSTRALIA LA English DT Review ID GENERAL-PRACTITIONERS; PHYSICIANS ATTITUDES; FAMILY PHYSICIANS; MEDICAL-PRACTICE; NATIONAL SURVEY; HEALTH-CARE; QUALITY; ADHERENCE; IMPLEMENTATION; STANDARD AB Objective: To systematically review surveys of clinicians' attitudes to clinical practice guidelines. Data sources: MEDLINE, HealthStar, Embase and CINAHL were searched electronically for English-only surveys published from 1990 to 2000. Study selection: We included surveys with responses to one or more of seven propositions (see below). Studies were excluded if they had fewer than 100 respondents or if the response rate was less than 60%. Results: Thirty studies included responses to one or more of the seven items, giving a total of 11 611 responses. The response rate for the included studies was 72% (95% confidence interval [CI], 69%-75%). Clinicians agreed that guidelines were helpful sources of advice (weighted mean, 75%; 66%-83%), good educational tools (71%; 63%-79%) and intended to improve quality (70%; 60%-80%). However, clinicians also considered guidelines impractical and too rigid to apply to individual patients (30%; 23%-36%), that they reduced physician autonomy and oversimplified medicine (34%; 22%-47%), would increase litigation (41%; 32%-49%) and were intended to cut healthcare costs (52.8%; 39%-66%). Conclusions: Surveys of healthcare providers consistently report high satisfaction with clinical practice guidelines and a belief that they will improve quality, but there are concerns about the practicality of guidelines, their role in cost-cutting and their potential for increasing litigation. C1 Agcy Healthcare Res & Qual, Ctr Practice Technol Assessment, Rockville, MD USA. RP Farquhar, CM (reprint author), Univ Auckland, Natl Womens Hosp, Dept Obstet & Gynaecol, Auckland 1, New Zealand. OI Farquhar, Cynthia/0000-0002-3685-3553 NR 65 TC 111 Z9 112 U1 2 U2 10 PU AUSTRALASIAN MED PUBL CO LTD PI SYDNEY PA LEVEL 1, 76 BERRY ST, SYDNEY, NSW 2060, AUSTRALIA SN 0025-729X J9 MED J AUSTRALIA JI Med. J. Aust. PD NOV 4 PY 2002 VL 177 IS 9 BP 502 EP 506 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA 623TF UT WOS:000179718400010 PM 12405894 ER PT J AU Weinick, RM AF Weinick, RM TI Things my data never told me SO ACADEMIC EMERGENCY MEDICINE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD USA. RP Weinick, RM (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD NOV PY 2002 VL 9 IS 11 BP 1071 EP 1073 PG 3 WC Emergency Medicine SC Emergency Medicine GA 614RC UT WOS:000179203100004 PM 12414453 ER PT J AU Burstin, H AF Burstin, H TI Crossing the quality chasm" in emergency medicine SO ACADEMIC EMERGENCY MEDICINE LA English DT Article; Proceedings Paper CT AEM Consensus Conference on Assuring Quality CY MAY, 2002 CL ST LOUIS, MISSOURI C1 US Dept Hlth & Human Sev, Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD 20852 USA. RP Burstin, H (reprint author), US Dept Hlth & Human Sev, Agcy Healthcare Res & Qual, Ctr Primary Care Res, 6010 Execut Blvd,Suite 201, Rockville, MD 20852 USA. NR 7 TC 13 Z9 13 U1 0 U2 0 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD NOV PY 2002 VL 9 IS 11 BP 1074 EP 1077 DI 10.1111/j.1553-2712.2002.tb01560.x PG 4 WC Emergency Medicine SC Emergency Medicine GA 614RC UT WOS:000179203100005 PM 12414454 ER PT J AU Elixhauser, A Machlin, SR Zodet, MW Chevarley, FM Patel, N McCormick, MC Simpson, L AF Elixhauser, A Machlin, SR Zodet, MW Chevarley, FM Patel, N McCormick, MC Simpson, L TI Health care for children and youth in the United States: 2001 Annual Report on Access, Utilization, Quality, and Expenditures SO AMBULATORY PEDIATRICS LA English DT Article DE health care utilization; hospitalization; insurance; quality; variation AB Objectives.-To provide an update on insurance coverage, use of health care services, and health expenditures for children and youth in the United States and new information on parents' perceived quality of care for their children and to provide information on variation in hospitalizations for children from a 24-state hospital discharge data source. Methods.-The data on insurance coverage, utilization, expenditures, and perceived quality of care come from the Medical Expenditure Panel Survey. The data on hospitalizations come from the Nationwide Inpatient Sample, which is part of the Healthcare Cost and Utilization Project. Both data sets are maintained by the Agency for Healthcare Research and Quality. Results.-In 2000, 64.5% of children were privately insured, 21.6% were insured through public sources, and 13.9% were uninsured. Children aged 15-17 years were more likely to be uninsured than children 1-4 years old. Children without health insurance coverage were less likely to use health care services, and when they did, their rates of utilization and expenditures were lower than insured children. Publicly insured children were the most likely to use hospital inpatient and emergency department (ED) care. Being black or Hispanic and living in families with incomes below 200% of the poverty line were associated with lower utilization and expenditures. A small proportion of children account for the bulk of health care expenditures: approximately 80% of all children's health care expenditures are attributable to 20% of children who used medical services. Although most parents report that their experiences with health care for their children are good, there are significant variations by type of insurance coverage. There are substantial differences in average length of hospitalization across the United States, ranging from 2.9-4.1 days, and rates of hospital admission through the ED, which vary across states from 10%-25%. Injuries are a major reason for hospitalization, accounting for I in 6 hospital stays among 10- to 14-year-olds. In the 10- to 17-year age group, more than I in 7 hospital stays are due to mental disorders. Among 15- to 17-year-olds, more than one third of all hospital stays are related to childbirth and pregnancy. The top 10 most common conditions treated in the hospital account for 40%-60% of all hospital stays. Conclusion.-Children's use of health care services varies considerably by the type of health insurance coverage, race/ethnicity, and family income. Quality of care, as measured by parents' experiences of care, also varies by type of coverage. There is substantial variation in use of hospital services across states. C1 US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. Harvard Univ, Sch Publ Hlth, Dept Maternal & Child Hlth, Boston, MA 02115 USA. RP Elixhauser, A (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, 2101 E Jefferson,Suite 605, Rockville, MD 20852 USA. OI McCormmick, Marie/0000-0002-3938-1707 NR 13 TC 69 Z9 69 U1 0 U2 0 PU ALLIANCE COMMUNICATIONS GROUP DIVISION ALLEN PRESS PI LAWRENCE PA 810 EAST 10TH STREET, LAWRENCE, KS 66044 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD NOV-DEC PY 2002 VL 2 IS 6 BP 419 EP 437 DI 10.1367/1539-4409(2002)002<0419:HCFCAY>2.0.CO;2 PG 19 WC Pediatrics SC Pediatrics GA 619CB UT WOS:000179454800003 PM 12437388 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Services Task Force TI Newborn hearing screening: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Article ID IDENTIFICATION; IMPAIRMENT C1 Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Texas, Hlth Sci Ctr, Sch Nursing, San Antonio, TX 78285 USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Sch Med, Rochester, NY USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Family Med, Newark, NJ 07103 USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA 02115 USA. Univ Texas, Hlth Sci Ctr, Audie L Murphy Mem Vet Hosp, San Antonio, TX 78285 USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Women & Infants Hosp Rhode Isl, Providence, RI 02908 USA. Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. CUNY Mt Sinai Sch Med, Div Gen Internal Med, New York, NY 10029 USA. CUNY Mt Sinai Sch Med, Med Serv Care Ctr, New York, NY 10029 USA. Mt Sinai Med Ctr, New York, NY 10029 USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ, Coll Phys & Surg, Dept Obstet & Gynecol, New York, NY USA. Virginia Commonwealth Univ, Dept Family Practice, Fairfax, VA USA. RP Berg, AO (reprint author), Care of Atkins D, US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 18 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD NOV PY 2002 VL 102 IS 11 BP 83 EP + PG 4 WC Nursing SC Nursing GA 615DZ UT WOS:000179231700033 PM 12436079 ER PT J AU Palmer, CS Brunner, E Ruiz-Flores, LG Paez-Agraz, F Revicki, DA AF Palmer, CS Brunner, E Ruiz-Flores, LG Paez-Agraz, F Revicki, DA TI A cost-effectiveness clinical decision analysis model for treatment of schizophrenia SO ARCHIVES OF MEDICAL RESEARCH LA English DT Article DE schizophrenia; antipsychotics; cost-effectiveness; relapse; haloperidol; risperidone; olanzapine ID ECONOMIC OUTCOMES; NEUROLEPTIC WITHDRAWAL; PSYCHOTIC DISORDERS; DRUG-THERAPY; OLANZAPINE; HALOPERIDOL; TRIAL; RISPERIDONE; UK AB Background. Schizophrenia afflicts approximately 0.7% of Mexican citizens during their lifetime. This study explored whether the difference in clinical efficacy and safety between atypical antipsychotics and conventional neuroleptics results in decreases in use and cost of medical services in Mexico, offsetting the higher price of atypical antipsychotics. Methods. A U.S. decision analytic Markov model was adapted for use in Mexico to determine cost-effectiveness of treatments and outcomes that Mexican patients with schizophrenia may experience over a 5-year period when treated with olanzapine, haloperidol, or risperidone. Model parameter estimates were based on clinical trial data, published medical literature, and where needed, clinician judgment. Direct medical costs were incorporated into the model and outcomes were estimated using lack of relapse and clinical outcomes based on the Brief Psychiatric Rating Scale (BPRS) as effectiveness indicators. All costs are reported in Mexican pesos. Results. Over a 5-year period, the cost of treating schizophrenia ranged from 196,620 pesos per patient initiating therapy with haloperidol to 226,670 pesos per patient beginning therapy with risperidone. Olanzapine was estimated to have slightly better non-relapse and BPRS-based effectiveness outcomes, but comparative total medical costs compared to risperidone. Patients receiving olanzapine experienced 13 and 2% fewer relapses compared with patients on haloperidol and risperidone, respectively. The 5-year incremental cost-effectiveness ratio of olanzapine compared with haloperidol was 52,740 pesos per improved patient, BPRS-based outcome and 212,540 pesos per avoided relapse. Sensitivity analyses indicated the model was sensitive only to changes in drug costs. Conclusions. Compared with haloperidol, olanzapine therapy results in improved symptoms, fewer relapses, and is cost-effective, even with conservative values for key model parameters. Olanzapine results in slightly improved patient outcomes and comparable costs compared with risperidone. (C) 2002 IMSS. Published by Elsevier Science Inc. C1 MEDTAP Int Inc, Ctr Hlth Outcomes Res, Bethesda, MD 20814 USA. Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD USA. IMSS, Ctr Med Nacl Siglo XXI, Hosp Especialidades, Dept Psiquiatria, Mexico City, DF, Mexico. Inst Jalisciense Salud Mental, Guadalajara, Jalisco, Mexico. RP Revicki, DA (reprint author), MEDTAP Int Inc, Ctr Hlth Outcomes Res, 7101 Wisconsin Ave,Suite 600, Bethesda, MD 20814 USA. NR 31 TC 27 Z9 30 U1 1 U2 5 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0188-4409 J9 ARCH MED RES JI Arch. Med. Res. PD NOV-DEC PY 2002 VL 33 IS 6 BP 572 EP 580 AR PII S0188-4409(02)00409-5 DI 10.1016/S0188-4409(02)00409-5 PG 9 WC Medicine, Research & Experimental SC Research & Experimental Medicine GA 623TD UT WOS:000179718200012 PM 12505105 ER PT J AU Clancy, C Stryer, D Eisenberg, JM AF Clancy, C Stryer, D Eisenberg, JM TI From publication to public action: Agency for Healthcare Research and Quality (AHRQ) perspectives on ethnicity and race-related outcomes research SO ETHNICITY & HEALTH LA English DT Editorial Material ID RACIAL-DIFFERENCES; BEHAVIORS; POLICY; RISK C1 Agcy Healthcare Res & Qual, Immediate Off Director, Rockville, MD 20852 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20852 USA. Agcy Healthcare Res & Qual, US Dept HHS, Rockville, MD 20852 USA. RP Clancy, C (reprint author), Agcy Healthcare Res & Qual, Immediate Off Director, 2101 E Jefferson Ave,Suite 600, Rockville, MD 20852 USA. EM cclancy@ahrq.gov NR 18 TC 1 Z9 1 U1 1 U2 4 PU CARFAX PUBLISHING PI BASINGSTOKE PA RANKINE RD, BASINGSTOKE RG24 8PR, HANTS, ENGLAND SN 1355-7858 J9 ETHNIC HEALTH JI Ethn. Health PD NOV PY 2002 VL 7 IS 4 BP 287 EP 290 DI 10.1080/1355785022000060745 PG 4 WC Ethnic Studies; Public, Environmental & Occupational Health SC Ethnic Studies; Public, Environmental & Occupational Health GA 659FP UT WOS:000181766900007 PM 12772548 ER PT J AU Vitullo, MW Taylor, AK AF Vitullo, MW Taylor, AK TI Latino adults' health insurance coverage: An examination of Mexican and Puerto Rican subgroup differences SO JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED LA English DT Article DE Hispanic Americans; employment; health insurance; emigration and immigration ID SERVICES; ACCESS; CARE; HISPANICS; MEDICAID AB Lack of health insurance is a serious problem in the United States. Using data from the 1996 Medical Expenditure Panel Survey, this paper examines how insurance varies between black, white, and Latino adults. Because Latino subgroups are not homogeneous, the paper also compares the factors associated with health insurance status for Mexican and Puerto Rican adults. Results indicate that access to private health insurance for Latino adults was more closely associated with workplace characteristics than employment itself. Time lived in the United States was a major factor associated with being uninsured for Mexican adults, while language barriers were a major factor limiting Puerto Rican individuals' access to private health insurance. The paper suggests two approaches for decreasing uninsurance among Latino adults: (1) strengthening the link between employment and private health insurance and (2) addressing disparities in access to public coverage for racial and ethnic groups, including recent immigrants. C1 Gallaudet Univ, Washington, DC 20002 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Vitullo, MW (reprint author), Gallaudet Univ, Washington, DC 20002 USA. NR 27 TC 19 Z9 19 U1 0 U2 0 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1049-2089 J9 J HEALTH CARE POOR U JI J. Health Care Poor Underserved PD NOV PY 2002 VL 13 IS 4 BP 504 EP 525 DI 10.1177/104920802237533 PG 22 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 604ME UT WOS:000178624600006 PM 12407965 ER PT J AU Gergen, PJ Mitchell, H Lynn, H AF Gergen, PJ Mitchell, H Lynn, H CA Natl Cooperative Inner City Asthma TI Understanding the seasonal pattern of childhood asthma: Results from the National Cooperative Inner-City Asthma Study (NCICAS) SO JOURNAL OF PEDIATRICS LA English DT Article ID AIR-POLLUTION; URINARY COTININE; OLD CHILDREN; EXPOSURE; ASSOCIATION; EXACERBATIONS; ADMISSIONS; INFECTIONS; MORBIDITY; ALLERGEN AB Objective: To contrast the seasonal patterns of asthma symptoms and utilization and determine the impact of allergen sensitivity, environmental tobacco smoke (ETS) exposure, and air pollution on the seasonal patterns of asthma. Study design: Participants in the National Cooperative Inner-City Asthma Study (NCICAS) were tracked for approximately 4 years after allergen skin testing and determination of exposure to ETS. Air pollution data were obtained from EPA monitoring sites in NCICAS cities. Results: Asthma symptoms (wheeze) and health care utilization (unscheduled visits and hospitalization) had similar seasonal patterns,,with low points during the summer months of June through August and a distinct autumn peak beginning in September. Seasonal patterns were similar among children with no allergen skin test reactivity, those reactive only to indoor allergens, and those reactive to outdoor allergens. ETS exposure, whether defined by self-report or urinary cotinine/creatinine ratio, was not related to the observed seasonal patterns. Among the pollutants evaluated, only the seasonal pattern of SO, coincided with that of asthma morbidity. Conclusions: Atopy, ETS, and most air pollutants do not appear to contribute to the distinct asthma seasonal pattern. On a population level changes in symptoms are mirrored by changes in utilization. C1 AHRQ, Ctr Primary Care & Res, MPH, Rockville, MD 20852 USA. Rho Inc, Chapel Hill, NC USA. RP Gergen, PJ (reprint author), AHRQ, Ctr Primary Care & Res, MPH, Ste 201,6010 Execut Blvd, Rockville, MD 20852 USA. FU PHS HHS [A1-30752, A1-30756, A1-30772, A1-30773-01, A1-30777, A1-30779, A1-30780, N01 A1-15105, U01 A1-30751] NR 29 TC 57 Z9 58 U1 0 U2 2 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0022-3476 EI 1097-6833 J9 J PEDIATR-US JI J. Pediatr. PD NOV PY 2002 VL 141 IS 5 BP 631 EP 636 DI 10.1067/mpd.2002.127510 PG 6 WC Pediatrics SC Pediatrics GA 614HM UT WOS:000179182300015 PM 12410190 ER PT J AU Manski, RJ Macek, MD Moeller, JF AF Manski, RJ Macek, MD Moeller, JF TI Private dental coverage - Who has it and how does it influence dental visits and expenditures? SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article ID INSURANCE; CARE AB Background: Dental insurance has had a significant impact on dentistry and dental care use. Dental insurance coverage may influence people's decisions to use dental care. During 1996, 42.9 percent of all dental expenditures were paid by private dental insurance. Methods: The focus of this analysis is on private dental coverage, use and expenditures for the U.S. civilian community-based population during 1996. The authors provide national estimates for the population with a dental visit, mean number of dental visits per year mean total expenditures for several socioeconomic and demographic categories during 1996, using Medical Expenditure Panel Survey, or MEPS, data. Results: Poor and low-income people were less likely to have private dental coverage than were people with higher incomes. People without higher incomes. People without coverage at all income levels were less likely to report a dental visit than education at any income level did not appear to affect the likelihood of people's having multiple visits or higher expenditures. Conclusions: People with private coverage are more likely to visit a dentist, have a greater number of visits and have higher expenditures than are those without coverage. Private dental insurance coverage, however, is not the only determinant of dental care use. MEPS data also show that other factors play key roles. Comprehensive strategies designed to improve dental care use should keep each of those determinants in mind. Practice Implications: While dentists may have a limited ability to influence people to seek care initially, they may be in a better position to influence the amount of care patients obtain, thereby helping make sure that patients receive the care that they need and want. C1 Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, Baltimore, MD 21201 USA. Agcy Healthcare Res & Qual, Ctr Cost Financing Studies, Rockville, MD USA. RP Manski, RJ (reprint author), Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, 666 W Baltimore St, Baltimore, MD 21201 USA. NR 22 TC 47 Z9 47 U1 0 U2 0 PU AMER DENTAL ASSN PI CHICAGO PA 211 E CHICAGO AVE, CHICAGO, IL 60611 USA SN 0002-8177 J9 J AM DENT ASSOC JI J. Am. Dent. Assoc. PD NOV PY 2002 VL 133 IS 11 BP 1551 EP 1559 PG 9 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 618CD UT WOS:000179399800020 PM 12462700 ER PT J AU Lenert, LA Burstin, H Connell, L Gosbee, J Phillips, G AF Lenert, LA Burstin, H Connell, L Gosbee, J Phillips, G TI Federal patient safety initiatives panel summary SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Editorial Material C1 Univ Calif San Diego, San Diego, CA 92103 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NASA, Ames Res Ctr, Moffett Field, CA 94035 USA. Dept Vet Affairs Natl Ctr Patient Safety, Ann Arbor, MI USA. US FDA, Rockville, MD 20857 USA. RP Lenert, LA (reprint author), Univ Calif San Diego, San Diego, CA 92103 USA. NR 3 TC 3 Z9 3 U1 0 U2 0 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD NOV-DEC PY 2002 VL 9 IS 6 SU S BP S8 EP S10 DI 10.1197/jamia.M1217 PG 3 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Information Science & Library Science; Medical Informatics SC Computer Science; Information Science & Library Science; Medical Informatics GA 611FK UT WOS:000179005600003 PM 12386172 ER PT J AU Ortiz, E Meyer, G Burstin, H AF Ortiz, E Meyer, G Burstin, H TI Clinical informatics and patient safety at the agency for Healthcare research and quality SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Medical-Information-Association CY NOV 03-07, 2001 CL WASHINGTON, D.C. SP Amer Med Informat Assoc ID PHYSICIAN ORDER ENTRY; MEDICATION ERRORS; SYSTEMS AB In 1998, the Institute of Medicine (IOM) issued a report on medical errors, which estimated that up to 98,000 people die in U.S. hospitals each year from errors. This report raised concerns that medical errors have become a national public health problem that should be addressed in the same manner as other epidemics such as heart disease, diabetes, and obesity. In 2001, the IOM released a follow-up report encompassing a broader range of quality issues. They concluded that the U.S. healthcare system is outmoded and incapable of providing consistent, high-quality care. They outlined a strategy for redesigning U.S. healthcare delivery to achieve safe, dependable, high-quality care, which emphasizes information technology as an integral part of the solution. AHRQ's fiscal year 2001 appropriation included $50 million dollars for initiatives to reduce medical errors and improve patient safety. AHRQ responded to this mandate by developing a series of research solicitations that form an integrated set of activities to design and test best practices for reducing errors in multiple health care settings. This paper discusses the components of this program and the central role of medical informatics research in the Agency's efforts to improve the safety of medical care in America. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Ortiz, E (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 16 TC 6 Z9 6 U1 1 U2 3 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD NOV-DEC PY 2002 VL 9 IS 6 SU S BP S2 EP S7 DI 10.1197/jamia.M1216 PG 6 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Information Science & Library Science; Medical Informatics SC Computer Science; Information Science & Library Science; Medical Informatics GA 611FK UT WOS:000179005600002 ER PT J AU Clancy, CM Burstin, H AF Clancy, CM Burstin, H TI John M. Eisenberg - Telling the story SO MEDICAL CARE LA English DT Editorial Material C1 Agcy Hlth Care Res & Qual, Rockville, MD USA. RP Clancy, CM (reprint author), AHRQ, 6010 Execut Blvd, Rockville, MD 20852 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD NOV PY 2002 VL 40 IS 11 BP 1012 EP 1013 DI 10.1097/01.MLR.0000033460.38867.B2 PG 2 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 611DP UT WOS:000179001400002 PM 12409846 ER PT J AU Weidmer, B Weech-Maldonado, R Darby, C Morales, LS AF Weidmer, B Weech-Maldonado, R Darby, C Morales, LS TI Health risks of Latino children SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 RAND Corp, Survey Res Grp, Santa Monica, CA 90407 USA. Penn State Univ, University Pk, PA 16802 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA USA. RP Weidmer, B (reprint author), RAND Corp, Survey Res Grp, Santa Monica, CA 90407 USA. NR 8 TC 2 Z9 2 U1 1 U2 2 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD OCT 23 PY 2002 VL 288 IS 16 BP 1982 EP 1983 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 606QW UT WOS:000178745500012 PM 12387640 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Serv Task Force TI Screening for osteoporosis in postmenopausal women: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID BONE DENSITOMETRY C1 Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. RP Berg, AO (reprint author), Care Of Atkins D, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 5 TC 6 Z9 6 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD OCT 15 PY 2002 VL 66 IS 8 BP 1430 EP 1432 PG 3 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 608VQ UT WOS:000178868300007 ER PT J AU Goode, LD Clancy, CM Kimball, HR Meyer, G Eisenberg, JM AF Goode, LD Clancy, CM Kimball, HR Meyer, G Eisenberg, JM TI When is "good enough"? The role and responsibility of physicians to improve patient safety SO ACADEMIC MEDICINE LA English DT Article AB In September 2001, the Agency for Healthcare Research and Quality (AHRQ) and the ABIM Foundation jointly sponsored an invitational conference entitled "The Role and Responsibility of Physicians to Improve Patient Safety." The goal of the conference was to begin a national conversation focusing on the individual clinician's role and strategies physicians might employ to advance patient safety. The authors summarize the main themes and issues that emerged at the conference. The authors draw from work by the Institute of Medicine (IOM) to support the need for greater emphasis on quality improvement. To date, most of the work in this area has involved a systems-level approach, and physicians are often viewed as obstacles to improvement programs. By contrast, physicians may view population or systems-based approaches to health care as interfering with the delivery of care to specific patients. The authors argue that physicians, individually and collectively, have a key role in quality improvement efforts, albeit a role that is yet fully defined. After reviewing successful examples involving physicians, the authors explore the major levers to achieve change-removing barriers, creating incentives, emphasizing collaboration, increasing education, and promulgating regulation-and summarize ten recurring themes, including both current and near-term opportunities, for physicians to exercise leadership in quality improvement and patient safety. Finally, they assert that even modest change can lead to substantial improvements, particularly if medical societies and the profession's standard-setting bodies work together. C1 Amer Board Internal Med, Philadelphia, PA 19106 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Washington, DC USA. ABIM Fdn, Philadelphia, PA USA. RP Goode, LD (reprint author), Amer Board Internal Med, 510 Walnut St,Suite 1700, Philadelphia, PA 19106 USA. NR 11 TC 20 Z9 20 U1 0 U2 1 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1040-2446 J9 ACAD MED JI Acad. Med. PD OCT PY 2002 VL 77 IS 10 BP 947 EP 952 DI 10.1097/00001888-200210000-00004 PG 6 WC Education, Scientific Disciplines; Health Care Sciences & Services SC Education & Educational Research; Health Care Sciences & Services GA 617MP UT WOS:000179365700004 PM 12377667 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for chlamydial infection: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Article C1 Care Of Atkins D, US Prevent Serv Task Force, Clin Prevent Serv, Agcy Healthcare Res & Qual,Ctr Practice & Technol, Rockville, MD 20852 USA. RP Berg, AO (reprint author), Care Of Atkins D, US Prevent Serv Task Force, Clin Prevent Serv, Agcy Healthcare Res & Qual,Ctr Practice & Technol, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 7 TC 9 Z9 9 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD OCT PY 2002 VL 102 IS 10 BP 87 EP + PG 4 WC Nursing SC Nursing GA 602RT UT WOS:000178518800038 PM 12394311 ER PT J AU Stryer, D Lawrence, W AF Stryer, D Lawrence, W TI Automated external defibrillators SO ANNALS OF INTERNAL MEDICINE LA English DT Letter ID PUBLIC-ACCESS DEFIBRILLATION C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Stryer, D (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 3 TC 0 Z9 0 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD OCT 1 PY 2002 VL 137 IS 7 BP 622 EP 622 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 599VD UT WOS:000178355100018 PM 12353959 ER PT J AU Chen, FM Phillips, RL Schneeweiss, R Andrilla, CHA Hart, LG Fryer, GE Casey, S Rosenblatt, RA AF Chen, FM Phillips, RL Schneeweiss, R Andrilla, CHA Hart, LG Fryer, GE Casey, S Rosenblatt, RA TI Accounting for graduate medical education funding in family practice training SO FAMILY MEDICINE LA English DT Article; Proceedings Paper CT 29th Annual Meeting of the North-American-Primary-Care-Research-Group CY OCT 14, 2001 CL HALIFAX, CANADA SP N Amer Primary Care Res Grp ID RURAL HOSPITALS; PERSPECTIVE; PAYMENTS; DEBATE; AREAS AB Background and Objectives: Medicare provides the majority of funding to support graduate medical education (GME). Following the flow of these funds from hospitals to training programs is an important step in accounting for GME funding. Methods: Using a national survey of 453 family practice residency programs and Medicare hospital cost reports, we assessed residency programs' knowledge of their federal GME funding and compared their responses with the actual amounts paid to the sponsoring hospitals by Medicare. Results: A total of 328 (72%) programs responded; 168 programs (51%) reported that they did not know how much federal GME funding they received. Programs that were the only residency in the hospital (61% versus 36%) and those that were community hospital-based programs (53% versus 22%) were more likely to know their GME allocation. Programs in hospitals with other residencies received less of their designated direct medical education payment than programs that were the only residency in the sponsoring hospital (45% versus +19%). Conclusions: More than half of family practice training programs do not know how much GME they receive. These findings call for improved accountability in the use of Medicare payments that are designated for medical education. C1 Univ Washington, Robert Wood Johnson Clin Scholars Program, Seattle, WA 98195 USA. Univ Washington, WWAMI Rural Hlth Res Ctr, Dept Family Med, Seattle, WA 98195 USA. Robert Graham Ctr, Washington, DC USA. Policy Studies Family Practice & Primary Care, Washington, DC USA. RP Chen, FM (reprint author), Ctr Primary Care Res, Agcy Healthcare Res & Qual, 6010 Execut Blvd,Suite 201, Rockville, MD 20852 USA. NR 18 TC 3 Z9 3 U1 0 U2 1 PU SOC TEACHERS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, STE 540, LEAWOOD, KS 66207 USA SN 0742-3225 J9 FAM MED JI Fam. Med. PD OCT PY 2002 VL 34 IS 9 BP 663 EP 668 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 604WJ UT WOS:000178643800014 PM 12455250 ER PT J AU Ejaz, F Sangl, J Darby, C Larwook, D Hampton, N Bernard, S Hirsh, M Hornbostel, R Walley, J Lucenti, L Shriver, M Bailer, A Noble, R Straker, J Lucas, J Lowe, T AF Ejaz, F Sangl, J Darby, C Larwook, D Hampton, N Bernard, S Hirsh, M Hornbostel, R Walley, J Lucenti, L Shriver, M Bailer, A Noble, R Straker, J Lucas, J Lowe, T TI Federal and state initiatives in nursing home consumer satisfaction: Building relationships in a changing world - Part I SO GERONTOLOGIST LA English DT Meeting Abstract C1 Benjamin Rose, Cleveland, OH 44114 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Ctr Medicare & Medicaid, Baltimore, MD USA. Res Triangle Inst, Res Triangle Pk, NC USA. Vital Res LLC, Los Angeles, CA USA. Ohio Dept Aging, Columbus, OH USA. Dept Aging & Disabil, Waterbury, CT USA. Vermont Hlth Care Assoc, Montpellier, France. Scripps Gerontol Ctr, Oxford, OH USA. Dept Math, Oxford, OH USA. Inst Hlth Hlth Care Policy, Brunswick, NJ USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2002 VL 42 SI 1 BP 159 EP 159 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 620PH UT WOS:000179541400560 ER PT J AU McDonald, M Feldman, P McLaughlin, M Murtaugh, C Morrison, R Slutsky, J AF McDonald, M Feldman, P McLaughlin, M Murtaugh, C Morrison, R Slutsky, J TI Translating research into practice: Report on initiative sponsored by AHRQ SO GERONTOLOGIST LA English DT Meeting Abstract C1 Visiting Nurse Serv New York, Ctr Home Care Policy & Res, New York, NY 10001 USA. CUNY Mt Sinai Sch Med, New York, NY USA. Ctr Home Care Policy & Res, New York, NY USA. Hertzberg Palliat Care Inst, New York, NY USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2002 VL 42 SI 1 BP 282 EP 283 PG 2 WC Gerontology SC Geriatrics & Gerontology GA 620PH UT WOS:000179541401010 ER PT J AU Spector, W Cohen, J AF Spector, W Cohen, J TI Home care, 1996 & 1998: Shifts in financing & services received SO GERONTOLOGIST LA English DT Meeting Abstract C1 Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2002 VL 42 SI 1 BP 297 EP 298 PG 2 WC Gerontology SC Geriatrics & Gerontology GA 620PH UT WOS:000179541401061 ER PT J AU Shaffer, T Spector, W Potter, D Rhee, Y AF Shaffer, T Spector, W Potter, D Rhee, Y TI Nursing home fractures: Evidence from the national medical expenditure panel survey, 1996 SO GERONTOLOGIST LA English DT Meeting Abstract C1 Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Pittsburgh, Pittsburgh, PA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2002 VL 42 SI 1 BP 324 EP 324 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 620PH UT WOS:000179541401147 ER PT J AU Robinson, K Velkoff, V Bernstein, A Smith, A Smith, D Potter, D Drabek, J McCormick, J Chulis, G AF Robinson, K Velkoff, V Bernstein, A Smith, A Smith, D Potter, D Drabek, J McCormick, J Chulis, G TI Issues in classifying and counting assisted living and other long-term care residences SO GERONTOLOGIST LA English DT Meeting Abstract C1 Natl Ctr Hlth Stat, Fed Forum Aging Related Stat, Hyattsville, MD 20782 USA. US Bur Census, Int Program Ctr, Washington, DC 20233 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. DHHS, OSASPE, Washington, DC USA. Ctr Medicare, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2002 VL 42 SI 1 BP 342 EP 343 PG 2 WC Gerontology SC Geriatrics & Gerontology GA 620PH UT WOS:000179541401196 ER PT J AU Sullivan, SD Weiss, KB Lynn, H Mitchell, H Kattan, M Gergen, PJ Evans, R AF Sullivan, SD Weiss, KB Lynn, H Mitchell, H Kattan, M Gergen, PJ Evans, R CA Natl Cooperative Inner City Asthma TI The cost-effectiveness of an inner-city asthma intervention for children SO JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY LA English DT Article ID CARE; MORBIDITY; TRIAL; EDUCATION AB Background: Comprehensive management efforts to reduce asthma morbidity among children in urban areas with high levels of poverty and large minority populations have been inconclusive. The National Cooperative Inner-City Asthma Study (NCICAS) demonstrated improved symptom outcomes but did not evaluate cost-effectiveness in this population. Objective: We sought to examine the incremental cost-effectiveness of a comprehensive social worker-based education program and environmental control in children with asthma stratified by baseline level of asthma control. Methods: We performed a prospective cost-effectiveness analysis alongside a randomized trial. A total of 1033 children and their families residing in 8 inner-city urban areas in the United States were enrolled in the NCICAS. Outcomes included symptom-free days, cost per symptom-free day gained, and annual costs of asthma morbidity compared by baseline symptom control, previous hospitalization, and previous unscheduled physician visits. Results: The NCICAS intervention significantly reduced asthma symptoms. First-year intervention costs were $245 higher for the intervention children compared with those receiving usual care. There were no additional intervention-related costs during the second year. When compared with usual care, the intervention improved outcomes at an average additional cost of $9.20 per symptom-free day gained (95% CI, -$12.56 to $55.29). The intervention was cost saving in 3 strata of children with increasing asthma severity. Conclusions: A multifaceted asthma intervention program reduced symptom days and was cost-effective for inner-city children with asthma. In children with more severe disease, the intervention was substantially more effective and reduced costs compared with that seen in control children. Organizations serving this population should consider this strategy as part of a comprehensive disease-management program for asthma. C1 Univ Washington, Dept Pharm, Seattle, WA 98195 USA. Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA. Hines VA Hosp, Midw Ctr Hlth Serv & Policy Res, Hines, IL USA. Rho Inc, Chapel Hill, NC USA. Mt Sinai Sch Med, New York, NY USA. Agcy Healthcare Res & Qual, Washington, DC USA. Childrens Mem Hosp, Chicago, IL 60614 USA. RP Sullivan, SD (reprint author), Univ Washington, Dept Pharm, Box 357630, Seattle, WA 98195 USA. RI Nurmagambetov, Tursynbek/A-5689-2012 FU NIAID NIH HHS [AI-30752, AI-30756, AI-30773-01, AI-30777, AI-30779, AI-30780, N01 AI-15105, U01 AI-30751] NR 22 TC 83 Z9 87 U1 2 U2 6 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0091-6749 J9 J ALLERGY CLIN IMMUN JI J. Allergy Clin. Immunol. PD OCT PY 2002 VL 110 IS 4 BP 576 EP 581 DI 10.1067/mai.2002.128009 PG 6 WC Allergy; Immunology SC Allergy; Immunology GA 602JJ UT WOS:000178501900006 PM 12373264 ER PT J AU Bondi, MA Atkins, D AF Bondi, MA Atkins, D TI State mandates for preventive health services SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 Partnership Prevent, Washington, DC USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Bondi, MA (reprint author), Partnership Prevent, Washington, DC USA. NR 3 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD SEP 11 PY 2002 VL 288 IS 10 BP 1233 EP 1233 DI 10.1001/jama.288.10.1233 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 592BW UT WOS:000177917700020 PM 12215128 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for breast cancer: Recommendations and rationale SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID AMERICAN-COLLEGE; GUIDELINES AB This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendations on screening for breast cancer and the supporting scientific evidence and updates the 1996 USPSTF recommendations on this topic. The complete USPSTF recommendation and rationale statement on this topic, which includes a brief review of the supporting evidence, is available through the USPSTF Web site (www.preventiveservices.ahrq.gov), the National Guideline Clearinghouse (www.guideline.gov), and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs@ahrq.gov). The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on the Web sites already mentioned. To update its recommendations on screening for breast cancer, the USPSTF reviewed the evidence regarding the effectiveness of mammography, clinical breast examination, and breast self-examination in reducing breast cancer mortality. The USPSTF did not review the evidence regarding genetic screening, surveillance of women with prior breast cancer, or formal evaluation of new screening modalities that have not been studied in the general population. A meta-analysis using a Bayesian random-effects model was conducted for the USPSTF to obtain a summary of relative risk estimates of the effectiveness of screening with mammography, either alone or in combination with clinical breast examination, in reducing breast cancer mortality. Clinical studies that evaluated breast self-examination were included in the review. Sources for estimates cited in this Recommendation and Rationale statement are described in the systematic evidence review on this topic, which is available on the USPSTF Web site (www.preventiveservices.ahrq.gov). C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. RP Berg, AO (reprint author), Univ Washington, Seattle, WA 98195 USA. NR 10 TC 10 Z9 13 U1 0 U2 3 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD SEP 3 PY 2002 VL 137 IS 5 BP 344 EP 346 PN 1 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 591DZ UT WOS:000177865600006 ER PT J AU Humphrey, LL Helfand, M Chan, BKS Woolf, SH AF Humphrey, LL Helfand, M Chan, BKS Woolf, SH TI Breast cancer screening: A summary of the evidence for the US Preventive Services Task Force SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID RANDOMIZED CONTROLLED TRIALS; POSITIVE PREDICTIVE VALUE; SWEDISH 2-COUNTY TRIAL; FAMILY HISTORY; FOLLOW-UP; REPLACEMENT THERAPY; SELF-EXAMINATION; SOJOURN TIME; RISK-FACTORS; DEATH RATES AB Purpose: To synthesize new data on breast cancer screening for the U.S. Preventive Services Task Force. Data Sources: MEDLINE; the Cochrane Controlled Trials Registry; and reference lists of reviews, editorials, and original studies. Study Selection: Eight randomized, controlled trials of mammography and 2 trials evaluating breast self-examination were included. One hundred fifty-four publications of the results of these trials, as well as selected articles about the test characteristics and harms associated with screening, were examined. Data Extraction: Predefined criteria were used to assess the quality of each study. Meta-analyses using a Bayesian random-effects model were conducted to provide summary relative risk estimates and credible intervals (CrIs) for the effectiveness of screening with mammography in reducing death from breast cancer. Data Synthesis: For studies of fair quality or better, the summary relative risk was 0.84 (95% CrI, 0.77 to 0.91) and the number needed to screen to prevent one death from breast cancer after approximately 14 years of observation was 1224 (CrI, 665 to 2564). Among women younger than 50 years of age, the summary relative risk associated with mammography was 0.85 (CrI, 0.73 to 0.99) and the number needed to screen to prevent one death from breast cancer after 14 years of observation was 1792 (CrI, 764 to 10 540). For clinical breast examination and breast self-examination, evidence from randomized trials is inconclusive. Conclusions: in the randomized, controlled trials, mammography reduced breast cancer mortality rates among women 40 to 74 years of age. Greater absolute risk reduction was seen among older women. Because these results incorporate several rounds of screening, the actual number of mammograms needed to prevent one death from breast cancer is higher. In addition, each screening has associated risks and costs. C1 Oregon Hlth & Sci Univ, Portland, OR USA. Portland Vet Affairs Med Ctr, Portland, OR USA. Virginia Commonwealth Univ, Med Coll Virginia, Fairfax, VA USA. RP Humphrey, LL (reprint author), Agcy Healthcare Res & Qual, Publicat Clearinghouse, Rockville, MD 20852 USA. FU PHS HHS [290-97-0018] NR 99 TC 662 Z9 686 U1 5 U2 34 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD SEP 3 PY 2002 VL 137 IS 5 BP 347 EP 360 PN 1 PG 14 WC Medicine, General & Internal SC General & Internal Medicine GA 591DZ UT WOS:000177865600007 PM 12204020 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv TI Screening for colorectal cancer: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Editorial Material ID FECAL-OCCULT-BLOOD; ASYMPTOMATIC ADULTS; SIGMOIDOSCOPY; MORTALITY C1 Care Of Atkins D, US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Berg, AO (reprint author), Care Of Atkins D, US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 31 TC 6 Z9 6 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD SEP PY 2002 VL 102 IS 9 BP 107 EP + PG 6 WC Nursing SC Nursing GA 594UF UT WOS:000178068800056 PM 12394026 ER PT J AU Chen, FM Hickner, J Fink, KS Galliher, JM Burstin, H AF Chen, FM Hickner, J Fink, KS Galliher, JM Burstin, H TI On the front lines: Family physicians. preparedness for bioterrorism SO JOURNAL OF FAMILY PRACTICE LA English DT Article DE bioterrorism; primary care; public health; disease outbreaks ID PUBLIC-HEALTH; INHALATIONAL ANTHRAX; BIOLOGICAL TERRORISM; THREAT AB OBJECTIVE The events of September 11, 2001, and the nation's recent experience with anthrax assaults made bioterrorism preparedness a national priority. Because primary care physicians are among the sentinel responders to bioterrorist attacks, we sought to determine family physicians' beliefs about their preparedness for such an attack. STUDY DESIGN In October 2001 we conducted a national survey of 976 family physicians randomly selected from the American Academy of Family Physicians' active membership directory. POPULATION 614 (63%) family physicians responded to the survey. OUTCOMES MEASURED Physicians' self-reported ability to "know what to do as a doctor in the event of a suspected bioterrorist attack, recognize signs and symptoms of an illness due to bioterrorism, and know where to call to report a suspected bioterrorist attack." RESULTS Ninety-five percent of physicians agreed that a bioterrorist attack is a real threat within the United States. However,. only 27% of family physicians believed that the US health care system could respond effectively to a bioterrorist attack; fewer (17%) thought that their local medical communities could respond effectively. Twenty-six percent of physicians reported that they would know what to do as a doctor in the event of a bioterrorist attack. Only 18% had previous training in bioterrorism preparedness. In a multivariate analysis, physicians' reported that preparedness for a bioterrorist attack was significantly associated with previous. bioterrorism preparedness training (OR 3.9 [95% CI 2.4-6.3]) and knowing how to obtain information in the event of a bioterrorist attack (OR 6.4 [95% CI 3.9-10-6]). CONCLUSIONS Only one quarter of family physicians felt prepared to respond to a bioterrorist event. However, training in bioterrorism preparedness. was significantly associated with physicians' perceived ability to respond effectively to an attack. Primary care physicians need more training in bioterrorism preparedness and easy access to public health and medical information in the event of a bioterrorist attack. C1 Amer Acad Family Phys, Natl Network Family Practice & Primary Care Res, Leawood, KS USA. Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD 20852 USA. RP Hickner, J (reprint author), Amer Acad Family Phys, Natl Network Family Practice & Primary Care Res, 11400 Tomahawk Creek Pkwy, Leawood, KS USA. FU AHRQ HHS [P20 HS 11182-S] NR 22 TC 41 Z9 41 U1 0 U2 1 PU DOWDEN PUBLISHING CORP PI MONTVALE PA 110 SUMMIT AVE, MONTVALE, NJ 07645-1712 USA SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD SEP PY 2002 VL 51 IS 9 BP 745 EP 750 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 593AH UT WOS:000177968700005 PM 12366891 ER PT J AU Huie, SAB Hummer, RA Rogers, RG AF Huie, SAB Hummer, RA Rogers, RG TI Individual and contextual risks of death among race and ethnic groups in the United States SO JOURNAL OF HEALTH AND SOCIAL BEHAVIOR LA English DT Article ID NATIONAL LONGITUDINAL MORTALITY; MULTILEVEL ANALYSIS; RESIDENTIAL SEGREGATION; ADULT MORTALITY; METROPOLITAN-AREAS; RACIAL-DIFFERENCES; ALAMEDA COUNTY; HEART-DISEASE; HEALTH; COMMUNITY AB An emerging area of social science research focuses on individual-level and contextual-level determinants of black-white adult mortality differentials in the United States. However, no research on adult mortality differentials has distinguished multiple Hispanic subgroups and explored the role of nativity at both the individual and contextual levels for small geographic areas. Using the 1986-1997 National Health Interview Survey-National Death Index linked file, we examine the effects of individual and contextual factors on black-white and multiple Hispanic subgroup (Mexican Americans, Puerto Ricans, and "other" Hispanic) differentials in adult mortally. In addition, we use a Ness; innovative geographic area-the very small area-as our contextual unit of analysis. We find that excess mortality risks for all race-ethnic groups considered are associated with not only individual characteristics, but also neighborhood characteristics. In addition, percent foreign born in a neighborhood is protective of Hispanic subgroup mortality for Puerto Rican, Mexican American, and "other" Hispanic adults in the 45-64 age category. These findings indicate a need for future research to examine more thoroughly the pathways through which neighborhood factors affect multiple Hispanic subgroup mortality and the role of nativity as a protective factor for older adult Hispanic mortality. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. Univ Texas, Populat Res Ctr, Austin, TX 78712 USA. Univ Colorado, Populat Program, Inst Behav Sci, Boulder, CO 80309 USA. RP Huie, SAB (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. EM shuie@ahrq.gov NR 63 TC 37 Z9 37 U1 1 U2 2 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0022-1465 EI 2150-6000 J9 J HEALTH SOC BEHAV JI J. Health Soc. Behav. PD SEP PY 2002 VL 43 IS 3 BP 359 EP 381 DI 10.2307/3090209 PG 23 WC Public, Environmental & Occupational Health; Psychology, Social SC Public, Environmental & Occupational Health; Psychology GA 616GX UT WOS:000179297000007 ER PT J AU Fleishman, JA Spector, WD Altman, BM AF Fleishman, JA Spector, WD Altman, BM TI Impact of differential item functioning on age and gender differences in functional disability SO JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES LA English DT Article ID PSYCHOMETRIC PROPERTIES; RESPONSE THEORY; OLDER ADULTS; SCALE; BIAS; DEPRESSION; COMMUNITY; DEMENTIA AB Objectives, Estimates of group differences in functional disability may be biased if items exhibit differential item functioning (DIF). For a given item. DIF exists if persons in different groups do not have the same probability of responding, given their level of disability. This Study examines the extent to which DIF affects estimates of age and gender group differences in disability severity among adults with some functional disability. Methods. Data came from the 1994/1995 National Health Interview Survey Disability Supplement. Analyses focused on 5,750 adult respondents who received help or supervision with at least one of 11 activities of daily living/instrumental activities of daily living tasks. We estimated gender and age group (18-39, 40-69, and 70+) differences in disability, using multiple-indicator/multiple-cause models, which treat functional disability as a latent trait. Results. Nine items manifested significant DIF by age or gender DIF was especially large for "shopping" and "money management." Without adjusting for DIF, middle-aged persons were less disabled than elderly men, and women were less disabled than men among nonelderly persons. After adjusting for DIF, middle-aged persons did not differ from elderly persons, and gender differences within age groups were not significant. Discussion. Comparisons of disability across sociodemographic groups need to take DIF into account. Future research Should examine the causes of DIF and develop alternative question wordings that reduce DIF effects. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. Natl Ctr Hlth Stat, Hyattsville, MD 20782 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 32 TC 48 Z9 48 U1 1 U2 2 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 1079-5014 J9 J GERONTOL B-PSYCHOL JI J. Gerontol. Ser. B-Psychol. Sci. Soc. Sci. PD SEP PY 2002 VL 57 IS 5 BP S275 EP S284 PG 10 WC Geriatrics & Gerontology; Gerontology; Psychology; Psychology, Multidisciplinary SC Geriatrics & Gerontology; Psychology GA 589NU UT WOS:000177766800011 PM 12198107 ER PT J AU Schmier, JK Palmer, CS Flood, EM Gourlay, G AF Schmier, JK Palmer, CS Flood, EM Gourlay, G TI Utility assessments of opioid treatment for chronic pain SO PAIN MEDICINE LA English DT Article DE chronic noncancer pain; chronic cancer pain; utilities; quality of life; opioids; patient preference ID QUALITY-OF-LIFE; DOCTOR-PATIENT-RELATIONSHIP; CONJOINT-ANALYSIS; TRANSDERMAL FENTANYL; RHEUMATOID-ARTHRITIS; PATIENTS PREFERENCES; CANCER-PATIENTS; HEALTH-CARE; MORPHINE; QLQ-C30 AB Objective. The primary study objective was to assess preferences for pain treatment outcomes among patients with cancer and noncancer chronic pain. A secondary objective was to assess their quality of life. Methods. Patients with cancer or noncancer chronic pain completed an interview using a computer to estimate utilities, or preference ratings, for health states related to pain treatment. The interview was devised using conjoint analysis methodology. Health states were characterized by four attributes (effectiveness of pain control, side effects, side effect severity, and opioid route of administration) and their levels, and each was assumed to last for a 14-day period. Participants also completed health-related quality of life and demographic questionnaires. Results. Mean preference ratings for participants with noncancer chronic pain (N = 96) ranged from a high of 0.87 (well-controlled pain with no side effects) to a low of 0.18 (poorly controlled pain with severe mood changes/alterations, severe respiratory depression, or severe vomiting). Mean preference ratings for participants with cancer pain (N = 25) were similar and ranged from a high of 0.89 (well-controlled pain with no side effects) to a low of 0.19 (poorly controlled pain with severe respiratory depression or severe vomiting). Results confirmed previous findings that chronic pain has a severe, multidimensional impact on patients, and that the quality of life of persons with chronic pain is among the lowest observed for any medical condition. Conclusions. This study provides a valuable assessment, from the patient's perspective, of the balance between treatment tolerability and manifestation of disease symptoms. Heightened awareness of patients preferences for treatment outcomes may lead to improved selection of treatments, better adherence, and ultimate treatment success. C1 Exponent Inc, Alexandria, VA 22314 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. MEDTAP Int Inc, Bethesda, MD USA. Flinders Med Ctr, Pain Management Unit, Bedford Pk, SA, Australia. RP Schmier, JK (reprint author), Exponent Inc, 1800 Diagonal Rd,Suite 355, Alexandria, VA 22314 USA. OI Schmier, Jordana/0000-0002-4662-8800 NR 45 TC 21 Z9 21 U1 0 U2 2 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 1526-2375 J9 PAIN MED JI Pain Med. PD SEP PY 2002 VL 3 IS 3 BP 218 EP 230 DI 10.1046/j.1526-4637.2002.02045.x PG 13 WC Medicine, General & Internal SC General & Internal Medicine GA 604KB UT WOS:000178618700008 PM 15099257 ER PT J AU Atkins, D AF Atkins, D TI Principles of preventive care SO PRIMARY CARE LA English DT Article ID CLINICAL-PRACTICE GUIDELINES; SERVICES-TASK-FORCE; BREAST-CANCER; HEALTH-CARE; MEDICAL LITERATURE; DECISION-MAKING; USERS GUIDES; RECOMMENDATIONS; CHOICE AB Growing interest in preventive care has contributed to a steady increase in the delivery of immunizations, common screening tests, and other preventive interventions. Clinicians today continue to face challenges in developing an office-based approach to prevention that is both evidence-based and practical. In this review, we explore how clinicians can find recommendations that are up-to-date and evidence-based, understand reasons for conflicting recommendations, and identify other issues that may affect the appropriateness of specific recommendations for one's practice. C1 Agcy Hlth Care Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. RP Atkins, D (reprint author), Agcy Hlth Care Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 43 TC 0 Z9 0 U1 0 U2 0 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0095-4543 J9 PRIMARY CARE JI Primary Care PD SEP PY 2002 VL 29 IS 3 BP 475 EP + AR PII S0095-4543(02)00008-8 DI 10.1016/S0095-4543(02)00008-8 PG 13 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 593UY UT WOS:000178013200002 PM 12529891 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Services Task Force TI Screening for depression: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Article RP Berg, AO (reprint author), Care Of Atkins D, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20912 USA. NR 9 TC 11 Z9 11 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD AUG 15 PY 2002 VL 66 IS 4 BP 647 EP 650 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 587UN UT WOS:000177662100009 ER PT J AU Burke, W Atkins, D Gwinn, M Guttmacher, A Haddow, J Lau, J Palomaki, G Press, N Richards, CS Wideroff, L Wiesner, GL AF Burke, W Atkins, D Gwinn, M Guttmacher, A Haddow, J Lau, J Palomaki, G Press, N Richards, CS Wideroff, L Wiesner, GL TI Genetic test evaluation: Information needs of clinicians, policy makers, and the public SO AMERICAN JOURNAL OF EPIDEMIOLOGY LA English DT Article DE factor V; genetic markers; genetic predisposition to disease; genetic screening; genetics; phenylketonurias ID FACTOR-V-LEIDEN; DEEP-VEIN THROMBOSIS; FOLLOW-UP CARE; VENOUS THROMBOEMBOLISM; BREAST-CANCER; INHERITED PREDISPOSITION; COLORECTAL-CANCER; FAMILY MEMBERS; RISK; BRCA2 AB Growing knowledge about gene-disease associations will lead to new opportunities for genetic testing. Many experts predict that genetic testing will become increasingly important as a guide to prevention, clinical management, and drug treatment based on genetic susceptibilities. As part of a Human Genetic Epidemiology workshop convened by the Centers for Disease Control and Prevention, a group of experts evaluated the evidence needed when considering the appropriate use of new genetic tests. Because new tests are likely to vary in their predictive value, their potential to direct prevention or treatment efforts, and their personal and social consequences, the task of determining appropriate use will require careful consideration of a variety of factors, including the analytic validity, clinical validity, clinical utility, and ethical, legal, and social implications of the test. Standardized formats are needed to summarize what is known and not known about new genetic tests with respect to each of these features. Following criteria for the objective assessment of test properties, reports should be structured to enable policy makers, clinicians, and the public to identify the available evidence, so that uncertainties can be taken into account when considering test use and planning future research. C1 Ctr Dis Control & Prevent, Off Genet & Dis Prevent, Atlanta, GA 30341 USA. Univ Washington, Seattle, WA 98195 USA. Agcy Healthcare Res & Qual, Bethesda, MD USA. NHGRI, Bethesda, MD 20892 USA. Fdn Blood Res, Scarborough, ME 04074 USA. Tufts Univ New England Med Ctr, Boston, MA 02111 USA. Oregon Hlth Sci Univ, Portland, OR 97201 USA. Baylor Coll Med, Houston, TX 77030 USA. NCI, Bethesda, MD 20892 USA. Case Western Reserve Univ, Cleveland, OH 44106 USA. RP Burke, W (reprint author), Ctr Dis Control & Prevent, Off Genet & Dis Prevent, 4770 Buford Highway NE,MS-K28, Atlanta, GA 30341 USA. RI Hernandez, Jessica/G-6527-2011 NR 39 TC 95 Z9 98 U1 3 U2 9 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0002-9262 J9 AM J EPIDEMIOL JI Am. J. Epidemiol. PD AUG 15 PY 2002 VL 156 IS 4 BP 311 EP 318 DI 10.1093/aje/kwf055 PG 8 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 584WX UT WOS:000177492700004 PM 12181100 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH CA Preventive Services Task Force TI Screening for bacterial vaginosis in pregnancy: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Article C1 Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Texas, Hlth Sci Ctr, Sch Nursing, San Antonio, TX USA. Univ Rochester, Cohocton, NY USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA USA. Univ Texas, Hlth Sci Ctr, Audie L Murphy Mem Vet Hosp, San Antonio, TX USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Brown Univ, Women & Infants Hosp, Providence, RI USA. Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. Dartmouth Hitchcock Med Ctr, Dept Med, Lebanon, NH 03766 USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ, Coll Phys & Surg, Dept Obstet & Gynecol, New York, NY USA. Virginia Commonwealth Univ Med Coll Virginia, Dept Family Practice, Fairfax, VA USA. RP Berg, AO (reprint author), Care of Atkins D, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 5 TC 3 Z9 3 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD AUG PY 2002 VL 102 IS 8 BP 91 EP 93 PG 3 WC Nursing SC Nursing GA 585TH UT WOS:000177540300044 PM 12394084 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for colorectal cancer: Recommendation and rationale SO ANNALS OF INTERNAL MEDICINE LA English DT Article AB This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer and the supporting scientific evidence and updates the 1995 recommendations contained in the Guide to Clinical Preventive Services, 2nd edition. At that time, the USPSTF recommended screening for colorectal cancer with annual fecal occult blood testing, periodic sigmoidoscopy, or the combination of fecal occult blood testing and sigmoidoscopy but concluded that the evidence was insufficient to recommend for or against colonoscopy or barium enema. The complete USPSTF recommendation and rationale statement on this topic, which includes a brief review of the supporting evidence, is available through the USPSTF Web site (www.preventiveservices.ahrq.gov), the National Guideline Clearing-house (www.guideline.gov), and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs@ahrq.gov). The complete information on which this statement is based, including tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on the Web sites already mentioned. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 6 TC 416 Z9 421 U1 0 U2 5 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD JUL 16 PY 2002 VL 137 IS 2 BP 129 EP 131 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 575VN UT WOS:000176969300009 ER PT J AU Halpern, MT Palmer, CS Zodet, M Kirsch, J AF Halpern, MT Palmer, CS Zodet, M Kirsch, J TI Cost-effectiveness of gemifloxacin: Results from the GLOBE study SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Article; Proceedings Paper CT American-Society-of-Health-System-Pharmacists Midyear Clinical Meeting CY DEC 04-07, 2000 CL LAS VEGAS, NEVADA SP Amer Soc Hlth Syst Pharmacists DE bronchitis; clarithromycin; costs; drug comparisons; drugs, clinical effectiveness; economics; gemifloxacin; macrolides; outcomes ID ACUTE BACTERIAL EXACERBATIONS; CHRONIC-BRONCHITIS; SUSCEPTIBILITY; CIPROFLOXACIN; INFECTIONS; EFFICACY; THERAPY AB The cost-effectiveness of treatment,with oral gemifloxacin versus oral clarithromycin for acute exacerbations of chronic bronchitis (AECB) was evaluated. Economic outcomes were assessed for the Gemifloxacin Long-term Outcomes in Bronchitis Exacerbations study. This prospective double-blind, controlled, health outcomes study compared health, economic, and clinical outcomes after randomized treatment with either oral gemifloxacin or oral clarithromycin for AECB. Base case analysis was performed from the third-party payer's perspective and considered the costs of respiratory tract infection-related medical care. Analysis from the societal perspective also included costs of lost productivity. Treatment effectiveness was measured as the proportion of patients without recurrence requiring antimicrobial treatment following resolution of the initial AECB. Data sources included the outcomes study itself and standard U.S. cost sources. Compared with clarithromycin, gemifloxacin, treatment resulted, in significantly more patients without AECB recurrence requiring antimicrobial treatment after 26 weeks (73.8% versus 63.8%, p = 0.024). Fewer patients receiving gemifloxacin were hospitalized (5 of 214 patients versus 14 of 224 patients, p = 0.059), and they had less time off from usual activities (8.3 days versus 10.1 days). The mean direct cost per patient receiving gemifloxacin was $127 less than with clarithromycin ($247 versus $374, respectively); mean total costs (direct plus indirect) per patient were $329 less for patients receiving gemifloxacin ($1413 versus $1742). Gemifloxacin dominated clarithromycin in cost-effectiveness analysis. Bootstrap analysis indicated that the probability of gemifloxacin being both cost saving and more effective than clarithromycin is 88% from a payer's perspective and 84% from the societal perspective. Gemifloxacin was more cost-effective, improving AECB outcomes and producing substantial cost offsets compared with clarithromycin. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. GlaxoSmithKline, Harlow, Essex, England. RP Halpern, MT (reprint author), Exponent Inc, 1800 Diagonal Rd,Suite 355, Alexandria, VA 22314 USA. NR 30 TC 13 Z9 14 U1 1 U2 1 PU AMER SOC HEALTH-SYSTEM PHARMACISTS PI BETHESDA PA 7272 WISCONSIN AVE, BETHESDA, MD 20814 USA SN 1079-2082 J9 AM J HEALTH-SYST PH JI Am. J. Health-Syst. Pharm. PD JUL 15 PY 2002 VL 59 IS 14 BP 1357 EP 1365 PG 9 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 577TL UT WOS:000177077900013 PM 12132563 ER PT J AU Clancy, CM Dougherty, D Walker, E AF Clancy, CM Dougherty, D Walker, E TI The importance of outcomes research in pediatric emergency medicine SO AMBULATORY PEDIATRICS LA English DT Article DE outcomes; pediatric emergency medicine; research methods ID ACUTE MYOCARDIAL-INFARCTION; CARE; SERVICES; TRAUMA; SURVIVAL; CHILDREN; POPULATION; INTUBATION; DISEASE; PROJECT AB Applying the methods and tools of outcomes research, "evaluation of the impact of health care on the health outcomes or 'end results' of patients and populations," to the clinical domain of emergency services for children offers an important strategic opportunity for addressing the questions that confront all health care services: What works? For which patients? At what cost? From whose perspective? Although the important questions to address are extensive, much of the intersection between emergency services and outcomes research remains unexplored. Important challenges for researchers intrigued by the opportunities at this intersection of fields include: 1) clear definition of the scope of emergency services; 2) consideration of the appropriate end-point of emergency services-the entire episode of illness and/or services provided within the emergency setting; 3) selection and development of measures that incorporate children's and families' perspectives; and 4) a clear focus on linking research findings with strategies for improving outcomes and informed decision making. This essay will provide an overview of accomplishments and challenges from the field of outcomes research, suggest important opportunities for applying existing methods to emergency medical services for children, and identify potential career paths for current and future investigators. C1 US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Dougherty, D (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 33 TC 8 Z9 8 U1 0 U2 1 PU AMBULATORY PEDIATRIC ASSOC PI MCLEAN PA 6728 OLD MCLEAN VILLAGE DR, MCLEAN, VA 22101-3906 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD JUL-AUG PY 2002 VL 2 IS 4 SU S BP 293 EP 300 DI 10.1367/1539-4409(2002)002<0293:TIOORI>2.0.CO;2 PG 8 WC Pediatrics SC Pediatrics GA 579BB UT WOS:000177154600002 PM 12135403 ER PT J AU Darby, C AF Darby, C TI Patient/parent assessment of the quality of care SO AMBULATORY PEDIATRICS LA English DT Article DE children's health care; emergency departments; interpersonal aspects of care; patient assessment of care; patient satisfaction ID DEVELOPING-COUNTRIES; SATISFACTION; EMERGENCY; SERVICES AB Providing patient-centered care is an accepted goal in medicine today. Focusing on the patient has drawn attention to the importance of the interpersonal aspects of care, such as communication between the health care provider and patient. or in the case of health care for children, the parent and child. Patients or parents may be the best or only source of information for assessing the personal aspects of care. In research on children, parents generally report on and evaluate the care. Assessing the interpersonal aspects of care has traditionally been referred to as the measurement of patient satisfaction. The varying expectations of patients and the presence of a ceiling effect on the measures often confound the use of patient satisfaction measures for evaluating the quality of care. One trend is to ask respondents to report on the interpersonal aspects of care, rather than to respond about their level of satisfaction. Studies on the assessment of the interpersonal aspects of health care in emergency departments for children are not plentiful. However. research provides some insight into ways in which emergency departments might improve interpersonal aspects of care for children. These include providing a clear picture to patients and parents of what to expect regarding the length of time they will have to wait, taking a caring approach with children and their parents. and explaining clearly to parents what they need to do to care for the child after discharge. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Darby, C (reprint author), Agcy Healthcare Res & Qual, Execut Blvd,Suite 200, Rockville, MD 20852 USA. NR 25 TC 17 Z9 18 U1 1 U2 2 PU AMBULATORY PEDIATRIC ASSOC PI MCLEAN PA 6728 OLD MCLEAN VILLAGE DR, MCLEAN, VA 22101-3906 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD JUL-AUG PY 2002 VL 2 IS 4 SU S BP 345 EP 348 DI 10.1367/1539-4409(2002)002<0345:PPAOTQ>2.0.CO;2 PG 4 WC Pediatrics SC Pediatrics GA 579BB UT WOS:000177154600011 PM 12135410 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv TI Screening for depression: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Article C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 13 TC 7 Z9 8 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD JUL PY 2002 VL 102 IS 7 BP 77 EP + PG 3 WC Nursing SC Nursing GA 578LD UT WOS:000177118300024 PM 12394063 ER PT J AU Kramer, JM Bosco, LA Califf, RM AF Kramer, JM Bosco, LA Califf, RM CA CERTs Steering Comm TI Centers for Education and Research on Therapeutics (CERTs) SO DRUG INFORMATION JOURNAL LA English DT Article DE CERTs; therapeutics; AHRQ; drugs; FDAMA AB The Centers for Education and Research on Therapeutics (CERTs) program is a national initiative authorized by the Food and Drug Modernization Act of 1997 (FDAMA) (Public Law 105-115) as a public-private partnership. The program is administered by the Agency for Healthcare Research and Quality (AHRQ) in close collaboration with the Food and Drug Administration (FDA). Seven research centers and a coordinating center together with representatives of AHRQ, FDA, the National Institutes of Health, the pharmaceutical industry, consumers, and at-large members collaborate on a steering committee led by an independent chairperson. Duke University Medical Center serves as a coordinating center to foster collaboration on research and educational themes and topics of importance in therapeutics. The CERTs vision is to serve as a trusted national resource for people seeking to improve their health through the best use of medical therapies. Two research projects are described that focus on assuring use of life-saving therapies (eg, beta-blockers for treatment of congestive heart failure) and avoiding misuse of high-risk therapies (eg, medications that may cause a fatal cardiac arrhythmia). C1 Duke Clin Res Inst, Durham, NC 27715 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Kramer, JM (reprint author), Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU DRUG INFORMATION ASSOCIATION PI FORT WASHINGTON PA 501 OFFICE CENTER DR, STE 450, FORT WASHINGTON, PA 19034-3212 USA SN 0092-8615 J9 DRUG INF J JI Drug Inf. J. PD JUL-SEP PY 2002 VL 36 IS 3 BP 717 EP 723 PG 7 WC Health Care Sciences & Services; Pharmacology & Pharmacy SC Health Care Sciences & Services; Pharmacology & Pharmacy GA 590QF UT WOS:000177833000025 ER PT J AU Robbins, J Langmore, S Hind, JA Erlichman, M AF Robbins, J Langmore, S Hind, JA Erlichman, M TI Dysphagia research in the 21st century and beyond: Proceedings from Dysphagia Experts Meeting, August 21, 2001 SO JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT LA English DT Article DE clinical trials; deglutition disorder; group meetings; therapeutics ID PREDICTORS; PRESSURE AB Swallowing problems (dysphagia) can occur at any age but are most prevalent in elderly individuals and are a growing healthcare concern as the geriatric population expands. Without effective diagnosis and treatment, dysphagia may lead to serious medical conditions such as pneumonia, dehydration, and malnutrition. Experts in the field of dysphagia met on August 21, 2001, in Rockville, Maryland, to respond to this heightened healthcare need and to deter-mine the course of dysphagia research. Presentations at the meeting included epidemiological data, geriatric-specific issues, diagnostic techniques, risk factors for pneumonia, and recent relevant trials. The experts identified outstanding issues in dysphagia research, such as study design, population selection, and the standardization of diagnostic and treatment protocols. They designed a clinical trial that represents what they deem is one of the greatest needs in dysphagia research, providing a critical springboard for research endeavors with far-reaching implications. C1 William S Middleton Mem Vet Adm Med Ctr, CRECC, Madison, WI 53705 USA. Univ Wisconsin, Dept Med, Madison, WI 53706 USA. Univ Wisconsin, Inst Aging, Madison, WI 53706 USA. AHRQ, Rockville, MD USA. Univ Calif San Francisco, Dept Neurol, San Francisco, CA 94143 USA. RP Robbins, J (reprint author), William S Middleton Mem Vet Adm Med Ctr, CRECC, 2500 Overlook Terrace,11G, Madison, WI 53705 USA. FU NIDCD NIH HHS [U01 DC0326]; NINDS NIH HHS [R01 NS24427] NR 13 TC 28 Z9 28 U1 0 U2 0 PU JOURNAL REHAB RES & DEV PI BALTIMORE PA DEPT OF VETERANS AFFAIRS REHABIL RES & DEVELOP CTR 103 SOUTH GAY STREET, BALTIMORE, MD 21202-4051 USA SN 0748-7711 J9 J REHABIL RES DEV JI J. Rehabil. Res. Dev. PD JUL-AUG PY 2002 VL 39 IS 4 BP 543 EP 547 PG 5 WC Rehabilitation SC Rehabilitation GA 612AL UT WOS:000179051000012 PM 17638151 ER PT J AU Foster, N Clancy, C Meyer, G AF Foster, N Clancy, C Meyer, G TI In appreciation: John Eisenberg of the Agency for Healthcare Research and Quality SO MEDICAL DECISION MAKING LA English DT Biographical-Item C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Foster, N (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0272-989X J9 MED DECIS MAKING JI Med. Decis. Mak. PD JUL-AUG PY 2002 VL 22 IS 4 BP 373 EP 374 PG 2 WC Health Care Sciences & Services; Medical Informatics SC Health Care Sciences & Services; Medical Informatics GA 574XA UT WOS:000176914100009 PM 12150603 ER PT J AU Owens, PL Bradley, EH Horwitz, SM Viscoll, CM Kernan, WN Brass, LM Sarrel, PM Horwitz, RI AF Owens, PL Bradley, EH Horwitz, SM Viscoll, CM Kernan, WN Brass, LM Sarrel, PM Horwitz, RI TI Clinical assessment of function among women with a recent cerebrovascular event: A self-reported versus performance-based measure SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID PHYSICAL PERFORMANCE; OLDER PERSONS; HEALTH-STATUS; DISABILITY; STROKE; REHABILITATION; LIMITATIONS; CAPACITY; ABILITY; ELDERS AB Background: Self-reported functional status is a commonly used health measure in clinical settings, yet the optimal approach for assessing function is often debated. Objective: To examine the agreement between a self-reported and a performance-based measure of function and the relative ability of each measure to predict long-term health outcomes. Design: Prospective cohort study. Setting: 20 hospitals in Connecticut and Massachusetts. Participants: 620 postmenopausal women (46 to 91 years of age) who had experienced a stroke or transient ischemic attack. Measurements: A self-reported and a performance-based measure of function were assessed at baseline (before intervention) by using the Barthel index and the Physical Performance Test. Results: Disagreement between the self-reported and performance-based measure of function was common (slight disagreement, 55.0%; substantial disagreement, 19.3%). Most women (95.4%) overreported their level of function. Women who were more clinically impaired (risk ratio [RR] for more comorbid conditions, 1.52 [95% CI, 1.17 to 1.97]; RR for recent stroke, 2.33 [CI, 1.45 to 3.73]; and RR for cognitive Impairment, 1.76 [CI, 1.34 to 2.32]); who were less educated (RR = 1.30 [CI, 1.02 to 1.67]); and who were of nonwhite ethnicity (RR 1.43 [CI, 1.07 to 1.91]) were more likely to overreport their level of function. An impaired performance-based measure of function predicted subsequent stroke or death (hazard ratio, 1.50, [CI, 1.06 to 2.11]); however, an impaired self-reported measure of function was not likely to predict these outcomes. Conclusions: Clinicians should be aware that results of self-reported and performance-based measures of function can differ In women who have experienced a recent cerebrovascular event Although more difficult to collect, results of a performance-based measure may provide information about long-term health outcomes that is not available from a self-reported measure. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Owens, PL (reprint author), Agcy Healthcare Res & Qual, 2101 E Jefferson,Suite 605, Rockville, MD 20852 USA. FU NIMH NIH HHS [5T32-MH15783, 5T32-MH19545]; PHS HHS [R01-N531251] NR 42 TC 12 Z9 13 U1 2 U2 3 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD JUN 4 PY 2002 VL 136 IS 11 BP 802 EP 811 PG 10 WC Medicine, General & Internal SC General & Internal Medicine GA 558KG UT WOS:000175964500003 PM 12044128 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Services Task Force TI Screening for lipid disorders in adults: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Article ID CORONARY HEART-DISEASE; CHOLESTEROL; PREDICTION C1 Care Of David Atkins, US Prevent Serv task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment,Clin Prevent Se, Rockville, MD 20852 USA. RP Berg, AO (reprint author), Care Of David Atkins, US Prevent Serv task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment,Clin Prevent Se, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 12 TC 3 Z9 3 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD JUN PY 2002 VL 102 IS 6 BP 91 EP + PG 3 WC Nursing SC Nursing GA 567CC UT WOS:000176466000036 PM 12394084 ER PT J AU Kovner, C Jones, C Zhan, C Gergen, PJ Basu, J AF Kovner, C Jones, C Zhan, C Gergen, PJ Basu, J TI Nurse staffing and postsurgical adverse events: An analysis of administrative data from a sample of US hospitals, 1990-1996 SO HEALTH SERVICES RESEARCH LA English DT Article DE registered nurse; staffing; adverse events; outcomes ID INTENSIVE-CARE UNITS; PATIENT OUTCOMES; MORTALITY; COMPLICATIONS; QUALITY; WORKFORCE; DISEASE; SURGERY; MODEL; RATES AB Objective. To examine the impact of nurse staffing on selected adverse events hypothesized to be sensitive to nursing care between 1990 and 1996, after controlling for hospital characteristics. Data Sources/Study Setting. The yearly cross-sectional samples of hospital discharges for states participating in the National Inpatient Sample (NIS) from 1990-1996 were combined to form the analytic sample. Six states were included for 1990-1992, four states were added for the period 1993-1994, and three additional states were added in 1995-1996. Study Design. The study design was cross-sectional descriptive. Data Collection/Extraction Methods. Data for patients aged 18 years and older who were discharged between 1990 and 1996 were used to create hospital-level adverse event indicators. Hospital-level adverse event data were defined by quality indicators developed by the Health Care Utilization Project (HCUP). These data were matched to American Hospital Association (AHA) data on community hospital characteristics, including registered nurse (RN) and licensed practical/vocational nurse (LPN) staffing hours, to examine the relationship between nurse staffing and four postsurgical adverse events: venous thrombosis/pulmonary embolism, pulmonary compromise after surgery, urinary tract infection, and pneumonia. Multivariate modeling using Poisson regression techniques was used. Principal Findings. An inverse relationship was found between RN hours per adjusted inpatient day and pneumonia (p < .05) for routine and emergency patient admissions. Conclusions. The inverse relationship between pneumonia and nurse staffing are consistent with previous findings in the literature. The results provide additional evidence for health policy makers to consider when making decisions about required staffing levels to minimize adverse events. C1 Univ N Carolina, Sch Nursing, Chapel Hill, NC USA. Agcy Healthcare Res & Qual, Ctr Qual Improvemtn & Patient Safety, Rockville, MD USA. Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD USA. RP Kovner, C (reprint author), NYU, Div Nursing, Sch Educ, 246 Greene St, New York, NY 10003 USA. NR 67 TC 129 Z9 129 U1 1 U2 5 PU BLACKWELL PUBL LTD PI OXFORD PA 108 COWLEY RD, OXFORD OX4 1JF, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD JUN PY 2002 VL 37 IS 3 BP 611 EP 629 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 569TC UT WOS:000176617500005 PM 12132597 ER PT J AU Hill, SC Thornton, C Trenholm, C Wooldridge, J AF Hill, SC Thornton, C Trenholm, C Wooldridge, J TI Risk selection among SSI enrollees in TennCare SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID ADVERSE SELECTION; MANAGED CARE; ORGANIZATIONS; ADJUSTMENT AB The issue of risk selection is especially important for states that enroll blind and disabled beneficiaries of Supplemental Security Income (SSI) in Medicaid managed care. SSI beneficiaries have persistent needs for care, have a wide variety of chronic conditions, and often need atypical and complex services. Risk selection occurs when the health care needs of beneficiaries enrolled in a specific plan differ systematically from the needs of the overall beneficiary population and payments do not reflect those needs. We assess the extent of risk selection among managed care plans for SSI beneficiaries over the first three years of Tennessee's Medicaid managed care program, TennCare. Using claims data containing fee-for-service expenditures prior to enrollment in managed care, we find substantial evidence of persistent risk selection among plans. Results are robust to most alternative measures of risk selection for most plans. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Hill, SC (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 22 TC 5 Z9 5 U1 0 U2 0 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SUM PY 2002 VL 39 IS 2 BP 152 EP 167 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 594CY UT WOS:000178032200006 PM 12371569 ER PT J AU Foster, NE AF Foster, NE TI John M. Eisenberg, MD, MBA - In memoriam SO INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE LA English DT Biographical-Item C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Foster, NE (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 1353-4505 J9 INT J QUAL HEALTH C JI Int. J. Qual. Health Care PD JUN PY 2002 VL 14 IS 3 BP 169 EP 171 PG 3 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 563HA UT WOS:000176249200001 PM 12227302 ER PT J AU Farquhar, CM Stryer, D Slutsky, J AF Farquhar, CM Stryer, D Slutsky, J TI Translating research into practice: the future ahead SO INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE LA English DT Article DE applied research; decision aids; evidence-based medicine; guidelines; implementation; quality improvements; research evidence ID HEALTH-CARE; QUALITY; INTERVENTIONS; MANAGEMENT; OUTCOMES; TRIALS AB Objective. To summarize and analyze the focus and methodologies of the Translating Research into Practice (TRIP) projects funded in 1999-2000 by the US Agency for Healthcare Research and Quality (AHRQ). Data sources and study design. An analysis of the successful applications for the TRIP I and II requests for applications in 1999 and 2000 was produced from the data collected. Data collection. The following items were abstracted from each of the successful applications: provider focus, patient population, vulnerable populations, methodologies, interventions for change, outcomes measured, and conceptual framework used. Principal findings. AHRQ funded 27 TRIP grants in 1999 and 2000. A wide variety of health care providers, settings, and patients were the target of the grants. The most common study design was a randomized controlled trial. The most common TRIP interventions were educational and the most common frameworks were either adult learning theory or organizational theory. More than half of the projects planned to use information technology and half the projects had a focus on reducing errors. Conclusions. The TRIP projects encompass a broad range of providers, environments, patients, and interventions. The field of applied research and quality improvements should be considerably enhanced by these research projects. C1 Agcy Healthcare Res & Qual, Ctr Practice Technol Assessment, Rockville, MD USA. Agcy Healthcare Res & Qual, Ctr Effectiveness & Outcomes Res, Rockville, MD USA. Agcy Healthcare Res & Qual, Ctr Practice Technol Assessment, Natl Guidelines Clearinghouse, Rockville, MD USA. RP Farquhar, CM (reprint author), Natl Womens Hosp, Dept Obstet & Gynaecol, Auckland, New Zealand. OI Farquhar, Cynthia/0000-0002-3685-3553 NR 22 TC 38 Z9 39 U1 1 U2 4 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 1353-4505 J9 INT J QUAL HEALTH C JI Int. J. Qual. Health Care PD JUN PY 2002 VL 14 IS 3 BP 233 EP 249 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 563HA UT WOS:000176249200012 PM 12108534 ER PT J AU Farquhar, CM Naoom, S Steiner, CA AF Farquhar, CM Naoom, S Steiner, CA TI The impact of endometrial ablation on hysterectomy rates in women with benign uterine conditions in the United States SO INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE LA English DT Article DE endometrial ablation; hysterectomy; menorrhagia ID LAPAROSCOPIC CHOLECYSTECTOMY; MENORRHAGIA AB Objective: To assess the impact of endometrial ablation on the utilization of hysterectomy in U.S. women with benign uterine conditions. Methods: Data are from the State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project for six states, 1990-97. Women who underwent hysterectomy (ICD-9-CM codes 68.3, 68.4, 68.5, 68.51, 68.59, 68.9) and endometrial ablation (68.23, 69.29) and had benign uterine conditions (ICD-9-CM code 218.0 and CCS groupings 47, 171, 173, 175, 176, 215) were extracted. Comparative rates, length of stay, total charges, age, payer, hospital, and teaching status of the hospital are reported. Results: The rates of hysterectomy decreased in three states: Colorado (37% decrease; 33 per 10,000 women in 1990 to 21 per 10,000 in 1997), Maryland (18% decrease; 17/10,000 in 1990 to 14/10,000 in 1997), and New Jersey (11% decrease; 9/10,000 to 8/10,000); were static in two states (Connecticut and New York) and increased in one state, Wisconsin (11% increase; 19/10,000 in 1994 to 21/10,000 in 1997). The rates for endometrial ablation increased in all states. The ratio of hysterectomy rates to endometrial ablation rates fell in each state across the 7 years. In two states (New York and New Jersey) the rate of endometrial ablation was equivalent to the rate of hysterectomies by 1997. The total combined rate for hysterectomy and endometrial ablation for women with benign uterine conditions for each state increased by more than 10%, with the exception of Maryland, which had an increase of only 5%, and Colorado, which had a decline of 23%. Conclusions: In the six states studied, the diffusion of endometrial ablation has had a varying impact on hysterectomy rates among women with benign uterine conditions. However, endometrial ablation is used as an additive medical technology rather than a substitute. C1 Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. RP Farquhar, CM (reprint author), Univ Auckland, Natl Womens Hosp, Dept Obstet & Gynaecol, Auckland 1, New Zealand. OI Farquhar, Cynthia/0000-0002-3685-3553 NR 29 TC 22 Z9 23 U1 0 U2 0 PU CAMBRIDGE UNIV PRESS PI NEW YORK PA 40 WEST 20TH ST, NEW YORK, NY 10011-4221 USA SN 0266-4623 J9 INT J TECHNOL ASSESS JI Int. J. Technol. Assess. Health Care PD SUM PY 2002 VL 18 IS 3 BP 625 EP 634 PG 10 WC Health Care Sciences & Services; Public, Environmental & Occupational Health; Medical Informatics SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Medical Informatics GA 602YN UT WOS:000178532200016 PM 12391955 ER PT J AU Gray, BM Selden, TM AF Gray, BM Selden, TM TI Adverse selection and the capped premium subsidy in the Federal Employees Health Benefits Program SO JOURNAL OF RISK AND INSURANCE LA English DT Article ID INSURANCE MARKETS; RISK ADJUSTMENT/; MEDICARE; INFORMATION; PLANS; MODEL; COMPETITION; EFFICIENCY; FEHBP; PRICE AB This article examines the relationship between adverse selection and the capped premium subsidy in the Federal Employees Health Benefit Program (FEHBP). Understanding this relationship is important, not only because the FEHBP is the largest employer-sponsored health program in the United States, but also because it has been proposed as a market-based model for the reform of both Medicare and the market for nongroup private coverage. We present a theoretical model of the FEHBP that we then test using enrollee data. In particular, we exploit the natural experiment that arises from variation in the premium subsidy cap across Metropolitan Statistical Areas (MSAs). Although the nominal subsidy cap is constant across MSAs, its real value varies greatly across MSAs with different price levels. The empirical analysis herein supports the contention that the premium subsidy in the FEHBP helps reduce adverse selection. C1 Univ Illinois, Div Hlth Policy & Adm, Inst Govt & Publ Affairs, Chicago, IL USA. Univ Illinois, Div Hlth Policy & Adm, Sch Publ Hlth, Chicago, IL USA. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Gray, BM (reprint author), Univ Illinois, Div Hlth Policy & Adm, Inst Govt & Publ Affairs, Chicago, IL USA. NR 37 TC 1 Z9 1 U1 2 U2 5 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0022-4367 J9 J RISK INSUR JI J. Risk Insur. PD JUN PY 2002 VL 69 IS 2 BP 209 EP 224 DI 10.1111/1539-6975.00015 PG 16 WC Business, Finance; Economics SC Business & Economics GA 557XN UT WOS:000175934500004 ER PT J AU Owens, PL Hoagwood, K Horwitz, SM Leaf, PJ Poduska, JM Kellam, SG Ialongo, NS AF Owens, PL Hoagwood, K Horwitz, SM Leaf, PJ Poduska, JM Kellam, SG Ialongo, NS TI Barriers to children's mental health services SO JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY LA English DT Article DE barriers to care; mental health ID DIAGNOSTIC INTERVIEW SCHEDULE; PSYCHIATRIC-DISORDERS; ADOLESCENTS; RELIABILITY; BEHAVIOR; YOUTH; CARE AB Objective: To examine the characteristics associated with barriers to children's mental health services, focusing on the effect of children's psychosocial problems on parents. Method: Data come from a first-grade, prevention-intervention project conducted in Baltimore, Maryland. Analyses were restricted to 116 families who participated in seventh-grade interviews and indicated the index child needed services. The Services Assessment for Children and Adolescents was used to measure barriers to children's mental health services. Results: More than 35% of parents reported a barrier to mental health services. Types of barriers included those related to structural constraints, perceptions of mental health, and perceptions of services (20.7%, 23.3%, and 25.9%, respectively). Although parenting difficulties were associated with all barriers (structural: OR = 10.63, 95% CI: 2.37, 47.64; mental health: OR = 8.31, 95% CI: 1.99, 34.79; services: OR = 5.22, 95% CI: 1.56, 17.51), additional responsibilities related to attendance at meetings was associated only with structural barriers (OR = 5,49, 95% CI: 1,22, 24.59). Conclusions: Researchers and policymakers interested in increasing children's access to mental health services should consider strategies to reduce barriers related to perceptions about mental health problems and services, in addition to structural barriers. Particular attention should be given to programs that focus on the needs of families who are most affected by their child's psychosocial problems. C1 Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Mental Hyg, Baltimore, MD USA. NIMH, Rockville, MD 20857 USA. Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, New Haven, CT 06510 USA. Amer Inst Res, Washington, DC USA. RP Owens, PL (reprint author), Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, 2101 E Jefferson St,Suite 605, Rockville, MD 20852 USA. FU NIMH NIH HHS [5P0-MH38725, 5T32-MH19545, 2P50-MH43703] NR 30 TC 168 Z9 169 U1 4 U2 13 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0890-8567 J9 J AM ACAD CHILD PSY JI J. Am. Acad. Child Adolesc. Psychiatr. PD JUN PY 2002 VL 41 IS 6 AR UNSP 0890-8567/02/4106-0731 DI 10.1097/00004583-200206000-00013 PG 8 WC Psychology, Developmental; Pediatrics; Psychiatry SC Psychology; Pediatrics; Psychiatry GA 554PM UT WOS:000175744700013 PM 12049448 ER PT J AU Clancy, CM Lawrence, W AF Clancy, CM Lawrence, W TI Is outcomes research on cancer ready for prime time? SO MEDICAL CARE LA English DT Article DE outcomes assessment; quality improvement; health services research; cancer; quality of life ID INCREASE MAMMOGRAPHY USE; SMALL-AREA VARIATIONS; CLINICAL-TRIALS; BREAST-CANCER; SKELETAL COMPLICATIONS; RADICAL PROSTATECTOMY; HEALTH-CARE; OLDER WOMEN; QUALITY; METAANALYSIS AB Contemporary treatment of patients with cancer has been challenged by the same influences that have stimulated broad interest among stakeholders in assessing the outcomes or "results" of medical care. These interrelated external forces include growing awareness of practice variations, increased recognition of the patient's central role in decision making, acknowledgment that treatment decisions for situations where cure is not possible require explicit metrics to assess trade-offs between length and quality of life, strong interest in cost containment, and broad public concern that efforts to rationalize spending may have led to decreases in quality of care. Clinical and health services researchers interested in cancer diagnosis and treatment have striven to address these issues and have been in the forefront of efforts to develop and use valid measures of health-related quality of life. However, the current challenges to the field of outcomes research are equally applicable to those applying its tools and methods to the study of cancer: lack of standardization of outcomes measures, limited evidence that assessing outcomes of care is followed by improved outcomes in practice, and development of a research infrastructure that links the products of outcomes research with informed, shared decision making in routine practice. The purpose of this article is to provide a brief overview of lessons learned from the first decade of outcomes research sponsored by the Agency for Healthcare Research and Quality that will inform suggested directions for future directions for cancer outcomes research. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, 6010 Execut Blvd, Rockville, MD 20852 USA. NR 47 TC 6 Z9 6 U1 1 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUN PY 2002 VL 40 IS 6 SU S BP 92 EP 100 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 556YG UT WOS:000175876700014 ER PT J AU Foster, N AF Foster, N TI John Meyer Eisenberg, MD - Obitituary SO QUALITY & SAFETY IN HEALTH CARE LA English DT Biographical-Item C1 AHRQ, Rockville, MD 20852 USA. RP Foster, N (reprint author), AHRQ, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BRITISH MED JOURNAL PUBL GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1475-3898 J9 QUAL SAF HEALTH CARE JI Qual. Saf. Health Care PD JUN PY 2002 VL 11 IS 2 BP 196 EP 196 PG 1 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 577GW UT WOS:000177054000031 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Services Task Force TI Screening for depression: Recommendations and rationale SO ANNALS OF INTERNAL MEDICINE LA English DT Article AB This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendations for screening for depression and the supporting scientific evidence and updates the 1996 USPSTF recommendations on this topic. At that time, the USPSTF concluded that there was insufficient evidence to recommend for or against routine use of standardized questionnaires to screen for depression in primary care patients. The complete information on which the current statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the systematic evidence review on this topic, which can be obtained through the USPSTF Web site (www.ahrq.gov/clinic/uspstfix.htm) and in print through the Agency for Healthcare Research and Quality Publications Cleaninghouse (800-358-9295). C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Berg, AO (reprint author), USPSTF, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 13 TC 291 Z9 292 U1 0 U2 5 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAY 21 PY 2002 VL 136 IS 10 BP 760 EP 764 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA 553FF UT WOS:000175664600007 ER PT J AU Berg, AO Atkins, D AF Berg, AO Atkins, D CA USPSTF TI Aspirin for the primary prevention of cardiovascular events: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Article ID LOW-DOSE ASPIRIN; RANDOMIZED TRIAL; DISEASE; RISK C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 15 TC 3 Z9 3 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD MAY 15 PY 2002 VL 65 IS 10 BP 2107 EP 2110 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 556LB UT WOS:000175849700011 ER PT J AU Berg, AO AF Berg, AO TI Screening for skin cancer: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Editorial Material C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Clin Prevent Serv, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Texas, Hlth Sci Ctr, Sch Nursing, San Antonio, TX USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Rochester, NY USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA USA. Univ Texas, Hlth Sci Ctr, Audie L Murphy Mem Vet Hosp, San Antonio, TX USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Brown Univ, Women & Infants Hosp, Providence, RI USA. Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. Dartmouth Hitchcock Med Ctr, Dept Med, Lebanon, NH 03766 USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ Coll Phys & Surg, Dept Obstet & Gynecol, New York, NY 10032 USA. Virginia Commonwealth Univ Med Coll Virginia, Dept Family Practice, Fairfax, VA USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Clin Prevent Serv, Ctr Practice & Technol Assessment, 6010 Exectur Blvd,Suite 300, Rockville, MD 20852 USA. NR 9 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD MAY PY 2002 VL 102 IS 5 BP 97 EP + PG 3 WC Nursing SC Nursing GA 550QJ UT WOS:000175513500052 ER PT J AU Chan, E Zhan, CL Homer, CJ AF Chan, E Zhan, CL Homer, CJ TI Health care use and costs for children with attention-deficit/hyperactivity disorder - National estimates front the Medical Expenditure Panel Survey SO ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE LA English DT Article; Proceedings Paper CT Annual Meeting of the Academy-for-Health-Services-Research-and-Health-Policy CY JUN 11, 2001 CL ATLANTA, GEORGIA SP Acad Hlth Serv Res & Hlth Policy ID DEFICIT HYPERACTIVITY DISORDER; COUNTY-WIDE SAMPLE; PSYCHOSOCIAL PROBLEMS; ASTHMA; IDENTIFICATION; ADOLESCENTS; MANAGEMENT; PATTERNS; CRITERIA AB Context: Although attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent chronic condition of childhood, little is known about patterns of health care use and associated expenditures. Objective: To compare health care use and costs among children with ADHD, children with asthma, and the general pediatric population. Design and Setting: The 1996 Medical Expenditure Panel Survey, a nationally representative household survey. Participants: All 5439 children aged 5 to 20 years from the 1996 Medical Expenditure Panel Survey were included in this analysis. Children who had ADHD, asthma,d or neither (general population) were identified from Into-national Classification of Diseases, Ninth Revision, Clinical Modification codes and prescription records. Main Outcome Measures: Mean health care use (outpatient visits, emergency department visits, hospital stays, home health visit days, and prescriptions) and associated expenditures. Results: We identified 105 children with ADHD, 322 with asthma, and 4052 with neither diagnosis. Children with ADHD had significantly higher mean total health care costs ($1151) compared with children with asthma ($1091 P<.05) and the general population ($712 P<.001). After adjusting for age, Sex, race, household income, access to care, parent education, and martial Status, excess total costs were $479 for children with ADHD (P<.001) and $437 for children with asthma (P<.01). Conclusions: Overall costs of care for children with ADHD are comparable to costs for children with asthma and significantly greater than for the general pediatric Population, Specific types of health care use and the sources of expenditures differ between children with ADHD and children with asthma. Because much ADHD-related care occurs within school and mental health settings, these figures likely underestimate the true costs of caring for children with this condition. C1 Childrens Hosp, Hlth Serv Res, Div Gen Pediat, Boston, MA 02115 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Chan, E (reprint author), Childrens Hosp, Hlth Serv Res, Div Gen Pediat, 300 Longwood Ave,LO-240, Boston, MA 02115 USA. FU BHP HRSA HHS [T32 PE10018] NR 27 TC 123 Z9 124 U1 1 U2 4 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 1072-4710 J9 ARCH PEDIAT ADOL MED JI Arch. Pediatr. Adolesc. Med. PD MAY PY 2002 VL 156 IS 5 BP 504 EP 511 PG 8 WC Pediatrics SC Pediatrics GA 548RC UT WOS:000175402100018 PM 11980558 ER PT J AU Crane, L Crowe, R Fine, S Gold, M Gorosh, K Gourevitch, M Hellinger, J Jovanovich, J Kalkut, G Keiser, P Matthews, C Nadler, J Nemechek, P Post, J Goldberg, B Rutstein, R Sharp, V Hollinger, F Fleishman, J Frazer, I Conviser, R Dilonardo, J Gaist, P Moore, R Keruly, J Gebo, K Reilly, E Zhao, M AF Crane, L Crowe, R Fine, S Gold, M Gorosh, K Gourevitch, M Hellinger, J Jovanovich, J Kalkut, G Keiser, P Matthews, C Nadler, J Nemechek, P Post, J Goldberg, B Rutstein, R Sharp, V Hollinger, F Fleishman, J Frazer, I Conviser, R Dilonardo, J Gaist, P Moore, R Keruly, J Gebo, K Reilly, E Zhao, M CA HIV Res Network TI Hospital and outpatient health services utilization among HIV-infected patients in care in 1999 SO JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE resource use; health services; cost of care; hospital admission; antiretroviral therapy ID COMBINATION ANTIRETROVIRAL THERAPY; HUMAN-IMMUNODEFICIENCY-VIRUS; INJECTION-DRUG USERS; MEDICAL-CARE; ERA; MORTALITY; DISEASE; COSTS; AIDS AB Background: The evolving epidemiology and therapeutic management of HIV disease has important implications for health care resource utilization in HIV-infected patients, and health care resource use data are also needed to support policy and financial decision making. Methods: Demographic, clinical, and resource utilization data were collected from 9 U.S. HIV primary and specialty care sites in calendar year 1999. Rates of resource use were calculated for hospital admission, length of hospital stay, and outpatient clinic/office visits. Results: The sample included 5255 patients from HIV primary care sites in 3 eastern, 3 midwestern, arid 3 western areas of the United States. Hospital admissions accounted for an annual mean of 297 days per 100 persons/y in 1999. Hospital days ranged from a low of 165 per 100 persons/mo for a CD4 > 500 cells/mm(3) to 840 per 100 persons/mo for a CD4 < 50 cells/mm(3) (p < .01). Mean annual outpatient clinic/office visits were 10.7 per person in 1999. A declining CD4 level and an increasing HIV-1 RNA level were both associated with higher hospital and outpatient utilization. HAART use was associated with fewer hospital days, and a higher outpatient visit rate. Injecting drug use risk was associated with an increase in hospital days. African American race was associated with a higher number of hospital days, but a lower outpatient visit rate. Female gender was associated with higher outpatient utilization. Mean monthly inpatient and outpatient expenditures in 1999 were $423 and $168, respectively. Conclusion: As HIV care continues to evolve, data from our network of HIV providers will be useful in quantifying changes in HIV health services utilization makers, as well as HIV care payers and providers. C1 Wayne State Univ, Detroit, MI USA. Alameda Cty Med Ctr, Oakland, CA USA. Community Hlth Network, Rochester, NY USA. Med Coll Penn & Hahnemann Univ, Philadelphia, PA USA. CORE Fdn, Chicago, IL USA. Montefiore Med Grp, Bronx, NY USA. Community Med Alliance, Boston, MA USA. Henry Ford Hosp, Detroit, MI 48202 USA. Montefiore Med Ctr, Bronx, NY 10467 USA. Parkland Hlth & Hosp Syst, Dallas, TX USA. Univ Calif San Diego, Owen Clin, San Diego, CA 92103 USA. Tampa Gen Hlth Care, Tampa, FL USA. Nemechek Hlth Renewal, Kansas City, MO USA. MIHS McDowell Healthcare Ctr, Phoenix, AZ USA. Care Oregon, Portland, OR USA. Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA. St Lukes Roosevelt Hosp, New York, NY USA. Agcy Healthcare Res & Qual, Rockville, MD USA. US Hlth Resources & Serv Adm, Rockville, MD USA. Subst Abuse & Mental Hlth Serv Adm, Rockville, MD USA. NIH, Off AIDS Res, Bethesda, MD 20892 USA. Johns Hopkins Univ, Sch Med, Baltimore, MD 21205 USA. RP Moore, R (reprint author), Johns Hopkins Univ, Sch Med, 1830 E Monument St,Room 8059, Baltimore, MD 21205 USA. RI Gebo, Kelly/B-9223-2009 NR 19 TC 46 Z9 46 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1525-4135 J9 J ACQ IMMUN DEF SYND JI J. Acquir. Immune Defic. Syndr. PD MAY 1 PY 2002 VL 30 IS 1 BP 21 EP 26 PG 6 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 548QY UT WOS:000175401600003 ER PT J AU Brown, LJ Wall, TP Manski, RJ AF Brown, LJ Wall, TP Manski, RJ TI The funding of dental services among US adults aged 18 years and older - Recent trends in expenditures and sources of funding SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article AB Background. This article is the second in a series of two that focus on recent changes in the funding of dental services in the United States. Methods. This study is based on the analyses of data regarding dental expenditures among adults aged 18 years and older from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Both of these surveys were designed to produce national estimates of annual medical expenditures in the United States. Results. Overall, real per-patient dental expenditures among adults aged 18 years older who,had had a dental visit fell from $529.93 in 1987 to $467.29 in 1996. Conclusions. Recent decreases in dental expenditures may be related to a shift from restorative to diagnostic and preventive services. Practice Implications. In the future, dentists' gross revenues may grow more an increase in the number of patients seen than from an increase in the average revenue per patient. C1 Amer Dent Assoc, Hlth Policy Resources Ctr, Chicago, IL 60611 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Maryland, Sch Dent, Dept Oral Hlth Care, Baltimore, MD 21201 USA. RP Brown, LJ (reprint author), Amer Dent Assoc, Hlth Policy Resources Ctr, 211 E Chicago Ave, Chicago, IL 60611 USA. NR 10 TC 11 Z9 11 U1 0 U2 1 PU AMER DENTAL ASSN PI CHICAGO PA 211 E CHICAGO AVE, CHICAGO, IL 60611 USA SN 0002-8177 J9 J AM DENT ASSOC JI J. Am. Dent. Assoc. PD MAY PY 2002 VL 133 IS 5 BP 627 EP 635 PG 9 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 552YQ UT WOS:000175648200023 PM 12036168 ER PT J AU Bauchner, H Adams, W Burstin, H AF Bauchner, H Adams, W Burstin, H TI "You've got mail": Issues in communicating with patients and their families by E-mail SO PEDIATRICS LA English DT Editorial Material C1 Boston Univ, Sch Med, Boston Med Ctr, Dept Pediat, Boston, MA 02118 USA. Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD 20852 USA. RP Bauchner, H (reprint author), 91 E Concord St, Boston, MA 02118 USA. NR 11 TC 12 Z9 14 U1 0 U2 0 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD MAY PY 2002 VL 109 IS 5 BP 954 EP 956 DI 10.1542/peds.109.5.954 PG 4 WC Pediatrics SC Pediatrics GA 547EZ UT WOS:000175321200049 PM 11986460 ER PT J AU Jiang, HJ Begun, JW AF Jiang, HJ Begun, JW TI Dynamics of change in local physician supply: an ecological perspective SO SOCIAL SCIENCE & MEDICINE LA English DT Article DE population ecology; physician workforce; local physician supply; specialty mix; hospital consolidation; managed care; USA ID GENERALIST PHYSICIANS; POPULATIONS; PROFESSIONALISM; WORKFORCE; SYSTEMS; TRENDS; REFORM AB The purpose of this study is to employ an ecological framework to identify factors that have an impact on change in local physician supply within the USA. A particular specialty type of patient care physicians in a local market is defined as a physician population. Four physician populations are identified generalists, medical specialists, surgical specialists, and hospital-based specialists. Based on population ecology theory, the proposed framework explains the growth of a particular physician population by four mechanisms: the intrinsic properties of this physician population; the local market's carrying capacity, which is determined by three environmental dimensions (munificence, concentration, diversity); competition within the same physician population, and interdependence between different physician populations. Data at the level of Metropolitan Statistical Areas (MSAs) were compiled from the US Area Resources File, the American Hospital Association Annual Surveys of Hospitals, the American Medical Association Census of Medical Groups, the InterStudy National HMO Census, and the US County Business Patterns, Changes in the number and percentage of physicians in a particular specialty population from 1985 to 1994 were regressed, respectively, on 1985-94 changes in the explanatory variables as well as their levels in 1985. The results indicate that the population ecology framework is useful in explaining dynamics of change in the local physician workforce. Variables measuring the three environmental dimensions were found to have significant, and in some cases, differential effects on change in the size of different specialty populations. For example, both hospital consolidation and managed care penetration showed significant positive effects on growth of the generalist population but suppressing effects on growth of the specialist population. The percentage of physicians in a particular specialty population in 1985 was negatively related to change in the size of that specialty population between 1985 and 1994, suggesting the existence of competition. Overall, the findings of this study facilitate a better understanding of the complexity of physician workforce supply. (C) 2002 Elsevier Science Ltd. All rights reserved. C1 Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. Univ Minnesota, Carlson Sch Management, Dept Healthcare Management, Minneapolis, MN 55455 USA. RP Jiang, HJ (reprint author), Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Suite 605,2101 E Jefferson St, Rockville, MD 20852 USA. NR 61 TC 21 Z9 21 U1 1 U2 4 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0277-9536 J9 SOC SCI MED JI Soc. Sci. Med. PD MAY PY 2002 VL 54 IS 10 BP 1525 EP 1541 AR PII S0277-9536(01)00132-0 DI 10.1016/S0277-9536(01)00132-0 PG 17 WC Public, Environmental & Occupational Health; Social Sciences, Biomedical SC Public, Environmental & Occupational Health; Biomedical Social Sciences GA 545TK UT WOS:000175233500006 PM 12061486 ER PT J AU Berg, AO AF Berg, AO TI Screening for skin cancer: Recommendations and rationale - US preventive services task force SO AMERICAN FAMILY PHYSICIAN LA English DT Article RP Berg, AO (reprint author), Care Of Atkins D, US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 4 TC 1 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD APR 15 PY 2002 VL 65 IS 8 BP 1623 EP 1626 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 544PD UT WOS:000175168300012 ER PT J AU Macek, MD Manski, RJ Vargas, CM Moeller, JF AF Macek, MD Manski, RJ Vargas, CM Moeller, JF TI Comparing oral health care utilization estimates in the United States across three nationally representative surveys SO HEALTH SERVICES RESEARCH LA English DT Article DE dental care/utilization; dental health surveys; United States epidemiology; adult ID BEHAVIORAL FREQUENCY QUESTIONS AB Objective. To compare estimates of dental visits among adults using three national surveys. Data Sources/Study Design. Gross-sectional data from the National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), and National Health Expenditure surveys (NMCES, NMES, MEPS). Study Design. This secondary data analysis assessed whether overall estimates and stratum-specific trends are different across surveys. Data Collection. Dental visit data are age standardized via the direct method to the 1990 population of the United States. Point estimates, standard errors, and test statistics are generated using SUDAAN. Principal Findings. Sociodemographic, stratum-specific trends are generally consistent across surveys; however, overall estimates differ (NHANES III [364-day estimate] versus 1993 NHIS: -17.5 percent difference, Z = 7.27, pvalue < 0.001; NHANES III [365-day estimate] vs. 1993 NHIS: 5.4 percent difference, Z = -2.50, p value = 0.006; MEPS vs. 1993 NHIS: -29.8 percent difference, Z = 16.71, p value < 0.001). MEPS is the least susceptible to intrusion, telescoping, and social desirability. Conclusions. Possible explanations for discrepancies include different reference periods, lead-in statements, question format, and social desirability of responses. Choice of survey should depend on the hypothesis. If trends are necessary, choice of survey should not matter; however, if health status or expenditure associations are necessary, then surveys that contain these variables should be used, and if accurate overall estimates are necessary, then MEPS should be used. A validation study should be conducted to establish "true" utilization estimates. C1 Univ Maryland, Baltimore Coll Dent Surg, Sch Dent, Dept Oral Hlth Care Delivery, Baltimore, MD 21201 USA. Univ Maryland, Baltimore Coll Dent Surg, Sch Dent,Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Baltimore, MD 21201 USA. Univ Maryland, Baltimore Coll Dent Surg, Sch Dent, Dept Oral Hlth Care Delivery, Baltimore, MD 21201 USA. Ctr Dis Control & Prevent, Natl Ctr Hlth Stat, Off Anal Epidemiol & Hlth Promot, Baltimore, MD USA. Ctr Cost & Financing Studies, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Macek, MD (reprint author), Univ Maryland, Baltimore Coll Dent Surg, Sch Dent, Dept Oral Hlth Care Delivery, 666 W Baltimore St,Room 3-E-02, Baltimore, MD 21201 USA. NR 25 TC 34 Z9 34 U1 1 U2 2 PU BLACKWELL PUBL LTD PI OXFORD PA 108 COWLEY RD, OXFORD OX4 1JF, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 2002 VL 37 IS 2 BP 499 EP 521 DI 10.1111/1475-6773.034 PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 550AL UT WOS:000175480800014 PM 12036005 ER PT J AU Felix-Aaron, K Gine-Nokes, N Burstin, H Bauchner, H AF Felix-Aaron, K Gine-Nokes, N Burstin, H Bauchner, H TI Patient centered care for low income patients: Missed opportunities. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract C1 Agcy Healthcare Res & Qual, Rockville, MD USA. Boston Med Ctr, Boston, MA USA. NR 0 TC 0 Z9 0 U1 0 U2 2 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2002 VL 17 SU 1 BP 157 EP 158 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 544LB UT WOS:000175158200607 ER PT J AU Fremont, AM Wickstrom, SL Bird, CE Shah, MM Rector, TS Bierman, AS Horstman, TV Escarce, JJ AF Fremont, AM Wickstrom, SL Bird, CE Shah, MM Rector, TS Bierman, AS Horstman, TV Escarce, JJ TI Racial and socioeconomic disparities in managed care settings: Variation in HEDIS measures performance for cardiovascular care. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract C1 RAND Corp, Santa Monica, CA USA. Ctr Hlth Care Policy & Evaluat, Minneapolis, MN USA. AHRQ, Rockville, MD USA. RI Bird, Chloe/C-7107-2008 NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2002 VL 17 SU 1 BP 158 EP 158 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 544LB UT WOS:000175158200608 ER PT J AU Steiner, CA Johantgen, M Vo, U AF Steiner, CA Johantgen, M Vo, U TI Surgery for breast cancer: Does outpatient care create disparity in treatment and outcome? SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract C1 AHRQ, Rockville, MD USA. Univ Maryland, Baltimore, MD 21201 USA. George Washington Univ, Washington, DC 20052 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2002 VL 17 SU 1 BP 250 EP 251 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 544LB UT WOS:000175158201045 ER PT J AU Wall, TP Brown, LJ Manski, RJ AF Wall, TP Brown, LJ Manski, RJ TI The funding of dental services among US children 2 to 17 years old - Recent trends in expenditures and sources of funding SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article ID UNTREATED CARIES; PRIMARY TEETH; PERMANENT AB Background. This article is the first of two that focus on recent changes in the funding of dental services in the United States. Methods. This study is based on analyses of data regarding dental expenditures among children 2 to 17 years of age from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Both of these surveys were designed to produce national estimates of annual medical expenditures in the United States. Results. Overall, real per capita dental expenditures among 2- to 17-year-old children who had had a dental visit fell from $578.05 in 1987 to $498.57 in 1996. Large increases per patient were reported for the poorest children, while decreases were reported for children from families with higher incomes. Conclusions. Much of the increase from 1987 to 1996 in dental expenditures among economically disadvantaged children who had had a dental visit was due to an increase in care provided by dentists that was not reimbursed. Practice Implications. More needs to be done to increase the number of economically disadvantaged children who visit a dentist. All segments of society must cooperate to achieve this result. C1 Amer Dent Assoc Hlth Fdn, Hlth Policy Resources Ctr, Chicago, IL 60611 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, Baltimore, MD 21201 USA. RP Brown, LJ (reprint author), Amer Dent Assoc Hlth Fdn, Hlth Policy Resources Ctr, 211 E Chicago Ave, Chicago, IL 60611 USA. NR 8 TC 9 Z9 9 U1 0 U2 0 PU AMER DENTAL ASSN PI CHICAGO PA 211 E CHICAGO AVE, CHICAGO, IL 60611 USA SN 0002-8177 J9 J AM DENT ASSOC JI J. Am. Dent. Assoc. PD APR PY 2002 VL 133 IS 4 BP 474 EP 482 PG 9 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 543ZF UT WOS:000175133200023 PM 11991466 ER PT J AU Barry, PP Bierman, AS Leipzig, RM Silliman, RA AF Barry, PP Bierman, AS Leipzig, RM Silliman, RA TI Evidence-based medicine and aging: Report of a needs assessment conference. SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Meeting Abstract C1 Merck Inst Aging & Hlth, Washington, DC USA. AHRQ, Ctr Outcomes & Effectiveness Res, Rockville, MD USA. Mt Sinai Sch Med, Dept Geriatr, New York, NY USA. Boston Univ, Med Ctr, Geriatr Sect, Boston, MA 02215 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD APR PY 2002 VL 50 IS 4 SU S MA P353 BP S126 EP S126 PG 1 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 542EL UT WOS:000175030500398 ER PT J AU Co, JPT Beal, AC Dougherty, D Jorsling, T Kam, J Perrin, JM Palmer, BH AF Co, JPT Beal, AC Dougherty, D Jorsling, T Kam, J Perrin, JM Palmer, BH TI Quality of care measures for childhood hospitalization SO PEDIATRIC RESEARCH LA English DT Meeting Abstract C1 Massachusetts Gen Hosp Children, Ctr Child & Adolescent Hlth Policy, Boston, MA USA. Agcy Hlth Care Res & Qual, Off Prior Populat Res, Rockville, MD USA. Harvard Univ, Sch Publ Hlth, QCARE, Boston, MA 02115 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2002 VL 51 IS 4 SU S MA 863 BP 148A EP 149A PN 2 PG 2 WC Pediatrics SC Pediatrics GA 536RA UT WOS:000174714600864 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Serv Task Force TI Screening for bacterial vaginosis in pregnancy: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Article C1 USPSTF, Agcy Healthcare Res & Qual, Ctr Pract & Technol Assessment, Rockville, MD 20852 USA. RP Berg, AO (reprint author), USPSTF, Agcy Healthcare Res & Qual, Ctr Pract & Technol Assessment, 6010 Execut Blvd Suite 300, Rockville, MD 20852 USA. NR 3 TC 1 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD MAR 15 PY 2002 VL 65 IS 6 BP 1147 EP 1150 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 533UT UT WOS:000174549300012 ER PT J AU Kusek, JW Greene, P Wang, SR Beck, G West, D Jamerson, K Agodoa, LY Faulkner, M Level, B AF Kusek, JW Greene, P Wang, SR Beck, G West, D Jamerson, K Agodoa, LY Faulkner, M Level, B CA African Amer Study Kidney Dis & Hy TI Cross-sectional study of health-related quality of life in African Americans with chronic renal insufficiency: The African American Study of Kidney Disease and Hypertension Trial SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE health-related quality of life (HRQL); chronic renal insufficiency (CRI); African Americans ID OF-LIFE; FUNCTIONAL STATUS; MEDICAL OUTCOMES; WHITEHALL-II; DIALYSIS; HEMODIALYSIS; INSTRUMENTS; SYMPTOMS; SF-36 AB We measured health-related quality of life (HRQL) by using the Medical Outcomes Study 36-Item Short-Form (SF-36) in a cross-sectional study of 1,094 African American men and women with mild to moderate chronic renal insufficiency (mean glomerular filtration rate, 45.7 mL/min/1.73 m(2)) caused by hypertension before randomization onto the African American Study of Kidney Disease and Hypertension (AASK) Trial. Scales contributing to physical health and a summary measure, the Physical Component Summary (PCs) score (mean, 43.4 +/- 10.9 [SD]), were significantly lower than scales relating to mental health and the Mental Component Summary (MCS) score (51.3 +/- 10.3). All scales (except Role-Physical) and the PCs and MCS were significantly higher in men (44.3 +/- 10.9 and 51.8 +/- 10.0, respectively) than women (41.9 +/- 10.8 and 50.5 +/- 10.6, respectively). In multivariate analysis, employment status, education level, household income, body mass index, comorbid medical conditions, years of hypertension, number of antihypertensive drugs prescribed, exercise status, and male sex were significant independent predictors of PCs. Fewer factors predicted MCS and included employment status, marital status, current smoking, age, comorbid medical conditions, and male sex. In the entire AASK cohort, mean scores for individual scales, except Mental Health, and the PCs were lower, but the mean MCS score was slightly higher than values for the US general population. Values for individual scales of the SF-36 and the PCs were substantially higher among AASK participants compared with African-American hemodialysis patients. Six of the eight scales were lower in the AASK cohort compared with groups of racially mixed and exclusively African-American hypertensive subjects. We conclude that physical aspects of quality of life are substantially reduced compared with mental components among AASK participants, and a number of demographic and clinical characteristics significantly impact on HRQL. (C) 2002 by the National Kidney Foundation, Inc. C1 NIDDKD, Div Kidney Urol & Hematol Dis, End Stage Renal Dis Program, Off Minor Hlth Coordinat,NIH, Bethesda, MD 20817 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Alabama, Dept Prevent Med, Behav Med Unit, Birmingham, AL USA. Cleveland Clin Fdn, Dept Biostat & Epidemiol, Cleveland, OH 44195 USA. Univ Michigan, Dept Internal Med, Div Hypertens, Ann Arbor, MI 48109 USA. Meharry Med Coll, Dept Internal Med, Div Nephrol, Nashville, TN 37208 USA. RP Kusek, JW (reprint author), NIDDKD, Div Kidney Urol & Hematol Dis, End Stage Renal Dis Program, Off Minor Hlth Coordinat,NIH, Rm 617,6707 Democracy Blvd, Bethesda, MD 20817 USA. FU NIDDK NIH HHS [U01 DK45388, U01 DK48645, U01 DK48652, U01 DK48677, U01 DK45386, U01 DK45381, U01 DK45426, U01 DK45373, U01 DK48669, U01 DK48643, U01 DK48648, U01 DK48659, U01 DK45430, U01 DK48682, U01 DK48689, U01 DK48621, U01 DK45387] NR 38 TC 65 Z9 68 U1 3 U2 4 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD MAR PY 2002 VL 39 IS 3 BP 513 EP 524 DI 10.1053/ajkd.2002.31401 PG 12 WC Urology & Nephrology SC Urology & Nephrology GA 525UW UT WOS:000174093300008 PM 11877570 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Murphy, AL Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Murphy, AL Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH TI Aspirin for the primary prevention of cardiovascular events: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Article ID DISEASE; RISK C1 Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Texas, Hlth Sci Ctr, Sch Nursing, San Antonio, TX USA. Univ Rochester, Sch Med, Rochester, NY USA. Tri Cty Family Med, Cohocton, NY USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Family Med, Newark, NJ 07103 USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA USA. Univ Texas, Hlth Sci Ctr, Audie L Murphy Mem Vet Hosp, San Antonio, TX USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Women & Infants Hosp Rhode Isl, Providence, RI 02908 USA. Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. Mt Sinai Sch Med, Div Gen Internal Med, New York, NY USA. Mt Sinai Sch Med, Primary Care & Med Serv Care Ctr, New York, NY USA. Mt Sinai Med Ctr, New York, NY 10029 USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ Coll Phys & Surg, Dept Obstet & Gynecol, New York, NY 10032 USA. Virginia Commonwealth Univ Med Coll Virginia, Dept Family Practice, Fairfax, VA USA. RP Berg, AO (reprint author), Care Of Atkins D, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 16 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD MAR PY 2002 VL 102 IS 3 BP 67 EP + PG 3 WC Nursing SC Nursing GA 531HR UT WOS:000174410400030 ER PT J AU Mukamel, DB Spector, WD AF Mukamel, DB Spector, WD TI The competitive nature of the nursing home industry: price mark ups and demand elasticities SO APPLIED ECONOMICS LA English DT Article ID MULTIPLE-OUTPUT ANALYSIS; MEDICAID REIMBURSEMENT; NEW-YORK; CARE; COST; SERVICES; QUALITY; ACCESS AB Nursing home markets are likely to deviate from a competitive structure because of limitations on entry imposed by Certificate of Need (CON) regulations and the potential for product differentiation along such attributes as location, religious affiliation and quality. This paper investigates the structure of nursing home markets in New York State by calculating price mark ups and residual private pay demand elasticities. It shows that the residual demand elasticity is bound by estimates based on price mark ups above marginal costs and above Medicaid rates. This approach allows estimation of demand elasticities in all markets, whether or not CON regulations constrain bed supply. Mean price elasticities (in absolute value) calculated for nursing homes in New York State in 1991 ranged from 3.46 to 3.85. C1 Univ Rochester, Med Ctr, Dept Community & Prevent Med, Rochester, NY 14642 USA. Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Mukamel, DB (reprint author), Univ Rochester, Med Ctr, Dept Community & Prevent Med, 601 Elmwood Ave,POB 644, Rochester, NY 14642 USA. NR 30 TC 13 Z9 13 U1 0 U2 4 PU ROUTLEDGE PI HANTS PA CUSTOMER SERVICES DEPT, RANKINE RD, BASINGSTOKE, HANTS RG24 8PR, ENGLAND SN 0003-6846 J9 APPL ECON JI Appl. Econ. PD MAR PY 2002 VL 34 IS 4 BP 413 EP 420 DI 10.1080/00036840110044199 PG 8 WC Economics SC Business & Economics GA 514QA UT WOS:000173451500002 ER PT J AU Zuvekas, SH Cohen, JW AF Zuvekas, SH Cohen, JW TI A guide to comparing health care expenditures in the 1996 MEPS to the 1987 NMES SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article AB Substantial changes in the organization, delivery, and financing of health care over the last decade, combined with data collection and methodological improvements in the 1996 Medical Expenditure Panel Survey (MEPS), pose special challenges in comparing expenditure estimates in MEPS with those in the 1987 National Medical Expenditure Survey (NMES). The 1987 NMES used charges as its fundamental expenditure concept, whereas the 1996 MEPS used actual payments as its expenditure measure. In spite of these differences, researchers and policymakers will want to be able to analyze trends in health care expenditures using these two surveys. We discuss these issues in detail and present a simple, straightforward adjustment method that can be applied to the 1987 NMES public use expenditure data to improve comparability to the MEPS. We base this adjustment method on an analysis of provider-reported payment data collected in NMES. We present several examples of the application of this method that illustrate the importance of the adjustments for analyses of trends in health care spending. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Div Social & Econ Res, Rockville, MD 20852 USA. RP Zuvekas, SH (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Div Social & Econ Res, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 12 TC 17 Z9 17 U1 0 U2 0 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SPR PY 2002 VL 39 IS 1 BP 76 EP 86 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 559QD UT WOS:000176036100008 PM 12067078 ER PT J AU Corn, M Rudzinski, KA Cahn, MA AF Corn, M Rudzinski, KA Cahn, MA TI Bridging the gap in medical informatics and health services research: Workshop results and next steps SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article AB In January 2000, the Agency for Healthcare Research and Quality (AHRQ) and the National Library of Medicine (NLM) cosponsored an invitational workshop entitled "Medical Informatics and Health Services Research: Bridging the Gap." Planned by a small committee of representatives from NLM and AHRQ institutional training centers, the workshop was designed to address the need for education of researchers interested in working at the intersection of the fields of medical informatics and health services research. More than 100 educators and researchers from AHRQ- and NLM-sponsored training programs in medical informatics and health services research participated in the workshop. Through a series of plenary presentations and breakout sessions, the workshop addressed ways of increasing the pool of persons interested, trained, and experienced in addressing specific areas of synergy between the two fields. This paper reports on the results of the workshop. C1 Natl Lib Med, NICHSR, Bethesda, MD 20894 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Cahn, MA (reprint author), Natl Lib Med, NICHSR, 8600 Rockville Pike,Bldg 38A,Room 4S-410,Mail St, Bethesda, MD 20894 USA. NR 4 TC 8 Z9 8 U1 0 U2 1 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD MAR-APR PY 2002 VL 9 IS 2 BP 140 EP 143 DI 10.1197/jamia.M0971 PG 4 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Information Science & Library Science; Medical Informatics SC Computer Science; Information Science & Library Science; Medical Informatics GA 541ZW UT WOS:000175018400009 PM 11861629 ER PT J AU Fitzmaurice, JM Adams, K Eisenberg, JM AF Fitzmaurice, JM Adams, K Eisenberg, JM TI Three decades of research on computer applications in health care: Medical informatics support at the agency for healthcare research and quality SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Review ID CORONARY-ARTERY DISEASE; COMPLICATIONS SCREENING-PROGRAM; OBSERVATION IDENTIFIER NAMES; PHYSICIAN PERFORMANCE; CLINICAL-PRACTICE; DECISION-SUPPORT; DATA-BANK; SYSTEM; REMINDERS; FEEDBACK AB The Agency for Healthcare Research and Quality and its predecessor organizations-collectively referred to here as AHRQ-have a productive history of funding research and development in the field of medical informatics, with grant investments since 1968 totaling $107 million. Many computerized interventions that are commonplace today, such as drug interaction alerts, had their genesis in early AHRQ initiatives. This review provides a historical perspective on AHRQ investment in medical informatics research. It shows that grants provided by AHRQ resulted in achievements that include advancing automation in the clinical laboratory and radiology, assisting in technology development (computer languages, software, and hardware), evaluating the effectiveness of computer-based medical information systems, facilitating the evolution of computer-aided decision making, promoting computer-initiated quality assurance programs, backing the formation and application of comprehensive data banks, enhancing the management of specific conditions such as HIV infection, and supporting health data coding and standards initiatives. Other federal agencies and private organizations have also supported research in medical informatics, some earlier and to a greater degree than AHRQ. The results and relative roles of these related efforts are beyond the scope of this review. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. Univ Maryland, Sch Med, Baltimore, MD 21201 USA. RP Fitzmaurice, JM (reprint author), Agcy Healthcare Res & Qual, 2101 E Jefferson St,Suite 600, Rockville, MD 20852 USA. NR 101 TC 30 Z9 31 U1 1 U2 1 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD MAR-APR PY 2002 VL 9 IS 2 BP 144 EP 160 PG 17 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Information Science & Library Science; Medical Informatics SC Computer Science; Information Science & Library Science; Medical Informatics GA 541ZW UT WOS:000175018400010 PM 11861630 ER PT J AU Berg, AO Atkins, D AF Berg, AO Atkins, D CA US Preventive Serv Task Force TI Screening for chlamydial infection: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Article C1 US Prevent Serv Task Force, Rockville, MD 20852 USA. RP Berg, AO (reprint author), Care Of Atkins D, US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 3 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD FEB 15 PY 2002 VL 65 IS 4 BP 673 EP 676 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 523QG UT WOS:000173966000011 ER PT J AU Manski, RJ Moeller, JF AF Manski, RJ Moeller, JF TI Use of dental services - An analysis of visits, procedures and providers, 1996 SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article ID CARE; AMERICANS AB Background. While many studies have provided data on Americans' access to dental care, few have provided a detailed understanding of what specific treatments patients receive. This article provides detailed information about the types of dental services that Americans receive and the types of providers who render them. Methods. The authors provide national estimates for the U.S. civilian noninstitutionalized population in several socioeconomic and demographic categories regarding dental visits, procedures performed and the types of providers who performed them, using household data from the 1996 Medical Expenditure Panel Survey, or MEPS. Results. Data show that while the combination of diagnostic and preventive services adds up to 65 percent of all dental procedures, the combination of periodontal and endodontic procedures represents only 3 percent. Additionally, while 81 percent of all dental visits were reported as visits to general dentists, approximately 7 percent and 5 percent of respondents who had had a dental visit reported having visited orthodontists or oral surgeons, respectively. Conclusion. MEPS data show the magnitude and nature of dental visits in aggregate and for each of several demographic and socioeconomic categories. This information establishes a nationally representative baseline for the U.S. population in terms of rates of utilization, number and types of procedures and variations in types of providers performing the procedures. These nationally representative estimates include data elements that describe specific dental visits, dental procedures and type of provider, and they offer details that are useful, important and not found elsewhere. Practice Implications. By understanding these analyses, U.S. dentists will be better positioned to provide care and better meet the dental care needs of all Americans. C1 Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, Baltimore, MD 21201 USA. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD USA. RP Manski, RJ (reprint author), Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, 666 W Baltimore St, Baltimore, MD 21201 USA. NR 13 TC 39 Z9 40 U1 0 U2 0 PU AMER DENTAL ASSN PI CHICAGO PA 211 E CHICAGO AVE, CHICAGO, IL 60611 USA SN 0002-8177 J9 J AM DENT ASSOC JI J. Am. Dent. Assoc. PD FEB PY 2002 VL 133 IS 2 BP 167 EP 175 PG 9 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 523YC UT WOS:000173984300012 PM 11868835 ER PT J AU Zhan, CL Sangl, J Meyer, GS Zaslavsky, AM AF Zhan, CL Sangl, J Meyer, GS Zaslavsky, AM TI Consumer assessments of care for children and adults in health plans - How do they compare? SO MEDICAL CARE LA English DT Article DE quality of health care; consumer satisfaction; health care surveys; child ID MEDICARE MANAGED-CARE; QUALITY AB OBJECTIVES. The Consumer Assessment of Health Plans Survey (CAHPS) includes an adult version and also a child version for parents or caretakers to rate children's care in health plans. This study examined how adult and child assessments differed in ranking health plans and explored whether the differences justified the additional cost and respondent burden in administering both surveys. METHODS. Data were from 136 commercial health plans participating in the National CAHPS Benchmarking Database, with 80,539 adults and 40,003 children. We compared mean assessments for adults and children on four global ratings and five composites, and determined respondent characteristics predictive of these assessments using regression analysis. We calculated correlations of plan mean scores for adults and children and kappa statistics for agreement when health plans are ranked as above average, average, or below average performers based on adult and child scores. RESULTS. CAHPS scores for children were significantly (P <0.001) higher than those for adults, except for customer service (lower for children) and specialist ratings. Similar respondent characteristics predicted adult and child scores. Plan-level correlations between corresponding adult and child mean scores were moderate to high (r = 0.60-0.85), which translate into fair to moderate agreement (kappa = 0.27-0.61) in ranking health plans. CONCLUSIONS. Adult and child CAHPS provide similar scores and plan rankings on many aspects of care. Child reports include information that may be useful for consumer choice and to health plans for targeting quality improvement. Methods should be developed for assessing health care for children that minimize cost and respondent burden. C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20852 USA. RP Zhan, CL (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 6011 Execut Blvd,Suite 200, Rockville, MD 20852 USA. NR 22 TC 15 Z9 15 U1 1 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD FEB PY 2002 VL 40 IS 2 BP 145 EP 154 DI 10.1097/00005650-200202000-00009 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 517DB UT WOS:000173594900009 PM 11802087 ER PT J AU Farquhar, CM Steiner, CA AF Farquhar, CM Steiner, CA TI Hysterectomy rates in the United States 1990-1997 SO OBSTETRICS AND GYNECOLOGY LA English DT Article ID ASSISTED VAGINAL HYSTERECTOMY; TOTAL ABDOMINAL HYSTERECTOMY; LAPAROSCOPIC HYSTERECTOMY; APPROPRIATENESS; COMPLICATIONS; MULTICENTER; OUTCOMES AB OBJECTIVE: To assess hysterectomy rates, type of hysterectomy, and other factors associated within the United States from 1990-1997. METHODS: A descriptive statistical analysis of national discharge data was undertaken. Data from the nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (from which national estimates are generated based on a 20% stratified sample of US community hospitals) were used for the years 1990-1997. All women who underwent hysterectomy were identified using International Classification of Diseases, 9th Revision, Clinical Modification, procedure codes. Outcome measures included rate, type of hysterectomy, age of patients, length of stay, total hospital charges, and diagnostic categories. RESULTS: Rates of hysterectomy have not changed significantly over the years from 1990-1997. Rates for hysterectomy in 1990 were 5.5 per 1000 women and increased slightly by 1997 to 5.6 per 1000 women. The type of hysterectomy has changed, with laparoscopic hysterectomy accounting for 9.9% of cases by 1997, with a concomitant decline in abdominal hysterectomy but no substantial change in vaginal hysterectomy rates. Length of stay decreased and total charges increased for all types of hysterectomy. Vaginal hysterectomy and laparoscopic hysterectomy are associated with shorter length of stay than abdominal hysterectomy. Abdominal hysterectomy is e most common procedure (63.0% in 1997). CONCLUSION: The majority of hysterectomies are abdominal, and the most common indication is uterine fibroids. The introduction of alternative techniques for controlling abnormal uterine bleeding such as endometrial ablation has not had an impact on hysterectomy rates, and there has only been a limited uptake of laparoscopic approaches. (C) 2002 by the American College of Obstetricians and Gynecologists. C1 Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, Rockville, MD USA. Ctr Practice & Technol Assessment, Org & Delivery Studies, Rockville, MD USA. RP Farquhar, CM (reprint author), Univ Auckland, Natl Womens Hosp, Dept Obstet & Gynaecol, Auckland 1, New Zealand. OI Farquhar, Cynthia/0000-0002-3685-3553 NR 25 TC 414 Z9 434 U1 0 U2 5 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0029-7844 J9 OBSTET GYNECOL JI Obstet. Gynecol. PD FEB PY 2002 VL 99 IS 2 BP 229 EP 234 DI 10.1016/S0029-7844(01)01723-9 PG 6 WC Obstetrics & Gynecology SC Obstetrics & Gynecology GA 516CB UT WOS:000173533100012 PM 11814502 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Serv Task Force TI Screening for lipid disorders in adults: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Article ID PREDICTION C1 UPSTF, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. RP Berg, AO (reprint author), UPSTF, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 7 TC 3 Z9 3 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JAN 15 PY 2002 VL 65 IS 2 BP 273 EP 276 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 514QQ UT WOS:000173452900013 ER PT J AU Eisenberg, JM AF Eisenberg, JM TI Measuring quality: Are we ready to compare the quality of care among physician groups? SO ANNALS OF INTERNAL MEDICINE LA English DT Editorial Material ID CONSUMERS C1 US Dept HHS, Agcy Healthcare Res & Qual, Washington, DC 20007 USA. RP Eisenberg, JM (reprint author), 2101 E Jefferson St, Rockville, MD 20852 USA. NR 7 TC 5 Z9 5 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD JAN 15 PY 2002 VL 136 IS 2 BP 153 EP 154 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 512PZ UT WOS:000173333900008 PM 11790069 ER PT S AU Graham, R AF Graham, R BE Weingarten, S Tinker, J TI Putting evidence to work: prevention, practice and policy SO EVIDENCE-BASED MEDICINE: A CRITICAL ASSESSMENT SE ROYAL SOCIETY OF MEDICINE INTERNATIONAL CONGRESS AND SYMPOSIUM SERIES LA English DT Proceedings Paper CT Conference on Evidence-based Medicine CY JAN 31-FEB 01, 2002 CL CEDARS SINAI MED CTR, LOS ANGELES, CA HO CEDARS SINAI MED CTR AB This paper will discuss how evidence-based medicine can be used as a policy tool and some of the challenges of using evidence as a discipline that will inform decision-making. Within the US federal structure (the Department of Health and Human Services, the US Public Health Service) there are a number of agencies which have fairly high public profiles, such as the National Institutes of Health (NIH), the Centers for Disease Control, and the Food and Drug Administration (FDA). The Agency for Healthcare Research and Quality (AHRQ) is a relatively small agency that has existed for about 10 years. Approximately $300 million dollars were appropriated to AHRQ in 2001, compared to $21 billion dollars devoted to the NIH for biomedical research. The sole focus of AHRQ is on health services. research and quality. Examples of activities which are funded by AHRQ include the US Preventive Services Task Force, technology assessment, evidence-based practice centres, translating research into practice, and basic health services research. Evidence-based medicine is fundamental to how AHRQ operates. AHRQ is also the leadership agency within the US Public Health Service for ensuring there is funding and dissemination of the issues of evidence-based medicine. C1 Agcy Hlth Care Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD USA. RP Graham, R (reprint author), Agcy Hlth Care Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD USA. NR 2 TC 0 Z9 0 U1 0 U2 0 PU ROYAL SOC MEDICINE PRESS LTD PI LONDON PA 1 WIMPOLE STREET, LONDON W1M 8AE, ENGLAND SN 0142-2367 BN 1-85315-520-9 J9 ROY SOC MED INT CONG PY 2002 VL 252 BP 29 EP 36 PG 8 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA BV44P UT WOS:000178984600003 ER PT J AU Gergen, PJ AF Gergen, PJ TI Rackemann and Colmes on the clinical characteristics of hypersensitiveness SO JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY LA English DT Article ID HOUSE-DUST MITE; ALLERGIC DISEASE; CHILDHOOD ASTHMA; MORTALITY; ASSOCIATION; EXPOSURE; ATOPY; TESTS; IGE C1 Ctr Primary Care & Res, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Gergen, PJ (reprint author), Ctr Primary Care & Res, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 22 TC 0 Z9 0 U1 0 U2 0 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0091-6749 J9 J ALLERGY CLIN IMMUN JI J. Allergy Clin. Immunol. PD JAN PY 2002 VL 109 IS 1 BP 180 EP 183 PG 4 WC Allergy; Immunology SC Allergy; Immunology GA 519RM UT WOS:000173739300033 ER PT J AU Aaron, KF Bass, EB AF Aaron, KF Bass, EB TI A call for papers - Community-based participatory research SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material ID HEALTH C1 Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD 20852 USA. RP Aaron, KF (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD 20852 USA. NR 4 TC 1 Z9 1 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JAN PY 2002 VL 17 IS 1 BP 84 EP 84 DI 10.1046/j.1525-1497.2002.11133.x PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 542FM UT WOS:000175032900012 PM 11903781 ER PT B AU Reilly, T Meyer, G Zema, C Crofton, C Larson, D Darby, C Crosson, K AF Reilly, T Meyer, G Zema, C Crofton, C Larson, D Darby, C Crosson, K GP OECD OECD TI Providing performance information for consumers: Experience from the United States SO MEASURING UP: IMPROVING HEALTH SYSTEM PERFORMANCE IN OECD COUNTRIES LA English DT Proceedings Paper CT Conference on Measuring Up - Improving Health System Performance in OECD Countries CY NOV 05-07, 2001 CL OTTAWA, CANADA ID HEALTH-CARE; QUALITY; CHALLENGES; STRATEGIES AB This paper provides a market-based example of using performance measurement to promote health care quality improvement. Underlying this approach is a model of informed consumers making choices among competing health care providers based on cost and quality. Providing information to consumers on quality can create incentives for providers to improve their performance as they attempt to maintain or expand their market share. The paper focuses on efforts in the United States to provide performance information to consumers. It provides an overview of current performance measurement and reporting efforts and summarizes empirical literature on the effects of such efforts on quality improvement. In brief, these efforts are in their early stages and have not yet had a large impact. The paper concludes by offering reflections on steps that can be taken to make the consumer reporting effort more effective. It suggests that there needs to be a sustained education/promotion effort to raise consumer awareness about quality and the availability of information that can be used to help make better choices. The awareness campaign needs to be closely integrated with a multifaceted infrastructure to provide clear cost and performance information and decision support. Work needs to be continued on horizontal and vertical measure development that is standardized and focused on consumers, with appropriate risk adjustment. Incentives from the market, regulation, and purchasing policy need to be aligned to assert consistent pressure for quality improvement. And, consumer reporting initiatives need to be evaluated to promote continuous improvement. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 52 TC 3 Z9 3 U1 1 U2 2 PU ORGANIZATION ECONOMIC COOPERATION & DEVELOPMENT PI PARIS PA 2, RUE ANDRE PASCAL, CEDEX 16, 75775 PARIS, FRANCE BN 92-64-19676-5 PY 2002 BP 97 EP 116 PG 20 WC Health Policy & Services SC Health Care Sciences & Services GA BU56A UT WOS:000176357800006 ER PT J AU Clancy, CM Andresen, EM AF Clancy, CM Andresen, EM TI Commentary - Meeting the health care needs of persons with disabilities SO MILBANK QUARTERLY LA English DT Editorial Material ID OUTCOMES AB The Agency for Healthcare Research and Quality (AHRQ) has established the Office of Priority Populations Research and is currently developing a research agenda to improve health care for persons with disability (PWDs). This article describes the background of and potential for the AHRQ disability agenda and some of the challenges ahead and considers future directions for disability-related health services research. Strategies for this agenda might include ensuring the inclusion of PWDs in current and future health care research studies and database development; support for studies and data focusing exclusively on PWDs; and support for studies of the challenges common to all or most of the priority populations. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. St Louis Univ, St Louis, MO 63103 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 25 TC 13 Z9 13 U1 2 U2 4 PU BLACKWELL PUBLISHERS PI MALDEN PA 350 MAIN STREET, STE 6, MALDEN, MA 02148 USA SN 0887-378X J9 MILBANK Q JI Milbank Q. PY 2002 VL 80 IS 2 BP 381 EP + DI 10.1111/1468-0009.t01-1-00008 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 568MQ UT WOS:000176546300008 PM 12101877 ER PT J AU Ortega, AN Gergen, PJ Paltiel, AD Bauchner, H Belanger, KD Leaderer, BP AF Ortega, AN Gergen, PJ Paltiel, AD Bauchner, H Belanger, KD Leaderer, BP TI Impact of site of care, race, and Hispanic ethnicity on medication use for childhood asthma SO PEDIATRICS LA English DT Article DE asthma; child; practice guidelines; health insurance; Hispanic Americans ID INNER-CITY CHILDREN; PRACTICE GUIDELINES; AFRICAN-AMERICAN; MANAGEMENT; MORBIDITY; BARRIERS; BELIEFS; VISITS; STATES; RISK AB Objective. To understand the importance of source of care and other factors that influence differences in asthma medication use by race and Hispanic ethnicity. Methods. The Childhood Asthma Severity Study provided 12-month, retrospective, parent-reported questionnaire data on a monthly basis for children ages less than or equal to 12 years in a community sample of 1002 children and their families from Connecticut and Massachusetts. Medications considered included cromolyn, beta2-agonist, inhaled steroids, anticholinergics, theophylline, and systemic steroids. Information was available on demographics, insurance status, symptom severity, primary care contact, and provider practice types. Results. Black and Hispanic children received fewer beta2-agonists, and Hispanic children received fewer inhaled steroids than white children after adjusting for patients' race, age, gender, insurance status, symptom severity, number of primary care visits for asthma, number of urgent visits to the regular provider, family income, maternal education, and site of care. When multivariate analyses were restricted to patients in private practice, the significant association between Hispanic ethnicity and low inhaled steroid use persisted, whereas differences in beta2-agonist use by race and ethnicity changed little but became nonsignificant. Conclusion. Even within private practices, patients' race and ethnicity are associated with clinician nonadherence to national guidelines. Programs to eliminate these disparities will need both to focus on site of care and to intervene at the provider and patient levels to be successful. C1 Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, Div Hlth Policy & Adm, New Haven, CT 06520 USA. Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD USA. Boston Univ, Sch Med, Dept Pediat, Boston, MA 02118 USA. Boston Univ, Sch Med, Dept Social & Behav Sci, Boston, MA 02118 USA. Boston Univ, Sch Publ Hlth, Boston, MA USA. RP Ortega, AN (reprint author), Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, Div Hlth Policy & Adm, 60 Coll St, New Haven, CT 06520 USA. FU NIEHS NIH HHS [ES-07456, ES-05410] NR 34 TC 78 Z9 81 U1 0 U2 4 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JAN PY 2002 VL 109 IS 1 AR e1 DI 10.1542/peds.109.1.e1 PG 6 WC Pediatrics SC Pediatrics GA 507BJ UT WOS:000173006600001 PM 11773569 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Services Task Force TI Newborn hearing screening: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Article ID IDENTIFICATION; INTERVENTION; IMPAIRMENT C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. RP Berg, AO (reprint author), Care of Atkins David, US Prevent Serv Task Force, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. EM datkins@ahrq.gov NR 17 TC 6 Z9 6 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X EI 1532-0650 J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD DEC 15 PY 2001 VL 64 IS 12 BP 1995 EP 1999 PG 5 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 505XK UT WOS:000172940700010 ER PT J AU Zhen, CL Sangl, J Bierman, AS Miller, MR Friedman, B Wickizer, SW Meyer, GS AF Zhen, CL Sangl, J Bierman, AS Miller, MR Friedman, B Wickizer, SW Meyer, GS TI Potentially inappropriate medication use in the community-dwelling elderly - Findings from the 1996 Medical Expenditure Panel Survey SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article; Proceedings Paper CT Annual Meeting of the Gerontological-Society-of-America CY NOV, 2000 CL WASHINGTON, D.C. SP Gerontol Soc Amer ID EXPLICIT CRITERIA; NURSING-HOMES; FACILITIES; RESIDENTS AB Context Inappropriate medication use is a major patient safety concerr, especially for the elderly population. Using explicit criteria, prior studies have found that 23.5% and 17.5% of the US community-dwelling elderly population used at least 1 of 20 potentially inappropriate medications in 1987 and 1992, respectively. Objectives To determine the prevalence of potentially inappropriate medication use in community-dwelling elderly persons in 1996, to assess trends over 10 years, categorize inappropriate medication use according to explicit criteria, and to examine risk factors for inappropriate medication use. Design, Setting, and Participants Respondents aged 65 years or older (n=2455) to the 1996 Medical Expenditure Panel Survey, a nationally representative survey of the US noninstitutionalized population were included. A 7-member expert panel was convened to categorize inappropriate medications. Main Outcome Measure Prevalence of use of 33 potentially inappropriate medications. Results In 1996, 21.3% (95% confidence interval [CI], 19.5%-23.1%)of community-dwelling elderly patients in the United States received at least 1 of 33 potentially inappropriate medications. Using the expert panel's classifications, about 2.6% of elderly patients (95% Cl, 2.0%-3.2%) used at least 1 of the 11 medications that should always be avoided by elderly patients; 9.1% (95% Cl, 7.9%-10.3%) used at least 1 cf the 8 that would rarely be appropriate; and 13.3% (95% Cl, 11.7%-14.9%) used at least 1 of the 14 medications that have some indications but are often misused. Use of some inappropriate medications declined between 1987 and 1996. Persons with poor health and more prescriptions had a significantly higher risk of inappropriate medication use. Conclusions Overall inappropriate medication use in elderly patients remains a serious problem. Despite challenges in using explicit criteria for assessing inappropriate medications for elderly patients, such criteria can be applied to population-based surveys to identify opportunities to improve quality of care and patient safety. Enhancements of existing data sources to include dosage, duration, and indication may augment national improvement and monitoring efforts. C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20852 USA. Johns Hopkins Univ, Dept Pediat, Baltimore, MD 21218 USA. Univ Rochester, Dept Community & Prevent Med, Rochester, NY USA. RP Zhen, CL (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 6011 Execut Blvd,Suite 200, Rockville, MD 20852 USA. NR 29 TC 6 Z9 10 U1 0 U2 4 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD DEC 12 PY 2001 VL 286 IS 22 BP 2823 EP 2829 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 500YC UT WOS:000172655400030 ER PT J AU Mandelblatt, JS Bierman, AS Gold, K Zhang, Y Ng, JH Maserejan, N Hwang, YT Meropol, NJ Hadley, J Silliman, RA AF Mandelblatt, JS Bierman, AS Gold, K Zhang, Y Ng, JH Maserejan, N Hwang, YT Meropol, NJ Hadley, J Silliman, RA TI Constructs of burden of illness in older patients with breast cancer: A comparison of measurement methods SO HEALTH SERVICES RESEARCH LA English DT Article DE breast cancer; comorbidity; elderly; health status ID LIFE EXPECTANCY; PROSTATE-CANCER; CONVENIENT APPROXIMATION; CO-MORBIDITY; COMORBIDITY; WOMEN; AGE; CARE; HEALTH; PATTERNS AB Objective. The burden of illness can influence treatment decisions, but there are limited data comparing the performance of different illness burden measures. We assessed the correlations between five previously validated measures of illness burden and global health and physical function and evaluated how each measure correlates with breast cancer treatment patterns in older women. Data Source. A cohort of 718 women > 67 years with early-stage breast cancer formed the study group. Study Design/Data Collection Methods. The study made a cross-sectional comparison of illness burden measures (Charlson index, Index of Co-existent Diseases, cardiopulmonary burden of illness, patient-specific life expectancy, and disease counts) and physical function and self-rated global health status. Data were collected from records and patient interviews. Principal Findings. All of the measures were significantly correlated with each other and with physical function and self-rated health (p < .001). After controlling for age and stage, life expectancy had the largest effect on surgical treatment, followed by self-rated physical function and health; life expectancy was also independent of physical function. For instance, women with higher life expectancy and better self-rated physical function and health were more likely to receive breast conservation and radiation than sicker women. Women with higher physical functioning were more likely to receive adjuvant chemotherapy than women with lower functioning. Conclusions. Several measures of illness burden were associated with breast cancer therapy, but each measure accounted for only a small amount of variance in treatment patterns. Future work is needed to develop and validate measures of burden of illness that are feasible, comprehensive, and relevant for diverse clinical and health services objectives. C1 Georgetown Univ, Med Ctr, Lombardi Canc Ctr, Dept Oncol, Washington, DC 20007 USA. Off Outcomes & Effectiveness, Agcy Healthcare Res & Qual, Rockville, MD USA. Georgetown Univ, Sch Med, Inst Hlth Care Policy & Res, Dept Biomath & Biostat, Washington, DC 20057 USA. Fox Chase Canc Ctr, Div Med Sci, Philadelphia, PA 19111 USA. Fox Chase Canc Ctr, Div Populat Sci, Philadelphia, PA 19111 USA. Georgetown Univ, Dept Publ Policy, Washington, DC 20057 USA. Boston Univ, Sch Med, Dept Med, Boston, MA 02215 USA. Boston Univ, Sch Med, Dept Epidemiol & Biostat, Boston, MA 02215 USA. Boston Univ, Sch Publ Hlth, Dept Epidemiol & Biostat, Boston, MA 02215 USA. Boston Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02215 USA. RP Mandelblatt, JS (reprint author), Georgetown Univ, Med Ctr, Lombardi Canc Ctr, Dept Oncol, 2233 Wisconsin Ave,Suite 317, Washington, DC 20007 USA. FU AHRQ HHS [R01 HS 08395] NR 66 TC 31 Z9 31 U1 3 U2 4 PU BLACKWELL PUBL LTD PI OXFORD PA 108 COWLEY RD, OXFORD OX4 1JF, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2001 VL 36 IS 6 BP 1085 EP 1107 PN 1 PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 502ZW UT WOS:000172773500008 PM 11775669 ER PT J AU Bailey, JJ Berson, AS Handelsman, H Hodges, M AF Bailey, JJ Berson, AS Handelsman, H Hodges, M TI Utility of current risk stratification tests for predicting major arrhythmic events after myocardial infarction SO JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY LA English DT Article ID HEART-RATE-VARIABILITY; SIGNAL-AVERAGED ELECTROCARDIOGRAM; SUDDEN CARDIAC DEATH; PROGRAMMED VENTRICULAR STIMULATION; TERM FOLLOW-UP; SPECTRAL TURBULENCE ANALYSIS; FIRST-CHOICE THERAPY; PROGNOSTIC-SIGNIFICANCE; LATE POTENTIALS; IMPLANTABLE DEFIBRILLATOR AB Objectives We surveyed the literature to estimate prediction values for five common tests for risk of major arrhythmic events (MAEs) after myocardial infarction. We then determined feasibility of a staged risk stratification using combinations of noninvasive tests, reserving an electrophysiologic study (EPS) as the final test. Background Improved approaches are needed for identifying those patients at highest risk for subsequent MAE and candidates for implantable cardioverter-defibrillators. Methods We located 44 reports for which values of MAE incidence and predictive accuracy could be inferred: signal-averaged electrocardiography; heart rate variability severe ventricular arrhythmia on ambulatory electrocardiography; left ventricular ejection fraction; and EPS. A meta-analysis of reports used receiver-operating characteristic curves to estimate mean values for sensitivity and specificity for each test and 95% confidence limits. We then simulated a clinical situation in which risk was estimated by combining tests in three stages. Results Test sensitivities ranged from 42.8% to 62.4%; specificities from 77.4% to 85.8%. A three-stage stratification yielded a low-risk group (80.0% with a two-year MAE risk of 2.9%), a high-risk group (11.8% with a 41.4% risk) and an unstratified group (8.2% with an 8.9% risk equivalent to a two-year incidence of 7.9%). Conclusions Sensitivities and specificities for the five tests were relatively similar. No one test was satisfactory alone for predicting risk. Combinations of tests in stages allowed us to stratify 91.8% of patients as either high-risk or low-risk. These data suggest that a large prospective study to develop a robust prediction model is feasible and desirable. (J Am Coll Cardiol 2001; 38:1902-11) (C) 2001 by the American College of Cardiology. C1 NIH, Ctr Informat Technol, Bethesda, MD 20892 USA. NHLBI, Bioengn Sci Res Grp, Bethesda, MD 20892 USA. Agcy Hlth Care Res & Qual, Ctr Practice & Technol Assessment, Bethesda, MD USA. Minneapolis Heart Inst Fdn, Minneapolis, MN USA. RP Bailey, JJ (reprint author), NIH, Ctr Informat Technol, Bldg 12A,Room 2007,MSC 5620,9000 Rockville Pike, Bethesda, MD 20892 USA. NR 70 TC 94 Z9 96 U1 1 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0735-1097 J9 J AM COLL CARDIOL JI J. Am. Coll. Cardiol. PD DEC PY 2001 VL 38 IS 7 BP 1902 EP 1911 DI 10.1016/S0735-1097(01)01667-9 PG 10 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 497LX UT WOS:000172458000020 PM 11738292 ER PT J AU Weinick, RM Burstin, H AF Weinick, RM Burstin, H TI Monitoring the safety net: Data challenges for emergency departments SO ACADEMIC EMERGENCY MEDICINE LA English DT Editorial Material DE monitoring; safety net; emergency departments; data collection; surveillance C1 Agcy Hlth Care Res & Qual, Ctr Primary Care Res, Rockville, MD USA. RP Weinick, RM (reprint author), Agcy Hlth Care Res & Qual, Ctr Primary Care Res, Rockville, MD USA. NR 2 TC 5 Z9 5 U1 1 U2 1 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD NOV PY 2001 VL 8 IS 11 BP 1019 EP 1021 DI 10.1111/j.1553-2712.2001.tb01108.x PG 3 WC Emergency Medicine SC Emergency Medicine GA 488YQ UT WOS:000171964900003 PM 11691661 ER PT J AU Sun, BC Adams, JG Burstin, HR AF Sun, BC Adams, JG Burstin, HR TI Validating a model of patient satisfaction with emergency care SO ANNALS OF EMERGENCY MEDICINE LA English DT Article; Proceedings Paper CT American-College-of-Emergency-Physicians-Research Forum CY OCT, 2001 CL CHICAGO, ILLINOIS SP Amer Coll Emergency Physicians ID QUALITY AB Study objective: We sought to validate a previously developed model of emergency department patient satisfaction in a general population using a standard mailed format. The study aims to export the findings of a comprehensive ED quality-of-care study to an easily measured patient population. Methods: A double-sided, single-page survey was mailed to all patients discharged home from 4 teaching hospital EDs during a 1-month period. Determinants of patient satisfaction were analyzed with a previously developed multivariate, ordinal logistic-regression model. Results: The mail survey response rate was 22.9% (2,373/10,381). The survey validates the importance of previously identified determinants of patient satisfaction, including age, help not received when needed, poor explanation of problem, not told about wait time, not told when to resume normal activity, poor explanation of test results, and not told when to return to the ED (P < .01). Greater age predicted higher patient satisfaction, whereas all other variables correlated with lower patient satisfaction. In contrast with prior findings, black race was not a significant predictor of satisfaction in the mail survey population. Low ratings of overall care are strongly correlated with reduced willingness to return (P < .0001). Conclusion: A patient satisfaction model was previously developed from a comprehensive research survey of ED care. We demonstrate the generalizability of this model to a mail survey population and replicate the finding that satisfaction strongly predicts willingness to return. The response rate of this study is typical of commercial patient-satisfaction surveys. The validated model suggests that ED patient satisfaction improvement efforts should focus on a limited number of modifiable and easily measured factors. C1 Brigham & Womens Hosp, Dept Emergency Med, Boston, MA 02115 USA. Northwestern Univ, Sch Med, Div Emergency Med, Chicago, IL USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Sun, BC (reprint author), Brigham & Womens Hosp, Dept Emergency Med, 75 Francis St, Boston, MA 02115 USA. NR 19 TC 47 Z9 48 U1 0 U2 3 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD NOV PY 2001 VL 38 IS 5 BP 527 EP 532 DI 10.1067/mem.2001.119250 PG 6 WC Emergency Medicine SC Emergency Medicine GA 488GK UT WOS:000171927700006 PM 11679864 ER PT J AU Stevenson, LA Gergen, PJ Hoover, DR Rosenstreich, D Mannino, DM Matte, TD AF Stevenson, LA Gergen, PJ Hoover, DR Rosenstreich, D Mannino, DM Matte, TD TI Sociodemographic correlates of indoor allergen sensitivity among United States children SO JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY LA English DT Article DE race; indoor allergens; sensitivity; children; prevalence; NHANES ID SKIN-TEST REACTIVITY; HOUSE-DUST MITE; DIESEL EXHAUST PARTICLES; INNER-CITY CHILDREN; ASTHMA HOSPITALIZATION; MEXICAN-AMERICAN; RISK-FACTORS; COCKROACH ALLERGEN; CAT ALLERGENS; PUERTO-RICAN AB Background: Exposure to indoor allergens is associated with asthma morbidity. Nationally, asthma morbidity disproportionately affects socially disadvantaged populations, but it is unclear whether exposure to indoor allergens follows a similar pattern. Objective: We sought to examine the national prevalences and demographic correlates of sensitivity to indoor allergens related to asthma. Methods: Analysis of a cross-sectional survey of a representative sample of 4164 United States children aged 6 to 16 years who participated in allergen testing in the Third National Health and Nutrition Examination Survey from 1988 to 1994 was performed. The main outcome measures were sensitivity reactions to cockroach, dust mite, cat, and Alternaria alternata, as measured via skin prick testing. Results: Multivariate models, including sex, age, race-ethnicity, education, poverty, family history, region of country, housing age, crowding, and urban residence, revealed significant racial-ethnic disparities in sensitivity. Compared with white children, African American children had higher odds ratios (ORs) of cockroach or dust mite sensitivity (cockroach,. [95% Cl, 1.9-3.2]; dust mite OR, 1.3 [95% CI, 1.0-1.7]), as did Mexican American children (cockroach OR, 1.9 [95% CI, 1.3-2.8]; dust mite OR, 1.6 [95% C1, 1.2-2.2]). African American children also had significantly higher odds of sensitivity to A alternata (OR, 2.1 [95% CI, 1.5-2.8]). Conclusions: African American and Mexican American children are substantially more likely than white children to be sensitized to allergens important in asthma. Differences in indoor allergen sensitivity are consistent with racial differences in asthma morbidity. Along with other data, these findings suggest that racial disparities in housing, community, or both environmental factors play a role in determining national patterns of asthma morbidity. C1 New York Acad Med, Ctr Urban Epidemiol Studies, New York, NY 10029 USA. New York City Hlth & Hosp Corp, New York, NY USA. Agcy Healthcare Res & Qual, Ctr Primary Care & Res, Rockville, MD USA. Rutgers State Univ, Dept Stat, Piscataway, NJ USA. Rutgers State Univ, Ctr Hlth Hlth Care Policy & Aging Res, Piscataway, NJ USA. Montefiore Med Ctr, Albert Einstein Coll Med, Div Allergy & Immunol, Bronx, NY 10467 USA. Ctr Dis Control & Prevent, Div Environm Hazards & Hlth Effects, Natl Ctr Environm Hlth, Atlanta, GA USA. RP Stevenson, LA (reprint author), New York Acad Med, Ctr Urban Epidemiol Studies, 1216 5th Ave, New York, NY 10029 USA. OI Mannino, David/0000-0003-3646-7828 NR 48 TC 66 Z9 66 U1 1 U2 1 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0091-6749 J9 J ALLERGY CLIN IMMUN JI J. Allergy Clin. Immunol. PD NOV PY 2001 VL 108 IS 5 BP 747 EP 752 DI 10.1067/mai.2001.119410 PG 6 WC Allergy; Immunology SC Allergy; Immunology GA 498RG UT WOS:000172523800014 PM 11692099 ER PT J AU Kirby, JB AF Kirby, JB TI Exposure, resistance, and recovery: a three-dimensional framework for the study of mortality from infectious disease SO SOCIAL SCIENCE & MEDICINE LA English DT Article DE mortality; infectious disease; cholera ID EDUCATION; COUNTRIES AB It has been suggested by several scholars that debates surrounding the study of mortality could benefit from a framework that integrates social and economic factors with the biological mechanisms of illness and death (Johannson and Mosk, Popul. Stud. 41 (1987) 207-236; Mosley, International Population Conference, Vol. 2, Florence, IUSSP, Liege, 1985, pp. 189-203; Mosley and Chen, in W. H. Mosley, L. C. Chen (Eds.), Child Survival: Strategies for Research, Population Council, New York, 1984, pp. 25-45; Murray and Chen, Soc. Sci. Med. 36(2) (1993) 143-155; Ruzicka, International Population Conference, Vol. 2, Florence, IUSSP, Liege, 1985, pp. 185-187). In this paper, I present a conceptual framework aimed at doing this for infectious disease mortality. The framework is built around three proximate processes: (1) exposure to potentially lethal pathogens, (2) resistance to disease pathogens after exposure, and (3) recovery from disease episodes after contraction. I apply this conceptual framework to morbidity and mortality from cholera across 41 less developed nations. Published by Elsevier Science Ltd. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Kirby, JB (reprint author), Agcy Healthcare Res & Qual, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 32 TC 0 Z9 0 U1 2 U2 2 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0277-9536 J9 SOC SCI MED JI Soc. Sci. Med. PD NOV PY 2001 VL 53 IS 9 BP 1205 EP 1215 DI 10.1016/S0277-9536(00)00420-2 PG 11 WC Public, Environmental & Occupational Health; Social Sciences, Biomedical SC Public, Environmental & Occupational Health; Biomedical Social Sciences GA 468MT UT WOS:000170762000008 PM 11556610 ER PT J AU Green, LA Lanier, D Yawn, BP AF Green, LA Lanier, D Yawn, BP TI The ecology of medical care revisited. Reply SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Letter C1 Robert Graham Ctr, Washington, DC 20036 USA. Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. Olmsted Med Ctr, Rochester, MN 55904 USA. RP Green, LA (reprint author), Robert Graham Ctr, Washington, DC 20036 USA. NR 0 TC 1 Z9 1 U1 0 U2 1 PU MASSACHUSETTS MEDICAL SOC/NEJM PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD OCT 18 PY 2001 VL 345 IS 16 BP 1212 EP 1212 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 482YX UT WOS:000171605800019 ER PT J AU Hellinger, FJ Young, GJ AF Hellinger, FJ Young, GJ TI Economic consequences of collective bargaining by physicians - Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. Boston Univ, Sch Publ Hlth, Dept Vet Affairs, Boston, MA USA. RP Hellinger, FJ (reprint author), Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD OCT 17 PY 2001 VL 286 IS 15 BP 1838 EP 1839 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 482UH UT WOS:000171595300022 ER PT J AU Simonsen, L Morens, DM Elixhauser, A Gerber, M Van Raden, M Blackwelder, WC AF Simonsen, L Morens, DM Elixhauser, A Gerber, M Van Raden, M Blackwelder, WC TI Effect of rotavirus vaccination programme on trends in admission of infants to hospital for intussusception SO LANCET LA English DT Article ID DEVELOPING-COUNTRIES; UNITED-STATES; IMMUNIZATION; INFECTION; CHILDREN; FUTURE AB Background Studies have reported a temporal association between a first dose of rotavirus vaccine (Rotashield) and infant intussusception. We investigated the effect of Rotashield vaccination use on intussusception admissions in ten US states. Methods We analysed electronic databases containing 100% hospital discharge records for 1993-99 from ten US states, where an estimated 28% of the birth cohort had received Rotashield (based on manufacturer's net sales data). We examined records of infants admitted to hospital (<365 days old) with any mention of intussusception (international Classification of Diseases, ninth revision. clinical modification code 560.0). Excess admissions for intussusception during the period of Rotashield availability (October 1998 to June 1999) were estimated by direct comparison with the corresponding period of October 1997 to June 1998 (before Rotashield was available) and with adjustment for secular trends during 1993-98 by Poisson regression. Findings Hospital admission for intussusception among infants younger than 365 days of age during the Rotashield period compared with previously was 4% lower (10 cases) by direct comparison and 10% lower (27 cases) by trend comparison, corresponding to a negative population attributable risk. Among infants aged 45-210 days (target age range for a first Rotashield dose), we estimated an increase in intussusception admissions of 1% (one excess admission) by direct comparison and 4% (4.6 excess admissions) by trend comparison, corresponding to a population attributable risk range of one excess admission in 66 000-302 000. Interpretation We found no evidence of increased infant intussusception admissions during the period of Rotashield availability. The total intussusception admission risk attributable to Rotashield was substantially lower than previous estimates based on studies focusing on the immediate postvaccination weeks. C1 NIAID, NIH, Bethesda, MD 20892 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Simonsen, L (reprint author), 6700-B Rockledge Dr,Room 3153, Bethesda, MD 20892 USA. OI Simonsen, Lone/0000-0003-1535-8526 NR 20 TC 76 Z9 78 U1 0 U2 0 PU LANCET LTD PI LONDON PA 84 THEOBALDS RD, LONDON WC1X 8RR, ENGLAND SN 0140-6736 J9 LANCET JI Lancet PD OCT 13 PY 2001 VL 358 IS 9289 BP 1224 EP 1229 DI 10.1016/S0140-6736(01)06346-2 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 481NX UT WOS:000171527000012 PM 11675060 ER PT J AU Fishman, A Fessler, H Martinez, F McKenna, RJ Naunheim, K Piantadosi, S Weinmann, G Wise, R AF Fishman, A Fessler, H Martinez, F McKenna, RJ Naunheim, K Piantadosi, S Weinmann, G Wise, R CA National Emphysema Treatment Trial TI Patients at high risk of death after lung-volume-reduction surgery SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID OBSTRUCTIVE PULMONARY-DISEASE; SEVERE EMPHYSEMA; DIFFUSING-CAPACITY; PREDICTORS; MORBIDITY; MORTALITY; VALUES; REHABILITATION; PNEUMONOPLASTY; PNEUMOPLASTY AB Background: Lung-volume-reduction surgery is a proposed treatment for emphysema, but optimal selection criteria have not been defined. The National Emphysema Treatment Trial is a randomized, multicenter clinical trial comparing lung-volume-reduction surgery with medical treatment. Methods: After evaluation and pulmonary rehabilitation, we randomly assigned patients to undergo lung-volume-reduction surgery or receive medical treatment. Outcomes were monitored by an independent data and safety monitoring board. Results: A total of 1033 patients had been randomized by June 2001. For 69 patients who had a forced expiratory volume in one second (FEV(sub 1)) that was no more than 20 percent of their predicted value and either a homogeneous distribution of emphysema on computed tomography or a carbon monoxide diffusing capacity that was no more than 20 percent of their predicted value, the 30-day mortality rate after surgery was 16 percent (95 percent confidence interval, 8.2 to 26.7 percent), as compared with a rate of 0 percent among 70 medically treated patients (P<0.001). Among these high-risk patients, the overall mortality rate was higher in surgical patients than medical patients (0.43 deaths per person-year vs. 0.11 deaths per person-year; relative risk, 3.9; 95 percent confidence interval, 1.9 to 9.0). As compared with medically treated patients, survivors of surgery had small improvements at six months in the maximal workload (P=0.06), the distance walked in six minutes (P=0.03), and FEV(sub 1) (P<0.001), but a similar health-related quality of life. The results of the analysis of functional outcomes for all patients, which accounted for deaths and missing data, did not favor either treatment. Conclusions: Caution is warranted in the use of lung-volume-reduction surgery in patients with emphysema who have a low FEV(sub 1) and either homogeneous emphysema or a very low carbon monoxide diffusing capacity. These patients are at high risk for death after surgery and also are unlikely to benefit from the surgery. (N Engl J Med 2001;345:1075-83.) Copyright (C) 2001 Massachusetts Medical Society. C1 Baylor Coll Med, Houston, TX 77030 USA. Brigham & Womens Hosp, Boston, MA 02115 USA. Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. Cleveland Clin Fdn, Cleveland, OH 44195 USA. Columbia Univ, New York, NY USA. Long Isl Jewish Med Ctr, New Hyde Pk, NY 11042 USA. Duke Univ, Med Ctr, Durham, NC USA. Mayo Clin & Mayo Fdn, Rochester, MN 55905 USA. Natl Jewish Med & Res Ctr, Denver, CO USA. Ohio State Univ, Columbus, OH 43210 USA. St Louis Univ, St Louis, MO 63103 USA. Temple Univ, Philadelphia, PA 19122 USA. Univ Calif San Diego, San Diego, CA 92103 USA. Univ Maryland, College Pk, MD 20742 USA. Johns Hopkins Univ Hosp, Baltimore, MD 21287 USA. Univ Michigan, Ann Arbor, MI 48109 USA. Univ Penn, Philadelphia, PA 19104 USA. Univ Pittsburgh, Pittsburgh, PA 15260 USA. Univ Washington, Seattle, WA 98195 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Johns Hopkins Univ, Coordinating Ctr, Baltimore, MD USA. Fred Hutchinson Canc Res Ctr, Cost Effectivness Data Ctr, Seattle, WA 98104 USA. Univ Iowa, CT Scan Image Storage & Anal Ctr, Iowa City, IA USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Temple Univ, Mkt Ctr, Philadelphia, PA 19122 USA. Univ Penn, Off Chair Steering Comm, Philadelphia, PA 19104 USA. NHLBI, Project Off, Bethesda, MD 20892 USA. RP Piantadosi, S (reprint author), NETT, Coordinating Ctr, 615 N Wolfe St,Rm 5010, Baltimore, MD 21205 USA. OI Wise, Robert/0000-0002-8353-2349 NR 50 TC 296 Z9 301 U1 0 U2 3 PU MASSACHUSETTS MEDICAL SOC/NEJM PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD OCT 11 PY 2001 VL 345 IS 15 BP 1075 EP 1083 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA 480QH UT WOS:000171473100001 ER PT J AU Gergen, PJ Murillo, S Macri, CJ AF Gergen, PJ Murillo, S Macri, CJ TI Sickle cell screening among pediatric Latino immigrants. SO AMERICAN JOURNAL OF HUMAN GENETICS LA English DT Meeting Abstract C1 AHRQ, Ctr Primary Care, Rockville, MD USA. Howard Univ, Dept Pediat, Washington, DC USA. Uniformed Serv Univ Hlth Sci, Dept Obstet & Gynecol, Bethesda, MD 20814 USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU UNIV CHICAGO PRESS PI CHICAGO PA 1427 E 60TH ST, CHICAGO, IL 60637-2954 USA SN 0002-9297 J9 AM J HUM GENET JI Am. J. Hum. Genet. PD OCT PY 2001 VL 69 IS 4 SU 1 MA 1460 BP 432 EP 432 PG 1 WC Genetics & Heredity SC Genetics & Heredity GA 483RD UT WOS:000171648901459 ER PT J AU Cohen, JW Dougherty, DD Machlin, SR Spector, WD AF Cohen, JW Dougherty, DD Machlin, SR Spector, WD TI Who pays for home health care: Shifting burdens past and present SO GERONTOLOGIST LA English DT Meeting Abstract C1 AHRQ, Rockville, MD 20852 USA. Westat Corp, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2001 VL 41 SI 1 BP 324 EP 324 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 478TA UT WOS:000171360401153 ER PT J AU Case, C Johantgen, M Steiner, C AF Case, C Johantgen, M Steiner, C TI Outpatient mastectomy: Clinical, payer, and geographic influences SO HEALTH SERVICES RESEARCH LA English DT Article; Proceedings Paper CT National Meeting of the Society-of-General-Internal-Medicine CY APR 29-MAY 01, 1999 CL SAN FRANCISCO, CALIFORNIA SP Soc Gen Internal Med DE ambulatory surgery; breast-conserving surgery; managed care; mastectomy; practice pattern variation ID BREAST-CANCER SURGERY; ASSOCIATION; ADVANTAGES; DISCHARGE; OUTCOMES; LENGTH; STAY; CARE AB Objective. To determine (1) the use of outpatient services for all surgical breast procedures for breast cancer and (2) the influence of payer and state on the use of outpatient services for complete mastectomy in light of state and federal length-of-stay managed care legislation. Data Sources. Healthcare Cost and Utilization Project representing all discharges from hospitals and ambulatory surgery centers for five states (Colorado, Connecticut, Maryland, New Jersey, and New York) and seven years (1990-96). Study Design. Longitudinal, cross-sectional analyses of all women undergoing inpatient and outpatient complete mastectomy (CMAS), subtotal mastectomy (STMAS), and lumpectomy (LUMP) for cancer were employed. Total age-adjusted rates and percentage of outpatient CMAS, STMAS, and LUMP were compared. Independent influence of state and HMO payer on likelihood of receiving an outpatient CMAS was determined from multivariate models, adjusting for clinical characteristics (age < 50 years, comorbidity, metastases, simple mastectomy, breast reconstruction) and hospital characteristics (teaching, ownership, urban). Principal Findings. In 1993, 1 to 2 percent of CMASs were outpatient in all states. By 1996, 8 percent of CMASs were outpatient in Connecticut, 13 percent were outpatient in Maryland, and 22 percent were outpatient in Colorado. In comparison, LUMPs were 78 to 88 percent outpatient, and by 1996, 43 to 72 percent of STMASs were outpatient. In 1996, women were 30 percent more likely to receive an outpatient CMAS in New York, 2.5 times more likely in Connecticut, 4.7 times more likely in Maryland, and 8.6 times more likely in Colorado compared to New Jersey. In addition, women with Medicare, Medicaid, or private commercial insurance were less likely to receive an outpatient CMAS compared to women with an HMO payer. Conclusions. LUMP is an outpatient procedure, and STMAS is becoming primarily outpatient. CMAS, while still primarily inpatient, is increasingly outpatient in some states. Although clinical characteristics remain important, the state in which a woman receives care and whether she has an HMO payer are strong determinants of whether she receives an outpatient CMAS. C1 US Dept HHS, Agcy Hlth Care Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. RP Steiner, C (reprint author), US Dept HHS, Agcy Hlth Care Res & Qual, Ctr Org & Delivery Studies, 2101 E Jefferson,Suite 605, Rockville, MD 20852 USA. NR 34 TC 23 Z9 24 U1 1 U2 4 PU HEALTH ADMINISTRATION PRESS PI CHICAGO PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES ONE N FRANKLIN ST, STE 1700, CHICAGO, IL 60606-3491 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD OCT PY 2001 VL 36 IS 5 BP 869 EP 884 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 482PA UT WOS:000171583400004 PM 11666108 ER PT J AU Federman, AD Cook, EF Phillips, RS Puopolo, AL Haas, JS Brennan, TA Burstin, HR AF Federman, AD Cook, EF Phillips, RS Puopolo, AL Haas, JS Brennan, TA Burstin, HR TI Intention to discontinue care among primary care patients - Influence of physician behavior and process of care SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article; Proceedings Paper CT 17th Annual Meeting of the Association-for-Health-Services-Research CY JUN 25-27, 2000 CL LOS ANGELES, CALIFORNIA SP Assoc Hlth Serv Res DE physician behavior; primary care; continuity of care; managed care ID FEE-FOR-SERVICE; MANAGED-CARE; MEDICAL-CARE; PATIENTS EXPECTATIONS; FINANCIAL INCENTIVES; OUTPATIENT CARE; SATISFACTION; OUTCOMES; CONTINUITY; DISENROLLMENT AB BACKGROUND: Specific elements of health care process and physician behavior have been shown to influence disenrollment decisions in HMOs, but not in outpatient settings caring for patients with diverse types of insurance coverage. OBJECTIVE: To examine whether physician behavior and process of care affect patients' intention to return to their usual health care practice. DESIGN. Cross-sectional patient survey and medical record review. SETTING: Eleven academically affiliated primary care medicine practices in the Boston area. PATIENTS: 2,782 patients with at least one visit in the preceding year. MEASUREMENT: Unwillingness to return to the usual health care practice. RESULTS: Of the 2,782 patients Interviewed, 160 (5.8%) indicated they would not be willing to return. Two variables correlated significantly with unwillingness to return after adjustment for demographics, health status, health care utilization, satisfaction with physician's technical skill, site of care, and clustering of patients by provider: dissatisfaction with visit duration (odds ratio [OR], 3.2; 95% confidence Interval [CI], 1.4 to 7.4) and patient reports that the physician did not listen to what the patient had to say (OR, 8.8; 95% Cl, 2.5 to 30.7). In subgroup analysis, patients who were prescribed medications at their last visit but who did not receive an explanation of the purpose of the medication were more likely to be unwilling to return (OR, 4.9; 95% Cl, 1.8 to 13.3). CONCLUSION: Failure of physicians to acknowledge patient concerns, provide explanations of care, and spend sufficient time with patients may contribute to patients' decisions to discontinue care at their usual site of care. C1 Brigham & Womens Hosp, Div Gen Med, Boston, MA 02115 USA. Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Div Gen Med & Primary Care, Boston, MA USA. Univ Calif San Francisco, Inst Hlth Policy Studies, San Francisco, CA 94143 USA. Univ Calif San Francisco, San Francisco Gen Hosp, Div Gen Internal Med, San Francisco, CA 94143 USA. Agcy Hlth Care Res & Qual, Rockville, MD USA. RP Brennan, TA (reprint author), Brigham & Womens Hosp, Div Gen Med, 75 Francis St, Boston, MA 02115 USA. FU PHS HHS [5T3211001-13] NR 41 TC 31 Z9 31 U1 2 U2 4 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD OCT PY 2001 VL 16 IS 10 BP 668 EP 674 DI 10.1111/j.1525-1497.2001.01028.x PG 7 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 485RV UT WOS:000171773400004 PM 11679034 ER PT J AU Ortega, AN Belanger, KD Paltiel, AD Horwitz, SM Bracken, MB Leaderer, BP AF Ortega, AN Belanger, KD Paltiel, AD Horwitz, SM Bracken, MB Leaderer, BP TI Use of health services by insurance status among children with asthma SO MEDICAL CARE LA English DT Article DE childhood asthma; United States; race; health-services; medicaid ID INNER-CITY CHILDREN; CHILDHOOD ASTHMA; PEDIATRIC ASTHMA; UNITED-STATES; PRIMARY-CARE; PREVALENCE; EMERGENCY; BARRIERS; MEDICAID; ACCESS AB OBJECTIVES. It is well known that asthmatic children receiving Medicaid use the emergency department (ED) more frequently than otherwise-insured asthmatic children. However, the extent to which this difference is attributable to provider characteristics, medication use, access to primary care, and symptomatology is poorly understood. These factors were explored as independent predictors of health care utilization. METHODS. Baseline data from a prospective cohort study of childhood asthma severity were used. Subjects were recruited from seven New England hospitals. Home interviews collected data on monthly symptoms, health care visits, insurance status, as well as sociodemographics and asthma-related risk factors (n=804). Characteristics of providers' practices, board certifications, and asthma specialty were obtained from Folio's Medical Dictionaries for Connecticut and Massachusetts. RESULTS. After adjusting for frequency of asthma-related primary care visits, primary provider practice type, use of asthma specialist, age, gender, medication use, and symptom-atology, Medicaid children still used the ED more frequently for asthma services than privately insured children (RR, 1.7; 95% CI, 1.1, 2.5). In general, race/ethnicity did not modify the relationship between insurance status and health care use, except that black children receiving Medicaid were 90% (95% Cl, 0.0, 0.7) less likely to have had greater than or equal to3 routine primary care visits for asthma in the previous year than black privately insured children. White children receiving Medicaid were 2.5 (95% CI, 1.0, 6.9) times more likely to use the ED for asthma than privately insured white children. CONCLUSIONS. The results suggest that enabling, structural, and need factors do not necessarily explain observed differences in pediatric asthma health care use by insurance status. Future investigation must explore other explanatory factors such as maternal attitudes and beliefs and patient-provider communication. C1 Yale Univ, Div Hlth Policy & Adm, Dept Epidemiol & Publ Hlth, Sch Med, New Haven, CT 06520 USA. Ctr Primary Care Res, Agcy Healthcare Res & Qual, Rockville, MD USA. Yale Univ, Div Chron Dis Epidemiol, Dept Epidemiol & Publ Hlth, Sch Med, New Haven, CT 06520 USA. Yale Univ, Div Environm Hlth Sci, Dept Epidemiol & Publ Hlth, Sch Med, New Haven, CT 06520 USA. RP Ortega, AN (reprint author), Yale Univ, Div Hlth Policy & Adm, Dept Epidemiol & Publ Hlth, Sch Med, 60 Coll St, New Haven, CT 06520 USA. OI Ortega, Alexander/0000-0001-6861-6993 FU NIEHS NIH HHS [ES-05410, ES-07456] NR 40 TC 38 Z9 39 U1 3 U2 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD OCT PY 2001 VL 39 IS 10 BP 1065 EP 1074 DI 10.1097/00005650-200110000-00004 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 477KT UT WOS:000171283300004 PM 11567169 ER PT J AU Bauchner, H Osganian, S Smith, K Triant, R AF Bauchner, H Osganian, S Smith, K Triant, R TI Improving parent knowledge about antibiotics: A video intervention SO PEDIATRICS LA English DT Article DE antibiotics; antimicrobial agents; parent education; video interventioN ID RESPIRATORY-TRACT INFECTIONS; GENERAL-PRACTICE; RESISTANCE; PRACTITIONERS; EXPECTATIONS; MANAGEMENT; EDUCATION; BEHAVIOR; OUTCOMES; CHILDREN AB Objective. To determine whether an educational video could improve parent knowledge, beliefs, and behaviors about the appropriate use of oral antibiotics. Study Design. A randomized, controlled trial was conducted in an urban primary care clinic and a suburban pediatric practice. Parents were randomly assigned to the intervention or control groups. Parents in the intervention group were asked to view a 20-minute video, specifically developed for this project, over a 2-month period, and given a brochure about antibiotics. Parent knowledge, beliefs, and behaviors were assessed at the time of enrollment and then by telephone 2 months later. Results. A total of 193 (94%) of 206 parents completed the study. The groups were equivalent with respect to all important baseline characteristics. No differences were found for adjusted posttest means between the intervention and control groups for knowledge, beliefs, or behavior. For example, the intervention group scored 8.04 on the knowledge questionnaire (11 true-false questions), compared with 7.82 for the control group. Subgroup analysis, based on site of enrollment, indicated that families in the intervention group from the primary care urban clinic improved their knowledge score (6.03 to 6.92) and were more likely to report that there were problems with children receiving too many antibiotics (intervention 67% vs control 34%). Conclusion. Overall, this video had only a modest effect on parent knowledge, beliefs, and self-reported behaviors regarding oral antibiotics. We believe that any campaign promoting the judicious use of oral antibiotics must use a multifaceted approach and target both parents and physicians. C1 Boston Univ, Sch Med, Div Gen Pediat, Boston, MA 02118 USA. Boston Med Ctr, Boston, MA USA. Univ Massachusetts, Sch Med, Div Prevent & Behav Med, Worcester, MA USA. New England Res Inst, Watertown, MA 02172 USA. RP Bauchner, H (reprint author), Agcy Healthcare Res & Qual, 6010 Execut Blvd,Suite 201, Rockville, MD 20852 USA. FU NIAID NIH HHS [5 R44 AI40815-03] NR 32 TC 26 Z9 27 U1 2 U2 2 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD OCT PY 2001 VL 108 IS 4 BP 845 EP 850 DI 10.1542/peds.108.4.845 PG 6 WC Pediatrics SC Pediatrics GA 478AC UT WOS:000171319600023 PM 11581434 ER PT J AU Gergen, PJ AF Gergen, PJ TI Environmental tobacco smoke as a risk factor for respiratory disease in children SO RESPIRATION PHYSIOLOGY LA English DT Article; Proceedings Paper CT Conference on Susceptibility Factors for Respiratory Diseases CY OCT 03-06, 2000 CL SANTA FE, NEW MEXICO SP Lovelace Respiratory Res Inst DE airways; wheeze; development; children; disease; asthma; mammals; humans; smoking; lung function; environmental tobacco smoke ID PRIMARY-SCHOOL CHILDREN; 1ST 3 YEARS; PASSIVE SMOKING; PARENTAL SMOKING; CHILDHOOD ASTHMA; MATERNAL SMOKING; URINARY COTININE; LUNG-FUNCTION; OLD CHILDREN; PRESCHOOL-CHILDREN AB Respiratory diseases are a frequent reason for using health care. In 1995-1996, diseases of the respiratory tract (ICD 460-519) contributed seven of the top 15 reasons for visits to physician offices among children under 15 years of age in the United States. Environmental tobacco smoke (ETS) is a wide-spread environmental pollutant that has been long linked with respiratory problems. This paper will review the available literature on the role ETS plays in respiratory diseases, including asthma. This review focuses not only on the respiratory problems caused by ETS, but also examines the influence of age at exposure on the consequences of ETS and the importance of the differing sources of ETS exposure. As ETS is a completely preventable form of environmental pollution, the success or failure of various types of interventions will also be reviewed. (C) 2001 Elsevier Science B.V. All rights reserved. C1 Agcy Healthcare Res & Qual, Ctr Primary Care & Res, Rockville, MD 20852 USA. RP Gergen, PJ (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care & Res, Rm 201,6010 Execut Blvd, Rockville, MD 20852 USA. NR 64 TC 38 Z9 39 U1 0 U2 3 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0034-5687 J9 RESP PHYSIOL JI Respir. Physiol. PD OCT PY 2001 VL 128 IS 1 BP 39 EP 46 DI 10.1016/S0034-5687(01)00263-8 PG 8 WC Physiology; Respiratory System SC Physiology; Respiratory System GA 477LB UT WOS:000171284100007 PM 11535261 ER PT J AU Selden, TM Levit, KR Cohen, JW Zuvekas, SH Moeller, JF McKusick, D Arnett, RH AF Selden, TM Levit, KR Cohen, JW Zuvekas, SH Moeller, JF McKusick, D Arnett, RH TI Reconciling medical expenditure estimates from the MEPS and the NHA, 1996 SO HEALTH CARE FINANCING REVIEW LA English DT Article AB This article compares 1996 estimates of national medical care expenditures from the Medical Expenditure Panel Survey MEPS) and the National Health Accounts (NHA). The MEPS estimate for total expenditures in 1996 was $548 billion; whereas, the NHA estimate for personal health care (PHC) in 1996 was $912 billion. Much of this apparent difference, however, arises from differences in scope between MEPS and NHA-rather than from differences in estimates for comparably-defined expenditures. We adjusted the NHA for differences in included populations and types of services covered, finding a much smaller difference between MEPS and a comparably-defined NHA. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Selden, TM (reprint author), Agcy Healthcare Res & Qual, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. EM tselden@ahrq.gov FU PHS HHS [290-99-0002] NR 26 TC 36 Z9 36 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2001 VL 23 IS 1 BP 161 EP 178 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 943TZ UT WOS:000230378800013 PM 12500370 ER PT J AU Encinosa, WE Selden, TM AF Encinosa, WE Selden, TM TI Designing employer health benefits for a heterogeneous workforce: Risk adjustment and its alternatives SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article; Proceedings Paper CT Conference on Private Employers and Risk Adjustment CY FEB, 2000 CL BOSTON UNIV, DEPT ECON, BOSTON, MASSACHUSETTS SP Agcy Healthcare Res & Qual, Dept Vet Affairs, Management Sci Grp HO BOSTON UNIV, DEPT ECON ID INSURANCE MARKETS; ADVERSE SELECTION; COMPETITION; INFORMATION; PLANS; CARE AB Main, health economists recommend that employers provide employees with a risk-adjusted choice among competing health insurance plans. However, formal risk adjustment is rarely if ever used by employers. This paper examines a range of health benefit design options available to employers, focusing attention not only on risk adjustment but also on its alternatives. We argue that while formal risk adjustment is rare, employers commonly use strategies that accomplish some of the same objectives at less cost. C1 Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Encinosa, WE (reprint author), Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 34 TC 9 Z9 9 U1 0 U2 0 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD FAL PY 2001 VL 38 IS 3 BP 270 EP 279 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 494BC UT WOS:000172257500005 PM 11761354 ER PT J AU Hellinger, FJ Fleishman, JA AF Hellinger, FJ Fleishman, JA TI Location, race, and hospital care for AIDS patients: An analysis of 10 states SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID ACQUIRED-IMMUNODEFICIENCY-SYNDROME; HIV-INFECTED ADULTS; UNITED-STATES; ANTIRETROVIRAL THERAPY; MEDICAID HOME; SERVICES; COST; COMMUNITY; MORTALITY; PROGRAMS AB This study is the first statewide comparison of hospital utilization and inpatient mortality rates for people with acquired immune deficiency syndrome (AIDS). Data from 120,772 hospital discharge abstracts for all AIDS-related admissions in 10 states (California, Colorado, Florida, Iowa, Kansas, Maryland, New Jersey, New York, Pennsylvania, and South Carolina) in 1996 were combined with data on the number and the racial and ethnic characteristics of all people living with AIDS (PLWAs) in each state. These data were used to derive population-based estimates of the use of hospital sen,ices per PLWA and of inpatient mortality rates in each state. Multivariate analyses examined sources of variation in inpatient length of stay and inpatient mortality. The primary finding of this study is that hospital utilization rates and inpatient mortality rates for people with AIDS vary, substantially across states and among racial and ethnic groups within states even after adjusting for severity of illness. Blacks and Hispanics had longer hospital stays and were more likely to die in the hospital than whites. State-level policies, such as home and community-based waiver programs and enhanced HIV reimbursement rates, significantly affected hospital use. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Hellinger, FJ (reprint author), Agcy Healthcare Res & Qual, 2101 E Jefferson St,Suite 605, Rockville, MD 20852 USA. NR 45 TC 12 Z9 12 U1 3 U2 5 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD FAL PY 2001 VL 38 IS 3 BP 319 EP 330 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 494BC UT WOS:000172257500011 PM 11761360 ER PT J AU Fleishman, JA Hellinger, FJ AF Fleishman, JA Hellinger, FJ TI Trends in HIV-related inpatient admissions from 1993 to 1997: A seven-state study SO JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE HIV; AIDS; inpatient hospital use; inpatient length of stay ID IMMUNODEFICIENCY-VIRUS INFECTION; ANTIRETROVIRAL THERAPY; UNITED-STATES; AIDS; ZIDOVUDINE; DISEASE; CARE AB Background and Objectives: Reports of declining HIV-related inpatient use have typically been based on limited or local data. Using comprehensive hospital discharge data from seven states, this study examines trends in HIV-related inpatient admission rates and lengths of stay from 1993 through 1997. Methods: We identified HIV-related admissions by the International Classification of Diseases, ninth edition (ICD-9-CM) diagnosis codes in the range 042 to 044. Analyses assessed effects of state, gender, race/ethnicity, insurance, and time period; they also examined differential patterns of change. Results: HIV-related inpatient admission rates rose between 1993 and 1995 but began declining steadily starting in late 1995. This general pattern occurred for all states, demographic groups, and insurers. The magnitude of the decline varied; admissions for white males and for patients with private insurance showed the greatest decreases. Admission rates were highest for African-American males and lowest for white females. Lengths of stay declined steadily; trends did not differ by demographic group or payer. Conclusions: Results document the recent decline in HIV-related hospital admission rates. Relative declines in admissions parallel reported disparities in access to new antiretroviral therapies. Racial/ethnic disparities in inpatient use persist. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 17 TC 21 Z9 21 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1525-4135 J9 J ACQ IMMUN DEF SYND JI J. Acquir. Immune Defic. Syndr. PD SEP 1 PY 2001 VL 28 IS 1 BP 73 EP 80 PG 8 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 476FA UT WOS:000171214500011 PM 11579280 ER PT J AU Chen, FM Rhodes, LA Green, LA AF Chen, FM Rhodes, LA Green, LA CA Robert Graham Center TI Family physicians' personal experiences of their fathers' health care SO JOURNAL OF FAMILY PRACTICE LA English DT Article DE physicians; family members [non-MESH]; quality of health care ID QUALITATIVE RESEARCH; OWN FAMILIES AB OBJECTIVE The American health care system is complicated and can be difficult to navigate. The physician who observes the care of a family member has a uniquely informed perspective on this system. We hoped to gain insight into some of the shortcomings of the health care system from the personal experiences of physician family members. STUDY DESIGN Using a key informant technique, we invited by E-mail any of the chairpersons of US academic departments of family medicine to describe their recent personal experiences with the health care system when their parent was seriously ill. In-depth, semi-structured telephone interviews were conducted with each of the study participants. The interviews were transcribed, coded, and labeled for themes. POPULATION Eight family physicians responded to the E-mail, and each was interviewed. These physicians had been in practice for an average of 19 years, were nationally distributed, and included both men and women. Each discussed his or her father's experience. RESULTS All participants spoke of the importance of an advocate for their fathers who would coordinate medical care. These physicians witnessed various obstacles in their fathers' care, such as poor communication arid fragmented care. As a result, many of them felt compelled to intervene in their fathers' care. The physicians expressed concern about the care their fathers received, believing that the system does not operate the way it should. CONCLUSIONS Even patients with a knowledgeable physician family member face challenges in receiving optimal medical care. Patients might receive better treatment if health care systems reinforced the role of an accountable attending physician, encouraged continuity of care, and emphasized the Value of knowing the patient as a person. C1 Univ Washington, Robert Wood Johnson Clin Scholars Program, Seattle, WA 98195 USA. Univ Washington, Dept Anthropol, Seattle, WA 98195 USA. Robert Graham Ctr Policy Studies Family Practice, Washington, DC USA. RP Chen, FM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Primary Care Res, 6010 Execut Blvd, Rockville, MD 20852 USA. NR 11 TC 8 Z9 8 U1 0 U2 1 PU DOWDEN PUBLISHING CORP PI MONTVALE PA 110 SUMMIT AVE, MONTVALE, NJ 07645-1712 USA SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD SEP PY 2001 VL 50 IS 9 BP 762 EP 766 PG 5 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 472UX UT WOS:000171004300006 PM 11674908 ER PT J AU Turner, BJ Fleishman, JA Wenger, N London, AS Burnam, MA Shapiro, MF Bing, EG Stein, MD Longshore, D Bozzette, SA AF Turner, BJ Fleishman, JA Wenger, N London, AS Burnam, MA Shapiro, MF Bing, EG Stein, MD Longshore, D Bozzette, SA TI Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE anti-HIV agents; substance-related disorders; substance abuse, intravenous drug abuse; mental disorders; HIV infections ID NATIONAL PROBABILITY SAMPLES; HUMAN-IMMUNODEFICIENCY-VIRUS; LOW-PREVALENCE DISEASES; SERVICES UTILIZATION; UNITED-STATES; COST; RECOMMENDATIONS; PSYCHOPATHOLOGY; COMORBIDITY; PREDICTORS AB OBJECTIVE: To distinguish the effects of drug abuse, mental disorders, and problem drinking on antiretroviral therapy (ART) and highly active ART (HAART) use. DESIGN. Prospective population-based probability sample of 2,267 (representing 213,308) HIV-infected persons in care In the United States in early 1996. MEASUREMENTS: Self-reported ART from first (January 1997-July 1997) to second (August 1997-January 1998) follow-up interviews. Drug abuse/dependence, severity of abuse, alcohol use, and probable mental disorders assessed in the first followup Interview. Adjusted odds ratios (AORs) and 95% confidence intervals (Cls) estimated from weighted models for 1) receipt of any ART, and 2) receipt of HAART among those on ART. RESULTS: Of our study population, ART was reported by 90% and HAART by 61%. Over one third had a probable mental disorder and nearly half had abused any drugs, but drug dependence (9%) or severe abuse (10%) was infrequent. Any ART was less likely for persons with dysthymia (AOR. 0.74; Cl, 0.58 to 0.95) but only before adjustment for drug abuse. After full adjustment with mental health and drug abuse variables, any ART was less likely for drug dependence (AOR, 0.58; CI, 0.34 to 0.97). severe drug abuse (AOR, 0.52; Cl, 0.32 to 0.87), and MV risk from injection drug use (AOR, 0.55; Cl, 0.39 to 0.79). Among drug users on ART, only mental health treatment was associated with HAART [AOR, 1.57; Cl, 1.11 to 2.08). CONCLUSIONS: Drug abuse-related factors were greater barriers to ART use in this national sample than mental disorders but once on ART, these factors were unrelated to type of therapy. C1 Univ Penn, Dept Med, Div Gen Internal Med, Philadelphia, PA 19104 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif Los Angeles, Los Angeles, CA USA. RAND Corp, Hlth Program, Santa Monica, CA USA. Univ Calif San Diego, San Diego, CA 92103 USA. Vet Affairs San Diego Hlth Syst, San Diego, CA USA. Charles R Drew Univ Med & Sci, Ctr AIDS Res Educ & Serv, Los Angeles, CA 90059 USA. Charles R Drew Univ Med & Sci, Collaborat Alcohol Res Ctr, Los Angeles, CA 90059 USA. Kent State Univ, Dept Sociol, Kent, OH 44242 USA. Rhode Isl Hosp, Div Gen Internal Med, Providence, RI 02903 USA. RP Turner, BJ (reprint author), Univ Penn, Dept Med, Div Gen Internal Med, 1122 Blockley Hall,423 Guardian Dr, Philadelphia, PA 19104 USA. FU AHRQ HHS [HS08578, U01 HS008578]; NIAAA NIH HHS [AA11899]; NIMH NIH HHS [K12 MH000990, MH00990] NR 36 TC 114 Z9 115 U1 0 U2 1 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD SEP PY 2001 VL 16 IS 9 BP 625 EP 633 DI 10.1046/j.1525-1497.2001.016009625.x PG 9 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 475TV UT WOS:000171184700008 PM 11556944 ER PT J AU Larson, SL Owens, PL Ford, D Eaton, W AF Larson, SL Owens, PL Ford, D Eaton, W TI Depressive disorder, dysthymia, and risk of stroke - Thirteen-year follow-up from the Baltimore Epidemiologic Catchment Area Study SO STROKE LA English DT Article DE affective disorders; cerebrovascular disorders; depression; depressive disorder; dysthymic disorder; stroke ID DIAGNOSTIC-INTERVIEW-SCHEDULE; CORONARY-ARTERY DISEASE; PLATELET REACTIVITY; MAJOR DEPRESSION; SYMPTOMS; VALIDITY; MEN AB Background and Purpose-This study examined depressive disorder as a risk factor for incident stroke in a prospective, population-based design. Methods-The Baltimore Epidemiologic Catchment Area Study is a prospective 13-year follow-up of a probability sample of household residents from Baltimore, Md. Depressive disorder was measured with the diagnostic interview schedule, and stroke was assessed by questions from the health interview survey or by documentation on a death certificate. Results-During the 13-year follow-up of 1703 individuals, 66 strokes were reported and 29 strokes were identified by death certificate search. Individuals with a history of depressive disorder were 2.6 times more likely to report stroke than those without this disorder after controlling for heart disease, hypertension, diabetes, and current and previous use of tobacco. Medications used in the treatment of depressive disorder at baseline did not alter this finding. A history of dysthymia demonstrated a similar relationship to stroke, although the estimate was not statistically significant. Conclusions-Depressive disorder is a risk factor for stroke that appears to be independent of traditional cardiovascular risk factors. Further research on mechanisms for the association and the impact of treatment for depressive disorder on subsequent stroke is needed. C1 Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA. Johns Hopkins Univ, Sch Med, Baltimore, MD USA. RP Larson, SL (reprint author), AHRQ, 2101 E Jefferson 500, Rockville, MD 20852 USA. RI Tanne, David/F-2560-2010 OI Tanne, David/0000-0002-6699-2220 FU NIMH NIH HHS [MH 47447] NR 27 TC 132 Z9 142 U1 5 U2 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0039-2499 J9 STROKE JI Stroke PD SEP PY 2001 VL 32 IS 9 BP 1979 EP 1983 DI 10.1161/hs0901.094623 PG 5 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA 471KX UT WOS:000170929500010 PM 11546884 ER PT J AU Weisman, CS Henderson, JT Schifrin, E Romans, M Clancy, CM AF Weisman, CS Henderson, JT Schifrin, E Romans, M Clancy, CM TI Gender and patient satisfaction in managed care plans: Analysis of the 1999 HEDIS/CAHPS 2.0H adult survey SO WOMENS HEALTH ISSUES LA English DT Article ID HEALTH-CARE; QUALITY; PERFORMANCE; PHYSICIANS; OWNERSHIP AB This paper investigates gender differences in satisfaction, and in the variables associated with satisfaction, using the Consumer Assessment of Health Plans Study (CAHPS) adult questionnaire administered by the National Committee for Quality Assurance (NCQA) as part of HEDIS 1999. Data represent 97,873 men and women enrolled in 206 commercial managed care plans nationwide. Mean plan-level gender differences in satisfaction measures are small, with no consistent pattern of one gender being more satisfied than the other. Controlling for health plan, member, utilization, and selected HEDIS performance indicators, health plan characteristics account for the largest proportion of variance explained in satisfaction. Not-for-profit status and lower turnover of primary care providers are stronger determinants of women's than men's satisfaction. We conclude that it can be useful to analyze CAHPS scores by gender to identify areas for quality improvement in women's health care. C1 Univ Michigan, Sch Publ Hlth, Ann Arbor, MI 48109 USA. Jacobs Inst Womens Hlth, Washington, DC USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Weisman, CS (reprint author), Univ Michigan, Sch Publ Hlth, Ann Arbor, MI 48109 USA. FU PHS HHS [99R30286901] NR 22 TC 19 Z9 20 U1 1 U2 4 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD SEP-OCT PY 2001 VL 11 IS 5 BP 401 EP 415 DI 10.1016/S1049-3867(01)00093-7 PG 15 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 473JA UT WOS:000171036700002 PM 11566283 ER PT J AU Bauchner, H Sharfstein, J AF Bauchner, H Sharfstein, J TI Failure to report ethical approval in child health research: review of published papers SO BRITISH MEDICAL JOURNAL LA English DT Article ID INFORMED CONSENT; BOARD APPROVAL AB More than 500 journals Have adopted the uniform requirements of the International Committee of Medical Journal Editors, which stipulate that authors should "indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation:" One major purpose of institutional review is to ensure that informed consent is obtained when possible. We investigated how often research publications about child health report ethics committee approval or unformed consent. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. Boston Univ, Sch Med, Dept Pediat, Div Gen Pediat, Boston, MA 02118 USA. RP Bauchner, H (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 5 TC 28 Z9 30 U1 0 U2 0 PU BRITISH MED JOURNAL PUBL GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0959-535X J9 BRIT MED J JI Br. Med. J. PD AUG 11 PY 2001 VL 323 IS 7308 BP 318 EP 319 DI 10.1136/bmj.323.7308.318 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 463HK UT WOS:000170470900020 PM 11498489 ER PT J AU Bing, EG Burnam, A Longshore, D Fleishman, JA Sherbourne, CD London, AS Turner, BJ Eggan, F Beckman, R Vitiello, B Morton, SC Orlando, M Bozzette, SA Ortiz-Barron, L Shapiro, M AF Bing, EG Burnam, A Longshore, D Fleishman, JA Sherbourne, CD London, AS Turner, BJ Eggan, F Beckman, R Vitiello, B Morton, SC Orlando, M Bozzette, SA Ortiz-Barron, L Shapiro, M TI Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States SO ARCHIVES OF GENERAL PSYCHIATRY LA English DT Article ID NATIONAL-COMORBIDITY-SURVEY; QUALITY-OF-LIFE; HIV-INFECTION; SUBSTANCE USE; COMMUNITY SAMPLE; HOMOSEXUAL MEN; GAY MEN; PREVALENCE; DEPRESSION; ILLNESS AB Background: There have been no previous nationally representative estimates of the prevalence of mental disorders and drug use among adults receiving care for human immunodeficiency virus (HIV) disease in the United States. it is also not known which clinical and sociodemographic factors are associated with these disorders. Subjects and Methods: We enrolled a nationally representative probability sample of 2864 adults receiving care for HIV in the United States in 1996. Participants were administered a brief structured psychiatric instrument that screened for psychiatric disorders (major depression, dysthymia, generalized anxiety disorders, and panic attacks) and drug use during the previous 12 months. Sociodemographic and clinical factors associated with screening positive for any psychiatric disorder and drug dependence were examined in multivariate logistic regression analyses. Results: Nearly half of the sample screened positive for a psychiatric disorder, nearly 40% reported using an illicit drug other than marijuana, and more than 12% screened positive for drug dependence during the previous 12 months. Factors independently associated with screening positive for a psychiatric disorder included number of HIV-related symptoms, illicit drug use, drug dependence, heavy alcohol use, and being unemployed or disabled. Factors independently associated with screening positive for drug dependence included having many HIV-related symptoms, being younger, being heterosexual, having frequent heavy alcohol use, and screening positive for a psychiatric disorder. Conclusions: Many people infected with HIV may also have psychiatric and/or drug dependence disorders. Clinicians may need to actively identify those at risk and work with policymakers to ensure the availability of appropriate care for these treatable disorders. C1 Charles R Drew Univ Med & Sci, Ctr AIDS Res Educ & Serv, Los Angeles, CA 90059 USA. Charles R Drew Univ Med & Sci, Collaborat Alcohol Res Ctr, Los Angeles, CA 90059 USA. Univ Calif Los Angeles, Dept Gen Internal Med, Los Angeles, CA USA. Michigan State Univ, Coll Med, E Lansing, MI 48824 USA. Univ Calif San Diego, Sch Med, Vet Affairs San Diego Healthcare Syst, Hlth Serv Res & Dev Unit, San Diego, CA 92103 USA. RAND Corp, Stat Grp, Santa Monica, CA USA. NIMH, Bethesda, MD 20892 USA. AIDS Coordinators Off, Los Angeles, CA USA. Univ Penn, Dept Med, Div Gen Med, Philadelphia, PA 19104 USA. Kent State Univ, Dept Sociol, Kent, OH 44242 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif Los Angeles, Los Angeles Drug Abuse Res Ctr, Los Angeles, CA USA. RP Bing, EG (reprint author), Charles R Drew Univ Med & Sci, Ctr AIDS Res Educ & Serv, 1651 E 120th St, Los Angeles, CA 90059 USA. FU AHRQ HHS [U-01HS08578]; NIAAA NIH HHS [AA11899]; NIMH NIH HHS [MH00990] NR 45 TC 578 Z9 586 U1 5 U2 30 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0003-990X J9 ARCH GEN PSYCHIAT JI Arch. Gen. Psychiatry PD AUG PY 2001 VL 58 IS 8 BP 721 EP 728 DI 10.1001/archpsyc.58.8.721 PG 8 WC Psychiatry SC Psychiatry GA 459JH UT WOS:000170246900001 PM 11483137 ER PT J AU Burnam, MA Bing, EG Morton, SC Sherbourne, C Fleishman, JA London, AS Vitiello, B Stein, M Bozzette, SA Shapiro, MF AF Burnam, MA Bing, EG Morton, SC Sherbourne, C Fleishman, JA London, AS Vitiello, B Stein, M Bozzette, SA Shapiro, MF TI Use of mental health and substance abuse treatment services among adults with HIV in the United States SO ARCHIVES OF GENERAL PSYCHIATRY LA English DT Article ID HUMAN-IMMUNODEFICIENCY-VIRUS; NATIONAL PROBABILITY SAMPLES; LOW-PREVALENCE DISEASES; QUALITY-OF-LIFE; PSYCHIATRIC-DISORDERS; INFECTION; COST; PSYCHOPATHOLOGY; HISTORY; WOMEN AB Background: The need for mental health and substance abuse services is great among those with human immunodeficiency virus (HIV), but little information is available on services used by this population or on individual factors associated with access to care. Methods: Data are from the HIV Cost and Services Utilization Study, a national probability survey of 2864 HIV-infected adults receiving medical care in the United States in 1996. We estimated 6-month use of services for mental health and substance abuse problems and examined socioeconomic, HIV illness, and regional factors associated with use. Results: We estimated that 61.4% of 231 400 adults under care for HIV used mental health or substance abuse services: 1.8% had hospitalizations, 3.4% received residential substance abuse treatment, 26.0% made individual mental health specialty visits, 15.2% had group mental health treatment, 40.3% discussed emotional problems with medical providers, 29.6% took psychotherapeutic medications, 5.6% received outpatient substance abuse treatment, and 12.4% participated in substance abuse self-help groups. Socioeconomic factors commonly associated with poorer access to health services predicted lower likelihood of using mental health outpatient care, but greater likelihood of receiving substance abuse treatment services. Those with less severe HIV illness were less likely to access services. Persons living in the Northeast were more likely to receive services. Conclusions: The magnitude of mental health and substance abuse care provided to those with known HIV infection is substantial, and challenges to providers should be recognized. Inequalities in access to care are evident, but differ among general medical, specialty mental health, and substance abuse treatment sectors. C1 RAND Corp, Santa Monica, CA 90407 USA. Univ Calif Los Angeles, Dept Med, Div Gen Internal Med, Los Angeles, CA 90024 USA. Vet Adm Med Ctr, La Jolla, CA 90034 USA. Rhode Isl Hosp, Providence, RI USA. Brown Univ, Sch Med, Providence, RI 02912 USA. NIMH, NIH, Bethesda, MD 20892 USA. Kent State Univ, Dept Sociol, Kent, OH 44242 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Charles R Drew Univ Med & Sci, Collaborat Alcohol Res Ctr, Los Angeles, CA 90059 USA. Charles R Drew Univ Med & Sci, Ctr AIDS Res Educ & Serv, Los Angeles, CA 90059 USA. RP Burnam, MA (reprint author), RAND Corp, 1700 Main St,POB 2138, Santa Monica, CA 90407 USA. FU AHRQ HHS [U-01HS08578]; NIAAA NIH HHS [AA11899]; NIMH NIH HHS [MH00990] NR 28 TC 110 Z9 111 U1 2 U2 6 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0003-990X J9 ARCH GEN PSYCHIAT JI Arch. Gen. Psychiatry PD AUG PY 2001 VL 58 IS 8 BP 729 EP 736 DI 10.1001/archpsyc.58.8.729 PG 8 WC Psychiatry SC Psychiatry GA 459JH UT WOS:000170246900002 PM 11483138 ER PT J AU Manski, RJ Edelstein, BL Moeller, JF AF Manski, RJ Edelstein, BL Moeller, JF TI The impact of insurance coverage on children's dental visits and expenditures, 1996 SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article ID CARE; ACCESS; NEEDS AB Background. Health insurance coverage has been shown to relate positively with the use of dental services. The purpose of the authors' study was to describe the level of dental coverage among U.S. children and to assess the impact of dental coverage on children's use of dental services and expenditures for dental care. Methods. The focus of these analyses is use and expendion dental care coverage, use and expenditures for U.S. children during 1996. National estimates are provided for the population with dental coverage, the population with a dental visit, and mean total expenditure for each of several socioeconomic and demographic categories during 1996 using data from the medical Expenditure Panel Survey. Results. Fifty-two percent of children younger than 18 years of age had private dental coverage during 1996. Approximately 56 percent of children in families with a poverty status level of 133 percent of federal poverty level or below were covered by Medicaid during 1996. Fifty-six percent of children with private coverage had made at least one dental visit, compared 28 percent of noncovered children. Twenty-eight percent of children covered by Medicaid had made at least one dental visit compared with 19 percent of noncovered children. Conclusion. Medicaid dental coverage seems to have had a lesser effect on the likelihood of a child's having a dental visit than had private coverage. Improving oral health for poorer children may depend partly on improving the design of Medicaid dental coverage programs. Practice Implications. By understanding these analyses, practitioners, advocates and policymakers will be better positioned to provide care, improve access and better meet the needs of all American children. C1 Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, Baltimore, MD 21201 USA. Columbia Univ, Sch Dent & Oral Surg, Div Community Hlth, New York, NY USA. Childrens Dent Hlth Project, Washington, DC USA. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD USA. RP Manski, RJ (reprint author), Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, 666 W Baltimore St, Baltimore, MD 21201 USA. NR 14 TC 31 Z9 32 U1 0 U2 0 PU AMER DENTAL ASSN PI CHICAGO PA 211 E CHICAGO AVE, CHICAGO, IL 60611 USA SN 0002-8177 J9 J AM DENT ASSOC JI J. Am. Dent. Assoc. PD AUG PY 2001 VL 132 IS 8 BP 1137 EP 1145 PG 9 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 464AT UT WOS:000170510700023 PM 11575023 ER PT J AU Gross, PA Greenfield, S Cretin, S Ferguson, J Grimshaw, J Grol, R Klazinga, N Lorenz, W Meyer, GS Riccobono, C Schoenbaum, SC Schyve, P Shaw, C AF Gross, PA Greenfield, S Cretin, S Ferguson, J Grimshaw, J Grol, R Klazinga, N Lorenz, W Meyer, GS Riccobono, C Schoenbaum, SC Schyve, P Shaw, C TI Optimal methods for guideline implementation - Conclusions from Leeds Castle meeting SO MEDICAL CARE LA English DT Article; Proceedings Paper CT Round Table Meeting on Implementing Evidence-Based Recommendations for Health Care CY OCT 05-06, 1999 CL LEEDS CASTLE, ENGLAND SP Pfizer Inc, Roche Pharmaceut, Int Div, Bristol Myers Squibb Co, GlaxoWellcome Inc, Merck & Co, Hackensack Univ Med Ctr DE practice guidelines; implementation; medical errors; physician's role; health services research; quality of health care; evidence-based medicine; small-area variation; organizational change ID ACUTE MYOCARDIAL-INFARCTION; COOPERATIVE CARDIOVASCULAR PROJECT; CONTINUING MEDICAL-EDUCATION; PHYSICIAN PERFORMANCE; SYSTEMATIC REVIEWS; QUALITY; CARE; OUTCOMES; IMPACT; TRIAL AB BACKGROUND. Quality problems in medical care are not a new finding. Variations in medical practice as well as actual medical errors have been pointed out for many decades. The current movement to write practice guidelines to attempt to correct these deviations from recommended medical practice has not solved the problem. OBJECTIVES. In order to gain greater acceptance of these guidelines and to change the behavior of health care providers, the science of guideline implementation must be understood better. RESEARCH DESIGN. A group of experts who have studied the problem of implementation in Europe and the United States was convened. This meeting summary enumerates the implementation methods studied to date, reviews the theories of behavioral change, and makes recommendation for effecting better implementation guidelines. RESULTS. A research agenda was proposed to further our knowledge of effective evidence-based implementation. C1 Hackensack Univ, Med Ctr, Dept Internal Med, Hackensack, NJ 07601 USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Newark, NJ 07103 USA. Tufts Univ, New England Med Ctr, Primary Care Outcomes Res Inst, Boston, MA 02111 USA. RAND Corp, Hlth Sci Program, Santa Monica, CA 90407 USA. Univ Aberdeen, Hlth Serv Res Unit, Aberdeen AB9 1FX, Scotland. Catholic Univ Nijmegen, NL-6525 ED Nijmegen, Netherlands. Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands. Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvement, Rockville, MD USA. Harvard Pilgrim Hlth Care, Providence, RI USA. Joint Commiss Accreditat Healthcare Org, Oak Brook Terrace, IL USA. Kings Fund, Hlth Qual Serv, London, England. RP Gross, PA (reprint author), Hackensack Univ, Med Ctr, Dept Internal Med, 30 Prospect Ave, Hackensack, NJ 07601 USA. RI Grol, Richard/C-8523-2013; Grimshaw, Jeremy/D-8726-2013 NR 40 TC 13 Z9 14 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD AUG PY 2001 VL 39 IS 8 SU LC2 BP II85 EP II92 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 460NL UT WOS:000170313600006 PM 11583124 ER PT J AU Bosco, L AF Bosco, L TI Databases for outcomes research: What has 10 years of experience taught us? SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Article; Proceedings Paper CT Mid-Year Symposium of the International-Society-for-Pharmacoepidemiology CY APR, 2000 CL CHAPEL HILL, NORTH CAROLINA SP Int Soc Pharmacoepidemiology DE health services research; pharmaceutical outcomes research; Agency for Healthcare Research and; Quality AB This paper describes how the mission of the Agency for Healthcare Research and Quality (AHRQ) is being executed through the many programs that it has developed and implemented. The Evidence-based Practice Center program was developed to provide systematic reviews on common and expensive conditions and health technologies and to ensure that this information is used to improve health care outcomes and costs. The National Guidelines Clearinghouse provides an internet-based source of clinical practice guidelines that are produced by clinical specialty organizations for the primary purpose of improving health care delivery and outcomes. Relevant to this symposium on databases, AHRQ has supported the development of databases to track hospital utilization. on a state-by-state basis. The Healthcare Cost and Utilization Project (HCUP) allows comparisons between states and within regions of individual states. New initiatives have been launched to evaluate interventions across systems rather than focusing on the individual patient (Translating Research into Practice-TRIP). The Centers for Education and Research on 'Therapeutics (CERTs) program was developed to conduct real world evaluations to better understand the benefits and risks of single and combined therapy. Both programs further the mission of the AHRQ to improve the outcomes and quality of health care, with additional focus on the cost-effectiveness, patient safety, and increasing access to care for all. Information on programs developed by the AHRQ is available in more detail at the Agency Web site http : // www.ahrq.gov. Copyright (C) 2001 John Wiley & Sons, Ltd. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. RP Bosco, L (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU JOHN WILEY & SONS LTD PI W SUSSEX PA BAFFINS LANE CHICHESTER, W SUSSEX PO19 1UD, ENGLAND SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG-SEP PY 2001 VL 10 IS 5 BP 445 EP 455 DI 10.1002/pds.597 PG 11 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 501UN UT WOS:000172704600016 PM 11802591 ER PT J AU Hellinger, FJ Young, GJ AF Hellinger, FJ Young, GJ TI An analysis of physician antitrust exemption legislation - Adjusting the balance of power SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article AB Current antitrust law restricts physicians from joining together to collectively negotiate. However, such activities may be approved by state laws under the so-called state action immunity doctrine and by federal legislation under an explicit antitrust exemption. In 1999, Texas became the first state to pass physician antitrust exemption legislation allowing physicians, under certain defined circumstances, to collectively negotiate fees with health plans, Last year, similar legislation was introduced in the US Congress, in 18 state legislatures, and in the District of Columbia. This legislation was passed only in the District of Columbia where its implementation was blocked by the city's financial control board, Nonetheless, legislation permitting physicians to collectively negotiate fees with managed care plans has been introduced in 10 state legislatures this year, and there is continued interest in introducing similar legislation in the US Congress. This analysis examines the basic features of this legislation and its potential impact on the balance of power between physicians and managed care plans. C1 Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. Boston Univ, Management Decis & Res Ctr, Vet Affairs Hlth Serv Res & Dev Serv, Boston, MA 02215 USA. Boston Univ, Sch Publ Hlth, Program Hlth Policy & Management, Boston, MA 02215 USA. RP Hellinger, FJ (reprint author), Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Suite 605,2101 E Jefferson St, Rockville, MD 20852 USA. NR 17 TC 10 Z9 10 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUL 4 PY 2001 VL 286 IS 1 BP 83 EP 88 DI 10.1001/jama.286.1.83 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 449GR UT WOS:000169676400027 PM 11434831 ER PT J AU Coffield, AB Maciosek, MV McGinnis, JM Harris, JR Caldwell, MB Teutsch, SM Atkins, D Richland, JH Haddix, A AF Coffield, AB Maciosek, MV McGinnis, JM Harris, JR Caldwell, MB Teutsch, SM Atkins, D Richland, JH Haddix, A TI Priorities among recommended clinical preventive services SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article DE cost-benefit analysis; delivery of health care; economics; healthcare quality, access, and evaluation; health policy; health priorities; preventive health services; preventive medicine; quality-adjusted life years ID FAMILY PHYSICIANS; UNITED-STATES; PRIMARY-CARE; RISK-FACTORS; DELIVERY; OREGON AB Background: Many recommended clinical preventive services are delivered at low rates. Decision-makers who wish to improve deliver) rates, but face competing demands for finite resources, need information oil the relative value of these services. This article describes the results of a systematic assessment of the value of clinical preventive services recommended for average-risk patients by the U.S. Preventive Services Task Force. Methods: The assessment of sen ices' value for the U.S, population was based on two dimensions: burden of disease prevented by each service and cost effectiveness. Methods were developed for measuring these criteria consistently across different types of services. A companion article describes the methods in greater detail. Each sen ice received 1 to 5 points on each of the two dimensions, for total scores ranging from 2 to 10. Priority opportunities for improving delivery rates were determined by comparing the ranking of sen ices with what is known of current delivery rates nationally. Results: The highest ranked services (scores of 7+) with the lowest delivery rates (less than or equal to 50% nationally) are providing tobacco cessation counseling to adults, screening older adults for undetected vision impairments, offering adolescents an anti-tobacco message or advice to quit, counseling adolescents on alcohol and drug abstinence, screening adults for colorectal cancer,, screening young women for chlamydial infection, screening adults for problem drinking, and vaccinating older adults against pneumococcal disease. Conclusions: Decision-makers can use the results to set their own priorities for increasing delivery of clinical preventive services. The methods provide a basis for future priority-setting efforts. C1 Partnership Prevent, Washington, DC 20036 USA. Hlth Partners Res Fdn, Minneapolis, MN USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Ctr Dis Control & Prevent, Atlanta, GA USA. Merck & Co Inc, W Point, PA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Amer Coll Prevent Med, Washington, DC USA. Emory Univ, Atlanta, GA 30322 USA. RP Coffield, AB (reprint author), Partnership Prevent, 1233 20th St NW, Washington, DC 20036 USA. OI Harris, Jeffrey/0000-0001-8728-7195 NR 39 TC 216 Z9 217 U1 0 U2 7 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD JUL PY 2001 VL 21 IS 1 BP 1 EP 9 DI 10.1016/S0749-3797(01)00308-7 PG 9 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 447RA UT WOS:000169585200001 PM 11418251 ER PT J AU Maciosek, MV Coffield, AB McGinnis, JM Harris, JR Caldwell, MB Teutsch, SM Atkins, D Richland, JH Haddix, H AF Maciosek, MV Coffield, AB McGinnis, JM Harris, JR Caldwell, MB Teutsch, SM Atkins, D Richland, JH Haddix, H TI Methods for priority setting among clinical preventive services SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article DE cost-benefit analysis; data collection; delivery of health care; economics; healthcare quality, access and evaluation; health priorities; preventive health services; preventive medicine; quality-adjusted life years AB Overview: Methods used to compare the value of clinical preventive services based on two criteria-clinically preventable burden (CPB) and cost effectiveness (CE)- are described. A companion article provides rankings of clinical preventive services and discusses its uses for decision-makers; this article focuses on the methods, challenges faced, and solutions. The authors considered all types of data essential to measuring CPB and CE for services recommended by the U.S. Preventive Services Task Force and developed methods essential to ensuring valid comparisons of different services' relative value. C1 Partnership Prevent, Washington, DC 20036 USA. Hlth Partners Res Fdn, Minneapolis, MN USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Ctr Dis Control & Prevent, Atlanta, GA USA. Merck & Co Inc, W Point, PA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Amer Coll Prevent Med, Washington, DC USA. Emory Univ, Atlanta, GA 30322 USA. RP Coffield, AB (reprint author), Partnership Prevent, 1233 20th St NW, Washington, DC 20036 USA. OI Harris, Jeffrey/0000-0001-8728-7195 NR 24 TC 56 Z9 56 U1 1 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD JUL PY 2001 VL 21 IS 1 BP 10 EP 19 DI 10.1016/S0749-3797(01)00309-9 PG 10 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 447RA UT WOS:000169585200002 PM 11418252 ER PT J AU Baine, WB Yu, W Summe, JP AF Baine, WB Yu, W Summe, JP TI Epidemiologic trends in the hospitalization of elderly Medicare patients for pneumonia, 1991-1998 SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID COMMUNITY-ACQUIRED PNEUMONIA; CARE; OUTCOMES; FACILITIES AB Objectives. This study determined hospitalization rates of elderly Americans for pneumonia from 1991 through 1998. Methods. Epidemiologic data were described for 273 143 pneumonia hospitalizations. Results. Annual hospitalizations for aspiration pneumonia increased by 93.5%. Pneumonia hospitalization rates increased steeply with age, especially among men. Black men were at highest risk for aspiration, unspecified, Klebsiella, "other gram-negative," and staphylococcal pneumonia; White men had the highest Haemophilus and pneumococcal pneumonia rates. Among women, Blacks predominated in aspiration and Klebsiella pneumonia; Whites had the highest Haemophilus and bronchopneumonia rates. Conclusions. An epidemic of hospitalization for aspiration pneumonia smoldered over 8 years. Significant disparities existed in hospitalization risks by race, sex, and principal diagnosis. C1 Ctr Outcomes & Effectiveness Res, Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20852 USA. Ctr Cost & Financing Studies, Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD USA. RP Baine, WB (reprint author), Ctr Outcomes & Effectiveness Res, Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, 6010 Execut Blvd, Rockville, MD 20852 USA. NR 22 TC 55 Z9 55 U1 0 U2 0 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD JUL PY 2001 VL 91 IS 7 BP 1121 EP 1123 DI 10.2105/AJPH.91.7.1121 PG 3 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 461BR UT WOS:000170345500024 PM 11441742 ER PT J AU Harris-Kojetin, LD McCormack, LA Jael, EF Sangl, JA Garfinkel, SA AF Harris-Kojetin, LD McCormack, LA Jael, EF Sangl, JA Garfinkel, SA TI Creating more effective health plan quality reports for consumers: Lessons from a synthesis of qualitative testing SO HEALTH SERVICES RESEARCH LA English DT Article DE consumer choice; document design; health plan decision making; report cards ID INFORMATION NEEDS; REPORT CARDS; CHOICE; WANT AB Objective. Social marketing techniques such as consumer testing have only recently been applied to develop effective consumer health insurance information. This article discusses lessons learned from consumer testing to create consumer plan choice materials. Data Sources/Study Setting. Data were collected from 268 publicly and privately insured consumers in three studies between 1994 and 1999. Study Design. Iterative testing and revisions were conducted to design seven booklets to help Medicaid, Medicare, and employed consumers choose a health plan. Data Collection Methods. Standardized protocols were used in 11 focus groups and 182 interviews to examine the content, comprehension, navigation, and utility of the booklets. Principal Findings. A method is suggested to help consumers narrow their plan choices by breaking down the process into smaller decisions using a set of guided worksheets. Conclusion. Implementing these lessons is challenging and not often done well. This article gives examples of evidence-based approaches to address cognitive barriers that designers of consumer health insurance information can adapt to their needs. C1 Res Triangle Inst, Washington, DC 20036 USA. Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvment, Rockville, MD USA. Amer Inst Res, Chapel Hill, NC USA. RP Harris-Kojetin, LD (reprint author), Res Triangle Inst, 1615 M St NW,Suite 740, Washington, DC 20036 USA. FU AHRQ HHS [5-U18-HS09218-02] NR 42 TC 25 Z9 25 U1 1 U2 4 PU HEALTH ADMINISTRATION PRESS PI CHICAGO PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES ONE N FRANKLIN ST, STE 1700, CHICAGO, IL 60606-3491 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD JUL PY 2001 VL 36 IS 3 BP 447 EP 476 PG 30 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 454XM UT WOS:000169997100002 PM 11482584 ER PT J AU Scanlon, DP Darby, C Rolph, E Doty, HE AF Scanlon, DP Darby, C Rolph, E Doty, HE TI The role of performance measures for improving quality in managed care organizations SO HEALTH SERVICES RESEARCH LA English DT Article DE CAMPS; HEDIS; managed care; NCQA; performance measurement; quality improvement; report cards ID PRACTICE GUIDELINES; ASSOCIATION AB Objectives. To understand how managed care plans use performance measures for quality improvement and to identify the strengths and weaknesses of currently used standardized performance measures such as the Health Plan Employer Data and Information Set (HEDIS (R)) and the Consumer Assessment of Health Plans (CAHPS (R)) survey. Data Sources/Study Setting. Representatives (chief executive officers, medical directors, and quality-improvement directors) from 24 health plans in four states were surveyed. The overall response rate was 58.3 percent, with a mean of 1.8 respondents per plan. Study Design. This exploratory qualitative research used a purposive sample of respondents. Two study authors conducted separate one-hour tape-recorded telephone interviews with multiple respondents from each health plan. Principal Findings. All managed care organizations interviewed use performance measures for quality improvement but the degree and sophistication of use varies. Many of our respondent plans use performance measures to target quality-improvement initiatives, evaluate current performance, establish goals for quality improvement, identify the root cause of problems, and monitor performance. Conclusion. Performance measures are used for quality improvement in addition to informing external constituents, but additional research is needed to understand how the benefits of measurement can be maximized. C1 Penn State Univ, Dept Hlth Policy & Adm, University Pk, PA 16802 USA. RAND Corp, Santa Monica, CA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Scanlon, DP (reprint author), Penn State Univ, Dept Hlth Policy & Adm, 119B Henderson Bldg, University Pk, PA 16802 USA. FU AHRQ HHS [HS09204] NR 30 TC 32 Z9 32 U1 2 U2 4 PU HEALTH ADMINISTRATION PRESS PI CHICAGO PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES ONE N FRANKLIN ST, STE 1700, CHICAGO, IL 60606-3491 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD JUL PY 2001 VL 36 IS 3 BP 619 EP 641 PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 454XM UT WOS:000169997100010 PM 11482592 ER PT J AU Encinosa, W AF Encinosa, W TI A comment on Neudeck and Podczeck's "adverse selection and regulation in health insurance markets" SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE adverse selection; health insurance minimum standards; regulation ID INFORMATION; EQUILIBRIUM AB Using the Grossman equilibrium concept, Neudeck and Podczeck [Journal of Health Economics 15 (1996) 387] show that imposing a minimum standard on a perfectly competitive insurance market can result in anti-competitive effects: decreased welfare with some insurers earning positive profits. However, the Grossman concept precludes an insurer from offering two separating, cross-subsidizing health plans. When an insurer can offer multiple plans las under both the Nash and Miyazaki-Wilson equilibrium concepts), I show that minimum standards result in a doubleton equilibrium, never allow positive total profits, and increase welfare. This is of interest since in 1997 more than half of establishments in the US offering choice of multiple plans did so through a single insurer. Published by Elsevier Science B.V. C1 Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. RP Encinosa, W (reprint author), Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Suite 605,2101 E Jefferson St, Rockville, MD 20852 USA. NR 6 TC 1 Z9 1 U1 0 U2 1 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD JUL PY 2001 VL 20 IS 4 BP 667 EP 673 DI 10.1016/S0167-6296(01)00079-0 PG 7 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 449XD UT WOS:000169711700010 PM 11463193 ER PT J AU Siegel, JE Goldie, SJ AF Siegel, JE Goldie, SJ TI Does cost-effectiveness analysis make a difference? Lessons from pap smears - Preface SO MEDICAL DECISION MAKING LA English DT Article ID PROSTATE-CANCER; BREAST-CANCER; ELDERLY WOMEN AB From the Department of Family Practice, University of Kentucky College of Medicine, Lexington (MDH); the Center for Primary Care and Outcomes Research, Stanford University, California, and the Veterans Affairs Palo Alto Health Care System, Palo Alto, California (AMG); the Harvard Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts (SJG); the Center for Health Services Research, Henry Ford Health System, Detroit, Michigan (JEL); the Department of Medicine and Lombardi Cancer Center, Georgetown University Medical Center, Washington, D.C. (JM); the Departments of Medicine and Economics, University of Chicago, Illinois (DM); the Program on the Economic Evaluation of Medical Technology, Harvard School of Public Health, Boston, Massachusetts (PN); the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, Maryland (JES); the Department of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire (HCS); the Department of Internal Medicine and the Institute for Health Policy and Health Services Research, University of Cincinnati Medical Center, Ohio (JT) This project was supported by Grant No. R13 HS10931 from. the Agency for Healthcare Research and Quality. The symposium was presented at the annual meeting of the Society for Medical Decision Making, 26 September 2000, Cincinnati, Ohio. C1 Univ Kentucky, Coll Med, Dept Family Practice, Lexington, KY USA. Vet Affairs Palo Alto Hlth Care Syst, Palo Alto, CA USA. Stanford Univ, Ctr Primary Care & Outcomes Res, Stanford, CA 94305 USA. Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Ctr Risk Anal, Boston, MA 02115 USA. Henry Ford Hlth Syst, Ctr Hlth Serv Res, Detroit, MI USA. Georgetown Univ, Med Ctr, Dept Med, Washington, DC 20007 USA. Georgetown Univ, Med Ctr, Vincent T Lombardi Canc Res Ctr, Washington, DC 20007 USA. Univ Chicago, Dept Med, Chicago, IL 60637 USA. Univ Chicago, Dept Econ, Chicago, IL 60637 USA. Harvard Univ, Sch Publ Hlth, Program Econ Evaluat Med Technol, Boston, MA 02115 USA. US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. Dartmouth Hitchcock Med Ctr, Dept Med, Hanover, NH USA. Univ Cincinnati, Med Ctr, Dept Internal Med, Cincinnati, OH 45267 USA. Univ Cincinnati, Med Ctr, Inst Hlth Policy & Hlth Serv Res, Cincinnati, OH 45267 USA. RP Siegel, JE (reprint author), Assessment Technol Inc, 2224 Young Dr, Lexington, KY 40505 USA. NR 11 TC 0 Z9 0 U1 0 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0272-989X J9 MED DECIS MAKING JI Med. Decis. Mak. PD JUL-AUG PY 2001 VL 21 IS 4 BP 307 EP 323 PG 17 WC Health Care Sciences & Services; Medical Informatics SC Health Care Sciences & Services; Medical Informatics GA 469EP UT WOS:000170801900006 ER PT J AU Green, LA Fryer, GE Yawn, BP Lanier, D Dovey, SM AF Green, LA Fryer, GE Yawn, BP Lanier, D Dovey, SM TI The ecology of medical care revisited SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID HEALTH-CARE; SYSTEM; PHYSICIANS; ICEBERG C1 Robert Graham Ctr, Washington, DC 20036 USA. Olmsted Med Ctr, Rochester, MN 55904 USA. Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Green, LA (reprint author), Robert Graham Ctr, 2023 Massachusetts Ave NW, Washington, DC 20036 USA. NR 34 TC 356 Z9 362 U1 2 U2 11 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JUN 28 PY 2001 VL 344 IS 26 BP 2021 EP 2025 DI 10.1056/NEJM200106283442611 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA 446HQ UT WOS:000169508200011 PM 11430334 ER PT J AU Bauchner, H Simpson, L Chessare, J AF Bauchner, H Simpson, L Chessare, J TI Changing physician behaviour SO ARCHIVES OF DISEASE IN CHILDHOOD LA English DT Article ID EVIDENCE-BASED MEDICINE; CLINICAL-PRACTICE; HEALTH-CARE; FINANCIAL INCENTIVES; PRACTICE GUIDELINES; ANTIBIOTIC USE; QUALITY; CHILDREN; INTERVENTIONS; PRESCRIPTION C1 Boston Univ, Sch Med Child & Adolescent Hlth, Boston, MA 02215 USA. Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Bauchner, H (reprint author), Boston Univ, Sch Med Child & Adolescent Hlth, Boston, MA 02215 USA. NR 40 TC 54 Z9 56 U1 1 U2 5 PU BRITISH MED JOURNAL PUBL GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0003-9888 J9 ARCH DIS CHILD JI Arch. Dis. Child. PD JUN PY 2001 VL 84 IS 6 BP 459 EP 462 DI 10.1136/adc.84.6.459 PG 4 WC Pediatrics SC Pediatrics GA 439KY UT WOS:000169117100004 PM 11369556 ER PT J AU Eisenberg, JM AF Eisenberg, JM TI Putting research to work: Reporting and enhancing the impact of health services research SO HEALTH SERVICES RESEARCH LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Div Publ Affairs, Off Hlth Care Informat, Rockville, MD 20852 USA. RP Eisenberg, JM (reprint author), Agcy Healthcare Res & Qual, Div Publ Affairs, Off Hlth Care Informat, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 7 TC 13 Z9 13 U1 0 U2 1 PU HEALTH ADMINISTRATION PRESS PI CHICAGO PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES ONE N FRANKLIN ST, STE 1700, CHICAGO, IL 60606-3491 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD JUN PY 2001 VL 36 IS 2 BP X EP XVII PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 441BN UT WOS:000169211300001 PM 11409822 ER PT J AU Baine, WB Yu, W Weis, KA AF Baine, WB Yu, W Weis, KA TI Trends and outcomes in the hospitalization of older Americans for cardiac conduction disorders or arrhythmias, 1991-1998 SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE aged; arrhythmia; heart block; hospitalization; Medicare Part A ID ATRIAL-FIBRILLATION; MANAGEMENT; PREVALENCE AB fOBJECTIVE: To identify epidemiological trends and measure outcomes in elderly patients hospitalized for cardiac conduction disorders or arrhythmias. DESIGN: Review of the standard 5% samples of the Medicare Provider Analysis and Review Files to characterize 144,512 discharges from 1991 through 1998 in which the principal diagnosis was a conduction disorder or arrhythmia, using the corresponding Enrollment Databases for denominator data. SETTING: Short-stay hospitals in the United States. PARTICIPANTS: Medicare beneficiaries age 65 and older in the standard 5% sample. MEASUREMENTS: Diagnosis-specific trends and rates; discharges by year; cumulative age-, race-, and sex-specific discharge rates; mean length of stay in hospital and in intensive care; mean Medicare reimbursement to the hospital; case-fatality rare in hospital; discharge destinations of patients discharged alive. RESULTS: Annual hospitalizations for sinoatrial node dysfunction, atrial flutter, atrial fibrillation, or ventricular fibrillation increased more rapidly than did the elderly Medicare beneficiary population. Hospitalizations with a principal diagnosis of ventricular extrasystoles or asystole showed steep secular declines. Discharge rates for sinoatrial node dysfunction, a group of rhythms with a nonsinus pacemaker, atrial fibrillation, Moditz I, or complete atrioventricular block all increased steeply and continuously with patient age. In contrast, discharge rates for atrial flutter or ventricular tachycardia or fibrillation peaked among 75- to 84-year-old patients. White men were at uniquely high risk of hospitalization for atrial flutter or ventricular tachycardia or fibrillation, acid, among the white majority, men had higher discharge rates than women for nine of the 11 commonest rubrics. Whites, particularly white women, had the highest discharge rates for atrial fibrillation. Blacks, especially black women, were at disproportionate risk for hospitalization for the group of nonsinus pacemaker rhythms. Diagnosis-specific mean resource costs were strongly correlated with each other and with mean Medicare reimbursement but not with case-fatality rate. CONCLUSION: Medicare claims data demonstrated striking differences among and within diagnoses of heart blocks or arrhythmias in terms of the populations at greatest risk for hospitalization. This variation should be explored further to generate and test hypotheses about differential causation or delivery of care. C1 Dept Hlth & Human Serv, Ctr Cost & Financing Studies, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. Dept Hlth & Human Serv, Ctr Outcomes & Effectiveness Res, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Baine, WB (reprint author), Dept Hlth & Human Serv, Ctr Outcomes & Effectiveness Res, Agcy Healthcare Res & Qual, 6010 Execut Blvd, Rockville, MD 20852 USA. NR 19 TC 29 Z9 29 U1 0 U2 0 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD JUN PY 2001 VL 49 IS 6 BP 763 EP 770 DI 10.1046/j.1532-5415.2001.49153.x PG 8 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 453EG UT WOS:000169903100010 PM 11454115 ER PT J AU Knight, JR AF Knight, JR TI The role of the primary care provider in preventing and treating alcohol problems in adolescents SO AMBULATORY PEDIATRICS LA English DT Editorial Material DE adolescence; adolescent behavior; alcohol drinking; health behavior; primary health care; substance-related disorders ID DISORDERS IDENTIFICATION TEST; ORIENTED SCREENING INSTRUMENT; 12 PROBLEM BEHAVIORS; TEST AUDIT; SUBSTANCE-ABUSE; BRIEF INTERVENTIONS; DRUG-USE; COLLEGE-FRESHMEN; PROBLEM DRINKING; CONSUMPTION QUESTIONS AB Adolescents use alcohol more frequently and heavily than all other illicit drugs combined.(1) Given the myriad health, developmental, and social problems associated with alcohol use, it is not surprising that the American Medical Association's Guidelines for Adolescent Preventive Services recommends that adolescents be asked annually about their use of alcohol, and those who report any use during the past year should be assessed further. However, routine alcohol screening of adolescents in primary care and emergency medical settings is not universally applied. In March 2000, the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health and the Agency for Health care Research and Quality jointly sponsored a meeting entitled The Expanding Role of Primary Care in the Prevention and Treatment of Alcohol-Use Disorders. The purpose of the meeting was to bring together researchers, policymakers, clinicians, insurance providers, and medical education specialists to determine the best approaches to increase the involvement of primary care physicians and other health care professionals in screening and intervening for alcohol problems in their patients. The National Institute on Alcohol Abuse and Alcoholism and Agency for Health care Research and Quality believe that the evidence of efficacy for primary care involvement is compelling and are working together to promote the translation of these findings into clinical practice. The following article summarizes what is currently known about adolescent alcohol use and how it can be addressed in primary care settings. It provided the background for the meeting's focus on adolescent issues. C1 Childrens Hosp, Ctr Adolescent Subst Abuse Res, Boston, MA 02115 USA. Harvard Univ, Sch Med, Dept Pediat, Boston, MA 02115 USA. Harvard Univ, Sch Med, Div Addict, Boston, MA 02115 USA. NIAAA, Off Collaborat Res, NIH, Bethesda, MD USA. Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD USA. RP Knight, JR (reprint author), Childrens Hosp, Ctr Adolescent Subst Abuse Res, JB 372,300 Longwood Ave, Boston, MA 02115 USA. NR 116 TC 12 Z9 12 U1 3 U2 5 PU AMBULATORY PEDIATRIC ASSOC PI MCLEAN PA 6728 OLD MCLEAN VILLAGE DR, MCLEAN, VA 22101-3906 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD MAY-JUN PY 2001 VL 1 IS 3 BP 150 EP 161 DI 10.1367/1539-4409(2001)001<0150:TROTPC>2.0.CO;2 PG 12 WC Pediatrics SC Pediatrics GA 473YJ UT WOS:000171076700006 PM 11888392 ER PT J AU Friedman, B Basu, J AF Friedman, B Basu, J TI Health insurance, primary care, and preventable hospitalization of children in a large state SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID MEDICAL-CARE; RATES; DISEASE; IMPACT AB Objectives: To analyze variations in the admission rate to hospitals of children with ambulatory care-sensitive (ACS) conditions and to test the relationship of ACS admission rates to insurance coverage, health maintenance organization (HMO) enrollment, availability of primary care, severity of illness, distance to hospital, and a number of other factors. Study Design: Hypotheses were derived from basic considerations about demand and use of primary care and preventive services and then were tested with a weighted linear regression model of the ACS admission rate for children residing in each county. Patients and Methods: The principal data were all hospital discharges for New York resident children admitted to hospitals in New York, Pennsylvania, New Jersey, or Connecticut in 1994. The data and methodology were noteworthy for including out-of-area hospital admissions. Results: There was a substantial negative association of the ACS rate with private HMO coverage. There also were sizable negative effects of the availability of primary care services in physician offices and the distance traveled. Large differences related to racial and ethnic composition of the population were found independent of other determinants. There was a positive association with the proportion of ail admissions (admissions for all conditions) covered by Medicaid or self-pay. Severity of illness and use of emergency departments were controlled. There was no independent effect of a location in New York City. Conclusions: The results are consistent with smaller-scale studies suggesting that improved health insurance for children could reduce hospital admissions. Contracting with HMOs also appears to be beneficial. Independently, programs to increase the availability of primary and preventive services could substantially reduce ACS admissions. C1 AHRQ, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. AHRQ, Ctr Primary Care Res, Rockville, MD 20852 USA. RP Friedman, B (reprint author), AHRQ, Ctr Org & Delivery Studies, Suite 605,2101 Jefferson St, Rockville, MD 20852 USA. RI Dalla Zuanna, Teresa/G-3133-2015 NR 20 TC 41 Z9 42 U1 1 U2 3 PU AMER MED PUBLISHING, M W C COMPANY PI JAMESBURG PA 241 FORSGATE DR, STE 102, JAMESBURG, NJ 08831 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD MAY PY 2001 VL 7 IS 5 BP 473 EP 481 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 433QR UT WOS:000168771700003 PM 11388127 ER PT J AU Hsia, DC AF Hsia, DC TI Can joint negotiation restore physicians' professional autonomy? SO ANNALS OF INTERNAL MEDICINE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Hsia, DC (reprint author), Agcy Healthcare Res & Qual, 6010 Execut Blvd, Rockville, MD 20852 USA. NR 12 TC 2 Z9 3 U1 0 U2 1 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAY 1 PY 2001 VL 134 IS 9 BP 780 EP 782 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 428PU UT WOS:000168470700008 PM 11329236 ER PT J AU Gergen, PJ AF Gergen, PJ TI Understanding the economic burden of asthma SO JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY LA English DT Article DE cost-of-illness study; direct costs; incidence; indirect costs; prevalence ID INDIRECT COSTS; UNITED-STATES; CHILDHOOD ASTHMA; EXPENDITURES; CHILDREN; SEVERITY; THERAPY AB The economic impact of asthma is large and growing, and the use of economic outcomes is increasing. Such outcomes serve as the basis for studies of the efficiency of care and are being reported increasingly as outcomes of clinical trials. This article presents the basic components of a cost-of-illness study, the influences that have an impact on these components, the relation of economic indicators to clinical outcomes, and the relative importance of the economic factors for differing groups in society. C1 Agcy Healthcare Res & Qual, Ctr Primary Care & Res, Rockville, MD 20852 USA. RP Gergen, PJ (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care & Res, 6010 Execut Blvd,Suite 201, Rockville, MD 20852 USA. NR 23 TC 30 Z9 31 U1 2 U2 4 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0091-6749 J9 J ALLERGY CLIN IMMUN JI J. Allergy Clin. Immunol. PD MAY PY 2001 VL 107 IS 5 SU S BP S445 EP S448 DI 10.1067/mai.2001.114992 PG 4 WC Allergy; Immunology SC Allergy; Immunology GA 435RD UT WOS:000168894200002 PM 11344373 ER PT J AU Manski, RJ Moeller, JF Maas, WR AF Manski, RJ Moeller, JF Maas, WR TI Dental services - An analysis of utilization over 20 years SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article ID CARE; AMERICANS AB Background. Utilization studies serve as an important tool for oral health policy decision-making. A number of important reports have been published that help to characterize the dental utilization patterns of most Americans. For the most part, these studies have focused on utilization estimates for a particular survey period or year. Fewer studies have examined changing utilization patterns over time. Methods. This article focuses on dental utilization and the changes in utilization for the civilian, community-based U.S. population during 1977, 1987 and 1996. Using data from the National Medical Care Expenditure Survey, National Medical Expenditure Survey and Medical Expenditure Panel Survey, the authors provide national estimates of dental visits for each of several socioeconomic and demographic categories during 1977, 1987 and 1996. Results. Although the dental use rates for children between 6 and 18 years of age were the highest of any age group in each of the three years studied, the use rate for children and the elderly increased during this same 20-year period. Data also showed that the gap in use rates between lower- and higher-income people widened during the 20-year period. Generally, use rates according to sex and race/ethnicity were unchanged in each of the survey years, except for a narrowing of the gap between whites and nonwhites by 1996. Conclusion. These data are unique and comparable and establish a mechanism by which dental visits can be compared during a 20-year period. While aggregate utilization rates generally were stable during this 20-year period, some differences within socioeconomic and demographic groups are notable. For instance, the use rate increased during the 20-year period for people 65 years of age and older and for children younger than 6 years of age. Practice Implications. By understanding these analyses, U.S. dentists will be better positioned to provide care and meet the needs of all Americans. C1 Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, Baltimore, MD 21201 USA. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD USA. Ctr Dis Control & Prevent, Div Oral Hlth, Atlanta, GA USA. RP Manski, RJ (reprint author), Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, 666 W Baltimore St, Baltimore, MD 21201 USA. NR 20 TC 67 Z9 68 U1 1 U2 4 PU AMER DENTAL ASSN PI CHICAGO PA 211 E CHICAGO AVE, CHICAGO, IL 60611 USA SN 0002-8177 J9 J AM DENT ASSOC JI J. Am. Dent. Assoc. PD MAY PY 2001 VL 132 IS 5 BP 655 EP 664 PG 10 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 431UT UT WOS:000168650700021 PM 11367970 ER PT J AU Hennessy, S Strom, BL AF Hennessy, S Strom, BL TI Statins and fracture risk SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID COA REDUCTASE INHIBITORS; HIP-FRACTURES; BONE C1 Agcy Healthcare Res & Qual, Ctr Clin Epidemiol & Biostat, Dept Biostat & Epidemiol, Rockville, MD USA. Univ Penn, Sch Med, Ctr Educ & Res Therapeut, Philadelphia, PA 19104 USA. RP Strom, BL (reprint author), Univ Penn, Sch Med, Ctr Clin Epidemiol & Biostat, 432 Guardian Dr,Room 824,Blockley Hall, Philadelphia, PA 19104 USA. NR 11 TC 18 Z9 19 U1 0 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD APR 11 PY 2001 VL 285 IS 14 BP 1888 EP 1889 DI 10.1001/jama.285.14.1888 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 418DY UT WOS:000167876700031 PM 11308404 ER PT J AU Eisenberg, JM Kamerow, DB AF Eisenberg, JM Kamerow, DB TI The agency for healthcare research and quality and the US Preventive Services Task Force - Public support for translating evidence into prevention practice and policy SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Editorial Material C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. RP Kamerow, DB (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Practice & Technol Assessment, 6010 Execut Blvd, Rockville, MD 20852 USA. NR 8 TC 7 Z9 7 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD APR PY 2001 VL 20 IS 3 SU S BP 1 EP 2 DI 10.1016/S0749-3797(01)00270-7 PG 2 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 423HV UT WOS:000168170700001 PM 11306223 ER PT J AU Woolf, SH Atkins, D AF Woolf, SH Atkins, D TI The evolving role of prevention in health care - Contributions of the US Preventive Services Task Force SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID PRACTICE GUIDELINES; SYSTEMATIC REVIEWS; CLINICAL-PRACTICE; UNITED-STATES; PHYSICIANS; IMPLEMENTATION; DECISIONS; MEDICINE C1 Virginia Commonwealth Univ, Med Coll Virginia, Fairfax, VA 22033 USA. Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD USA. RP Woolf, SH (reprint author), Virginia Commonwealth Univ, Med Coll Virginia, 3712 Charles Stewart Dr, Fairfax, VA 22033 USA. NR 47 TC 42 Z9 43 U1 1 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD APR PY 2001 VL 20 IS 3 SU S BP 13 EP 20 DI 10.1016/S0749-3797(01)00262-8 PG 8 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 423HV UT WOS:000168170700006 PM 11306228 ER PT J AU Harris, RP Helfand, M Woolf, SH Lohr, KN Mulrow, CD Teutsch, SM Atkins, D AF Harris, RP Helfand, M Woolf, SH Lohr, KN Mulrow, CD Teutsch, SM Atkins, D CA Methods Work Grp Third US Preventi TI Current methods of the US Preventive Services Task Force - A review of the process SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article DE MEDLINE; preventive health services; evidence-based medicines; methods; practice guidelines ID CLINICAL-PRACTICE GUIDELINES; EVIDENCE-BASED MEDICINE; USERS GUIDES; ARTICLE AB The U.S. Preventive Services Task Force (USPSTF/Task Force) represents one of several efforts to take a more evidence-based approach to the development of clinical practice guidelines. As methods have matured for assembling and reviewing evidence and for translating evidence into guidelines, so too have the methods of the USPSTF. This paper summarizes the current methods of the third USPSTF, supported by the Agency for Healthcare Research and Quality (AHRQ) and two of the AHRQ Evidence-based Practice Centers (EPCs). The Task Force limits the topics it reviews to those conditions that cause a large burden of suffering to society and that also have available a potentially effective preventive service. It focuses its reviews on the questions and evidence most critical to making a recommendation. It uses analytic frameworks to specify the linkages and key questions connecting the preventive service with health outcomes. These linkages, together with explicit inclusion criteria, guide the literature searches for admissible evidence. Once assembled, admissible evidence is reviewed at three strata: (1) the individual study, (2) the body of evidence concerning a single linkage in the analytic framework, and (3) the body of evidence concerning the entire preventive sen ice. For each stratum, the Task Force uses explicit criteria as general guidelines to assign one of three grades of evidence: good, fair, or poor. Good or fair quality evidence for the entire preventive service must include studies of sufficient design and quality to provide an unbroken chain of evidence-supported linkages, generalizable to the general primary care population, that connect the preventive service with health outcomes. Poor evidence contains a formidable break in the evidence chain such that the connection between the preventive service and health outcomes is uncertain. For services supported by overall good or fair evidence, the Task Force uses outcomes tables to help categorize the magnitude of benefits, harms, and net benefit fi-om implementation of the preventive service into one of four categories: substantial, moderate, small, or zero/negative. The Task Force uses its assessment of the evidence and magnitude of net benefit to make a recommendation, coded as a letter: from A (strongly recommended) to D (recommend against). It gives an I recommendation in situations in which the evidence is insufficient to determine net benefit. The third Task Force and the EPCs will continue to examine a variety of methodologic issues and document work group progress in future communications. C1 Univ N Carolina, Cecil G Sheps Ctr Hlth Serv Res, Chapel Hill, NC 27599 USA. Oregon Hlth Sci Univ, Div Med Informat & Outcomes Res, Portland, OR 97201 USA. Univ N Carolina, Sch Med, Chapel Hill, NC 27599 USA. Oregon Hlth Sci Univ, Evidence Based Practice Ctr, Portland, OR 97201 USA. Vet Affairs Med Ctr, Portland, OR USA. Virginia Commonwealth Univ, Med Coll Virginia, Dept Family Practice, Richmond, VA 23298 USA. Res Triangle Inst, Res Triangle Pk, NC 27709 USA. Univ N Carolina, Program Hlth Outcomes, Chapel Hill, NC 27515 USA. Univ N Carolina, Sch Publ Hlth, Chapel Hill, NC 27515 USA. Univ Texas, Hlth Sci Ctr, Dept Med, San Antonio, TX 78284 USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD USA. RP Harris, RP (reprint author), Univ N Carolina, Cecil G Sheps Ctr Hlth Serv Res, CB 7590,725 Airport Rd, Chapel Hill, NC 27599 USA. FU PHS HHS [290-97-0011, 290-97-0018] NR 40 TC 1039 Z9 1054 U1 0 U2 25 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD APR PY 2001 VL 20 IS 3 SU S BP 21 EP 35 DI 10.1016/S0749-3797(01)00261-6 PG 15 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 423HV UT WOS:000168170700007 PM 11306229 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for skin cancer - Recommendations and rationale SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article C1 Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Texas, Hlth Sci Ctr, Sch Nursing, San Antonio, TX 78284 USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Rochester, NY 14627 USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA USA. Univ Texas, Hlth Sci Ctr, Audie L Murphy Mem Vet Hosp, San Antonio, TX 78284 USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Brown Univ, Women & Infants Hosp, Providence, RI 02908 USA. Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. Dartmouth Hitchcock Med Ctr, Dept Med, Lebanon, NH 03766 USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ Coll Phys & Surg, Dept Obstet & Gynecol, New York, NY 10032 USA. Med Coll Virginia, Dept Family Practice, Fairfax, VA USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD USA. NR 9 TC 7 Z9 7 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD APR PY 2001 VL 20 IS 3 SU S BP 44 EP 46 DI 10.1016/S0749-3797(01)00259-8 PG 3 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 423HV UT WOS:000168170700009 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for bacterial vaginosis in pregnancy - Recommendations and rationale SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article C1 Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20912 USA. RP Berg, AO (reprint author), Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20912 USA. NR 5 TC 7 Z9 7 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD APR PY 2001 VL 20 IS 3 SU S BP 59 EP 61 DI 10.1016/S0749-3797(01)00257-4 PG 3 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 423HV UT WOS:000168170700011 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening adults for lipid disorders - Recommendations and rationale SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID CORONARY-HEART-DISEASE; CHOLESTEROL; PREDICTION C1 Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20912 USA. RP Berg, AO (reprint author), Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20912 USA. EM dbest@ahrq.gov NR 12 TC 4 Z9 4 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0749-3797 EI 1873-2607 J9 AM J PREV MED JI Am. J. Prev. Med. PD APR PY 2001 VL 20 IS 3 SU S BP 73 EP 76 DI 10.1016/S0749-3797(01)00266-5 PG 4 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 423HV UT WOS:000168170700013 ER PT J AU Pignone, MP Phillips, CJ Atkins, D Teutsch, SM Mulrow, CD Lohr, KN AF Pignone, MP Phillips, CJ Atkins, D Teutsch, SM Mulrow, CD Lohr, KN TI Screening and treating adults for lipid disorders SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article DE cardiovascular disease; cholesterol; coronary disease; hyperlipidemia; preventive health services; evidence-based medicine; MEDLINE; methods; lipids; mass screening; mortality; drug therapy ID CORONARY HEART-DISEASE; SERUM-CHOLESTEROL CONCENTRATION; RANDOMIZED CONTROLLED TRIALS; CARDIOVASCULAR RISK-FACTORS; EVENTS CARE TRIAL; BLOOD CHOLESTEROL; PRIMARY-PREVENTION; MYOCARDIAL-INFARCTION; HEALTH CHECKS; PRAVASTATIN AB Context: Screening and treatment of lipid disorders in people at high risk for future coronary heart disease (CHD) events has gained wide acceptance, especially for patients with known CHD, but the proper role in people with low to medium risk is controversial. Objective: To examine the evidence about the benefits and harms of screening and treatment of lipid disorders in adults without known cardiovascular disease for the U.S. Preventive Services Task Force. Data Sources: We identified English-language articles on drug therapy, diet and exercise therapy, and screening for lipid disorders from comprehensive searches of the MEDLINE database from 1994 through July 1999, We used published systematic reviews, hand searching of relevant articles, the second Guide to Clinical Preventive Services, and extensive peer review to identify important older articles and to ensure completeness. Data Synthesis: There is strong, direct evidence that drug therapy reduces CHD events, CHD mortality, and possibly total mortality in middle-aged men (35 to 65 years) with abnormal lipids and a potential risk of CHD events greater than 1% to 2% per year. Indirect evidence suggests that drug therapy is also effective in other adults with similar levels of risk. The evidence is insufficient about benefits and harms of treating men younger than 35 years and women younger than 45 years who have abnormal lipids but no other risk factors for heart disease and low risk for CHD events (less than 1% per year). Trials of diet therapy for primary prevention have led to long-term reductions in cholesterol of 3% to 6% but have not demonstrated a reduction in CHD events overall. Exercise programs that maintain or reduce body weight can produce short-term reductions in total cholesterol of 3% to 6%, but longer-term results in unselected populations have found smaller or no effect. To identify accurately people with abnormal lipids, at least two measurements: of total cholesterol and high-density lipoprotein cholesterol are required. The role of measuring triglycerides and the optimal screening interval are unclear from the available evidence. Conclusions: On the basis of the effectiveness of treatment, the availability of accurate and reliable tests, and the likelihood of identifying people with abnormal lipids and increased CHD risk, screening appears to be effective in middle-aged and older adults and in young adults with additional cardiovascular risk factors. C1 Univ N Carolina, Sch Med, Dept Med, Chapel Hill, NC USA. AF Med Operat Agcy, Off Prevent & Hlth Serv Assessment, San Antonio, TX USA. Audie L Murphy Mem Vet Adm Med Ctr, Dept Med, San Antonio, TX 78284 USA. US Dept HHS, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Res Triangle Inst, Res Triangle Pk, NC 27709 USA. Univ N Carolina, Program Hlth Outcomes, Chapel Hill, NC USA. Univ N Carolina, Sch Publ Hlth, Chapel Hill, NC USA. RP Pignone, MP (reprint author), UNC Hosp, CB 7110,5039 Old Clin Bldg, Chapel Hill, NC 27599 USA. RI H, V/M-5550-2014 FU PHS HHS [290-97-0011] NR 68 TC 46 Z9 46 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD APR PY 2001 VL 20 IS 3 SU S BP 77 EP 89 DI 10.1016/S0749-3797(01)00255-0 PG 13 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 423HV UT WOS:000168170700014 PM 11306236 ER PT J AU Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, PS Homer, CJ Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Sox, HC Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for chlamydial infection - Recommendations and rationale SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article C1 Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20912 USA. RP Berg, AO (reprint author), Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 6010 Execut Blvd,Suite 300, Rockville, MD 20912 USA. NR 7 TC 11 Z9 13 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD APR PY 2001 VL 20 IS 3 SU S BP 90 EP 94 DI 10.1016/S0749-3797(01)00254-9 PG 5 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 423HV UT WOS:000168170700015 ER PT J AU Wong, HS Hellinger, FJ AF Wong, HS Hellinger, FJ TI Conducting research on the Medicare market: The need for better data and methods SO HEALTH SERVICES RESEARCH LA English DT Article; Proceedings Paper CT Conference on Data Needs for Studies of Competition in Market Ares CY JUN 21-22, 1999 CL WASHINGTON, D.C. DE data; methods; HMO; Medicare market; selection bias ID CAPITATION PAYMENTS; SELECTION; HMOS AB Objective. To highlight data limitations, the need to improve data collection, the need to develop better analytic methods, and the need to use alternative data sources to conduct research related to the Medicare program. Objectives were achieved by reviewing existing studies on risk selection in Medicare HMOs, examining their data limitations, and introducing a new approach that circumvents many of these shortcomings. Data Sources. Data for years 1995-97 for five states (Arizona, Florida, Massachusetts, New York, and Pennsylvania) from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs), maintained by the Agency for Healthcare Research and Quality; and the Health Care Financing Administration's Medicare Managed Care Market Penetration Data Files and Medicare Provider Analysis and Review Files. Study Design. Analysis of hospital utilization rates for Medicare beneficiaries in the traditional fee-for-service (FFS) Medicare and Medicare HMO sectors and examination of the relationship between these rates and the Medicare HMO penetration rates. Principal Findings. Medicare HMOs have lower hospital utilization rates than their FFS counterparts, differences in utilization rates vary across states, and HMO penetration rates are inversely related to our rough measure of favorable selection. Conclusions. Substantial growth in Medicare HMO enrollment and the implementation of a new risk-adjusted payment system have led to an increasing need for research on the Medicare program. Improved data collection, better methods, new creative approaches, and alternative data sources are needed to address these issues in a timely and suitable manner. C1 Ctr Org & Delivery Studies, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Wong, HS (reprint author), Ctr Org & Delivery Studies, Agcy Healthcare Res & Qual, 2101 E Jefferson St,Suite 605, Rockville, MD 20852 USA. NR 27 TC 4 Z9 4 U1 0 U2 3 PU HEALTH ADMINISTRATION PRESS PI CHICAGO PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES ONE N FRANKLIN ST, STE 1700, CHICAGO, IL 60606-3491 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 2001 VL 36 IS 1 BP 291 EP 308 PN 2 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 420UR UT WOS:000168024100007 PM 11327178 ER PT J AU Goodson, JD Bierman, AS Fein, O Rask, K Rich, EC Selker, HP AF Goodson, JD Bierman, AS Fein, O Rask, K Rich, EC Selker, HP TI The future of capitation - The physician role in managing change in practice SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE capitation; physician reimbursement; physician organization; physician financial risk; universal health care access ID FEE-FOR-SERVICE; HEALTH MAINTENANCE ORGANIZATIONS; PREPAID GROUP-PRACTICE; PRIMARY-CARE; MEDICAL OUTCOMES; FINANCIAL INCENTIVES; RISK-ADJUSTMENT; RANDOMIZED TRIAL; SYSTEMS; PAYMENT AB Capitation-based reimbursement significantly influences the practice of medicine. As physicians, we need to assure that payment models do not jeopardize the care we provide when we accept higher levels of personal financial risk. In this paper, we review the literature relevant to capitation, consider the interaction of financial incentives with physician and medical risk, and conclude that primary care physicians need to work to assure that capitated systems incorporate checks and balances that protect both patients and providers, We offer the following proposals for individuals and groups considering capitated contracts: (1) reimbursement for primary care physicians should recognize both individual patient encounters and the administrative work of patient care management; (2) reimbursement for subspecialists should recognize both access to subspecialty knowledge and expertise as well as patient care encounters, but in some situations, subspecialists may provide the majority of care to individual patients and will be reimbursed as primary care providers; (3) groups of physicians should accept financial risk for patient care only if they have the tools and resources to manage the care; (4) physicians sharing risk for patient care should meet regularly to discuss care and resource management; and (5) physicians must disclose the financial relationships they have with health plans and medical care organizations. and engage patients and communities in discussions about resource allocation. As a payment model, capitation offers opportunities for primary care physicians to influence the future of health care by improving the management of resources at a local level. C1 Massachusetts Gen Hosp, Boston, MA 02114 USA. Harvard Univ, Sch Med, Boston, MA USA. US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. Cornell Univ, Weill Med Coll, Dept Clin Med & Clin Publ Hlth, New York, NY USA. Emory Univ, Sch Med, Dept Med, Atlanta, GA USA. Creighton Univ, Sch Med, Dept Med, Ctr Practice Improvement & Outcomes Res, Omaha, NE USA. New England Med Ctr, Div Clin Care Res, Boston, MA 02111 USA. Tufts Univ, Sch Med, Dept Med, Boston, MA 02111 USA. RP Goodson, JD (reprint author), Massachusetts Gen Hosp, WAC 625, Boston, MA 02114 USA. RI rask, kimberly/M-8001-2016 NR 60 TC 14 Z9 14 U1 0 U2 1 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2001 VL 16 IS 4 BP 250 EP 256 DI 10.1046/j.1525-1497.2001.016004250.x PG 7 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 420GH UT WOS:000167996900006 PM 11318926 ER PT J AU Eisenberg, JM AF Eisenberg, JM TI What does evidence mean? Can the law and medicine be reconciled? SO JOURNAL OF HEALTH POLITICS POLICY AND LAW LA English DT Article C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Eisenberg, JM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 8 TC 11 Z9 12 U1 0 U2 0 PU DUKE UNIV PRESS PI DURHAM PA 905 W MAIN ST, STE 18-B, DURHAM, NC 27701 USA SN 0361-6878 J9 J HEALTH POLIT POLIC JI J. Health Polit. Policy Law PD APR PY 2001 VL 26 IS 2 BP 369 EP 381 DI 10.1215/03616878-26-2-369 PG 13 WC Health Care Sciences & Services; Health Policy & Services; Medicine, Legal; Social Issues; Social Sciences, Biomedical SC Health Care Sciences & Services; Legal Medicine; Social Issues; Biomedical Social Sciences GA 421PX UT WOS:000168073700008 PM 11330084 ER PT J AU Burstin, H Lanier, D AF Burstin, H Lanier, D TI Update from funders - Center for primary care research and agency for health cave research and quality SO MEDICAL CARE LA English DT Article C1 Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD USA. RP Burstin, H (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD APR PY 2001 VL 39 IS 4 BP 309 EP 311 DI 10.1097/00005650-200104000-00001 PG 3 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 419RD UT WOS:000167961700001 PM 11329517 ER PT J AU Rhoades, JA Altman, BM AF Rhoades, JA Altman, BM TI Personal characteristics and contextual factors associated with residential expenditures for individuals with mental retardation SO MENTAL RETARDATION LA English DT Article ID DEVELOPMENTAL-DISABILITIES; COST; COMMUNITY; SERVICES; INSTITUTIONS AB A multivariate analysis was done to determine the relative importance of facility, resident, and community characteristics to expenditures. Facility factors associated with higher expenditures included ownership, facility size, facility services, and location. Individuals with a greater number of activity of daily living limitations, developmental disabilities, and more severe levels of mental retardation had higher expenses. Findings could improve our understanding of the costs of longterm residential care, assisting us to economically and effectively bring this population into the community. Data used are from the 1987 National Medical Expenditure Survey Institutional Population Component. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. Natl Ctr Hlth Stat, Hyattsville, MD 20782 USA. RP Rhoades, JA (reprint author), Agcy Healthcare Res & Qual, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 36 TC 4 Z9 4 U1 2 U2 3 PU AMER ASSOC MENTAL RETARDATION PI WASHINGTON PA 444 N CAPITOL ST, NW, STE 846, WASHINGTON, DC 20001-1512 USA SN 0047-6765 J9 MENT RETARD JI Ment. Retard. PD APR PY 2001 VL 39 IS 2 BP 114 EP 129 DI 10.1352/0047-6765(2001)039<0114:PCACFA>2.0.CO;2 PG 16 WC Education, Special; Rehabilitation SC Education & Educational Research; Rehabilitation GA 423FK UT WOS:000168164600003 PM 11340961 ER PT J AU McNamara, RL Powe, NR Thiemann, DR Shaffer, T Weller, W Anderson, G AF McNamara, RL Powe, NR Thiemann, DR Shaffer, T Weller, W Anderson, G TI Specialty of principal care physician and Medicare expenditures in patients with coronary artery disease: Impact of comorbidity and severity SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article; Proceedings Paper CT 47th Annual Scientific Session of the American-College-of-Cardiology CY MAR 29-APR 07, 1998 CL ATLANTA, GEORGIA SP Amer Coll Cardiol ID ACUTE MYOCARDIAL-INFARCTION; UNITED-STATES; OUTCOMES; SYSTEMS; CARDIOLOGISTS; SATISFACTION; INTERNISTS; DATABASES; PAYMENT; THERAPY AB Objective: To explore differences in expenditures for elderly patients with acute and chronic coronary artery disease according to the specialty of the principal care physician. Study Design: Retrospective analysis of Medicare claims. Patients and Methods: A total of 250,514 patients with coronary artery disease (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 410-414) were drawn from a national random sample of 1992 Medicare expenditures. Patients were classified by the physician type with the highest number of Medicare Part B outpatient claims into a cardiologist group and a generalist group. The outcome was mean total expenditures, stratifying (1) by comorbidity as measured by the modified Charlson Index and (2) by severity defined as the proportion of patients with acute myocardial infarction or unstable angina. Results: Those patients in the cardiologist group had lower comorbidity and higher severity than those in the generalist group. Overall mean expenditures were significantly higher for the cardiologist group than for the generalist group ($7658 vs $6047; P < .001). These differences in mean expenditures were evident at each level of comorbidity. However, when stratified by severity of diagnosis, differences were seen predominantly in those with acute diagnoses. For those with either acute myocardial infarction or unstable angina, the mean expenditures were higher for the cardiologist group than for the combined generalist group ($15,378 vs $12,260; P<.001); however, the mean expenditures for those with only chronic conditions were similar ($4856 vs $4745; P=.53). Conclusion: Expenditures were higher when cardiologists were the principal care physicians treating patients with acute disease but not chronic disease. C1 Chinle Comprehens Hlth Care Facil, Indian Hlth Serv, Chinle, AZ 86503 USA. Johns Hopkins Med Inst, Dept Epidemiol, Baltimore, MD 21205 USA. Johns Hopkins Med Inst, Dept Med, Baltimore, MD 21205 USA. Johns Hopkins Med Inst, Dept Hlth Policy & Management, Baltimore, MD 21205 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP McNamara, RL (reprint author), Chinle Comprehens Hlth Care Facil, Indian Hlth Serv, POB PH, Chinle, AZ 86503 USA. NR 27 TC 4 Z9 4 U1 0 U2 1 PU AMER MED PUBLISHING, M W C COMPANY PI JAMESBURG PA 241 FORSGATE DR, STE 102, JAMESBURG, NJ 08831 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD MAR PY 2001 VL 7 IS 3 BP 261 EP 266 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 409AN UT WOS:000167362500003 PM 11258143 ER PT J AU Ramsey, SD Sullivan, SD Kaplan, RM Wood, DE Chiang, YP Wagner, JL AF Ramsey, SD Sullivan, SD Kaplan, RM Wood, DE Chiang, YP Wagner, JL CA NETT Res Grp TI Economic analysis of lung volume reduction surgery as part of the National Emphysema Treatment Trial SO ANNALS OF THORACIC SURGERY LA English DT Article ID OBSTRUCTIVE PULMONARY-DISEASE; COST-EFFECTIVENESS; BREAST-CANCER; HEALTH-CARE; TRANSPLANTATION; GUIDELINES; TECHNOLOGY; QUALITY AB Background. In today's cost-conscious health care environment, obtaining timely and accurate economic information regarding new medical technologies has become extremely important. The National Emphysema Treatment Trial, a multicenter, randomized controlled trial of lung volume reduction surgery (LVRS) plus medical therapy, versus medical therapy for patients with severe emphysema, includes a parallel cost-effectiveness analysis. Methods. The analysis is designed to determine the cost-effectiveness of LVRS versus medical therapy for those who are eligible for the procedure. After describing theoretical foundations of cost-effectiveness analysis as they apply to this study, we describe the economic and quality of life data that are being collected alongside the clinical trial, methods of analysis, and approach to presenting the results. Results. The cost-effectiveness of LVRS relative to medical therapy will be presented as costs per quality-adjusted life years gained. Conclusions. This analysis will provide timely economic data that can be considered alongside the clinical results of the National Emphysema Treatment Trial. As one of the largest clinical trials to include a parallel, prospective cost-effectiveness analyses, this study will also provide valuable practical information about conducting an economic analysis alongside a multicenter clinical trial. (C) 2001 by The Society of Thoracic Surgeons. C1 Univ Washington, Dept Med, Seattle, WA 98195 USA. Univ Washington, Dept Pharm, Seattle, WA 98195 USA. Univ Washington, Dept Surg, Seattle, WA 98195 USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD USA. Univ Calif San Diego, Dept Family & Prevent Med, San Diego, CA 92103 USA. Congress Budget Off, Hlth & Human Resources Div, Washington, DC USA. RP Ramsey, SD (reprint author), Fred Hutchinson Canc Res Ctr, 1100 Fairview Ave N,Mailstop MP-900, Seattle, WA 98109 USA. NR 23 TC 22 Z9 24 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0003-4975 J9 ANN THORAC SURG JI Ann. Thorac. Surg. PD MAR PY 2001 VL 71 IS 3 BP 995 EP 1002 DI 10.1016/S0003-4975(00)02283-9 PG 8 WC Cardiac & Cardiovascular Systems; Respiratory System; Surgery SC Cardiovascular System & Cardiology; Respiratory System; Surgery GA 410KM UT WOS:000167439200055 PM 11269488 ER PT J AU Berk, ML Monheit, AC AF Berk, ML Monheit, AC TI The concentration of health care expenditures, revisited SO HEALTH AFFAIRS LA English DT Article AB In two previous publications, we described the distribution of health care expenditures among the civilian, noninstitutionalized U.S. population, specifically in terms of the share of aggregate expenditures accounted for by the top spenders in the distribution. Our focus revealed considerably skewed distribution, with a relatively small proportion of the population accounting for a large share of expenditures. In this paper we update our previous tabulations (last computed using data more than a decade old) with new data from the 1996 Medical Expenditure Panel Survey (MEPS). Our findings show that the skewed concentration of health care expenditures has remained very stable; 5 percent of the population accounts for the majority of health expenditures. C1 Project HOPE Ctr Hlth Affairs, Bethesda, MD USA. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Div Social & Econ Res, Rockville, MD USA. RP Berk, ML (reprint author), Project HOPE Ctr Hlth Affairs, Bethesda, MD USA. NR 12 TC 133 Z9 133 U1 1 U2 3 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2001 VL 20 IS 2 BP 9 EP 18 DI 10.1377/hlthaff.20.2.9 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 411YC UT WOS:000167526400003 PM 11260963 ER PT J AU Zuvekas, SH AF Zuvekas, SH TI Trends in mental health services use and spending, 1989-1996 SO HEALTH AFFAIRS LA English DT Article C1 AHRQ, Ctr Cost & Financing Studies, Rockville, MD USA. RP Zuvekas, SH (reprint author), AHRQ, Ctr Cost & Financing Studies, Rockville, MD USA. NR 15 TC 57 Z9 57 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2001 VL 20 IS 2 BP 214 EP 224 DI 10.1377/hlthaff.20.2.214 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 411YC UT WOS:000167526400024 PM 11260946 ER PT J AU Meyer, GS AF Meyer, GS TI Balancing the quality cycle: Tackling the measurement-improvement gap in health care. Part II SO NUTRITION LA English DT Article; Proceedings Paper CT Roundtable Conference on Comparing European and US Experiences CY OCT 06, 1999 CL MAIDSTONE, ENGLAND ID PHYSICIANS C1 Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvement, Rockville, MD 20852 USA. RP Meyer, GS (reprint author), Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvement, Suite 502,2101 E Jefferson St, Rockville, MD 20852 USA. NR 7 TC 0 Z9 0 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0899-9007 J9 NUTRITION JI Nutrition PD MAR PY 2001 VL 17 IS 3 BP 271 EP 273 DI 10.1016/S0899-9007(00)00558-X PG 3 WC Nutrition & Dietetics SC Nutrition & Dietetics GA 419BD UT WOS:000167928700022 PM 11312078 ER PT J AU Rucker, DW Brennan, TA Burstin, HR AF Rucker, DW Brennan, TA Burstin, HR TI Delay in seeking emergency care SO ACADEMIC EMERGENCY MEDICINE LA English DT Article DE patients; delay; care seeking; emergency department ID ACUTE MYOCARDIAL-INFARCTION; HOSPITAL EMERGENCY; TIME; DETERMINANTS; INSURANCE; ILLNESS; VISITS AB Objective: To determine whether patient clinical and socioeconomic characteristics predict patient delay in coming to the emergency department (ED). Methods: Adult ED patients at five urban teaching hospitals were surveyed regarding self-reported delay in coming to the ED. Delay was measured by self-perception as well as by the number of days ill and unable to work. Patient socioeconomic and clinical characteristics were obtained by survey questionnaire and chart review. Cross-sectional analysis within a prospective study of 4,094 consecutive patients was performed using a subset of 1,920 patients (84% eligible rate) to whom questionnaires were administered. Results: Overall, 32% of the patients completing the survey reported delay in seeking ED care. Of these patients reporting delay, 71% thought their problem would go a away or was not serious. Patients who were older, had higher acuity, or were frequent ED users reported less delay in coming to the ED, while patients without a regular physician or who were African American reported more delay. Perception of increased number of days ill prior to visiting the ED was reported by frequent ED users and those with worse baseline physical function, while patients who had higher acuity reported fewer days ill prior to coming to the ED. Conclusions: A patient's decision to delay coming to the ED often reflects a belief that his or her illness is either self-limited or not serious. The decision to delay correlates with patient characteristics and access to a regular physician. The correlates of delay in seeking ED care may depend on the delay measure used. Better understanding of patients at risk for delaying care may influence interventions to reduce delay. C1 Beth Israel Deaconess Med Ctr, Dept Emergency Med, Boston, MA 02215 USA. Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. Brigham & Womens Hosp, Dept Med, Div Gen Med, Boston, MA 02115 USA. RP Burstin, HR (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Res, 6010 Execut Blvd,Suite 201, Washington, DC 20009 USA. NR 27 TC 18 Z9 18 U1 0 U2 1 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD FEB PY 2001 VL 8 IS 2 BP 163 EP 169 DI 10.1111/j.1553-2712.2001.tb01282.x PG 7 WC Emergency Medicine SC Emergency Medicine GA 408GU UT WOS:000167319100011 PM 11157293 ER PT J AU Battles, JB Shea, CE AF Battles, JB Shea, CE TI A system of analyzing medical errors to improve GME curricula and programs SO ACADEMIC MEDICINE LA English DT Article ID EVENT-REPORTING SYSTEMS; TRANSFUSION MEDICINE; MISTAKES AB The report of the Institute of Medicine (IOM) To Err is Human recommended that both mandatory and voluntary event-reporting systems be established to identify and learn from errors. Because of the tight coupling of graduate medical education (GME) programs and the delivery of care, any event-reporting system used in a teaching hospital should be able to document the types of errors that are being made by graduate medical trainees (GTs). The authors performed an analysis of the root causes of events involving GTs that were recorded in hospital-based near-miss reporting systems. The root causes were classified using the Eindhoven Classification Model, medical version. Case histories of three separate events, one from an accident and emergency department in the United Kingdom, and two from a large teaching hospital in the United States, are used to illustrate the method. In all three cases, lack of knowledge on the part of the trainee contributed to the incident. Inadequate educational preparation had the potential for causing significant harm to the patient. Organizational causes were also present in each case, which illustrates the need to examine not only educational issues but also procedural and management issues related to GME. In each case, the analysis revealed in striking clarity deficiencies of educational content and problems of program structure. The authors conclude that doing a root-cause analysis in conjunction with a near-miss event-reporting system in a teaching hospital can be a valuable source of documented information to guide needed educational and system changes to GME programs. C1 Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvement, Rockville, MD 20852 USA. Univ Texas, SW Med Ctr, Off Med Educ, Dallas, TX USA. RP Battles, JB (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvement, 2101 E Jefferson St,Suite 502, Rockville, MD 20852 USA. FU NHLBI NIH HHS [R01-HL53772] NR 28 TC 48 Z9 48 U1 1 U2 7 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1040-2446 J9 ACAD MED JI Acad. Med. PD FEB PY 2001 VL 76 IS 2 BP 125 EP 133 DI 10.1097/00001888-200102000-00008 PG 9 WC Education, Scientific Disciplines; Health Care Sciences & Services SC Education & Educational Research; Health Care Sciences & Services GA 399YX UT WOS:000166842800008 PM 11158830 ER PT J AU London, AS Fleishman, JA Goldman, DP McCaffrey, DF Bozzette, SA Shapiro, MF Leibowitz, AA AF London, AS Fleishman, JA Goldman, DP McCaffrey, DF Bozzette, SA Shapiro, MF Leibowitz, AA TI Use of unpaid and paid home care services among people with HIV infection in the USA SO AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Sociological-Association CY AUG 20-27, 1998 CL SAN FRANCISCO, CALIFORNIA SP Amer Sociol Assoc ID NATIONAL PROBABILITY SAMPLES; LOW-PREVALENCE DISEASES; UNITED-STATES; AIDS PATIENTS; COSTS; PERSPECTIVES; CAREGIVERS; PARTNERS; STRESS; MEN AB This paper examines utilization of paid and unpaid home health care using data from a nationally representative sample of HIV-positive persons receiving medical care in early 1996 (N = 2,864). Overall, 21.0% used any home care, 12.2% used paid care and 13.6% used unpaid care. Most (70.0%) users of home care received care fi om only one type of provider. Substantially more hours Of unpaid than paid care were used. We also found evidence of a strong association between type of service used and type of care provider: 62.4% of persons who used nursing services only received paid care only; conversely, 55.5% of persons who used personal care services only received care only from unpaid caregivers. Use of home care overall was concentrated among persons with AIDS: 39.5% of persons with AIDS received any home health care, compared to 9.5% of those at earlier disease stages. In addition to having an AIDS diagnosis, logistic regression analyses indicated that other need variables significantly increased utilization; a higher number of HIV-related symptoms, lower physical functioning, less energy, a diagnosis of CMV and a recent hospitalization each independently increased the odds of overall home care utilization. Sociodemographic variables had generally weak relationships with overall home care utilization. Among users of home care, non-need variables had more influence on use of paid than unpaid care. Both paid and unpaid home health care is a key component of community-based systems of care for people with HIV infection. The results presented in this paper are the first nationally representative estimates of home care utilization by persons with HIV/AIDS and are discussed with reference to policy and future research. C1 Kent State Univ, Dept Sociol, Kent, OH 44242 USA. Agcy Healthcare Res & Qual, San Diego, CA USA. RAND, San Diego, CA USA. Univ Calif San Diego, San Diego, CA 92103 USA. Univ Calif Los Angeles, Sch Med, Los Angeles, CA USA. RAND, Los Angeles, CA USA. RP London, AS (reprint author), Kent State Univ, Dept Sociol, Kent, OH 44242 USA. FU AHRQ HHS [U-01HS08578] NR 41 TC 8 Z9 8 U1 2 U2 4 PU CARFAX PUBLISHING PI BASINGSTOKE PA RANKINE RD, BASINGSTOKE RG24 8PR, HANTS, ENGLAND SN 0954-0121 J9 AIDS CARE JI Aids Care-Psychol. Socio-Med. Asp. Aids/Hiv PD FEB PY 2001 VL 13 IS 1 BP 99 EP 121 DI 10.1080/09540120020018215 PG 23 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychology, Multidisciplinary; Respiratory System; Social Sciences, Biomedical SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychology; Respiratory System; Biomedical Social Sciences GA 394JU UT WOS:000166521600008 PM 11177468 ER PT J AU Baine, WB Yu, W Summe, JP AF Baine, WB Yu, W Summe, JP TI The epidemiology of hospitalization of elderly Americans for septicemia or bacteremia in 1991-1998: Application of Medicare claims data SO ANNALS OF EPIDEMIOLOGY LA English DT Article DE aged; bacteremia; epidemiology; hospital costs; hospitalization; Medicare part A; Medicare part B; septicemia ID COMB-NOV; GEN-NOV; MORTALITY; BURKHOLDERIA; PALLERONI; PROPOSAL; TRENDS; COSTS AB PURPOSE: To describe the epidemiology of hospitalization of elderly Americans for septicemia or bacteremia. METHODS: Medicare claims data for discharges from 1991 through 1998 were used to study 75,920 hospitalizations with the principal diagnosis of septicemia or bacteremia in patients aged 65 years or older. RESULTS: "Unspecified septicemia" was the commonest principal diagnosis, followed by septicemia due to Escherichia coli or staphylococci. From 1991 through 1997, annual discharges for "unspecified septicemia" increased 108%, and those for pneumococcal septicemia increased 310%. Decreases in reported septicemia were seen after increases in the proportion of beneficiaries in Medicare health maintenance organizations. Discharge rates for septicemia principal diagnoses increased steeply with age. Age-specific discharge rates were usually highest fur black men and lowest for white women. Exceptions included septicemia due to E. coli, with white men at low risk, and pneumococcal septicemia, without significant differences between races or sexes. The case-fatality rate in hospital ranged from 4.2% with "bacteremia" and 6.9% with E. coli septicemia to 22.2% with "septicemia due to gram negative organism, unspecified," and 26.8% with "unspecified septicemia." Staphylococcal septicemia, septicemia due to pseudomonas, and septicemia due to anaerobes were the costliest common principal diagnoses in terms of the mean duration of hospital stay. CONCLUSIONS: Unexplained sharp increases were reported in hospitalization for septicemia or bacteremia in elderly Americans. Marked variation by race and sex were evident in discharge rates with these principal diagnoses. Prognosis and average cost of treatment also differed substantially among common rubrics. Further investigation of individual diagnoses should concentrate on explaining secular trends, exploring the basis for variation by race and sex, and elucidating risk factors for poor clinical outcomes. Ann Epidemiol 2001;11:118-126. (C) 2001 Elsevier Science Inc. All rights reserved. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, US Dept HHS, Rockville, MD 20852 USA. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, US Dept HHS, Rockville, MD 20852 USA. RP Baine, WB (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, US Dept HHS, 6010 Execut Blvd, Rockville, MD 20852 USA. NR 28 TC 34 Z9 35 U1 0 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 1047-2797 J9 ANN EPIDEMIOL JI Ann. Epidemiol. PD FEB PY 2001 VL 11 IS 2 BP 118 EP 126 DI 10.1016/S1047-2797(00)00184-8 PG 9 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 399TB UT WOS:000166827500006 PM 11164128 ER PT J AU Zuvekas, SH Banthin, JS Selden, TM AF Zuvekas, SH Banthin, JS Selden, TM TI How would mental health parity affect the marginal price of care? SO HEALTH SERVICES RESEARCH LA English DT Article DE mental health; parity; health insurance coverage ID MEDICAL OUTCOMES; UNITED-STATES; MANAGED CARE; INSURANCE; DISORDERS; SERVICES; PREPAID; SYSTEM AB Objective. To determine the impact of parity in mental health benefits on the marginal prices that consumers face for mental health treatment. Data Sources/Data Collection. We used detailed information on health plan benefits for a nationally representative sample of the privately insured population under age 65 taken from the 1987 National Medical Expenditure Survey (Edwards and Berlin 1989). The survey was carefully aged and reweighted to represent 1995 population and coverage characteristics. Study Design. We computed marginal out-of-pocket costs from the cost-sharing benefits described by policy booklets under current coverage and under parity for various mental health treatment expenditure levels using the MEDSIM health care microsimulation model developed by researchers at the Agency for Healthcare Research and Quality. Descriptive analyses and two-limit Tobit regression models are used to examine how insurance generosity varies across individuals by demographic and socioeconomic characteristics. Our analyses are limited to a description of how parity would change the marginal incentives faced by consumers under their existing plan's cost-sharing arrangements for mental and physical health care. We do not attempt to simulate how parity might affect the level of benefits, including whether benefits are offered at all, or the level of managed care that affects the actual benefits that plan members receive. Rather, we focus only on the nominal benefits described in their policy booklets. Principal Findings. Our results show that as of 1995 parity coverage would substantially reduce the share of mental health expenditures that consumers would pay at the margin under their existing plan's cost-sharing provisions, with larger changes for outpatient care than for inpatient care. Because current mental health coverage generally becomes less generous as expenditures rise, while coverage for other medical care becomes more generous (due to stop-loss provisions), the difference in incentives between current mental health coverage and the assumed parity coverage widens as total expenditure grows. We also find that the impact of parity on marginal incentives would vary greatly across the privately insured population. Conclusions. Based on the large variation in the impact of parity on marginal incentives across the population under current plan cost-sharing arrangements, changes in the demand for mental health treatment will likely also vary across the population. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Zuvekas, SH (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 28 TC 9 Z9 9 U1 0 U2 2 PU HEALTH ADMINISTRATION PRESS PI CHICAGO PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES ONE N FRANKLIN ST, STE 1700, CHICAGO, IL 60606-3491 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD FEB PY 2001 VL 35 IS 6 BP 1207 EP 1227 PG 21 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 404AJ UT WOS:000167075000002 PM 11221816 ER PT J AU Meyer, GS AF Meyer, GS TI Balancing the quality cycle: Tackling the measurement-improvement gap in health care. Part I SO NUTRITION LA English DT Article ID CONTINUING MEDICAL-EDUCATION; ACUTE MYOCARDIAL-INFARCTION; HOSPITALIZED-PATIENTS; ADVERSE EVENTS; STRATEGIES C1 Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvement, Dept Hlth & Human Serv, Rockville, MD 20852 USA. RP Meyer, GS (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvement, Dept Hlth & Human Serv, Suite 502,2101 E Jefferson St, Rockville, MD 20852 USA. NR 26 TC 0 Z9 0 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0899-9007 J9 NUTRITION JI Nutrition PD FEB PY 2001 VL 17 IS 2 BP 172 EP 174 DI 10.1016/S0899-9007(00)00516-5 PG 3 WC Nutrition & Dietetics SC Nutrition & Dietetics GA 407KM UT WOS:000167270800019 PM 11240351 ER PT J AU McCormick, MC Weinick, RM Elixhauser, A Stagnitti, MN Thompson, J Simpson, L AF McCormick, MC Weinick, RM Elixhauser, A Stagnitti, MN Thompson, J Simpson, L TI Annual report on access to and utilization of health care for children and youth in the United States-2000 SO AMBULATORY PEDIATRICS LA English DT Article ID INSURANCE PROGRAM; HOSPITALIZATION; INFANTS; RATES; NEEDS AB Objective.-This report provides an update on insurance coverage, use of health care services, and health expenditures for children and youth in the United States. In addition, the report provides information on variation in hospitalizations for children from a new 22-state hospital discharge data source. Methods.-The data on insurance coverage, utilization, and expenditures come from the Medical Expenditure Panel Survey. The data on hospitalizations come from the Database for Pediatric Studies, which is part of the Healthcare Cost and Utilization Project. Both data sets have been prepared by the Agency for Healthcare Research and Quality. Results.-Few changes in insurance coverage occurred between 1996 and 1998. About two thirds of American children are covered by private insurance and 19% by public sources; the remaining 15% are uninsured. Of the 71.5% of children who have at least I doctor's office visit, the average number of visits was 3.9, but this ranged from 2.7 among the uninsured to 4.2 for those with private insurance. Slightly more than half of children had a prescription, and these averaged 5.4 prescriptions. The majority of children (85%) incur medical expenditures, averaging $1019 for children with any expenditure. Private health insurance was by far the largest payer of medical care expenses for children, even more so than among the general population. However, nearly 21% of expenditures for children's health care were paid out of pocket by children's families. The data also show substantial differences in average length of hospitalization across states, ranging from 2.7 to 4.0 days, and rates of hospital admission through the emergency department, which vary across states from 9% to 23%. Injuries are a major reason for hospitalization, accounting for 1 in 6 hospital stays among 10- to 14-year-olds. In the 10-17 age group, 1 in 7 hospital stays are due to mental disorders. Among 15- to 17-year-olds, more than one third of all hospital stays are related to childbirth and pregnancy. Conclusion.-Children's use of health care services varies considerably by what type of health insurance coverage they have. Expenditures for children entail a substantial out-of-pocket component, which may be quite large for children with major health problems and which may represent a significant burden on lower-income families. Substantial variation in hospitalization exits across states. C1 Harvard Univ, Sch Publ Hlth, Dept Maternal & Child Hlth, Harvard Ctr Childrens Hlth, Boston, MA 02115 USA. US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Arkansas, Dept Pediat, Little Rock, AR 72204 USA. RP McCormick, MC (reprint author), Harvard Univ, Sch Publ Hlth, Dept Maternal & Child Hlth, Harvard Ctr Childrens Hlth, 677 Huntington Ave, Boston, MA 02115 USA. OI McCormmick, Marie/0000-0002-3938-1707 NR 22 TC 49 Z9 49 U1 0 U2 4 PU AMBULATORY PEDIATRIC ASSOC PI MCLEAN PA 6728 OLD MCLEAN VILLAGE DR, MCLEAN, VA 22101-3906 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD JAN-FEB PY 2001 VL 1 IS 1 BP 3 EP 15 DI 10.1367/1539-4409(2001)001<0003:AROATA>2.0.CO;2 PG 13 WC Pediatrics SC Pediatrics GA 473YE UT WOS:000171076200002 PM 11888366 ER PT J AU Newacheck, PW Lieu, T Kalkbrenner, AE Chi, FW Ray, GT Cohen, JW Weinick, RM AF Newacheck, PW Lieu, T Kalkbrenner, AE Chi, FW Ray, GT Cohen, JW Weinick, RM TI A comparison of health care experiences for Medicaid and commercially enrolled children in a large, nonprofit health maintenance organization SO AMBULATORY PEDIATRICS LA English DT Article DE health care access; health care satisfaction; health care utilization; health maintenance organizations; Medicaid ID MANAGED CARE; CHRONIC ILLNESS; STATES; PLANS AB Background.-Proponents of Medicaid managed care have argued that this type of care offers the potential to provide mainstream health care for poor children and the elimination of the 2-tier system of care that has long existed for poor and nonpoor children. However, few studies have attempted to assess whether differences in access, utilization, and satisfaction exist between Medicaid and commercially sponsored children who are enrolled in the same managed care plan. Objective.-To systematically answer the following research question: Within the same large, nonprofit, group-model health maintenance organization (HMO), how do children enrolled in Medicaid compare with children enrolled commercially across the domains of access, utilization, and satisfaction with care? Methods.-We compared access, satisfaction, and utilization of services between Medicaid and commercially sponsored children enrolled in Kaiser Permanente of Northern California during 1998 through use of a telephone survey and administrative data. Kaiser Permanente is a nonprofit, integrated, group HMO that serves 2.8 million members in more than 15 counties in northern California. The sample for this survey included 510 Medicaid- enrolled children and 512 commercially enrolled children. An overall response rate of 82% was achieved. Bivariate and multivariate analyses were used to compare Medicaid and commercially enrolled children. Results.-We found few differences between commercial and Medicaid enrollees across the domains of access, utilization, and satisfaction. Where access differences were present (problems in finding a personal care provider, problems getting care overall, and experiencing I or more barriers to care), the differences favored Medicaid-enrolled children. That is, Medicaid enrollees were reported to experience significantly fewer access problems and barriers than commercial enrollees, even after adjustment for confounding factors. Only one difference was found between Medicaid and commercial enrollees across the 6 utilization variables examined (volume of emergency department visits), and no differences were found among the 4 satisfaction and 2 global assessments of care received. Taken together, our results suggest that Medicaid-enrolled children experience as good as or better care than their commercially enrolled counterparts. However, there are other possible explanations for our findings. It may be that families of Medicaid-enrolled children hold their care providers to a lower standard than families of commercially enrolled children, given historic inequities in care between poor and nonpoor families. In addition, some degree of selection bias may be present in our sample, although that is true for both the Medicaid and commercial populations. Conclusions.-Our findings suggest that large commercial HMOs are capable of eliminating the access barriers and stigma traditionally associated with the Medicaid program. However, this conclusion must be tempered with the knowledge that other explanations for our findings may also be at play. C1 Univ Calif San Francisco, Inst Hlth Policy Studies, San Francisco, CA 94118 USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA USA. Kaiser Permanente Div Res, Oakland, CA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Newacheck, PW (reprint author), Univ Calif San Francisco, Inst Hlth Policy Studies, 3333 Calif St,Suite 265, San Francisco, CA 94118 USA. NR 17 TC 3 Z9 3 U1 0 U2 1 PU AMBULATORY PEDIATRIC ASSOC PI MCLEAN PA 6728 OLD MCLEAN VILLAGE DR, MCLEAN, VA 22101-3906 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD JAN-FEB PY 2001 VL 1 IS 1 BP 28 EP 35 DI 10.1367/1539-4409(2001)001<0028:ACOHCE>2.0.CO;2 PG 8 WC Pediatrics SC Pediatrics GA 473YE UT WOS:000171076200005 PM 11888369 ER PT J AU Lohr, KN Dougherty, D Simpson, L AF Lohr, KN Dougherty, D Simpson, L TI Methodologic challenges in health services research in the pediatric population SO AMBULATORY PEDIATRICS LA English DT Article DE child health and development; evidence-based practice; health services research; outcomes; pediatrics; quality of care C1 Res Triangle Inst, Res Triangle Pk, NC 27709 USA. Univ N Carolina, Sch Publ Hlth, Chapel Hill, NC USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Lohr, KN (reprint author), POB 12194, Res Triangle Pk, NC 27709 USA. NR 16 TC 4 Z9 4 U1 0 U2 0 PU AMBULATORY PEDIATRIC ASSOC PI MCLEAN PA 6728 OLD MCLEAN VILLAGE DR, MCLEAN, VA 22101-3906 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD JAN-FEB PY 2001 VL 1 IS 1 BP 36 EP 38 DI 10.1367/1539-4409(2001)001<0036:MCIHSR>2.0.CO;2 PG 3 WC Pediatrics SC Pediatrics GA 473YE UT WOS:000171076200006 PM 11888370 ER PT J AU Palmer, RH Miller, MR AF Palmer, RH Miller, MR TI Methodologic challenges in developing and implementing measures of quality for child health care SO AMBULATORY PEDIATRICS LA English DT Article DE child health services; epidemiologic methods; health care quality assessment ID AUDIT DEMONSTRATION PROJECT; PERFORMANCE-MEASUREMENT; PRACTICE GUIDELINES; SERVICES RESEARCH; MENTAL-HEALTH; MANAGED CARE; ASTHMA; PRACTITIONERS; IMPROVEMENT; MEDICAID AB Objective.-To review the major building blocks in measurement of quality for child health care, with recommendations for future research. Methods.-We describe a framework of building blocks for quality measurement and discuss how an investigator's choices for each component are constrained by the special features of child health care. Results.-Methodologic challenges for children's health care include developmental change and dependency on others, fragmentary care and inadequate health care data, unusual care settings, potential for long-term consequences, proxy reporting of outcomes and patient experience, small sample sizes, and lack of evidence that links processes and outcomes of care and of methods for risk adjustment. We cite examples of child-specific measures of quality that illustrate solutions to these challenges. Conclusions.-Children are different from adults, and measures of health care quality for children must differ from those for adults. We suggest future research on measures of quality directed toward overcoming the methodologic problems specific to child health care. C1 Harvard Univ, Sch Publ Hlth, Ctr Qual Care Res & Educ, Boston, MA 02115 USA. Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA 02115 USA. Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvement, Baltimore, MD USA. Johns Hopkins Univ, Dept Pediat, Baltimore, MD 21218 USA. RP Palmer, RH (reprint author), Harvard Univ, Sch Publ Hlth, Ctr Qual Care Res & Educ, 677 Huntington Ave, Boston, MA 02115 USA. NR 97 TC 20 Z9 20 U1 0 U2 1 PU AMBULATORY PEDIATRIC ASSOC PI MCLEAN PA 6728 OLD MCLEAN VILLAGE DR, MCLEAN, VA 22101-3906 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD JAN-FEB PY 2001 VL 1 IS 1 BP 39 EP 52 DI 10.1367/1539-4409(2001)001<0039:MCIDAI>2.0.CO;2 PG 14 WC Pediatrics SC Pediatrics GA 473YE UT WOS:000171076200007 PM 11888371 ER PT J AU Pappas, G Akhtar, T Gergen, PJ Hadden, WC Khan, AQ AF Pappas, G Akhtar, T Gergen, PJ Hadden, WC Khan, AQ TI Health status of the Pakistani population: A health profile and comparison with the United States SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID PROSPECTS; TETANUS AB Objectives. The health status of the Pakistani population was compared with that of the US population to provide a better understanding of the health problems in a developing nation and shed light on the dynamics of selected diseases. Methods. Results from the National Health Survey of Pakistan (n=18315) and the US National Health and Nutrition Examination Survey (n=31311) were compared. Standardized and comparable methods were used in both surveys. Results. indicators of undernutrition among children were high throughout Pakistan. Among adults, there were urban-rural differences acid economic gradients in indicators of undernutrition and risk factors for heart disease and cancer. In comparison with the US Population, the Pakistani population has a higher rate of undernutrition, a lower rate of high cholesterol, and an approximately equal rate of high blood pressure. Conclusions. There are major inequalities in health within Pakistan and between Pakistan and the United States. Standardized national health examination survey methodology can be used to monitor health status and plan health transition policy in developing countries. C1 Ctr Dis Control & Prevent, Natl Ctr Hlth Stat, Hyattsville, MD 20782 USA. Off Assistant Secretary Hlth, Washington, DC USA. Khyber Med Coll, Peshawar, Pakistan. Agcy Healthcare Res & Qual, Rockville, MD USA. MRC, Islamabad, Pakistan. RP Hadden, WC (reprint author), Ctr Dis Control & Prevent, Natl Ctr Hlth Stat, 6525 Belcrest Rd,Room 1100, Hyattsville, MD 20782 USA. NR 43 TC 42 Z9 44 U1 1 U2 1 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD JAN PY 2001 VL 91 IS 1 BP 93 EP 98 PG 6 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 387GP UT WOS:000166115100019 PM 11189831 ER PT J AU Schone, BS Cooper, PF AF Schone, BS Cooper, PF TI Assessing the impact of health plan choice SO HEALTH AFFAIRS LA English DT Article; Proceedings Paper CT 16th Annual Meeting of the Association-for-Health-Services-Research CY JUN 27-29, 1999 CL CHICAGO, ILLINOIS SP Assoc Hlth Serv Res AB Many health policy researchers have argued that increased insurance plan choice will enhance the efficiency of the health care system. However, relatively little is known about plan choice and its association with insurance coverage and access to and satisfaction with health care. Using data from the 1996 Medical Expenditure Panel Survey, we find that 55 percent of workers had plan choice in that year. Approximately 26 percent of workers with choice obtained it through a family member. Controlling for other factors, plan choice is associated with higher levels of employment-based insurance coverage and a greater likelihood that workers are satisfied that their families' health care needs are being met. C1 Agcy Healthcare Res & Qual, AIIRQ, Ctr Cost & Financing Studies, Div Social & Econ Res, Rockville, MD 20852 USA. RP Schone, BS (reprint author), Agcy Healthcare Res & Qual, AIIRQ, Ctr Cost & Financing Studies, Div Social & Econ Res, Rockville, MD 20852 USA. NR 20 TC 18 Z9 18 U1 2 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2001 VL 20 IS 1 BP 267 EP 275 DI 10.1377/hlthaff.20.1.267 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 395VY UT WOS:000166603000030 PM 11194850 ER PT J AU Goldman, DP Schoenbaum, ML Potosky, AL Weeks, JC Berry, SH Escarce, JJ Weidmer, BA Kilgore, ML Wagle, N Adams, JL Figlin, RA Lewis, JH Cohen, J Kaplan, R McCabe, M AF Goldman, DP Schoenbaum, ML Potosky, AL Weeks, JC Berry, SH Escarce, JJ Weidmer, BA Kilgore, ML Wagle, N Adams, JL Figlin, RA Lewis, JH Cohen, J Kaplan, R McCabe, M TI Measuring the incremental cost of clinical cancer research SO JOURNAL OF CLINICAL ONCOLOGY LA English DT Article ID BREAST-CANCER; TRIALS; CARE; BARRIERS; CHEMOTHERAPY; KNOWLEDGE; ATTITUDES AB Purpose: To summarise evidence on the costs of treating patients in clinical trials and to describe the Cost of Cancer Treatment Study, an ongoing effort to produce generalizable estimates of the incremental costs of government-sponsored cancer trials. Methods: A retrospective study of costs will be conducted with 1,500 cancer patients recruited from ct randomly selected sample of institutions in the United States. Patients accrued to either phase II or phase III National Cancer Institute-sponsored clinical trials during a 15-month period will be asked to participate in a study of their health care utilization (n = 750). Costs will be measured approximately 1 year after their trial enrollment from a combination of billing records, medical records, and an in-person survey questionnaire. Similar data will be collected for a comparable group of cancer patients not in trials (n = 750) to provide an estimate of the incremental colt. Results: Evidence suggests insurers limit access to trials because of cost concerns. Public and private efforts are underway to change these policies, but their permanent status is unclear. previous studies found that treatment costs in clinical trials are similar to costs of standard therapy. However, it is difficult to generalize from these studies because of the unique practice settings, insufficient sample sizes, and the exclusion of potentially important costs. Conclusion: Denials of coverage for treatment in a clinical trial limit patient access to trials and could impede clinical research. Preliminary estimates suggest changes to these policies would not be expensive, but these results are not generalizable. The Cost of Cancer Treatment Study is an ongoing effort to provide generalizable estimates of the incremental treatment cost of phase II and phase III cancer trials. The results should be of great interest to insurers and the research community as they consider permanent ways to finance cancer trials. J Clin Oncol 19:105-110. (C) 2001 by American Society of Clinical Oncology. C1 RAND Corp, Santa Monica, CA 90407 USA. NCI, Div Canc Control & Populat Sci, Bethesda, MD USA. NCI, Div Canc Treatment & Diag, Bethesda, MD USA. NCI, Off Educ & Special Initiat, Bethesda, MD USA. Dana Farber Canc Inst, Boston, MA 02115 USA. Univ Calif Los Angeles, Johnson Comprehens Canc Ctr, Los Angeles, CA USA. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD USA. RP Goldman, DP (reprint author), RAND Corp, 1700 Main St, Santa Monica, CA 90407 USA. NR 30 TC 18 Z9 18 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0732-183X J9 J CLIN ONCOL JI J. Clin. Oncol. PD JAN 1 PY 2001 VL 19 IS 1 BP 105 EP 110 PG 6 WC Oncology SC Oncology GA 389FT UT WOS:000166228500014 PM 11134202 ER PT J AU Encinosa, W AF Encinosa, W TI The economics of regulatory mandates on the HMO market SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE health insurance regulation; minimum standards; adverse selection ID MINIMUM QUALITY STANDARDS; INSURANCE MARKETS; SCOPE; INFORMATION; SCALE AB Recently proposed HMO regulations have involved mandates of two forms: (1) minimum quality standards, and (2) mandated increases in access to speciality care. I show that piecemeal regulation, which uses only one of either mandate (1) or (2), may decrease welfare for all HMO consumers. Under full regulation using both (1) and (2), if the minimum standard is set too low, say, due to political bargaining, a floor-to-ceiling effect occurs. This involves HMOs setting quality at the minimum standard, even when their quality would be above the standard in an unregulated market. Finally, I show how premiums may either increase or decrease under a mandate. Published by Elsevier Science B.V. JEL classification: L51; I11; I18. C1 Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Bethesda, MD 20892 USA. RP Encinosa, W (reprint author), Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Suite 605,2101 E Jefferson St, Bethesda, MD 20892 USA. NR 14 TC 6 Z9 6 U1 0 U2 3 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD JAN PY 2001 VL 20 IS 1 BP 85 EP 107 DI 10.1016/S0167-6296(00)00064-3 PG 23 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 381BL UT WOS:000165742400005 PM 11148873 ER PT J AU Ortiz, E Meyer, G Burstin, H AF Ortiz, E Meyer, G Burstin, H TI The role of clinical informatics in the agency for healthcare research and quality's efforts to improve patient safety SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article; Proceedings Paper CT Annual Symposium of the American-Medical-Informatics-Association (AMIA 2001) CY NOV 03-07, 2001 CL WASHINGTON, D.C. SP Amer Med Informat Assoc ID PHYSICIAN ORDER ENTRY; MEDICATION ERRORS; SYSTEMS AB In 1998, the institute of Medicine (IOM) issued a report on medical errors, which estimated that up to 98, 000 people die in U.S. hospitals each year from errors. This report raised concerns that medical errors have become a national public health problem that should be addressed in the same manner as other epidemics such as heart disease, diabetes, and obesity. In 2001, the IOM released a follow-up report encompassing a broader range of quality issues. They concluded that the U.S. healthcare system is outmoded and incapable of providing consistent, high-quality care. They outlined a strategy for redesigning U.S. healthcare delivery to achieve safe, dependable, high-quality care, which emphasizes information technology as an integral part of the solution. AHRQs fiscal year 2001 appropriation included an increase of $50 million dollars for initiatives to reduce medical errors and improve patient safety. AHRQ responded to this mandate by developing a series of research solicitations that form an integrated set of activities to design and test best practices for reducing errors in multiple health care settings. This paper discusses the components of this program and the central role of medical informatics research in the Agency's efforts to improve the safety of medical care in America. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Ortiz, E (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 16 TC 1 Z9 1 U1 1 U2 2 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PY 2001 SU S BP 508 EP 512 PG 5 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Information Science & Library Science; Medical Informatics SC Computer Science; Information Science & Library Science; Medical Informatics GA 494CZ UT WOS:000172263400104 ER PT J AU Ferris, TG Dougherty, D Blumenthal, D Perrin, JM AF Ferris, TG Dougherty, D Blumenthal, D Perrin, JM TI A report card on quality improvement for children's health care SO PEDIATRICS LA English DT Review DE child; adolescent; quality; quality improvement; CQI; TQM; guidelines; benchmark; review ID CLINICAL-PRACTICE GUIDELINES; RANDOMIZED CONTROLLED TRIAL; FOLLOW-UP; IMMUNIZATION RATES; PATIENT OUTCOMES; PHYSICIAN PERFORMANCE; PARENT SATISFACTION; PEDIATRIC EMERGENCY; DISEASE MANAGEMENT; ASTHMA AB Objective. Improving the quality of health care is a national priority. Nonetheless, no systematic effort has assessed the status of quality improvement (QI) initiatives for children or reviewed past research in child health care QI. This assessment is necessary to establish priorities for QI programs and research. Methods. To assess the status of QI initiatives and research, we reviewed the literature and interviewed experts experienced in QI for child health services. We defined QI as activities intended to close the gap between desired processes and outcomes of care and what is actually delivered. We classified reports published between 1985 and 1997 by publication characteristics, study design, clinical problem addressed, site of intervention, the QI method(s) used, and explicit association with a continuous quality improvement program. Results. We reviewed 68 reports meeting our definition of QI. More than half (48) were published after 1994. The reviewed reports included controlled evaluations in 36% of all identified interventions, and 3% of the reports were associated with continuous quality improvement. QI methods demonstrating some effectiveness included reminder systems for office-based preventive services and inpatient pathways for complex care. Reportedly successful QI initiatives more commonly described improvement in administrative measures such as rate of hospitalization or length of stay rather than functional status or quality of life. Interviews found that barriers to QI for children were similar to those for adults, but were compounded by difficulties in measuring child health outcomes, limited resources among public organizations and small provider groups, and relative lack of competition for pediatric tertiary care providers. Research and dissemination of QI for children were seen as less well developed than for adults. Conclusions. Attempts to improve the quality of child health services have been increasing, and the evidence we reviewed suggests that it is possible to improve the quality of care for children. Nonetheless, numerous gaps remain in the understanding of QI for children, and widespread improvement in the quality of health services for children faces significant barriers. C1 Massachusetts Gen Med Sch, Inst Hlth Policy, Boston, MA USA. Massachusetts Gen Med Sch, Ctr Child & Adolescent Hlth Policy, Boston, MA USA. Agcy Hlth Care Res & Qual, Silver Spring, MD USA. RP Ferris, TG (reprint author), Massachusetts Gen Hosp, Partners Inst Hlth Policy, 50 Staniford St,9th Floor, Boston, MA 02114 USA. FU NICHD NIH HHS [K12-HD00850] NR 112 TC 46 Z9 47 U1 6 U2 12 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JAN PY 2001 VL 107 IS 1 BP 143 EP 155 DI 10.1542/peds.107.1.143 PG 13 WC Pediatrics SC Pediatrics GA 387YL UT WOS:000166150600036 PM 11134448 ER PT J AU Simpson, L AF Simpson, L TI Quality of care: Time to make the grade SO PEDIATRICS LA English DT Editorial Material ID HEALTH-CARE C1 US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Simpson, L (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, 2101 E Jefferson St,Suite 600, Rockville, MD 20852 USA. NR 6 TC 2 Z9 2 U1 0 U2 0 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JAN PY 2001 VL 107 IS 1 BP 171 EP 171 DI 10.1542/peds.107.1.171 PG 1 WC Pediatrics SC Pediatrics GA 387YL UT WOS:000166150600039 PM 11134451 ER PT J AU Stout, JW White, LC Redding, GJ Morray, BH Martinez, PE Gergen, PJ AF Stout, JW White, LC Redding, GJ Morray, BH Martinez, PE Gergen, PJ TI Differences in asthma prevalence between samples of American Indian and Alaska native children SO PUBLIC HEALTH REPORTS LA English DT Article ID NEW-ZEALAND; BRONCHIAL HYPERRESPONSIVENESS; VIDEO QUESTIONNAIRE; UNITED-STATES; HOSPITALIZATIONS; SYMPTOMS; SCHOOLCHILDREN; METHACHOLINE; MORTALITY; ISAAC AB Objectives. To better understand the prevalence of asthma among American Indian and Alaska Native (Al/AN) children and to explore the contribution of locale to asthma symptoms and diagnostic assignment, the authors surveyed Al/AN middle school students, comparing responses from metropolitan Tacoma, Washington (metro WA) and a non-metropolitan area of Alaska (non-metro AK). Methods. Students in grades 6-9 completed an asthma screening survey. The authors compared self-reported rates of asthma symptoms, asthma diagnoses, and health care utilization for 147 children ages 11-16 self-reporting as Al/AN in metro WA and 365 in non-metro AK. Results. The prevalences of self-reported asthma symptoms were similar for the metro WA and non-metro AK populations, but a significantly higher percentage of metro WA than of non-metro AK respondents reported having received a physician diagnosis of asthma (OR 2.33; 95% Cl 1.23, 4.39). The percentages of respondents who reported having visited a medical provider for asthma-like symptoms in the previous year did not differ. Conclusions. The difference in rates of asthma diagnosis despite similar rates of asthma symptoms and respiratory-related medical visits may reflect differences in respiratory disease patterns, diagnostic labeling practices, or environmental factors. Future attempts to describe asthma prevalence should consider the potential contribution of non-biologic factors such as diagnostic practices. C1 Univ Washington, Sch Med, Dept Pediat, Seattle, WA 98195 USA. Childrens Hosp & Reg Med Ctr, Div Pulm Med, Seattle, WA USA. Yukon Kuskokwim Delta Reg Hosp, Bethel, AK USA. Agcy Healthcare Res & Qual, Ctr Primary Care & Res, Rockville, MD USA. RP Stout, JW (reprint author), Childhood Asthma Study Team, 146 N Canal St,Suite 300, Seattle, WA 98103 USA. FU NIAID NIH HHS [U01 AI39761]; PHS HHS [6T72-MC00008-09S1] NR 28 TC 11 Z9 11 U1 1 U2 1 PU US GOVERNMENT PRINTING OFFICE PI WASHINGTON PA SUPERINTENDENT DOCUMENTS,, WASHINGTON, DC 20402-9325 USA SN 0033-3549 J9 PUBLIC HEALTH REP JI Public Health Rep. PD JAN-FEB PY 2001 VL 116 IS 1 BP 51 EP 57 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 468NJ UT WOS:000170763500008 PM 11571408 ER PT J AU Paxton, P Curran, PJ Bollen, KA Kirby, J Chen, FN AF Paxton, Pamela Curran, Patrick J. Bollen, Kenneth A. Kirby, Jim Chen, Feinian TI Monte Carlo Experiments: Design and Implementation SO STRUCTURAL EQUATION MODELING-A MULTIDISCIPLINARY JOURNAL LA English DT Article AB The use of Monte Carlo simulations for the empirical assessment of statistical estimators is becoming more common in structural equation modeling research. Yet, there is little guidance for the researcher interested in using the technique. In this article we illustrate both the design and implementation of Monte Carlo simulations. We present 9 steps in planning and performing a Monte Carlo analysis: (1) developing a theoretically derived research question of interest, (2) creating a valid model, (3) designing specific experimental conditions, (4) choosing values of population parameters, (5) choosing an appropriate software package, (6) executing the simulations, (7) file storage, (8) troubleshooting and verification, and (9) summarizing results. Throughout the article, we use as a running example a Monte Carlo simulation that we performed to illustrate many of the relevant points with concrete information and detail. C1 [Paxton, Pamela] Ohio State Univ, Dept Sociol, Columbus, OH 43210 USA. [Curran, Patrick J.] Univ N Carolina, Dept Psychol, LL Thurstone Quantitat Lab, Chapel Hill, NC USA. [Bollen, Kenneth A.; Chen, Feinian] Univ N Carolina, Dept Sociol, Carolina Populat Ctr, Chapel Hill, NC USA. [Kirby, Jim] US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Paxton, P (reprint author), Ohio State Univ, Dept Sociol, 300 Bricker Hall,190 N Oval Mall, Columbus, OH 43210 USA. EM paxton.36@osu.edu NR 23 TC 91 Z9 94 U1 4 U2 17 PU PSYCHOLOGY PRESS PI HOVE PA 27 CHURCH RD, HOVE BN3 2FA, EAST SUSSEX, ENGLAND SN 1070-5511 J9 STRUCT EQU MODELING JI Struct. Equ. Modeling PY 2001 VL 8 IS 2 BP 287 EP 312 DI 10.1207/S15328007SEM0802_7 PG 26 WC Mathematics, Interdisciplinary Applications; Social Sciences, Mathematical Methods SC Mathematics; Mathematical Methods In Social Sciences GA V19HX UT WOS:000208064600007 ER PT J AU Cooper, R Cutler, J Desvigne-Nickens, P Fortmann, SP Friedman, L Havlik, R Hogelin, G Marler, J McGovern, P Morosco, G Mosca, L Pearson, T Stamler, J Stryer, D Thom, T AF Cooper, R Cutler, J Desvigne-Nickens, P Fortmann, SP Friedman, L Havlik, R Hogelin, G Marler, J McGovern, P Morosco, G Mosca, L Pearson, T Stamler, J Stryer, D Thom, T TI Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States - Findings of the National Conference on Cardiovascular Disease Prevention SO CIRCULATION LA English DT Article DE cardiovascular diseases; epidemiology; prevention ID ACUTE MYOCARDIAL-INFARCTION; ATRIAL-FIBRILLATION; DIABETES-MELLITUS; ACE-INHIBITORS; MORTALITY; FAILURE; PATTERNS; HEALTH; PREVALENCE; PHYSICIANS AB A workshop was held September 27 through 29, 1999: to address issues relating to national trends in mortality and morbidity from cardiovascular diseases; the apparent slowing of declines in mortality from cardiovascular diseases; levels and trends in risk factors for cardiovascular diseases; disparities in cardiovascular diseases by race/ethnicity, socioeconomic status, and geography; trends in cardiovascular disease preventive and treatment services; and strategies for efforts to reduce cardiovascular diseases overall and to reduce disparities among subpopulations. The conference concluded that coronary heart disease mortality is still declining in the United States as a whole, although perhaps at a slower rate than in the 1980s; that stroke mortality rates have declined little, if at all, since 1990; and that there are striking differences in cardiovascular death rates by race/ethnicity, socioeconomic status, and geography. Trends in risk factors are consistent with a slowing of the decline in mortality; there has been little recent progress in risk factors such as smoking, physical inactivity, and hypertension control. There are increasing levels of obesity and type 2 diabetes, with major differences among subpopulations. There is considerable activity in population-wide prevention, primary prevention for higher risk people, and secondary prevention, but wide disparities exist among groups on the basis of socioeconomic status and geography, pointing to major gaps in efforts to use available, proven approaches to control cardiovascular diseases. Recommendations for strategies to attain the year 2010 health objectives were made. C1 NHLBI, NIH, Bethesda, MD 20892 USA. Loyola Univ, Med Ctr, Chicago, IL 60611 USA. Stanford Univ, Palo Alto, CA 94304 USA. NIA, Bethesda, MD 20892 USA. Ctr Dis Control & Prevent, Atlanta, GA USA. NINDS, Bethesda, MD 20892 USA. Univ Minnesota, St Paul, MN 55108 USA. Columbia Univ, New York, NY USA. Cornell Univ, New York, NY USA. Univ Rochester, Rochester, NY USA. Northwestern Univ, Sch Med, Chicago, IL USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Friedman, L (reprint author), NHLBI, NIH, 31 Ctr Dr,MSC 2482, Bethesda, MD 20892 USA. NR 77 TC 490 Z9 499 U1 12 U2 45 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD DEC 19 PY 2000 VL 102 IS 25 BP 3137 EP 3147 PG 11 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 384EU UT WOS:000165930500027 PM 11120707 ER PT J AU Atkins, D AF Atkins, D TI Pneumococcal vaccine recommendations - In Reply SO AMERICAN FAMILY PHYSICIAN LA English DT Letter ID POLYSACCHARIDE VACCINE; EFFICACY C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Atkins, D (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 3 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD DEC 15 PY 2000 VL 62 IS 12 BP 2588 EP 2589 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 386CW UT WOS:000166043400004 ER PT J AU Gross, CP Steiner, CA Bass, EB Powe, NR AF Gross, CP Steiner, CA Bass, EB Powe, NR TI Relation between prepublication release of clinical trial results and the practice of Carotid Endarterectomy SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID INGELFINGER RULE; MYOCARDIAL-INFARCTION; UNITED-STATES; STENOSIS; ATHEROSCLEROSIS; APPROPRIATE; EMBARGOES AB Context Little is known about how clinical practice is affected by disseminating results of clinical trials prior to publication in peer-reviewed journals. Objective To determine whether prepublication release of carotid endarteredomy (CEA) trial results via National Institutes of Health Clinical Alerts was associated with prompt changes in patient care that were consistent with the new medical evidence. Design, Setting, and Patients Longitudinal data series analysis using acute care hospital discharge data from the Healthcare Cost and Utilization Project for patients who had CEA performed in acute care hospitals in 7 states (New York, California, Pennsylvania, Florida, Colorado, Illinois, and Wisconsin). The trials were the North American Symptomatic Carotid Endarterectomy Trial (NASCET clinical alert released February 1991) and the Asymptomatic Carotid Atherosclerosis Study (ACAS clinical alert released September 1994). Main Outcome Measure Carotid endarterectomy rate during each month from 1989 (2 years before the NASCET clinical alert) to 1996 (2 years after the ACAS clinical alert), adjusted for age and sex. Because both trials were limited to patients 80 years or younger in hospitals with low mortality, we also stratified CEA rates by patient age and hospital mortality rate. Results From 1989 through 1996, 272 849 CEAs were performed in the acute care hospitals in these 7 states, with the annual number increasing from 22 300 to 51 495. After the NASCET clinical alert, the adjusted CEA rate increased 3.4% per month (95% confidence interval [Ct], 1.6%-5.3%) during the following 6 months and then increased 0.5% per month (95% CI, 0.2%-0.8%; P<.04) after journal publication of the NASCET study. After the ACAS clinical alert,the CEA rate increased 7.3% per month (95% CI, 6.0%-8.5%) during the following 7 months and then decreased by 0.44% per month (95% CI, -0.86% to -0.0002%; P<.04) after journal publication of the ACAS study. After the ACAS clinical alert, the CEA rate increased more in patients aged 80 years or older than in younger patients; whereas, after journal publication of ACAS, the CEA rate decreased more rapidly in the older population. The overall proportion of CEAs performed in low-mortality hospitals did not change substantially after release of the clinical alerts or after journal publication. Conclusion In this study, prepublication dissemination of CEA trial results with clinical alerts was associated with prompt and substantial changes in medical practice, but the observed changes suggest that the results were extrapolated to patients and settings not directly supported by the trials. C1 Yale Univ, Sch Med, Primary Care Ctr, Primary Care Sect, New Haven, CT 06520 USA. Johns Hopkins Med Inst, Div Gen Internal Med, Baltimore, MD 21205 USA. Johns Hopkins Med Inst, Welch Ctr Prevent Epidemiol & Clin Res, Dept Hlth & Management, Baltimore, MD 21205 USA. Johns Hopkins Med Inst, Dept Epidemiol, Baltimore, MD 21205 USA. Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD USA. RP Gross, CP (reprint author), Yale Univ, Sch Med, Primary Care Ctr, Primary Care Sect, 333 Cedar St,POB 208025, New Haven, CT 06520 USA. NR 45 TC 48 Z9 48 U1 0 U2 4 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD DEC 13 PY 2000 VL 284 IS 22 BP 2886 EP 2893 DI 10.1001/jama.284.22.2886 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 380RJ UT WOS:000165717000028 PM 11147985 ER PT J AU Gotto, AM Boccuzzi, SJ Cook, JR Alexander, CM Roehm, JB Meyer, GS Clearfield, M Weis, S Whitney, E AF Gotto, AM Boccuzzi, SJ Cook, JR Alexander, CM Roehm, JB Meyer, GS Clearfield, M Weis, S Whitney, E CA AFCAPS-TexCAPS Res Grp TI Effect of lovastatin on cardiovascular resource utilization end costs in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) SO AMERICAN JOURNAL OF CARDIOLOGY LA English DT Article ID AVERAGE CHOLESTEROL LEVELS; INTERVENTION TRIAL; ARTERY DISEASE; HEART-DISEASE; MEN; PRAVASTATIN; REGRESSION; THERAPY; EVENTS; POPULATION AB This cast-consequences analysis of the Air Force/Texas Coronary Atherosclerosis Prevention Study compares the costs of lovastatin treatment with the casts of cardiovascular hospitalizations and procedures. The cost of lovastatin treatment was defined as the average retail price and the cast of drug safety monitoring and adverse experiences. Costs were determined by actual rates of hospitalizations and procedures. Within a trial, lovastatin treatment cost approximately $4,654/patient. Lovastatin treatment significantly reduced the cumulative rate of cardiovascular hospitalizations and procedures (P = 0.002). Over the duration of the study, the cumulative number of cardiovascular hospitalizations and related therapeutic procedures was significantly reduced by 29%. The time to first cardiovascular-related hospitalization or procedure was significantly extended by lovastatin (p = 0.002). Lovastatin reduced the frequency of cardiovascular hospitalization (28%), and cardiovascular therapeutic (32%) and diagnostic procedures (23%). Among therapeutic procedures, treatment reduced coronary artery bypass graft surgery by 19% and percutaneous transluminal coronary angioplasty by 37%. Total cardiovascular-related hospital days were reduced by 26% (p = 0.025). The between-group offset in direct medical costs was $524, which resulted in a 11% cost offset of lovastatin therapy over the mean study duration of 5.2 years. Lovastatin provides meaningful reductions in cardiovascular-related resource utilization and reductions in direct cardiovascular-related costs associated with the onset of coronary disease. (C) 2000 by Excerpta Medica, Inc. C1 Cornell Univ, Weill Med Coll, New York, NY USA. Merck & Co Inc, US Med & Sci Affairs, W Point, PA USA. Merck Res Labs, Blue Bell, PA USA. Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Univ N Texas, Hlth Sci Ctr, Ft Worth, TX USA. Heart & Vasc Inst Texas, San Antonio, TX USA. RP Gotto, AM (reprint author), Care of Jou J, Cornell Univ, Weill Med Coll, 445 E 69th St,OH205, New York, NY 10021 USA. NR 27 TC 21 Z9 21 U1 0 U2 0 PU EXCERPTA MEDICA INC PI NEW YORK PA 650 AVENUE OF THE AMERICAS, NEW YORK, NY 10011 USA SN 0002-9149 J9 AM J CARDIOL JI Am. J. Cardiol. PD DEC 1 PY 2000 VL 86 IS 11 BP 1176 EP 1181 DI 10.1016/S0002-9149(00)01198-X PG 6 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 378HV UT WOS:000165579700004 PM 11090787 ER PT J AU Gergen, PJ Turkeltaub, PC Sempos, CT AF Gergen, PJ Turkeltaub, PC Sempos, CT TI Is allergen skin test reactivity a predictor of mortality? Findings from a national cohort SO CLINICAL AND EXPERIMENTAL ALLERGY LA English DT Article DE atopy; survival; allergen skin test reactivity ID DEATH-INDEX; CANCER INCIDENCE; UNITED-STATES; ASTHMA; DISEASE; POPULATION; HEALTH; IGE AB Background The importance of atopy on subsequent mortality is controversial. A clearer understanding is important as atopy is increasing worldwide. Objective To determine the influence of allergen skin test reactivity on observed mortality of a national cohort. Methods Baseline health status and atopic status (allergen skin testing) was measured as part of the second National Health and Nutrition Examination Survey (NHANES II), a representative sample of the US population, during the years 1976-80. Vital status and cause of death were assessed through December 31, 1992 for all examinees 30 years of age or older at baseline (n = 9252) as part of the NHANES II Mortality Study (NH2MS). The analytic sample contained 8179 men and women after excluding missing data. Allergen skin test reactivity was defined as weal greater than or equal to 3 mm to one of eight 1 : 20 (w/v), 50% glycerinated ('No US Standard of Potency') allergens licensed by the FDA: house dust, cat, dog, Alternaria, mixed giant/short ragweed, oak, perennial rye grass, and Bermuda grass. Survival analyses were conducted using multivariate adjusted Cox regression models to evaluate the association between atopy and all-cause, cardiovascular, and cancer mortality. Results There was no association between allergen skin test reactivity and all cause mortality: 30-44 years RR = 1.07 (95% CI 0.63-1.84); 45-59 years RR = 1.10 (0.78-1.55); 60-75 years RR = 1.07 (0.91-1.25). Results were unchanged when cancer or heart disease mortality were examined separately. The presence or absence of allergic symptoms, using the flare to define skin test reactivity, eliminating deaths in the first 5 years of follow-up, or eliminating individuals with pre-existing conditions did not alter the findings. Conclusions Atopy, defined by allergen skin test reactivity, with or without symptoms, is not a predictor of subsequent mortality. C1 Agcy Healthcare Res & Qual, Ctr Primary Care & Res, Rockville, MD 20852 USA. US FDA, Ctr Biol Evaluat & Res, Rockville, MD 20857 USA. SUNY Buffalo, Dept Social & Prevent Med, Buffalo, NY 14260 USA. RP Gergen, PJ (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care & Res, Suite 201,6010 Execut Blvd, Rockville, MD 20852 USA. NR 38 TC 26 Z9 28 U1 2 U2 2 PU BLACKWELL SCIENCE LTD PI OXFORD PA P O BOX 88, OSNEY MEAD, OXFORD OX2 0NE, OXON, ENGLAND SN 0954-7894 J9 CLIN EXP ALLERGY JI Clin. Exp. Allergy PD DEC PY 2000 VL 30 IS 12 BP 1717 EP 1723 DI 10.1046/j.1365-2222.2000.00971.x PG 7 WC Allergy; Immunology SC Allergy; Immunology GA 392FR UT WOS:000166401100008 PM 11122209 ER PT J AU Monheit, AC Selden, TM AF Monheit, AC Selden, TM TI Cross-subsidization in the market for employment-related health insurance SO HEALTH ECONOMICS LA English DT Article DE employment-related health insurance; cross-subsidization ID ADVERSE SELECTION; BENEFITS; INFORMATION; CHOICE; COVERAGE; PREMIUMS; MOBILITY; PLANS AB This paper uses data from the 1987 National Medical Expenditure Survey to examine the nature of equilibrium in the market for employment-related health insurance. We examine coverage generosity, premiums, and insurance benefits net of expenditures on premiums, showing that despite a degree of market segmentation, there was a substantial amount of pooling of heterogeneous risks in 1987 among households with employment-related coverage. Our results are largely invariant to (i) firm size and (ii) whether or not employers offer a choice among plans. Our results suggest the need for caution concerning incremental reforms that would weaken the link between employment and insurance without substituting alternative institutions for the pooling of risks. Published in 2000 by John Wiley & Sons, Ltd. C1 Agcy Healthcare Res & Qual, Ctr Coast & Financing Studies, Rockville, MD 20852 USA. RP Monheit, AC (reprint author), Agcy Healthcare Res & Qual, Ctr Coast & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 40 TC 1 Z9 1 U1 0 U2 2 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1057-9230 J9 HEALTH ECON JI Health Econ. PD DEC PY 2000 VL 9 IS 8 BP 699 EP 714 DI 10.1002/1099-1050(200012)9:8<699::AID-HEC546>3.0.CO;2-5 PG 16 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 390UG UT WOS:000166314800004 PM 11137951 ER PT J AU Siegel, JE Clancy, CM AF Siegel, JE Clancy, CM TI Community-based interventions: Taking on the cost and cost-effectiveness questions SO HEALTH SERVICES RESEARCH LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD USA. RP Siegel, JE (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD USA. NR 8 TC 0 Z9 0 U1 1 U2 2 PU HEALTH ADMINISTRATION PRESS PI CHICAGO PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES ONE N FRANKLIN ST, STE 1700, CHICAGO, IL 60606-3491 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2000 VL 35 IS 5 BP 905 EP 909 PN 1 PG 5 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 383ZE UT WOS:000165913900002 PM 11130803 ER PT J AU Stryer, D Tunis, S Hubbard, H Clancy, C AF Stryer, D Tunis, S Hubbard, H Clancy, C TI The outcomes of outcomes and effectiveness research: Impacts and lessons from the first decade SO HEALTH SERVICES RESEARCH LA English DT Article; Proceedings Paper CT 21st Annual Meeting of the Society-of-General-Internal-Medicine CY APR 23-25, 1998 CL CHICAGO, ILLINOIS SP Soc Gen Internal Med DE outcomes research; effectiveness; impact; research policy; evaluation ID RANDOMIZED CONTROLLED TRIAL; CHEST PAIN; MEDICAL-CARE; HEALTH-CARE; NEW-HAVEN; PREVENTION; EMERGENCY; MORTALITY; CATARACT; DISEASE AB Objective. To assess the outcomes of the Agency for Healthcare Research and Quality's (AHRQ formerly the Agency for Health Care Policy and Research, AHCPR) first decade of focus on outcomes and effectiveness research (OER) and to identify needs and opportunities for the study of OER in the coming years. Data Source. Study findings were collected in response to an inquiry by the Center for Outcomes and Effectiveness Research at AHRQ in July 1997 to all principal investigators (PIs) funded between 1989 and 1997. The request was for investigators to identify their "most salient findings" and supply material for up to three slides. Study Design. A taxonomy of 11 non-mutually exclusive categories was used to group the investigators' salient findings by characteristics of methodology or purpose. Two health services researchers assigned findings to up to three categories for each discrete study. Principal Findings. Responses were received from 61 (64 percent) of the 91 PIs, reporting on 115 studies. Of the 246 category assignments made, descriptive epidemiology was the most common (24 percent), followed by comparative effectiveness (17 percent) and economic assessments (12 percent). Most studies were retrospective analyses of administrative data. Viewed within a conceptual framework for assessing the impact of research, OER has built a solid foundation for future quality improvement efforts by identifying problems, generating hypotheses, and developing new methodologies and has had limited impact on health care policies, practices and outcomes. Conclusions. OER has had moderate but significant success meeting initial expectations for the field. Challenges for the next generation of OER include advancing from hypothesis generation to definitive studies of effectiveness, and acceleration of the process by which findings effect policy, practice, and outcomes. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. US Hlth Care Financing Adm, Coverage & Anal Grp, Baltimore, MD 21207 USA. RP Stryer, D (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. NR 47 TC 27 Z9 27 U1 0 U2 1 PU HEALTH ADMINISTRATION PRESS PI CHICAGO PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES ONE N FRANKLIN ST, STE 1700, CHICAGO, IL 60606-3491 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2000 VL 35 IS 5 BP 977 EP 993 PN 1 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 383ZE UT WOS:000165913900006 PM 11130807 ER PT J AU Weinick, RM AF Weinick, RM TI Family change and family policies in Great Britain, Canada, New Zealand, and the United States. SO JOURNAL OF COMPARATIVE FAMILY STUDIES LA English DT Book Review C1 Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Weinick, RM (reprint author), Agcy Hlth Care Policy & Res, 2191 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU J COMPARATIVE FAMILY STUDIES PI CALGARY PA UNIV CALGARY-DEPT SOCIOLOGY 2500 UNIVERSITY DRIVE NW, CALGARY, AB T2N 1N4, CANADA SN 0047-2328 J9 J COMP FAM STUD JI J. Comp. Fam. Stud. PD WIN PY 2000 VL 31 IS 1 BP 133 EP 134 PG 2 WC Family Studies SC Family Studies GA 264XC UT WOS:000084207400013 ER PT J AU Crystal, S Fleishman, JA Hays, RD Shapiro, MF Bozzette, SA AF Crystal, S Fleishman, JA Hays, RD Shapiro, MF Bozzette, SA TI Physical and role functioning among persons with HIV - Results from a nationally representative survey SO MEDICAL CARE LA English DT Article DE HIV; functioning; impairment; quality of life ID LOW-PREVALENCE DISEASES; QUALITY-OF-LIFE; SERVICES UTILIZATION; ANTIRETROVIRAL THERAPY; PROBABILITY SAMPLES; INFECTED ADULTS; UNITED-STATES; AIDS; CARE; COST AB BACKGROUND. Functional limitations of persons living with HIV affect their care needs and ability to perform social roles such as employment. Earlier estimates are outdated, and nationally representative estimates of prevalence and distribution of these limitations have not previously been available. OBJECTIVES. The objectives of this study were to characterize physical and role limitations experienced by adults in care for HIV disease in the United States and to analyze variations by demographic and health characteristics in a multivariate framework. METHODS. Among 2,836 respondents in the HIV Cost and Services Utilization Survey, we assessed physical functioning with a 9-item scale designed to span a broad continuum of tasks and administered the 2-item ACTG SF-21 role functioning scale. Linearization methods were used to account for the multistage survey design. RESULTS. Limitation in complex roles-working at a job, working around the house, or going to school-was more prevalent than limitation in most specific physical tasks. Among physical tasks, limitation was more prevalent in energy-demanding activities such as climbing stairs (43%) or walking >1 block (26%) than in self-care tasks such as bathing and dressing (14%). Greater limitation was associated with older age, lower educational attainment, more advanced disease, and higher symptom burden. Protease inhibitor treatment was associated with somewhat less physical limitation but no difference in role limitation. CONCLUSIONS. Functional status varied widely, suggesting the need for flexible, individualized care system responses. Results identified subgroups whose needs warrant special attention. Symptom intensity, pain, and fatigue were strongly associated with Limitation; improved management of these disease manifestations might improve physical and social functioning. C1 Rutgers State Univ, Ctr State Hlth Policy, Div Aging, New Brunswick, NJ 08903 USA. Rutgers State Univ, Inst Hlth Hlth Care Policy & Aging Res, AIDS Res Grp, New Brunswick, NJ 08903 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif Los Angeles, Sch Med, Los Angeles, CA 90024 USA. Univ Calif San Diego, La Jolla, CA 92093 USA. Vet Affairs San Diego Hlth Care Syst, La Jolla, CA USA. RP Crystal, S (reprint author), 30 Coll Ave, New Brunswick, NJ 08901 USA. RI Hays, Ronald/D-5629-2013 FU AHRQ HHS [U-01HS08578]; NIDA NIH HHS [R01-DA-11362]; NIMH NIH HHS [P0I-MH 43450] NR 27 TC 57 Z9 57 U1 3 U2 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD DEC PY 2000 VL 38 IS 12 BP 1210 EP 1223 DI 10.1097/00005650-200012000-00008 PG 14 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 379CK UT WOS:000165623200008 PM 11186300 ER PT J AU Weinick, RM Krauss, NA AF Weinick, RM Krauss, NA TI Racial/ethnic differences in children's access to care SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID HEALTH-INSURANCE; UNITED-STATES; MEDICAL-CARE; POVERTY; RACE; ADOLESCENTS AB Objectives. This study explored reasons for racial and ethnic differences in children's usual sources of care. Methods. Data from the 1996 Medical Expenditure Panel Survey were examined by means of logistic regression techniques. Results. Black and Hispanic children were substantially less likely than White children to have a usual source of care. These differences persisted after control for health insurance and socioeconomic status. Control for language ability, however, eliminated differences between Hispanic and White children. Conclusions. Results suggest that the marked Hispanic disadvantage in children's access to care noted in earlier studies may be related to language ability. C1 Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD 20852 USA. RP Weinick, RM (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Res, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 20 TC 165 Z9 165 U1 0 U2 1 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD NOV PY 2000 VL 90 IS 11 BP 1771 EP 1774 DI 10.2105/AJPH.90.11.1771 PG 4 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 369FJ UT WOS:000165055000019 PM 11076248 ER PT J AU Burstin, H AF Burstin, H TI Traversing the digital divide SO HEALTH AFFAIRS LA English DT Editorial Material C1 US Dept HHS, Ctr Primary Care Res, Agcy Healthcare Res & Qual, Washington, DC 20201 USA. RP Burstin, H (reprint author), US Dept HHS, Ctr Primary Care Res, Agcy Healthcare Res & Qual, Washington, DC 20201 USA. NR 0 TC 6 Z9 6 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD NOV-DEC PY 2000 VL 19 IS 6 BP 245 EP 249 DI 10.1377/hlthaff.19.6.245 PG 5 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 373PH UT WOS:000165297500028 PM 11192410 ER PT J AU Miller, MR McNamara, RL Segal, JB Kim, N Robinson, KA Goodman, SN Powe, NR Bass, EB AF Miller, MR McNamara, RL Segal, JB Kim, N Robinson, KA Goodman, SN Powe, NR Bass, EB TI Efficacy of agents for pharmacologic conversion of atrial fibrillation and subsequent maintenance of sinus rhythm - A meta-analysis of clinical trials SO JOURNAL OF FAMILY PRACTICE LA English DT Article; Proceedings Paper CT 48th Annual Scientific Session of the American-College-of-Cardiology CY MAR 07-11, 1999 CL NEW ORLEANS, LOUISIANA SP Amer Coll Cardiol DE atrial fibrillation; anti-arrhythmia agents; meta-analysis; clinical trials; randomized controlled trials ID ORAL PROPAFENONE; DOUBLE-BLIND; SUPRAVENTRICULAR ARRHYTHMIAS; ELECTRICAL CARDIOVERSION; INTRAVENOUS AMIODARONE; FLECAINIDE ACETATE; FLUTTER; SAFETY; PLACEBO; PREVENTION AB CONTEXT Physicians have little evidentiary guidance for pharmacologic agent selection for atrial fibrillation (AF). OBJECTIVE To assess antiarrhythmic agent efficacy for AF conversion and subsequent maintenance of sinus rhythm (MSR). DATA SOURCE We searched the clinical trial database of the Cochrane Collaboration and MEDLINE encompassing literature from 1948 to May 1998. STUDY SELECTION We selected 36 (28%) articles eligible as randomized trials of nonpost-operative AF conversion or MSR in adults, DATA EXTRACTION Study quality; rates of conversion, MSR, and adverse events were extracted. DATA SYNTHESIS Compared with control treatment (placebo, verapamil, diltirizem, or digoxin), the odds ratio (OR) fur conversion was greatest for ibutilide/dofetilide (OR=29.1: 95% confidence interval [CI], 9.8-86.1) and flecainide (OR=24.7; 95% CI, 9.0-68.3). Less strong but conclusive evidence existed for propafenone (OR=4.6; 95% CI, 2.6-8.2). Quinidine (OR=2.9; 95% CI, 1.2-7.0) had moderate evidence of efficacy for conversion. Disopyramide (OR=7.0; 95% CI, 0.3-153.0) and amiodarone (OR=5.7; 95% CI, 1.0-33.4) had suggestive evidence of efficacy. Sotalol (OR=0.4; 95% CI, 0.0-3.0) had suggestive evidence of negative efficacy. For MSR, strong evidence of efficacy existed for quinidine (OR=4.1; 95% CI, 2.5-6.7), disopyramide (OR=3.4; CI, 1.6-7.1), flecainide (OR=3.1; 95% CI, 1.5-6.2), propafenone (OR=3.7; 95% CI, 2.4-5.7), and sotalol (OR=7.1; 95% CI, 3.8-13.4). The only amiodarone data, from comparison with disopyramide, provided moderate evidence of efficacy for MSR. No trial evaluated procainamide. Direct agent comparisons and adverse event data were limited. CONCLUSIONS Although multiple antiarrhythmic agents had strong evidence of efficacy compared with control treatment For MSR, ibutilide/dofetilide and flecainide had particularly strong evidence of efficacy compared with control treatment for AF conversion. There is sparse and inconclusive evidence on direct agent comparisons and adverse event rates. Obtaining information regarding these relative efficacies should be a research priority. C1 Johns Hopkins Univ, Sch Med, Div Pediat Cardiol, Baltimore, MD USA. Johns Hopkins Univ, Sch Med, Div Cardiol, Baltimore, MD USA. Johns Hopkins Univ, Sch Med, Div Gen Internal Med, Baltimore, MD USA. Johns Hopkins Univ, Sch Med, Ctr Oncol, Baltimore, MD USA. Johns Hopkins Univ, Sch Med, Div Biostat, Baltimore, MD USA. Johns Hopkins Univ, Sch Hyg & Publ Hlth, Grad Training Program Clin Invest, Baltimore, MD USA. Johns Hopkins Univ, Sch Hyg & Publ Hlth, Dept Epidemiol, Baltimore, MD USA. Univ Maryland, Baltimore Cochrane Ctr, Baltimore, MD 21201 USA. RP Miller, MR (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvement, 2101 E Jefferson St,Suite 502, Rockville, MD 20852 USA. RI Segal, Jodi/A-2863-2009 OI Segal, Jodi/0000-0003-3978-9662 FU PHS HHS [290-97-0006] NR 57 TC 56 Z9 63 U1 0 U2 0 PU DOWDEN PUBLISHING CORP PI MONTVALE PA 110 SUMMIT AVE, MONTVALE, NJ 07645-1712 USA SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD NOV PY 2000 VL 49 IS 11 BP 1033 EP 1046 PG 14 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 372UD UT WOS:000165251700009 PM 11093570 ER PT J AU Farquhar, C AF Farquhar, C TI Evidence on endometriosis - Elitism about randomised controlled trials is inappropriate - Reply SO BRITISH MEDICAL JOURNAL LA English DT Letter C1 Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. RP Farquhar, C (reprint author), Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. NR 5 TC 0 Z9 0 U1 0 U2 0 PU BRITISH MED JOURNAL PUBL GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0959-8138 J9 BRIT MED J JI Br. Med. J. PD OCT 28 PY 2000 VL 321 IS 7268 BP 1078 EP 1078 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 369PU UT WOS:000165076800037 ER PT J AU Fiscella, K Franks, P Gold, MR Clancy, CM AF Fiscella, K Franks, P Gold, MR Clancy, CM TI Inequalities in racial access to health care - Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 Univ Rochester, Sch Med & Dent, Rochester, NY 14642 USA. CUNY, Sch Med, New York, NY 10031 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Fiscella, K (reprint author), Univ Rochester, Sch Med & Dent, Rochester, NY 14642 USA. NR 4 TC 8 Z9 8 U1 1 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD OCT 25 PY 2000 VL 284 IS 16 BP 2053 EP 2053 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 364QA UT WOS:000089902100013 PM 11042742 ER PT J AU Eisenberg, JM Power, EJ AF Eisenberg, JM Power, EJ TI Transforming insurance coverage into quality health care - Voltage drops from potential to delivered quality SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article; Proceedings Paper CT Commonwealth Funds Ditchley Conference CY MAY 22-23, 1999 CL OXFORD, ENGLAND ID RANDOMIZED CONTROLLED TRIAL; PATIENT SATISFACTION; PREVENTIVE SERVICES; CHILDREN; ACCESS; STATE; COST; MORTALITY; PHYSICIAN; HOSPITALS AB Although the US health care system is often touted as one of the best in the world, disparities exist in quality of care received by different: populations, in different regions, and across different institutions and clinicians, Initiatives to provide access to health insurance have been a major policy tool to ensure that Americans receive high-quality health care. However, availability of insurance coverage does not automatically lead to high-quality care. This article explores points of vulnerability in the US health cave system at which the potential to achieve high-quality care can be lost: (1) access to insurance coverage; (2) enrollment in available insurance plans; (3) access to covered services, clinicians, and health care institutions; (4) choice of plans, clinicians, and health care institutions; (5) access to a consistent source of primary care; (6) access to referral services; and (7) delivery of high-quality health care services, Ensuring high-quality health care requires that each of these "voltage drops" be recognized and addressed. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Natl Forum Healthcare Qual Measurement & Reportin, Washington, DC USA. RP Eisenberg, JM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 66 TC 77 Z9 77 U1 2 U2 7 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD OCT 25 PY 2000 VL 284 IS 16 BP 2100 EP 2107 DI 10.1001/jama.284.16.2100 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 364QA UT WOS:000089902100031 PM 11042759 ER PT J AU Gergen, PJ AF Gergen, PJ TI Remembering the patient SO ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE LA English DT Editorial Material ID INNER-CITY CHILDREN; ASTHMA MORBIDITY; CHILDHOOD; TRIAL C1 Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD 20852 USA. RP Gergen, PJ (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Res, 2101 E Jefferson St,Suite 601, Rockville, MD 20852 USA. NR 18 TC 0 Z9 0 U1 1 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 1072-4710 J9 ARCH PEDIAT ADOL MED JI Arch. Pediatr. Adolesc. Med. PD OCT PY 2000 VL 154 IS 10 BP 977 EP 978 PG 2 WC Pediatrics SC Pediatrics GA 361NA UT WOS:000089728100001 PM 11030847 ER PT J AU Cunningham, WE Markson, LE Andersen, RM Crystal, SH Fleishman, JA Golin, C Gifford, A Liu, HHH Nakazono, TT Morton, S Bozzette, SA Shapiro, MF Wenger, NS AF Cunningham, WE Markson, LE Andersen, RM Crystal, SH Fleishman, JA Golin, C Gifford, A Liu, HHH Nakazono, TT Morton, S Bozzette, SA Shapiro, MF Wenger, NS CA HCSUS Consortium TI Prevalence and predictors of highly active antiretroviral therapy use in patients with HIV infection in the United States SO JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE HIV; AIDS; HAART use ID NATIONAL PROBABILITY SAMPLES; INJECTION-DRUG USERS; SERVICES UTILIZATION; ADULTS; CARE; AIDS; COST; DISEASES AB Background: Highly active antiretroviral therapy (HAART) became standard for HIV in 1996, Studies at that time showed that most people infected with HIV had initiated HAART, but that members of minority groups and poor people had lower HAART use. It is not known whether high levels of HAART use have been sustained or whether socioeconomic and racial disparities have diminished over time. Objectives: To determine the proportion of patients who had received and were receiving HAART by January 1998, and to evaluate predictors of HAART receipt. Design and Participants: Prospective cohort study of a national probability sample of 2267 adults receiving HIV care who completed baseline, first follow-up, and second follow-up interviews from January 1996 to January 1998. Main outcome variables: Proportion currently using HAART at second follow-up (August 1997 to January 1998), contrasted with the cumulative proportions using HAART at any time before January 1998 and before December 1996. Analyses: Bivariate and multiple logistic regression analysis of population characteristics predicting current use of HAART at the time of the second follow-up interview. Results: The proportion of patients ever having received HAART increased from 37% in December 1996 to 71% by January 1998, but only 53% of people were receiving HAART at the time of the second follow-up interview. Differences between sociodemographic groups in ever using HAART narrowed after 1996, In bivariate analysis, several groups remained significantly less likely to be using HAART at the time of the second follow-up interview: blacks, male and female drug users, female heterosexuals, people with less education, those uninsured and insured by Medicaid, those in the Northeast, and those with CD4 counts of greater than or equal to 500 cells/mul (all p < .05). Using multiple logistic regression analysis, low CD4 count (for CD4 <50 cells/mul: odds ratio [OR], 3.20; p < .001) remained a significant predictor of current HAART use at the time of the second follow-up interview, but lack of insurance (OR, 0.71; p < .05) predicted not receiving HAART. Conclusions: The proportion of persons under HIV care in the United States who had ever received HAART increased to over 70% of the affected population by January 1998 and the disparities in use between groups narrowed but did not disappear. However, nearly half of those eligible for HAART according to the U.S. Department of Health and Human Services guidelines were not actually receiving it nearly 2 years after these medications were first introduced. Strategies to promote the initiation and continuation of HAART are needed for those without contraindications and those who can tolerate it. C1 Univ Calif Los Angeles, Sch Publ Hlth, Dept Med, Div Gen Internal Med & Hlth Serv Res, Los Angeles, CA 90095 USA. Univ Calif Los Angeles, Dept Hlth Serv, Los Angeles, CA 90095 USA. Merck & Co, W Point, PA USA. Rutgers State Univ, Inst Hlth, AIDS Res Grp, New Brunswick, NJ 08903 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ N Carolina, Sch Med, Div Gen Med, Chapel Hill, NC USA. San Diego VA Healthcare Syst, Dept Med, San Diego, CA USA. Univ Calif San Diego, La Jolla, CA 92093 USA. RAND Corp, Hlth Sci Program, Santa Monica, CA USA. RP Cunningham, WE (reprint author), Univ Calif Los Angeles, Sch Publ Hlth, Dept Med, Div Gen Internal Med & Hlth Serv Res, 10833 LeConte Ave,Room 21-254A CHS, Los Angeles, CA 90095 USA. FU AHRQ HHS [U-01HS08578] NR 27 TC 144 Z9 144 U1 2 U2 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1525-4135 J9 J ACQ IMMUN DEF SYND JI J. Acquir. Immune Defic. Syndr. PD OCT 1 PY 2000 VL 25 IS 2 BP 115 EP 123 DI 10.1097/00126334-200010010-00005 PG 9 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 376AA UT WOS:000165434600004 PM 11103041 ER PT J AU Steiner, C Wong, H Stocks, C Baysac, F AF Steiner, C Wong, H Stocks, C Baysac, F TI Outcomes and health systems determinants of early bypass following acute myocardial infarction. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract C1 AHRQ, Rockville, MD USA. HCFA, Rockville, MD USA. NR 0 TC 5 Z9 5 U1 0 U2 0 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD OCT PY 2000 VL 15 SU 2 BP 4 EP 5 DI 10.1046/j.1525-1497.2000.15200-17.x PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 374CK UT WOS:000165326700018 ER PT J AU Steiner, C Johantgen, M Case, C AF Steiner, C Johantgen, M Case, C TI Quality of breast-conserving surgery. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract C1 AHRQ, Rockville, MD USA. Univ Maryland, Rockville, MD USA. Georgetown Univ, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD OCT PY 2000 VL 15 SU 2 BP 5 EP 5 DI 10.1046/j.1525-1497.2000.15200-18.x PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 374CK UT WOS:000165326700019 ER PT J AU Huttin, C Moeller, JF Stafford, RS AF Huttin, C Moeller, JF Stafford, RS TI Patterns and costs for hypertension treatment in the United States - Clinical, lifestyle and socioeconomic predictors from the 1987 National Medical Expenditures Survey SO CLINICAL DRUG INVESTIGATION LA English DT Article ID CHRONIC ILLNESS; HEALTH-STATUS; CARE; PREVENTION; ADJUSTMENT; INSURANCE; ALCOHOL; DISEASE; ACCESS AB Objective: To estimate the impact of clinical and non-clinical predictors of patterns of medication use and expenditures for the treatment of hypertension in the USA. Data Sources: The 1987 National Medical Expenditures Survey was used to identify 6398 individuals with hypertension over the age of 18 years. Pharmacological treatment was identified through patient self-reports of antihypertensive medications. Study Design: This retrospective, cross-sectional study used a multivariate two-stage decision model to estimate the demand for antihypertensive medications conditional on receipt of at least one antihypertensive prescription drug. Results: Women and the elderly were more likely to obtain medications and had greater expenditures on antihypertensive medications. Privately insured patients were 59% (if non-elderly) or 163% (if elderly with Medicare) more likely to receive drug therapy than uninsured patients. Patients with only Medicaid coverage were 126% more likely to receive drug therapy than uninsured patients. Compared with patients characterised as lower risk-takers, very high and high risk-takers were 38% and 24% less likely to be on drug therapy, respectively. Black, non-Hispanics were 30% more likely to be on drug therapy than White, non-Hispanics, but had lower annual expenditures on antihypertensive drugs. Severely overweight individuals [bodymass index (BMI) >30] were 62% more likely than patients with a BMI <27 to be on drug therapy and also had higher drug expenditures. Conclusions: Insurance had a more striking effect on access to antihypertensive drug therapy than on patterns of drug use or expenditures. Race/ethnicity and patient attitudes towards, risk were important determinants of access to antihypertensive drug therapies, as well as patterns of drug use and expenditures. C1 Univ Paris 10, Business Dept, Fac Econ, Paris, France. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD USA. Partners Massachusetts Gen Hosp, Inst Hlth Policy, Boston, MA USA. RP Huttin, C (reprint author), Univ Paris 10, BP 14, F-92420 Vaucresson, France. NR 32 TC 13 Z9 13 U1 0 U2 2 PU ADIS INTERNATIONAL LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 10, NEW ZEALAND SN 1173-2563 J9 CLIN DRUG INVEST JI Clin. Drug Invest. PD SEP PY 2000 VL 20 IS 3 BP 181 EP 195 DI 10.2165/00044011-200020030-00006 PG 15 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 358FY UT WOS:000089549000006 ER PT J AU Rhoades, JA AF Rhoades, JA TI Where are the missing nursing homes? SO HEALTH AFFAIRS LA English DT Letter C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Rhoades, JA (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 3 TC 1 Z9 1 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SEP-OCT PY 2000 VL 19 IS 5 BP 249 EP 250 DI 10.1377/hlthaff.19.5.249-a PG 2 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 353RA UT WOS:000089288200037 PM 10992679 ER PT J AU Chernew, ME Encinosa, WE Hirth, RA AF Chernew, ME Encinosa, WE Hirth, RA TI Optimal health insurance: the case of observable, severe illness SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE health insurance; treatment-specific copayments; moral hazard ID MEDICAL-CARE; SURGERY; CANCER; COSTS AB We explore optimal cost-sharing provisions for insurance contracts when individuals have observable, severe diseases with a discrete number of medically appropriate treatment options. Variation in preferences for alternative treatments is unobserved by the insurer and non-contractible. Interest in such situations is increasingly common, exemplified by disease carve-out programs and shared decision-making (SDM) tools. We demonstrate that optimal insurance charges a copay to patients choosing the high-cost treatment and provides consumers of the low-cost treatment a cash payment. A simulation of the effect of such a policy, based on prostate cancer, indicates a substantial reduction in moral hazard. (C) 2000 Elsevier Science B.V. All rights reserved. JEL classification: I11; D81. C1 Univ Michigan, Dept Hlth Management & Policy, Ann Arbor, MI 48109 USA. NBER, Ann Arbor, MI 48109 USA. US Dept HHS, Agcy Healthcare Res & Qual, Washington, DC 20201 USA. RP Chernew, ME (reprint author), Univ Michigan, Dept Hlth Management & Policy, 109 Observ Dr, Ann Arbor, MI 48109 USA. NR 25 TC 18 Z9 19 U1 2 U2 4 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD SEP PY 2000 VL 19 IS 5 BP 585 EP 609 DI 10.1016/S0167-6296(00)00061-8 PG 25 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 349TA UT WOS:000089060600002 PM 11184795 ER PT J AU Clancy, CM Lipscomb, J AF Clancy, CM Lipscomb, J TI From the sponsors SO MEDICAL CARE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. NCI, Outcomes Res Sect, Bethesda, MD 20892 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2000 VL 38 IS 9 SU S BP 2 EP 2 PG 1 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 349FM UT WOS:000089033000001 ER PT J AU Patrick, DL Chiang, YP AF Patrick, DL Chiang, YP TI Convening health outcomes methodologists SO MEDICAL CARE LA English DT Editorial Material C1 Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Patrick, DL (reprint author), Univ Washington, Dept Hlth Serv, Box 357660, Seattle, WA 98195 USA. NR 0 TC 16 Z9 16 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2000 VL 38 IS 9 SU S BP 3 EP 6 PG 4 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 349FM UT WOS:000089033000002 ER PT J AU Patrick, DL Chiang, YP AF Patrick, DL Chiang, YP TI Measurement of health outcomes in treatment effectiveness evaluations - Conceptual and methodological challenges SO MEDICAL CARE LA English DT Article; Proceedings Paper CT Health Outcome Methodology Symposium CY SEP 16-17, 1999 CL WARRENTON, VIRGINIA SP Agcy Healthcare Res & Qual, Ctr Outcomes & Effect Res, NCI, Outcomes Res Branch DE health status; quality of life; randomized controlled trials; treatment effectiveness; psychometrics ID QUALITY-OF-LIFE; CANCER-PATIENTS; CHILDREN; SF-36 AB Major challenges in the evaluation of the "end results" of health services include ensuring that concepts are correctly defined and measured, that the validity of measures used in different applications and populations is well documented, and that observed effects can be clearly interpreted. Health status is the most widely interpretable concept to apply in the context of health services. Quality of life connotes inclusion of the environment outside the context of the person and of health care and may or may not be health related, depending on the evaluation context and the impact of disease and treatment. All concepts and constructs must be defined in reference to their theoretical origin and to a model of relationships among different concepts. Modern test theory offers the potential for individualized, comparable assessments and for the careful examination and application of different measurement models. Selection and critique of measures should be based on the intended application and accumulated evidence for that application. Thus, there are no valid instruments per se. Validity in use, including responsiveness, interpretation of effects, and generalizability to diverse populations, is the most important measurement characteristic for treatment effectiveness. An evaluation of the validity of preference-based measures is particularly important for the interpretation and comparability of outcomes in cost-effectiveness evaluations. The successful translation of research into policy and practice is limited by the extent to which these critical issues are addressed in actual treatment evaluations. C1 Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Patrick, DL (reprint author), Univ Washington, Dept Hlth Serv, Box 357660, Seattle, WA 98195 USA. NR 55 TC 120 Z9 122 U1 2 U2 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2000 VL 38 IS 9 SU S BP 14 EP 25 PG 12 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 349FM UT WOS:000089033000004 ER PT J AU Patrick, D Chiang, YP AF Patrick, D Chiang, YP TI Postscript - The remaining questions SO MEDICAL CARE LA English DT Article; Proceedings Paper CT Health Outcome Methodology Symposium CY SEP 16-17, 1999 CL WARRENTON, VIRGINIA SP Agcy Healthcare Res & Qual, Ctr Outcomes & Effect Res, NCI, Outcomes Res Branch C1 Univ Washington, Seattle, WA 98195 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Patrick, D (reprint author), Univ Washington, Seattle, WA 98195 USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2000 VL 38 IS 9 SU S BP 209 EP 210 PG 2 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 349FM UT WOS:000089033000025 ER PT J AU Charles, JP Piper, S Mailey, SK Davis, P Baigis, J AF Charles, JP Piper, S Mailey, SK Davis, P Baigis, J TI Nurse salaries in Washington DC and nationally SO NURSING ECONOMICS LA English DT Article ID CARE AB The District of Columbia is overstaffed compared to the rest of the nation. The authors determined that a local area direct data collection was needed to examine nurse supply and salaries in the District of Columbia. An 11-item tool was developed by the DC Consortium and mailed to 187 employers of nurses in July of 1997. This sample included hospitals, long-term care facilities home health agencies. The initial response rate was only 34%, however telephone and direct followup raised this to 81%. The ranges of salaries for several categories of nurses including nurse assistants, LPNs, and both basic and advanced practice nurses were tracked. Expected salary advances were also estimated according to institutional responses. "Across DC facilities higher salaries and wider salary ranges exist for those with higher skill levels and advanced preparation." "Demand for skilled RNs in hospitals will increase by 36% by the year 2020.". C1 Walcoff Technol, Agcy Healthcare Res & Qual, Rockville, MD USA. Catholic Univ Amer, Sch Nursing, Washington, DC 20064 USA. Marymount Univ, Sch Hlth Profess, Arlington, VA USA. Assoc Occupat & Environm Clin, Washington, DC USA. Georgetown Univ, Sch Nursing, Washington, DC USA. RP Charles, JP (reprint author), Walcoff Technol, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 21 TC 1 Z9 1 U1 0 U2 0 PU JANNETTI PUBLICATIONS, INC PI PITMAN PA EAST HOLLY AVENUE, BOX 56, PITMAN, NJ 08071-0056 USA SN 0746-1739 J9 NURS ECON JI Nurs. Econ. PD SEP-OCT PY 2000 VL 18 IS 5 BP 243 EP 249 PG 7 WC Nursing SC Nursing GA 533YF UT WOS:000174557300004 ER PT J AU Pillsbury, HC Cannon, CR Holzer, SES Jacoby, I Nielsen, DR Benninger, MS Denneny, JC Smith, RV Cheng, EY Hagner, AP Meyer, GS AF Pillsbury, HC Cannon, CR Holzer, SES Jacoby, I Nielsen, DR Benninger, MS Denneny, JC Smith, RV Cheng, EY Hagner, AP Meyer, GS TI The workforce in otolaryngology-head and neck surgery: Moving into the next millennium SO OTOLARYNGOLOGY-HEAD AND NECK SURGERY LA English DT Article ID INTERNAL-MEDICINE; SUBSPECIALISTS AB OBJECTIVE: The goal was to examine the current scope of otolaryngologists' practices, their geographic distribution, and the roles otolaryngologists and other specialists play in caring for patients with otolaryngic and related conditions of the head and neck. STUDY DESIGN: A large national survey and administrative claims databases were examined to develop practice profiles and compile a physician supply for otolaryngology. A focus group of otolaryngologists provided information to model future scenarios. RESULTS: The current and predicted workforce supply and demographics are at a satisfactory level and are decreasing as a proportion of the increasing population. Empiric data analysis supports the diverse nature of an otolaryngologist's practice and the unique role for otolaryngologists that is not shared by many other providers. Together with the focus group results, the study points to areas for which more background and training are warranted. CONCLUSIONS: This study represents a first step in a process to form coherent workforce recommendations for the field of otolaryngology. C1 Univ N Carolina, Med Ctr, Div Otolaryngol CB 7070, Chapel Hill, NC 27599 USA. Amer Acad Otolaryngol Head & Neck Surg, Physician Resources Comm, Jackson, MS USA. Amer Acad Otolaryngol, Head & Neck Surg Fdn, Alexandria, VA USA. Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA. Mayo Clin, Scottsdale, AZ USA. Henry Ford Med Ctr, Detroit, MI USA. Montefiore Med Ctr, Bronx, NY 10467 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Pillsbury, HC (reprint author), Univ N Carolina, Med Ctr, Div Otolaryngol CB 7070, 610 Burnett Womack Bldg, Chapel Hill, NC 27599 USA. NR 22 TC 21 Z9 21 U1 1 U2 1 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0194-5998 J9 OTOLARYNG HEAD NECK JI Otolaryngol. Head Neck Surg. PD SEP PY 2000 VL 123 IS 3 BP 341 EP 356 DI 10.1067/mhn.2000.109761 PG 16 WC Otorhinolaryngology; Surgery SC Otorhinolaryngology; Surgery GA 352KQ UT WOS:000089214800039 PM 10964321 ER PT J AU Leatherman, S Donaldson, LJ Eisenberg, JM AF Leatherman, S Donaldson, LJ Eisenberg, JM TI International collaboration: harnessing differences to meet common needs in improving quality of care SO QUALITY IN HEALTH CARE LA English DT Editorial Material C1 Univ Cambridge, Judge Inst Management Studies, Cambridge CB2 1TN, England. Univ N Carolina, Sch Publ Hlth, Chapel Hill, NC 27515 USA. Dept Hlth, London SW1A 2NS, England. Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Leatherman, S (reprint author), Univ Cambridge, Judge Inst Management Studies, Cambridge CB2 1TN, England. NR 6 TC 3 Z9 3 U1 0 U2 0 PU BRITISH MED JOURNAL PUBL GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0963-8172 J9 QUAL HEALTH CARE JI Qual. Health Care PD SEP PY 2000 VL 9 IS 3 BP 143 EP 144 DI 10.1136/qhc.9.3.143 PG 2 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 357DH UT WOS:000089482900001 PM 10980072 ER PT J AU Fleishman, JA Sherbourne, CD Crystal, S Collins, RL Marshall, GN Kelly, M Bozzette, SA Shapiro, MF Hays, RD AF Fleishman, JA Sherbourne, CD Crystal, S Collins, RL Marshall, GN Kelly, M Bozzette, SA Shapiro, MF Hays, RD CA HCSUS Consortium TI Coping, conflictual social interactions, social support, and mood among HIV-infected persons SO AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY LA English DT Article DE coping; social support; AIDS; psychological distress ID GAY MEN; PSYCHOLOGICAL ADJUSTMENT; DEPRESSIVE SYMPTOMS; RHEUMATOID-ARTHRITIS; SELF-ESTEEM; STRATEGIES; STRESS; AIDS; OPTIMISM; DISTRESS AB This study considers the interrelationships among coping, conflictual social interactions, and social support, as well as their combined associations with positive and negative mood Research has shown that each of these variables affects adjustment to stressful circumstances. Few studies, however, examine this full set of variables simultaneously. One hundred forty HN-infected persons completed a questionnaire containing measures of coping, social support, conflictual social interactions, and positive and negative mood. Factor analyses showed that perceived social support and conflictual social interactions formed separate factors and were not strongly related. Compared to perceived social support, social conflict was more strongly related to coping behaviors, especially to social isolation, anger, wishful thinking. Conflictual social interactions were more strongly related to negative mood than was perceived social support. Coping by withdrawing socially was significantly related to less positive and greater negative mood. The findings point to the importance of simultaneously considering coping, supportive relationships, and conflictual relationships in studies of adjustment to chronic illness. In particular, a dynamic may occur in which conflictual social interactions and social isolation aggravate each other and result in escalating psychological distress. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RAND Corp, Santa Monica, CA 90406 USA. Rutgers State Univ, Piscataway, NJ 08855 USA. Univ Calif San Diego, La Jolla, CA 92093 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, 2101 E Jefferson St, Rockville, MD 20852 USA. RI Hays, Ronald/D-5629-2013 FU AHRQ HHS [3-UO1-HS08578]; NIMH NIH HHS [5-P50-MH45294] NR 64 TC 63 Z9 66 U1 3 U2 8 PU SPRINGER/PLENUM PUBLISHERS PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0091-0562 J9 AM J COMMUN PSYCHOL JI Am. J. Community Psychol. PD AUG PY 2000 VL 28 IS 4 BP 421 EP 453 DI 10.1023/A:1005132430171 PG 33 WC Public, Environmental & Occupational Health; Psychology, Multidisciplinary; Social Work SC Public, Environmental & Occupational Health; Psychology; Social Work GA 340ZX UT WOS:000088567500002 PM 10965385 ER PT J AU Rathore, SS McGreevey, JD Schulman, KA Atkins, D AF Rathore, SS McGreevey, JD Schulman, KA Atkins, D TI Mandated coverage for cancer-screening services - Whose guidelines do states follow? SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article; Proceedings Paper CT Annual Conference of the Society-for-Medical-Decision-Making CY OCT 24-28, 1998 CL BOSTON, MASSACHUSETTS SP Soc Med Decis Making DE mass screening; neoplasms; legislation; insurance coverage; guidelines ID PROSTATE-CANCER; PREVENTIVE CARE; PHYSICIANS AB Objectives: To determine the prevalence and nature of state coverage mandates for cancer screening. Methods: We contacted insurance departments in 50 states, Washington, DC, and Puerto Rico for copies of state codes that mandate coverage of screening for breast, cervical, prostate, and colorectal cancer by private insurers. We further compared mandates, when identified, with American Cancer Society (ACS) and U.S. Preventive Services Task Force (USPSTF) guidelines for likely sources of screening recommendations. Results: Forty-three states and the District of Columbia currently mandate coverage of cancer screening. Breast cancer-screening coverage was most frequently mandated (n = 44), followed by cervical (n = 22), prostate (n = 18), and colorectal cancer screening (n = 1), Twenty-three states used ACS guidelines only, 18 states used ACS and non-ACS/non-USPSTF guidelines, and 3 states used only non-ACS/non-USPSTF guidelines in development of coverage mandates. No state screening coverage mandate reflected USPSTF-screening guidelines. Of 85 mandates in place, 57 have been passed since 1990. Conclusions: Although state mandates for insurer coverage of cancer screening are common and increasing, we found noticeable inter- and intra-state variation in coverage, selection, and use of screening guidelines. C1 Georgetown Univ, Med Ctr, Dept Med, Clin Econ Res Unit, Washington, DC 20007 USA. Penn State Univ, Coll Med, Hershey, PA USA. US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Schulman, KA (reprint author), Duke Univ, Med Ctr, Duke Clin Res Inst, Ctr Clin & Genet Econ, Room 0311,Terrace Level,2400 Pratt St, Durham, NC 27705 USA. NR 33 TC 24 Z9 24 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD AUG PY 2000 VL 19 IS 2 BP 71 EP 78 DI 10.1016/S0749-3797(00)00179-3 PG 8 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 338YA UT WOS:000088449800001 PM 10913895 ER PT J AU Miller, MR Forrest, CB Kan, JS AF Miller, MR Forrest, CB Kan, JS TI Parental preferences for primary and specialty care collaboration in the management of teenagers with congenital heart disease SO PEDIATRICS LA English DT Article DE primary health care; chronic disease; specialist; congenital heart defects; patient care management ID CHRONIC ILLNESS; CHILDREN; PHYSICIAN; PATTERNS; ISSUES AB Objectives. We examined parental preferences for locus of service delivery for their teenager's congenital heart disease (CHD) and the influence of disease severity, sociodemographic factors, and insurance on these preferences. Methods. A consecutive sample of parents of teenagers followed in a pediatric cardiology clinic completed a mailed questionnaire. Disease severity was classified as low (less than or equal to 1 cardiovascular procedure), moderate (> 1 cardiovascular procedure), and high (cyanosis or single ventricle physiology). Results. Eighty-six of 148 parents responded (58%): 40, low severity; 36, moderate severity; and 10, high severity of illness. Parents preferred using primary care providers (PCPs) as a point of first contact for all 11 of 11 general health concerns and 5 of 7 potential cardiovascular-related concerns: chest pain (52%), syncope (73%), seeming seriously ill (79%), sports physical examination (79%), and endocarditis prophylactic antibiotics (94%). Increasing disease severity was significantly associated with preferring cardiologists for 6 of 7 cardiovascular-related concerns. Overall, 58% of parents viewed their care as a PCP-cardiologist comanagement model versus a cardiologist-dominated model. Lower family income (odds ratio [OR]: 1.5; confidence interval [CI]: 1.0-2.2) and severity of illness (OR: 2.1; CI: 1.0-4.4) were associated with a comanagement model of health care versus a cardiologist-dominated model. Conclusions. This study suggests that the majority of parents of teenagers with CHD prefer to use their teenager's PCP for all routine health care needs and many cardiovascular health needs. Severity of illness and family income are positively associated with greater preference for cardiologist care. C1 Johns Hopkins Univ, Sch Med, Div Pediat Cardiol, Baltimore, MD USA. Johns Hopkins Univ, Sch Hyg & Publ Hlth, Grad Training Program Clin Invest, Baltimore, MD USA. Johns Hopkins Univ, Sch Hyg & Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA. RP Miller, MR (reprint author), Agcy Hlth Care Policy & Res, Ctr Qual Measurement & Improvement, 2101 E Jefferson St,Suite 502, Rockville, MD 20852 USA. NR 20 TC 15 Z9 15 U1 1 U2 1 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD AUG PY 2000 VL 106 IS 2 BP 264 EP 269 DI 10.1542/peds.106.2.264 PG 6 WC Pediatrics SC Pediatrics GA 340MM UT WOS:000088538100019 PM 10920149 ER PT J AU Ray, GT Lieu, T Weinick, RM Cohen, JW Fireman, B Newacheck, P AF Ray, GT Lieu, T Weinick, RM Cohen, JW Fireman, B Newacheck, P TI Comparing the medical expenses of children with medicaid and commercial insurance in an HMO SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article; Proceedings Paper CT 16th Annual Meeting of the Association-for-Health-Services-Research CY JUN 27-29, 1999 CL CHICAGO, ILLINOIS SP Assoc Hltht Serv Res ID MANAGED CARE; POPULATIONS; PROGRAM; CHOICE AB Background: In recent years, growing numbers of children with Medicaid have been enrolled in managed care plans nationwide. Yet, large, commercial managed care plans are increasingly discontinuing their participation in Medicaid because of low Medicaid payment rates. Objective: To compare the healthcare utilization and costs of children with Medicaid and children with commercial insurance within the same health maintenance organization (HMO). Study Design: Retrospective study using electronically captured cost and utilization data. Patients and Methods: We compared the healthcare utilization and costs of children with Medicaid (n=42,636) and children with commercial insurance (n=159,651) who were members of the same large, nonprofit HMO at any time between January ii 1995, and December 31, 1997. Medicaid children were grouped as income eligible, medically needy, and blind or disabled. Results: The unadjusted costs of income-eligible, Medicaid-insured children were not significantly different from those of commercially insured children. The medically needy were $25 per month more expensive than commercially insured children (P =.02), and the blind or disabled were $213 per month more expensive (P <.01). After adjusting for age and sex, income-eligible children were $5 per month more expensive than children with commercial insurance (P =.07), the medically needy were $20 per month more expensive (P =.02), and the blind or disabled were $216 per month more expensive (P <.01). Conclusions: The costs of income-eligible, Medicaid-insured children in this HMO were similar to those of commercially insured children, but the costs for the medically needy and the blind and disabled were substantially higher. C1 Kaiser Permanente, Div Res, Med Care Program No Calif Reg, Oakland, CA 94611 USA. Harvard Univ, Sch Med, Boston, MA 02115 USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif San Francisco, Dept Pediat, San Francisco, CA 94143 USA. Univ Calif San Francisco, Inst Hlth Policy Studies, San Francisco, CA 94143 USA. RP Ray, GT (reprint author), Kaiser Permanente, Div Res, Med Care Program No Calif Reg, 3505 Broadway, Oakland, CA 94611 USA. NR 21 TC 6 Z9 6 U1 0 U2 1 PU AMER MED PUBLISHING, M W C COMPANY PI JAMESBURG PA 241 FORSGATE DR, STE 102, JAMESBURG, NJ 08831 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD JUL PY 2000 VL 6 IS 7 BP 753 EP 760 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 337PY UT WOS:000088371900002 PM 11067373 ER PT J AU Marcus, M Freed, JR Coulter, ID Der-Martirosian, C Cunningham, W Andersen, R Garcia, I Schneider, DA Maas, WR Bozzette, SA Shapiro, MF AF Marcus, M Freed, JR Coulter, ID Der-Martirosian, C Cunningham, W Andersen, R Garcia, I Schneider, DA Maas, WR Bozzette, SA Shapiro, MF TI Perceived unmet need for oral treatment among a national population of HIV-positive medical patients: Social and clinical correlates SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID HEALTH-CARE; DENTAL-CARE; ACCESS; INFECTION; SERVICES; SAMPLES AB Objectives. This study examines social, behavioral, and clinical correlates of perceived unmet need for oral health care for people with HIV infection, Methods. Baseline in-person interviews with 2864 individuals were conducted with the HIV Cast and Services Utilization Study cohort, a nationally representative probability sample of HIV-infected persons in medical care. Bivariate and logistic regression analyses were conducted with unmet need in the last 6 months as the dependent variable and demographic, social, behavioral, and disease characteristics as independent variables. Results. We estimate that 19.3% of HIV-infected medical patients (n = 44550) had a perceived unmet need for dental care in the last 6 months. The odds of having unmet dental needs were highest for those on Medicaid in states without dental benefits (odds ratio [OR] = 2.21), for others with no dental insurance (OR = 2.26), for those with incomes under $5000 (OR = 2.20), and for those with less than a high school education (OR = 1.83). Low CD4 count was not significant. Conclusions. Perceived unmet need was related more to social and economic factors than to stage of infection. An expansion of dental benefits for those on Medicaid might reduce unmet need for dental care. C1 Univ Calif Los Angeles, Sch Dent, Los Angeles, CA 90095 USA. Univ Calif Los Angeles, Sch Med, Los Angeles, CA 90095 USA. Univ Calif Los Angeles, Sch Publ Hlth, Los Angeles, CA 90095 USA. Natl Inst Dent & Craniofacial Res, Bethesda, MD USA. US Hlth Care Financing Adm, Baltimore, MD 21207 USA. Agcy Healthcare Res & Qual, Atlanta, GA USA. Univ Calif San Diego, Sch Med, San Diego, CA 92103 USA. RAND Corp, Santa Monica, CA USA. RP Marcus, M (reprint author), Univ Calif Los Angeles, Sch Dent, 10833 Le Conte Ave,Box 951668, Los Angeles, CA 90095 USA. FU AHRQ HHS [HS08578] NR 19 TC 29 Z9 29 U1 1 U2 1 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD JUL PY 2000 VL 90 IS 7 BP 1059 EP 1063 DI 10.2105/AJPH.90.7.1059 PG 5 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 327TR UT WOS:000087810000011 PM 10897183 ER PT J AU Freiman, MP Zuvekas, SH AF Freiman, MP Zuvekas, SH TI Determinants of ambulatory treatment mode for mental illness SO HEALTH ECONOMICS LA English DT Article DE mental health; psychotropic medications; treatment choice; supplier-induced demand ID LIFE-SUSTAINING TREATMENTS AB We estimate a reduced-form bivariate probit model to analyse jointly the choice of ambulatory treatment from the specialty mental health sector and/or the use of psychotropic drugs for a nationally representative sample of US household residents. We find significant differences in treatment choice by education, gender, race and ethnicity, while controlling for several aspects of self-reported mental health and treatment attitudes. For example, while women are more likely than men to use the specialty mental health sector and more likely to take psychotropic medications, this difference between men and women is much greater for psychotropic medications. The estimated differences may reflect patient preferences in a manner traditionally assumed when interpreting these coefficients in such equations, but we discuss how they may also reflect biases and misperceptions on the parts of patients and providers. We also discuss how our results relate to some findings and policies in the general health care sector. Published in 2000 by John Wiley & Sons, Ltd. C1 ABT Associates Inc, Washington, DC 20005 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Freiman, MP (reprint author), ABT Associates Inc, 1110 Vermont Ave NW,Suite 240, Washington, DC 20005 USA. NR 17 TC 8 Z9 8 U1 1 U2 3 PU JOHN WILEY & SONS LTD PI W SUSSEX PA BAFFINS LANE CHICHESTER, W SUSSEX PO19 1UD, ENGLAND SN 1057-9230 J9 HEALTH ECON JI Health Econ. PD JUL PY 2000 VL 9 IS 5 BP 423 EP 434 DI 10.1002/1099-1050(200007)9:5<423::AID-HEC526>3.0.CO;2-X PG 12 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 342UZ UT WOS:000088664700006 PM 10903542 ER PT J AU Clancy, CM Bierman, AS AF Clancy, CM Bierman, AS TI Quality and outcomes of care for older women with chronic disease SO WOMENS HEALTH ISSUES LA English DT Article ID OF-LIFE; HEALTH-CARE; URINARY-INCONTINENCE; MEDICAL OUTCOMES; PATIENT OUTCOMES; MANAGED CARE; IMPACT; INJURIES; ILLNESS; FALLS C1 Ctr Outcomes & Effectiveness Res, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Clancy, CM (reprint author), Ctr Outcomes & Effectiveness Res, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 59 TC 3 Z9 4 U1 1 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD JUL-AUG PY 2000 VL 10 IS 4 BP 178 EP 190 DI 10.1016/S1049-3867(00)00050-5 PG 13 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 374UQ UT WOS:000165363100002 PM 10899665 ER PT J AU Fiore, MC Bailey, WC Cohen, SJ Dorfman, SF Fox, BJ Goldstein, MG Gritz, E Hasselblad, V Heyman, RB Jaen, CR Jorenby, D Kottke, TE Lando, HA Mecklenburg, RE Mullen, PD Nett, L Piper, M Robinson, L Stitzer, M Tommasello, A Welsch, S Villejo, L Wewers, ME Baker, TB AF Fiore, MC Bailey, WC Cohen, SJ Dorfman, SF Fox, BJ Goldstein, MG Gritz, E Hasselblad, V Heyman, RB Jaen, CR Jorenby, D Kottke, TE Lando, HA Mecklenburg, RE Mullen, PD Nett, L Piper, M Robinson, L Stitzer, M Tommasello, A Welsch, S Villejo, L Wewers, ME Baker, TB CA Tobacco Use Dependence Clin Prac TI A clinical practice guideline for treating tobacco use and dependence - A US Public Health Service report SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID SMOKING-CESSATION; COST-EFFECTIVENESS; NICOTINE GUM; MAINTENANCE ORGANIZATION; QUIT; ADVICE; PROGRAMS; PATTERNS; BENEFITS; SMOKERS AB Objective To summarize the recently published US Public Health Service report Treating Tobacco Use and Dependence. A Clinical Practice Guideline, which provides recommendations for brief clinical interventions, intensive clinical interventions, and system changes to promote the treatment of tobacco dependence. Participants An independent panel of 18 scientists, clinicians, consumers, and methodologists selected by the US Agency for Healthcare Research and Quality. A consortium of 7 governmental and nonprofit organizations sponsored the update. Evidence Approximately 6000 English-language, peer-reviewed articles and abstracts, published between 1975 and 1999, were reviewed for data that addressed assessment and treatment of tobacco dependence. This literature served as the basis for more than 50 meta-analyses. Consensus Process One panel meeting and numerous conference calls and staff meetings were held to evaluate meta-analytic and other results, to synthesize the results, and to develop recommendations. The updated guideline was then externally reviewed by more than 70 experts and revised. Conclusions This evidence-based, updated guideline provides specific recommendations regarding brief and intensive tobacco cessation interventions as well as system-level changes designed to promote the assessment and treatment of tobacco use. Brief clinical approaches for patients willing and unwilling to quit are described. Major conclusions and recommendations include: (1) Tobacco dependence is a chronic condition that warrants repeated treatment until long-term or permanent abstinence is achieved. (2) Effective treatments for tobacco dependence exist and all tobacco users should be offered those treatments. (3) Clinicians and health care delivery systems must institutionalize the consistent identification, documentation, and treatment of every tobacco user at every visit. (4) Brief tobacco dependence treatment is effective, and every tobacco user should be offered at least brief treatment. (5) There is a strong dose-response relationship between the intensity of tobacco dependence counseling and its effectiveness. (6) Three types of counseling were found to be especially effective-practical counseling, social support as part of treatment, and social support arranged outside of treatment. (7) Five first-line pharmacotherapies for tobacco dependence-sustained-release bupropion hydrochloride, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch-are effective, and at least 1 of these medications should be prescribed in the absence of contraindications. (8) Tobacco dependence treatments are cost-effective relative to other medical and disease prevention interventions; as such, all health insurance plans should include as a reimbursed benefit the counseling and pharmacotherapeutic treatments identified as effective in the updated guideline. C1 Univ Wisconsin, Sch Med, Ctr Tobacco Res & Intervent, Madison, WI 53711 USA. Univ Alabama, Birmingham, AL USA. Univ Arizona, Prevent Ctr, Tucson, AZ 85721 USA. Bayer Inst Hlth Care Commun, Portland, OR USA. Univ Texas, MD Anderson Canc Ctr, Houston, TX 77030 USA. Duke Clin Res Inst, Durham, NC USA. Amer Acad Pediat, Elk Grove Village, IL USA. SUNY Buffalo, Buffalo, NY 14260 USA. Mayo Clin, Rochester, MN USA. Univ Minnesota, Sch Publ Hlth, Minneapolis, MN 55455 USA. NCI, Bethesda, MD 20892 USA. Univ Texas, Sch Publ Hlth, Houston, TX USA. Natl Lung Hlth Educ Program, Denver, CO USA. Philadelphia Dept Hlth, Philadelphia, PA USA. Johns Hopkins Bayview Med Ctr, Baltimore, MD 21224 USA. Univ Maryland, Sch Pharm, College Pk, MD 20742 USA. Ohio State Univ, Columbus, OH 43210 USA. NHLBI, NIH, Bethesda, MD USA. Agcy Hlth Care Res & Qual, Rockville, MD USA. NIDA, Bethesda, MD USA. Ctr Dis Control & Prevent, Off Smoking & Hlth, Atlanta, GA USA. Ctr Dis Control & Prevent, Div Reprod Hlth, Atlanta, GA USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. RP Fiore, MC (reprint author), Univ Wisconsin, Sch Med, Ctr Tobacco Res & Intervent, 1930 Monroe St,Suite 200, Madison, WI 53711 USA. NR 43 TC 474 Z9 491 U1 9 U2 80 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 28 PY 2000 VL 283 IS 24 BP 3244 EP 3254 PG 11 WC Medicine, General & Internal SC General & Internal Medicine GA 326TY UT WOS:000087753900039 ER PT J AU Hays, RD Cunningham, WE Sherbourne, CD Wilson, IB Wu, AW Cleary, PD McCaffrey, DF Fleishman, JA Crystal, S Collins, R Eggan, F Shapiro, MF Bozzette, SA AF Hays, RD Cunningham, WE Sherbourne, CD Wilson, IB Wu, AW Cleary, PD McCaffrey, DF Fleishman, JA Crystal, S Collins, R Eggan, F Shapiro, MF Bozzette, SA TI Health-related quality of life in patients with human immunodeficiency virus infection in the United States: Results from the HIV cost and services utilization study SO AMERICAN JOURNAL OF MEDICINE LA English DT Article ID OF-LIFE; MEDICAL OUTCOMES; FUNCTIONAL STATUS; DISEASE; RELIABILITY; INSTRUMENT; VALIDITY; AIDS; POPULATION; IMPACT AB PURPOSE: To measure health-related quality of life among adult patients with human immunodeficiency virus (HIV) disease; to compare the health-related quality of life of adults with HIV with that of the general population and with patients with other chronic conditions; and to determine the associations of demographic variables and disease severity with health-related quality of life. SUBJECTS AND METHODS: We studied 2,864 HIV-infected adults participating in the HIV Cost and Services Utilization Study, a probability sample of adults with HIV receiving health care In the contiguous United States (excluding military hospitals, prisons, or emergency rooms). A battery of 28 items covering eight domains of health (physical functioning, emotional well-being, role functioning, pain, general health perceptions, social functioning, energy, disability days) was administered. The eight domains were combined into physical and mental health summary scores. SF-36 physical functioning and emotional well-being scales were compared with the US general population and patients with other chronic diseases on a 0 to 100 scale. RESULTS: Physical functioning was about the same for adults with asymptomatic HIV disease as for the US population [mean (+/- SD) of 92 +/- 16 versus 90 +/- 17) but was much worse for those with symptomatic HIV disease (76 +/- 28) or who met criteria for the acquired immunodeficiency syndrome (AIDS; 58 +/- 31). Patients with AIDS had worse physical functioning than those with other chronic diseases (epilepsy, gastroesophageal reflux disease, clinically localized prostate cancer, clinical depression, diabetes) for which comparable data were available. Emotional well-being was comparable among patients with various stages of HIV disease (asymptomatic, 62 +/- 9; symptomatic, 59 +/- 11; AIDS, 59 +/- 11), but was significantly worse than the general population and patients with other chronic diseases except depression. In multivariate analyses, HIV-related symptoms were strongly associated with physical and mental health, whereas race, sex, health insurance status, disease stage, and CD4 count were at most weakly associated with physical and mental health. CONCLUSIONS: There is substantial morbidity associated with HIV disease in adults. The variability in health-related quality of life according to disease progression is relevant for health policy and allocation of resources, and merits the attention of clinicians who treat patients with HIV disease. Am J Med. 2000;108:714-722. (C)2000 by Excerpta Medica, Inc. C1 Univ Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res, Los Angeles, CA 90095 USA. RAND Corp, Hlth Program, Boston, MA USA. Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. New England Med Ctr, Boston, MA 02111 USA. Tufts Univ, Sch Med, Div Clin Care Res, Boston, MA 02111 USA. Johns Hopkins Univ, Dept Hlth Policy & Management, Baltimore, MD 21218 USA. Johns Hopkins Univ, Dept Med, Baltimore, MD 21218 USA. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, New Brunswick, NJ USA. Rutgers State Univ, Inst Hlth Healthcare Policy & Aging Res, New Brunswick, NJ 08903 USA. city Los Angeles, AIDS Coordinator Off, Los Angeles, CA USA. Univ Calif San Diego, Dept Med, San Diego, CA 92103 USA. Vet Affairs Med Ctr, San Diego, CA 92161 USA. Vet Affairs San Diego Healthcare Syst, Hlth Serv Res & Dev Unit, San Diego, CA USA. RP Hays, RD (reprint author), Univ Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res, 911 Broxton Plaza,Room 110,Box 951736, Los Angeles, CA 90095 USA. RI Hays, Ronald/D-5629-2013; Wilson, Ira/F-9190-2016 OI Wilson, Ira/0000-0002-0246-738X FU AHRQ HHS [HS08578] NR 40 TC 189 Z9 197 U1 3 U2 31 PU EXCERPTA MEDICA INC PI NEW YORK PA 650 AVENUE OF THE AMERICAS, NEW YORK, NY 10011 USA SN 0002-9343 J9 AM J MED JI Am. J. Med. PD JUN 15 PY 2000 VL 108 IS 9 BP 714 EP 722 DI 10.1016/S0002-9343(00)00387-9 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA 338YG UT WOS:000088450400004 PM 10924648 ER PT J AU Hellinger, FJ Fleishman, JA AF Hellinger, FJ Fleishman, JA TI Estimating the national cost of treating people with HIV disease: Patient, payer, and provider data SO JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE treatment cost; HIV disease; estimating ID ANTIRETROVIRAL THERAPY; MEDICAL-CARE; INFECTION; AIDS; MEN AB Objective: Existing estimates of the national cost of treating all people with HIV disease use data from a sample of people with HIV disease to extrapolate the cost of treating all people with HIV disease (patient-based approach). This study derives estimates using two novel approaches (i.e., payer-based and provider-based) and compares these with existing estimates. Data Sources: These include the Health Insurance Association of American and the American Council of Life Insurance 1996 HIV survey, the 1996 State Inpatient Databases (SID) maintained by the Agency for Healthcare Research and Quality, and the IMS America Ltd. survey of independent and chain drugstores. Principal Findings: The cost of treating all people with HIV disease in 1996 was between $6.7 and $7.8 billion U.S., and the average annual cost of treating a person with HIV disease was between $20,000 and $24,700 U.S. Conclusions: Analysts should derive estimates of the cost of treating people with HIV disease using several different approaches. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Hellinger, FJ (reprint author), Agcy Healthcare Res & Qual, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 28 TC 24 Z9 30 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1525-4135 J9 J ACQ IMMUN DEF SYND JI J. Acquir. Immune Defic. Syndr. PD JUN 1 PY 2000 VL 24 IS 2 BP 182 EP 188 PG 7 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 339QU UT WOS:000088490100014 PM 10935696 ER PT J AU Fiscella, K Franks, P Gold, MR Clancy, CM AF Fiscella, K Franks, P Gold, MR Clancy, CM TI Inequality in quality - Addressing socioeconomic, racial, and ethnic disparities in health care SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Review ID ACUTE MYOCARDIAL-INFARCTION; OF-VETERANS-AFFAIRS; MEDICAL-CARE; INSURANCE STATUS; UNITED-STATES; INNER-CITY; PREVENTABLE HOSPITALIZATIONS; REVASCULARIZATION PROCEDURES; CORONARY ANGIOGRAPHY; CARDIAC PROCEDURES AB Socioeconomic and racial/ethnic disparities in health care quality have been extensively documented, Recently, the elimination of disparities in health care has become the focus of a national initiative, Yet, there is little effort to monitor and address disparities in health care through organizational quality improvement. After reviewing literature on disparities in health care, we discuss the limitations in existing quality assessment for identifying and addressing these disparities, We propose 5 principles to address these disparities through modifications in quality performance measures: disparities represent a significant quality problem; current data collection efforts are inadequate to identify and address disparities; clinical performance measures should be stratified by race/ethnicity and socioeconomic position for public reporting; population-wide monitoring should incorporate adjustment for race/ethnicity and socioeconomic position; and strategies to adjust payment for race/ethnicity and socioeconomic position should be considered to reflect the known effects of both on morbidity. C1 Univ Rochester, Sch Med & Dent, Dept Family Med, Rochester, NY USA. Univ Rochester, Sch Med & Dent, Dept Community & Prevent Med, Rochester, NY USA. CUNY, Sch Med, Dept Community Hlth & Social Med, New York, NY 10031 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Fiscella, K (reprint author), Family Med Ctr, 885 S Ave, Rochester, NY 14620 USA. RI Dalla Zuanna, Teresa/G-3133-2015 FU PHS HHS [R01 09963-01] NR 115 TC 573 Z9 577 U1 8 U2 68 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAY 17 PY 2000 VL 283 IS 19 BP 2579 EP 2584 DI 10.1001/jama.283.19.2579 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 312VL UT WOS:000086964600042 PM 10815125 ER PT J AU Sun, BC Adams, J Orav, EJ Rucker, DW Brennan, TA Burstin, HR AF Sun, BC Adams, J Orav, EJ Rucker, DW Brennan, TA Burstin, HR TI Determinants of patient satisfaction and willingness to return with emergency care SO ANNALS OF EMERGENCY MEDICINE LA English DT Article ID MEDICAL-CARE; WAITING TIME; QUALITY; PERCEPTIONS; INFORMATION; DELIVERY AB Study objective: To identify emergency department process of care measures that are significantly associated with satisfaction and willingness to return. Methods: Patient satisfaction and willingness to return at 5 urban, teaching hospital EDs were assessed. Baseline questionnaire, chart review, and 10-day follow-up telephone inter views were performed, and 38 process of care measures and 30 patient characteristic were collected for each respondent. Overall satisfaction was modeled with ordinal logistic regression. Willingness to return was modeled with logistic regression. Results: During a 1-month study period, 2,899 (84% of eligible) on-site questionnaires were completed. Telephone interviews were completed by 2,333 patients (80% of patients who completed a questionnaire). Patient-reported problems that were highly correlated with satisfaction included help not received when needed (odds ratio [OR] 0.345; 95% confidence interval [CI] 0.261 to 0.456), poor explanation of causes of problem (OR 0.434; 95% CI 0.345 to 0.546), not told about potential wait time (OR 0.479; 95% CI 0.399 to 0.577), not told when to resume normal activities (OR 0.691, 95% CI 0.531 to 0.901), poor explanation of test results (OR 0.647; 95% CI 0.495 to 0.845), and not told when to return to the ED (OR 0.656; 95% CI 0.494 to 0.871). Other process of care measures correlated with satisfaction include nonacute triage status (OR 0.701, 95% CI 0.578 to 0.851) and number of treatments in the ED (OR 1.164 per treatment; 95% CI 1.073 to 1.263). Patient characteristics that significantly predicted less satisfaction included younger age and black race. Determinants of willingness to return include poor explanation of causes of problem (OR 0.328; 95% CI 0.217 to 0.495), unable to leave a message for family (OR 0.391; 95% CI 0.226 to 0.677), not told about potential wait time (OR 0.561; 95% CI 0.381 to 0.825), poor explanation of test results (OR 0.541; 95% CI 0.347 to 0.846), and help not received when needed (OR 0.537; 95% CI 0.340 to 0.846). Patients with a chief complaint of hand laceration were less willing to return compared with a reference population of patients with abdominal pain. Willingness to return is strongly predicted by overall satisfaction (OR 2.601; 95% CI 2.292 to 2.951). Conclusion: These data identify specific process of care measures that are determinants of patient satisfaction and willingness to return. Efforts to increase patient satisfaction and willingness to return should focus on improving ED performance on these identified process measures. C1 Brigham & Womens Hosp, Dept Emergency Med, Boston, MA 02115 USA. RP Burstin, HR (reprint author), Agcy Healthcare Res & Qual, Agcy Primary Care Res, 6010 Execut Blvd, Rockville, MD 20852 USA. NR 31 TC 150 Z9 150 U1 5 U2 26 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD MAY PY 2000 VL 35 IS 5 BP 426 EP 434 DI 10.1067/mem.2000.104195 PG 9 WC Emergency Medicine SC Emergency Medicine GA 310LT UT WOS:000086830200003 PM 10783404 ER PT J AU Clancy, CM AF Clancy, CM TI Searching for the best of primary care SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material ID CONTINUING MEDICAL-EDUCATION; PERFORMANCE; OUTCOMES; QUALITY C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 11 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD MAY PY 2000 VL 15 IS 5 BP 348 EP 349 DI 10.1046/j.1525-1497.2000.03019.x PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 316UD UT WOS:000087185700011 PM 10840272 ER PT J AU Katz, MH Cunningham, WE Fleishman, JA Andersen, RM Kellogg, T Bozzette, SA Shapiro, MF AF Katz, MH Cunningham, WE Fleishman, JA Andersen, RM Kellogg, T Bozzette, SA Shapiro, MF TI Impact of case management for HIV-infected persons. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract C1 RAND Corp, Santa Monica, CA USA. Univ Calif Los Angeles, Vet Affairs San Diego Healthcare Syst, Los Angeles, CA USA. Agcy Healthcare Res & Qual, Bethesda, MD USA. Univ Calif Los Angeles, Sch Publ Hlth, Los Angeles, CA USA. Dept Publ Hlth, San Francisco, CA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2000 VL 15 SU 1 BP 76 EP 76 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 308CE UT WOS:000086690400226 ER PT J AU Sucato, GS Banthin, J AF Sucato, GS Banthin, J TI Impact of health insurance on adolescent use of ambulatory care SO PEDIATRIC RESEARCH LA English DT Meeting Abstract C1 Univ Washington, Seattle, WA 98195 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2000 VL 47 IS 4 SU S MA 74 BP 13A EP 13A PN 2 PG 1 WC Pediatrics SC Pediatrics GA 298TM UT WOS:000086155300075 ER PT J AU Thompson, JW Elixhauser, A AF Thompson, JW Elixhauser, A TI Use of the healthcare cost and utilization project to guide quality improvement and performance assessments for child and adolescent health SO PEDIATRIC RESEARCH LA English DT Meeting Abstract C1 Agcy Hlth Care Policy & Res, Washington, DC USA. Univ Arkansas Med Sci, Dept Pediat, Little Rock, AR 72205 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2000 VL 47 IS 4 SU S MA 1358 BP 230A EP 230A PN 2 PG 1 WC Pediatrics SC Pediatrics GA 298TM UT WOS:000086155301357 ER PT J AU Doescher, MP Franks, P Banthin, JS Clancy, CM AF Doescher, MP Franks, P Banthin, JS Clancy, CM TI Supplemental insurance and mortality in elderly Americans - Findings from a national cohort SO ARCHIVES OF FAMILY MEDICINE LA English DT Article ID PRIVATE HEALTH-INSURANCE; DEATH-INDEX; FUNCTIONAL STATUS; OLDER PERSONS; ASCERTAINMENT; TERMINATION; MEDICARE; CARE AB Context: As the burden of out-of-pocket health care expenditures for Medicare beneficiaries has grown, the need to assess the relationship between uncovered costs and health outcomes has become more pressing, Objective: To assess the relationship between risk for out-of-pocket expenditures and mortality in elderly persons with private supplemental insurance. Design: Retrospective cohort study using proportional hazards survival analyses to assess mortality as a function of health insurance, adjusting for sociodemographic, access, and case mix-health status measures. Setting: The 1987 National Medical Expenditure Survey, a representative cohort of the US civilian population, linked to the National Death Index. Participants: A total of 3751 persons aged 65 years and older. Main Outcomes Measures: Five-year mortality rate. Results: After 5 years, 18.5% of persons at low risk for out-of-pocket expenditures, 22.5% of those at intermediate risk, and 22.6% of those at high risk had died. After multivariate adjustment, a significant linear trend (P = .02) toward increasing mortality with increasing risk category was observed. Compared with the low-risk group, persons in the intermediate-risk group had an adjusted hazard ratio of 1.2 (95% confidence interval, 0.9-1.6), whereas those in the high-risk group had an adjusted hazard ratio of 1.4 (95% confidence interval, 1.0-1.9). Conclusions: Increasing risk for out-of-pocket costs is associated with higher subsequent mortality among elderly Americans with supplemental private coverage. Although research is needed to identify which specific components of out-of-pocket expenditures are adversely associated with health outcomes, findings support policies to decrease out-of-pocket health care expenditures to reduce the risk for premature mortality in elderly Americans. C1 Univ Washington, Sch Med, Dept Family Med, Seattle, WA 98105 USA. Univ Rochester, Dept Family Med, Primary Care Inst, Rochester, NY USA. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD USA. RP Doescher, MP (reprint author), Univ Washington, Sch Med, Dept Family Med, 4225 Roosevelt Way NE,Suite 308, Seattle, WA 98105 USA. FU AHRQ HHS [R03 HS09522-01] NR 42 TC 8 Z9 8 U1 2 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 1063-3987 J9 ARCH FAM MED JI Arch. Fam. Med. PD MAR PY 2000 VL 9 IS 3 BP 251 EP 257 DI 10.1001/archfami.9.3.251 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 293XC UT WOS:000085879700010 PM 10728112 ER PT J AU Pope, GC Ellis, RP Ash, AS Liu, CF Ayanian, JZ Bates, DW Burstin, H Iezzoni, LI Ingber, MJ AF Pope, GC Ellis, RP Ash, AS Liu, CF Ayanian, JZ Bates, DW Burstin, H Iezzoni, LI Ingber, MJ TI Principal inpatient diagnostic cost group model for Medicare risk adjustment SO HEALTH CARE FINANCING REVIEW LA English DT Article ID CAPITATION AB The Balanced Budget Act (BBA) of 1997 required HCFA to implement health-status-based risk adjustment for Medicare capitation payments for managed care plans by January 1, 2000. In support of this mandate, HCFA has been collecting inpatient encounter data from health plans since 1997. These data include diagnoses and other information that can be used to identify chronic medical problems that contribute to higher costs, so that health plans can be Paid more when they care for sicker patients. In this article, the authors describe the risk-adjustment model HCFA is implementing in the year 2000 known as the Principal Inpatient Diagnostic Cost Group (PIPDCG) model. C1 Hlth Econ Res Inc, Waltham, MA 02452 USA. Boston Univ, Boston, MA 02215 USA. Boston Univ, Sch Med, Boston, MA 02118 USA. Vet Adm Puget Sound Hlth Care Syst, Seattle, WA USA. Harvard Univ, Sch Med, Cambridge, MA 02138 USA. Brigham & Womens Hosp, Boston, MA 02115 USA. Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. Harvard Univ, Beth Israel Deaconess Med Ctr, Sch Med, Boston, MA 02215 USA. Charles A Dana Res Inst, Boston, MA 02215 USA. Harvard Univ, Thorndike Lab, Cambridge, MA 02138 USA. HCFA, Washington, DC 20201 USA. RP Pope, GC (reprint author), Hlth Econ Res Inc, 411 Waverley Oaks Rd,Suite 330, Waltham, MA 02452 USA. NR 15 TC 73 Z9 73 U1 0 U2 3 PU HEALTH CARE FINANCING REVIEW PI BALTIMORE PA 7500 SECURITY BLVD, C-3-11-07, BALTIMORE, MD 21224-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2000 VL 21 IS 3 BP 93 EP 118 PG 26 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 401XT UT WOS:000166954900005 PM 11481770 ER PT J AU Meyer, GS Cheng, EY Elting, J AF Meyer, GS Cheng, EY Elting, J TI Differences between generalists and specialists in characteristics of patients receiving gastrointestinal procedures SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE colonoscopy; esophagogastroduodenoscopy; sigmoidoscopy; generalist physician; specialist; physician practice patterns ID PRIMARY-CARE PHYSICIANS; FAMILY PHYSICIAN; ENDOSCOPY; COLONOSCOPY; SKILLS AB BACKGROUND: As a result of market: forces and maturing technology, generalists are currently providing services, such as colonoscopy, that in the past were deemed the realm of specialists. OBJECTIVE: To determine whether there were differences in patient characteristics, procedure complexity, and clinical indications when gastrointestinal endoscopic procedures were provided by generalists versus specialists. DESIGN: Retrospective cohort study. PATIENTS: A random 5% sample of aged Medicare beneficiaries who underwent rigid and flexible sigmoidoscopy, colonoscopy, and esophagogastroduodenoscopy (EGD) performed by specialists (gastroenterologists, general surgeons, and colorectal surgeons) or generalists (general practitioners, family practitioners, and general internists). MEASUREMENTS: characteristics of patients, indications for the procedure, procedural complexity, and place of service were compared between generalists and specialists using descriptive statistics and logistic regression. MAIN RESULTS:Our sample population had 167,347 gastrointestinal endoscopies. Generalists performed 7.7% of the 57,221 colonoscopies, 8.7% of the 62,469 EGDs, 42.7% of the 38,261 flexible sigmoidoscopies, and 35.2% of the 9,396 rigid sigmoidoscopies. Age and gender of patients were similar between generalists and specialists, hut white patients were more likely to receive complex endoscopy from specialists. After adjusting for patient differences in age, race, and gender, generalists were more likely to have provided a simple diagnostic procedure [odds ratio [OR] 4.2; 95% confidence interval [95% CI] 4.0, 4.4), perform, the procedure for examination and screening purposes (OR 4.9; 95% CI, 4.3 to 5.6), and provide these procedures in rural areas (OR 1.5; 95% CI 1.4 to 1.6). CONCLUSIONS: Although generalists perform the full spectrum of gastrointestinal endoscopies, their procedures are often of lower complexity and less likely to have been performed for investigating severe morbidities. C1 Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvement, Rockville, MD 20852 USA. RP Meyer, GS (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Measurement & Improvement, 2101 E Jefferson St,Suite 502, Rockville, MD 20852 USA. NR 31 TC 10 Z9 10 U1 1 U2 3 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD MAR PY 2000 VL 15 IS 3 BP 188 EP 194 DI 10.1046/j.1525-1497.2000.06039.x PG 7 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 292ZY UT WOS:000085828100007 PM 10718900 ER PT J AU Basu, J Cooper, J AF Basu, J Cooper, J TI Out-of-area travel from rural and urban counties: A study of ambulatory care sensitive hospitalizations for New York State residents SO JOURNAL OF RURAL HEALTH LA English DT Article ID ACCESS; CLOSURES; CHOICE; COMMUNITIES; PHYSICIANS; DISTANCE; DISEASE AB Rural patients who are admitted to hospitals outside their residence county or who travel great distances for hospitalization deprive local rural hospitals of revenue. To provide more information about such rural residents, we studied their characteristics compared to those admitted in the same county. Characteristics studied included illness severity, demographics and county resources. To validate the findings and to provide a different analytic approach, characteristics of residents who travel long distances for admission were also studied. We studied admissions for ambulatory care sensitive conditions, as they might be most responsive to policy changes such as increasing recruitment of local primary-care physicians. Hospital discharges during 1994 for 248,656 New York State residents were studied. We constructed multivariate models using logistic regression and ordinary least squares methods. The models were applied to residents in three types of geographic location along an urban-rural continuum. Outside admissions were associated with younger age, higher illness severity and fewer county hospital resources. Same county admissions were associated with nonwhite race, and lack of insurance. Surprisingly, in rural counties, outside admissions were directly associated with increased primary-care providers. Results from the distance model generally supported findings from the outside admission model. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Basu, J (reprint author), Agcy Healthcare Res & Qual, Suite 201,6010 Execut Blvd, Rockville, MD 20852 USA. RI Dalla Zuanna, Teresa/G-3133-2015 NR 35 TC 33 Z9 33 U1 1 U2 3 PU NATL RURAL HEALTH ASSOC PI KANSAS CITY PA ONE WEST ARMOUR BLVD, STE 301, KANSAS CITY, MO 64111 USA SN 0890-765X J9 J RURAL HEALTH JI J. Rural Health PD SPR PY 2000 VL 16 IS 2 BP 129 EP 138 DI 10.1111/j.1748-0361.2000.tb00446.x PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 343PR UT WOS:000088711200006 PM 10981364 ER PT J AU Lara, M Sherbourne, C Duan, NH Morales, L Gergen, P Brook, RH AF Lara, M Sherbourne, C Duan, NH Morales, L Gergen, P Brook, RH TI An English and Spanish pediatric asthma symptom scale SO MEDICAL CARE LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Thoracic-Society CY APR 24-29, 1998 CL CHICAGO, ILLINOIS SP Amer Thorac Soc DE pediatric asthma; Latino/Hispanic; Spanish surveys; asthma symptoms; psychometric methods ID INNER-CITY CHILDREN; QUALITY-OF-LIFE; HISPANIC CHILDREN; CHILDHOOD ASTHMA; HEALTH-STATUS; PUERTO-RICAN; SEVERITY; PREVALENCE; ACCURACY; QUESTIONNAIRE AB BACKGROUND. Pediatric asthma survey measures have not been adequately tested in non-English-speaking populations. OBJECTIVES. To test the reliability and validity of an English and Spanish symptom scale to measure asthma control in children. SUBJECTS. Parents (54% Spanish-speaking; 61% not high school graduates) of 234 children seen in the emergency department for an asthma exacerbation. MEASURES. Parent report of frequency and perceived severity of child asthma symptoms during the beginning and after resolution of the exacerbation. RESULTS. An 8-item scale composed of reports of cough, wheezing, shortness of breath, asthma attacks, chest pain, night symptoms, and overall perceived severity had very good psychometric properties in both English and Spanish. The reliability (Cronbach's alpha) of the scale ranged from 0.81 to 0.87 for both languages and time frames. In both languages, the validity of the scale was supported by responsiveness to changes in clinical status (lower symptom score after resolution of the exacerbation, P < 0.001) and by moderate to strong correlations (P < 0.001) with other asthma morbidity measures (parent report of child bother: r = 0.59-0.65; school days lost: r = 0.38-0.67; and activity days lost: p = 0.41-0.59). There were no statistically significant differences in the reliability or construct validity of the summary symptom scale by language, although Spanish speakers reported a lower frequency of some symptoms than did English speakers. CONCLUSIONS. A reliable and valid 8-item scale can be used to measure control of asthma symptoms in Spanish-speaking populations of low literacy. Additional research to evaluate language equivalency of asthma measures is necessary. C1 Univ Calif Los Angeles, RAND Program Latino Children Asthma, Los Angeles, CA USA. Univ Calif Los Angeles, Dept Pediat, Div Gen Pediat, Los Angeles, CA USA. RAND Hlth, Los Angeles, CA USA. Agcy Hlth Care Policy & Res, Ctr Primary Care & Res, Washington, DC USA. RP Lara, M (reprint author), RAND Hlth, 1700 Main St,POB 2138, Santa Monica, CA 90401 USA. RI Praena-Crespo, Manuel/E-7172-2010 OI Praena-Crespo, Manuel/0000-0002-1928-9663 NR 47 TC 31 Z9 32 U1 1 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2000 VL 38 IS 3 BP 342 EP 350 DI 10.1097/00005650-200003000-00011 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 289WC UT WOS:000085644100011 PM 10718359 ER PT J AU Bierman, AS Clancy, CM AF Bierman, AS Clancy, CM TI Making capitated Medicare work for women: Policy and research challenges SO WOMENS HEALTH ISSUES LA English DT Article; Proceedings Paper CT 1st Annual Meeting on Women and Medicare CY SEP, 1999 CL WASHINGTON, D.C. SP Commonwealth Fund ID QUALITY-OF-LIFE; ACUTE MYOCARDIAL-INFARCTION; FEE-FOR-SERVICE; HEALTH-CARE; URINARY-INCONTINENCE; DISEASE MANAGEMENT; GENDER DIFFERENCES; HMO; DISENROLLMENT; SATISFACTION AB Growth in capitated Medicare has special ramifications for older women who comprise the majority of Medicare beneficiaries. Older women are more likely than men to have chronic conditions that lead to illness and disability, and they often have fewer financial and social resources to cope with these problems. Gender differences in health status have a number of important implications for the financing and delivery of care for older women under both traditional fee-for-service Medicare and capitation. The utilization of effective preventive interventions, new therapeutic interventions for the management of common chronic disorders, and more cost-effective models of chronic disease management could potentially extend the active life expectancy of older women. However, there are financial and delivery system barriers to achieving these objectives. Traditional FFS Medicare has gaps in coverage of care for chronic illness and disability that disproportionately impact women. Managed care potentially offers flexibility to allocate resources creatively, to develop new models of care, and offer enhanced benefits with lower out-of-pocket costs. However, challenges to realizing this potential under Medicare managed care with unique implications for older women include: possible gender bias in capitation payments, risk selection, inadequacy of risk adjustment models, benefit and market instability, and disenrollment patterns. C1 Agcy Hlth Care Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD USA. RP Bierman, AS (reprint author), Agcy Hlth Care Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD USA. NR 59 TC 9 Z9 9 U1 0 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD MAR-APR PY 2000 VL 10 IS 2 BP 59 EP 69 DI 10.1016/S1049-3867(99)00042-0 PG 11 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 338EF UT WOS:000088404600006 PM 10736559 ER PT J AU Sherbourne, CD Hays, RD Fleishman, JA Vitiello, B Magruder, KM Bing, EG McCaffrey, D Burnam, A Longshore, D Eggan, F Bozzette, SA Shapiro, MF AF Sherbourne, CD Hays, RD Fleishman, JA Vitiello, B Magruder, KM Bing, EG McCaffrey, D Burnam, A Longshore, D Eggan, F Bozzette, SA Shapiro, MF TI Impact of psychiatric conditions on health-related quality of life in persons with HIV infection SO AMERICAN JOURNAL OF PSYCHIATRY LA English DT Article ID HUMAN-IMMUNODEFICIENCY-VIRUS; OF-LIFE; DISORDERS; PREVALENCE; DEPRESSION; DISEASE; MEN; RELIABILITY; DISABILITY; VALIDITY AB Objective: Little is known about the impact of comorbid psychiatric symptoms in persons with HIV. This study estimates the burden on health-related quality of life associated with comorbid psychiatric conditions in a nationally representative sample of persons with HIV. Method: The authors conducted a multistage sampling of urban and rural areas to produce a national probability sample of persons with HIV receiving medical care in the contiguous United States (N=2,864). Subjects were screened for psychiatric conditions with the short form of the Composite International Diagnostic interview. Heavy drinking was assessed on the basis of quantity and frequency of drinking. Health-related quality of life was rated with a 28-item instrument adapted from similar measures used in the Medical Outcomes Study. Results: HIV subjects with a probable mood disorder diagnosis had significantly lower scores on health-related quality of life measures than did those without such symptoms. Diminished health-related quality of life was not associated with heavy drinking, and in drug users it was accounted for by presence of a comoribid mood disorder. Conclusions: Optimization of health-related quality of life is particularly important now that HIV is a chronic disease with the prospect of long-term survival. Comorbid psychiatric conditions may serve as markers for impaired functioning and well-being in persons with HIV, Inclusion of sufficient numbers of appropriately trained mental health professionals to identify and treat such conditions may reduce unnecessary utilization of other health services and improve health-related quality of life in persons with HIV infection. C1 RAND Corp, Hlth Div, Santa Monica, CA 90407 USA. NIMH, Rockville, MD 20857 USA. Agcy Healthcare Res & Qual, Rockville, MD 20857 USA. RP Sherbourne, CD (reprint author), RAND Corp, Hlth Div, 1700 Main St,Box 2138, Santa Monica, CA 90407 USA. RI Hays, Ronald/D-5629-2013 FU AHRQ HHS [HS-08578] NR 35 TC 151 Z9 157 U1 1 U2 8 PU AMER PSYCHIATRIC PRESS, INC PI WASHINGTON PA 1400 K ST, N W, STE 1101, WASHINGTON, DC 20005 USA SN 0002-953X J9 AM J PSYCHIAT JI Am. J. Psychiat. PD FEB PY 2000 VL 157 IS 2 BP 248 EP 254 DI 10.1176/appi.ajp.157.2.248 PG 7 WC Psychiatry SC Psychiatry GA 281PC UT WOS:000085169000016 PM 10671395 ER PT J AU Hinman, AR Briss, PA Carande-Kulis, VG Bernier, RR Ndiaye, SM Rodewald, LE Shefer, AM Strikas, RA Williams, SM Yusuf, HR Atkins, D Chin, J Evans, CA Gyorkos, TW Isham, GJ Lett, SM Matulionis, RM Novick, LF Saari, TN Schaffner, W Scrimshaw, SC Amr, S Gendler, JE Gugelman, RJ Teagle, SE Khetsuriani, N Kimsey, CD Williams, SG Smith-Akin, CK AF Hinman, AR Briss, PA Carande-Kulis, VG Bernier, RR Ndiaye, SM Rodewald, LE Shefer, AM Strikas, RA Williams, SM Yusuf, HR Atkins, D Chin, J Evans, CA Gyorkos, TW Isham, GJ Lett, SM Matulionis, RM Novick, LF Saari, TN Schaffner, W Scrimshaw, SC Amr, S Gendler, JE Gugelman, RJ Teagle, SE Khetsuriani, N Kimsey, CD Williams, SG Smith-Akin, CK CA Task Force Community Preventive S TI Recommendations regarding interventions to improve vaccination coverage in children, adolescents, and adults SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article DE vaccine-preventable diseases; vaccination coverage; community health services; decision-making; evidence-based medicine; systematic reviews; population-based interventions; practice guidelines; preventive health services; public health practice; task force C1 Ctr Dis Control & Prevent, Community Prevent Serv Guide Dev Activ, Epidemiol Program Off, Atlanta, GA 30341 USA. Task Force Child Survival & Dev, Atlanta, GA USA. Ctr Dis Control & Prevent, Natl Immunizat Program, Atlanta, GA USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. US Hlth Care Financing Adm, Baltimore, MD 21207 USA. NIH, Bethesda, MD 20892 USA. Montreal Gen Hosp, Montreal, PQ H3G 1A4, Canada. McGill Univ, Montreal, PQ, Canada. HealthPartners, Bloomington, MN USA. Massachusetts Dept Publ Hlth, Boston, MA USA. Assoc State Territorial Directors Hlth Promot & P, Washington, DC USA. Onondaga Cty Hlth Dept, Syracuse, NY USA. Univ Wisconsin, Madison, WI USA. Vanderbilt Univ, Nashville, TN USA. Univ Illinois, Chicago, IL USA. Johns Hopkins Sch Hyg & Publ Hlth, Baltimore, MD USA. Dept Hlth & Social Serv, Wilmington, DE USA. Gugelman Melville & Associates, Chapel Hill, NC USA. Res Triangle Inst, Res Triangle Pk, NC 27709 USA. RP Briss, PA (reprint author), Ctr Dis Control & Prevent, Community Prevent Serv Guide Dev Activ, Epidemiol Program Off, MS K73,4770 Buford Highway, Atlanta, GA 30341 USA. NR 2 TC 0 Z9 0 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD JAN PY 2000 VL 18 IS 1 SU S BP 92 EP 96 PG 5 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 276TC UT WOS:000084892600013 ER PT J AU Branscome, JM Cooper, PF Sommers, J Vistnes, JP AF Branscome, JM Cooper, PF Sommers, J Vistnes, JP TI Private employer-sponsored health insurance: New estimates by state SO HEALTH AFFAIRS LA English DT Article C1 Agcy Hlth Care Policy & Res, Rockville, MD 20854 USA. RP Branscome, JM (reprint author), Agcy Hlth Care Policy & Res, Rockville, MD 20854 USA. NR 19 TC 12 Z9 12 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2000 VL 19 IS 1 BP 139 EP 147 DI 10.1377/hlthaff.19.1.139 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 278JU UT WOS:000084987300011 PM 10645080 ER PT J AU Bailey, JJ Berson, AS Handelsman, H AF Bailey, JJ Berson, AS Handelsman, H TI Dysrhythmia hazard after hospitalization for myocardial infarction: Two ECG prognostic methods compared SO JOURNAL OF ELECTROCARDIOLOGY LA English DT Article; Proceedings Paper CT 25th Annual Conference of the International-Society-for-Computerized-Electrocardiology CY APR 29-MAY 04, 2000 CL YOSEMITE, CALIFORNIA SP Agilent Technologies Inc, GE Marquette Med Syst Inc, Medtron Physio Control Corp, Mortara Instrument Inc, Schillerag, Siemens Elema AB, Spacelabs Burdick Inc, Zymed Inc, NHLBI DE risk stratification; heart rate variability; signal-averaged electrocardiogram ID COST-EFFECTIVENESS; DEFIBRILLATOR; SURVIVORS; THERAPY; DEATH; RISK AB We retrieved reports of heart rate variability and signal-averaged electrocardiograms (SAECG) used to predict risk of a dysrhythmic event. From each report the number of cases with and without events was extracted to establish accurate values for true positive rate (tpr = sensitivity) and false positive rate (fpr = 1 minus specificity). For all the heart rate variability reports, these values were collected and tpr values were plotted versus fpr. The (fpr,tpr) data were summarized by a meta ROC graph using the method of Moses and Shapiro. A composite weighted mean value and 95% confidence interval were also derived. A summary meta-ROC curve for thc SAECG reports was similarly obtained., Meta-ROC analysis of multiple reports better summarizes the performances of different prognostic methods and allows the effect of combining tests for a larger population to be simulated. C1 NIH, Ctr Informat Technol, Bethesda, MD 20892 USA. NHLBI, Bioengn Sci Res Grp, Bethesda, MD 20892 USA. Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD USA. RP Bailey, JJ (reprint author), NIH, Ctr Informat Technol, Bldg 12A,Room 2007,MSC 5620, Bethesda, MD 20892 USA. NR 9 TC 0 Z9 0 U1 0 U2 0 PU CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS PI PHILADELPHIA PA CURTIS CENTER, INDEPENDENCE SQUARE WEST, PHILADELPHIA, PA 19106-3399 USA SN 0022-0736 J9 J ELECTROCARDIOL JI J. Electrocardiol. PY 2000 VL 33 SU S BP 151 EP 154 DI 10.1054/jelc.2000.20294 PG 4 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 404JV UT WOS:000167095000023 PM 11265715 ER PT J AU Mukamel, DB Spector, WD AF Mukamel, DB Spector, WD TI Nursing home costs and risk-adjusted outcome measures of quality SO MEDICAL CARE LA English DT Article; Proceedings Paper CT 51st Annual Scientific Meeting of the Gerontological-Society-of-America CY NOV 20-24, 1998 CL PHILADELPHIA, PENNSYLVANIA SP Gerontol Soc Amer DE nursing homes; cost functions; quality of care; risk-adjusted outcomes ID LONG-TERM-CARE; HOSPITAL CHARACTERISTICS; INSTRUMENTAL VARIABLES; MORTALITY; OWNERSHIP; POLICY; REIMBURSEMENT; COMPETITION; TECHNOLOGY; MARKET AB BACKGROUND. The inadequacy of quality of care in nursing homes has been and continues to be a focus of public concerns. Understanding the relationship between quality and costs can offer guidance to policies designed to encourage high quality. OBJECTIVES. TO investigate the relationship between costs and quality of care in nursing homes, and to test the hypothesis that higher quality may be associated with lower casts. RESEARCH DESIGN. Statistical regression techniques were used to estimate nursing home variable-cost functions that included three risk-adjusted outcome measures of quality. Quality measures were based on decline in functional status, worsening pressure ulcers, and mortality. The study hypothesis was tested by an F test for the exclusion of nonlinear quality variables in the cost functions. SUBJECTS. The study included 525 freestanding private and public nursing homes in New York State, or 84% of all nursing homes in the state during 1991. RESULTS. F tests rejected the hypotheses that the three quality measures could be excluded from the cost function and that the association between costs and quality was linear. An inverted U-shaped relationship between quality and costs suggests that there are quality regimens in which higher quality is associated with lower costs. CONCLUSIONS. Policies that encourage research to identify care protocols and management strategies leading to better outcomes and lower costs, as well as policies that encourage dissemination of such practices, may prevent decline in quality despite the continued financial constraints faced by nursing homes. C1 Univ Rochester, Med Ctr, Rochester, NY 14642 USA. Agcy Hlth Care Policy & Res, Rockville, MD USA. RP Mukamel, DB (reprint author), Univ Rochester, Dept Community & Prevent Med, Sch Med, 601 Elmwood Ave,Box 644, Rochester, NY 14642 USA. FU NIA NIH HHS [R01 AG15965] NR 54 TC 51 Z9 53 U1 4 U2 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JAN PY 2000 VL 38 IS 1 BP 78 EP 89 DI 10.1097/00005650-200001000-00009 PG 12 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 270ZG UT WOS:000084566600009 PM 10630722 ER PT J AU Oleske, DM Linn, ES Nachman, KL Marder, RJ Sangl, JA Smith, T AF Oleske, DM Linn, ES Nachman, KL Marder, RJ Sangl, JA Smith, T TI Effect of medicaid managed care on pregnancy complications SO OBSTETRICS AND GYNECOLOGY LA English DT Article ID FEE-FOR-SERVICE; PRENATAL-CARE; HOSPITAL DISCHARGE; UTILIZATION INDEX; OUTCOMES; BIRTH; ADEQUACY AB Objective: This study examined the impact of managed care on hospital obstetric outcomes in Medicaid-sponsored women. Methods: The study sample consisted of a total of 525,517 maternal deliveries for singleton births from three payer groups, Medicaid managed care, Medicaid fee-for-service, and private managed care in 439 short-term-stay nonfederal hospitals in California and Florida. Quality of care comparisons were made using six indicators. Data were derived from linked computer files of birth certificates, hospital discharge abstracts, Medicaid eligibility records, Medicaid health care claims, and surveys of hospital characteristics. Results: The overall multivariate likelihood of an adverse maternal outcome during hospitalization for a delivery was not significantly different between Medicaid managed care and Medicaid fee-for-service groups in California and Florida. However, mothers in the Medicaid managed care group compared with mothers in the private managed care group experienced a higher likelihood of eclampsia (California) (adjusted odds ratio = 1.26; 95% confidence interval 1.05, 1.57; P=.04). Conclusion: Overall, managed care has not adversely affected pregnancy outcomes in Medicaid-sponsored women. Yet, payer system changes may be insufficient to achieve complete parity of outcomes relative to private managed care patients. (Obstet Gynecol 2000;95:6-13. (C) 2000 by The American College of Obstetricians and Gynecologists.). C1 Rush Univ, Dept Hlth Syst Management, Chicago, IL 60612 USA. Advocate Lutheran Hosp, Pk Ridge, IL USA. Agcy Hlth Care Policy & Res, Rockville, MD USA. Calif Dept Hlth Serv, Maternal & Child Hlth Branch, Sacramento, CA USA. RP Oleske, DM (reprint author), Rush Univ, Dept Hlth Syst Management, 1653 W Congress Pkwy, Chicago, IL 60612 USA. FU PHS HHS [18-P-90249/5] NR 24 TC 8 Z9 8 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0029-7844 J9 OBSTET GYNECOL JI Obstet. Gynecol. PD JAN PY 2000 VL 95 IS 1 BP 6 EP 13 DI 10.1016/S0029-7844(99)00534-7 PG 8 WC Obstetrics & Gynecology SC Obstetrics & Gynecology GA 272EU UT WOS:000084638200002 PM 10636493 ER PT J AU McCormick, MC Kass, B Elixhauser, A Thompson, J Simpson, L AF McCormick, MC Kass, B Elixhauser, A Thompson, J Simpson, L TI Annual Report on Access to and Utilization of Health Care for Children and Youth in the United States - 1999 SO PEDIATRICS LA English DT Review ID INSURANCE C1 Harvard Univ, Sch Publ Hlth, Dept Maternal & Child Hlth, Boston, MA 02115 USA. Harvard Univ, Harvard Ctr Childrens Hlth, Boston, MA 02115 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Univ Arkansas, Dept Pediat, Little Rock, AR 72204 USA. RP McCormick, MC (reprint author), Harvard Univ, Sch Publ Hlth, Dept Maternal & Child Hlth, 677 Huntington Ave, Boston, MA 02115 USA. OI McCormmick, Marie/0000-0002-3938-1707 NR 22 TC 96 Z9 97 U1 0 U2 1 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JAN PY 2000 VL 105 IS 1 SU S BP 219 EP 230 PN 3 PG 12 WC Pediatrics SC Pediatrics GA 279VX UT WOS:000085066700003 PM 10617727 ER PT J AU Murray, EW AF Murray, EW TI Smoking cessation clinical practice guideline update and Agency for Healthcare Research and Quality tobacco resources SO TOBACCO CONTROL LA English DT Article; Proceedings Paper CT 2nd Annual Addressing Tobacco in Managed Care National Conference CY JAN 31-FEB 02, 1999 CL SAN DIEGO, CALIFORNIA SP Amer Assoc Hlth Plan, Address Tobacco Managed Care Natl Techn Assistance Off Partners, Alliance Commun Hlth Plans C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Murray, EW (reprint author), Agcy Healthcare Res & Qual, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 2 TC 1 Z9 1 U1 0 U2 0 PU BRITISH MED JOURNAL PUBL GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0964-4563 J9 TOB CONTROL JI Tob. Control PY 2000 VL 9 SU 1 BP 72 EP 73 PG 2 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 292NB UT WOS:000085800100032 ER PT J AU Espada, R Rodarte, J Miller, C Barnard, C Carter, J DuBose, K Flanigan, T Fox, P Haddad, J Hale, K Hood, E Jahn, A King, K Nguyen, C Norman, S Officer, T Reardon, M Ricketts, J Sax, S Tucker, M Williams, K Reilly, J Sugarbaker, D Fanning, C Birkenmaier, K Body, S Catanzano, C Duffy, S Formanek, V Fuhlbrigge, A Hartigan, P Hunsaker, A Jacobson, F Mark, L Russell, R Saunders, D Simons, G Swanson, S McKenna, R Mohsenifar, Z Geaga, C Aberle, D Brown, J Clark, S Cooper, C Ferrill, R Frantz, R Gelb, A Goldin, J Gordon, J Head, D Joyner, M Julien, P Levine, M Lewis, M Pendio, M Silverman, J Walker, P Williams, B Yegyan, V Yoou, C Maurer, J De Camp, M Meli, Y Aviv, L Hearn, C Kraenzler, E Marlow, S McCarthy, K Mehta, A Meziane, M O'Donovan, P Schilz, R Sullivan, E Ginsburg, M Scharf, S Jellen, P Asegu, A Austin, J Bartels, M Berkman, Y Berkoski, P Brogan, F Delphin, E Demercado, G DiMango, A DePrisco, L Gonzales, J Gotthelf, J Herman, P Khan, A Mantinaos, M McKeon, K Mets, B Pearson, G Pfeffer, J Rossoff, L Sunshine, A Simonelli, P Stavrolakes, K Thomashow, B Vilotijevic, D Yip, C MacIntyre, N Davis, RD Howe, J Crouch, R Grichnik, K Harpole, D Krichman, A Lawlor, B McAdams, H Norten, J Rinaldo-Gallo, S Steele, M Tapson, V Hubmayr, R Deschamps, C Bartling, S Aughenbaugh, G Bradt, K Edgar, M Elliott, B Edell, E Garrett, J Hanson, K Hanson, L Harms, G Hartman, T Kalra, S Karsell, P Midthun, D Miller, D Mottram, C Odenbrett, K Swensen, S Sykes, AM Torres, N Utz, J Cherniack, R Make, B Gilmartin, M Buquor, B Canterbury, J Carlos, M Chetham, P Fernandez, E Geyman, L Lynch, D Newell, J Pomerantz, M Raymond, C Safilian, B Tolliver, R Whalen-Price, J Winner, K Zamora, M Diaz, P Ross, P Kelsey, M Dinant, S King, M Harter, R Mikelinich, E Rittenger, D Shaffer, S Naunheim, K Keller, C Osterloh, J Alvarez, F Borosh, S Bowen, C Frese, S Glockner, J Heidberg, E Hibbett, A Kleinhenz, ME McCain, D Ruppel, G Turnage, S Criner, G Furukawa, S Kuzman, AM Barnette, R Boiselle, P Brester, N D'Alonzo, G Gilmartin, M Keresztury, M Kish, L Lautensack, K Leonard, E Leyenson, V Lorenzon, M O'Brien, G O'Grady, T Rising, P Schartel, S Travaline, J Ries, A Kaplan, R Ramirez, C Brewer, N Colt, H Crawford, S Frankville, D Friedman, P Johnson, J Kapelanski, D Larsen, C Limberg, T Magliocca, M Olson, L Papatheofanis, J Prewitt, L Resnikoff, P Sassi-Dambron, D Krasna, M Orens, J Moskowitz, I Altemus, M Bochicchio, D Britt, J Cook, L Fessler, H Gaetani, D Gheorghiu, I Gilbert, T Hasnain, J Kearney, A Kim, S King, K Markus, S Miller, N Schneider, R Shade, D Silver, K Smith, K Turner, BS Weir, C Wheeler, J White, C Martinez, F Iannettoni, M Meldrum, C Alexander, J Bria, W Campbell, K Christensen, P Foss, C Gill, P Kazanjian, P Kazerooni, E Knieper, V Lowenbergh, N Meldrum, M Miller, R Ojo, T Pergentili, D Poole, L Qunt, L Rysso, P Spear, M True, M Woodcock, B Kaiser, L Hansen-Flaschen, J Wurster, A Alavi, A Alcorn, T Aronchick, J Arcasoy, S Aukberg, S Benedict, B Craemer, S Edelman, J Gefter, W Kotler-Klein, L Kotloff, R Manaker, S Mendez, J Miller, W Miller, W Palevsky, H Russell, W Simcox, R Snedeker, S Tino, G Keenan, R Sciurba, F George, E Ayres, G Bauldoff, G Brown, M Costello, P Donahoe, M Fuhrman, C Hoffman, R Holbert, M Johnson, P Kopp, T Lacomis, J Sexton, J Silfies, L Slivka, W Stroll, D Sullivan, E Tullock, W Benditt, J Wood, D Snyder, M Anable, K Battaglia, N Boitanao, L Bowdle, A Chan, L Chwalik, C Culver, B Godwin, D Golden, S Ibrahim, A Lockhart, D Marglin, S McDowell, P Nellum, K Van Norman, G Bosco, L Chiang, YP Clancy, C Handelsman, H Piantadosi, S Tonascia, J Belt, P Collins, K Collison, B Dawson, C Dawson, D Donithan, M Edmonds, V Harle, J Jackson, R Lee, S Levine, C Meinert, J Nowakowski, D Reshef, D Smith, M Simon, B Sternberg, A Van Natta, M Wise, R Kaplan, RM Chaing, YP Fahs, MC Fendrick, AM Moskowitz, AJ Pathak, D Ramsey, SD Richter, E Schwartz, JS Sheingold, S Shroyer, AL Wagner, J Yusen, R Waldhausen, J Bernard, G DeMets, D Hoover, E Levine, R Mahler, D McSweeney, AJ Wiener-Kronish, J Williams, OD Younes, M Sheingold, S McVearry, K Mone, C Proctor-Young, J Fishman, AP Weinmann, G Deshler, J Albert, P Hurd, S Kiley, J Wu, M AF Espada, R Rodarte, J Miller, C Barnard, C Carter, J DuBose, K Flanigan, T Fox, P Haddad, J Hale, K Hood, E Jahn, A King, K Nguyen, C Norman, S Officer, T Reardon, M Ricketts, J Sax, S Tucker, M Williams, K Reilly, J Sugarbaker, D Fanning, C Birkenmaier, K Body, S Catanzano, C Duffy, S Formanek, V Fuhlbrigge, A Hartigan, P Hunsaker, A Jacobson, F Mark, L Russell, R Saunders, D Simons, G Swanson, S McKenna, R Mohsenifar, Z Geaga, C Aberle, D Brown, J Clark, S Cooper, C Ferrill, R Frantz, R Gelb, A Goldin, J Gordon, J Head, D Joyner, M Julien, P Levine, M Lewis, M Pendio, M Silverman, J Walker, P Williams, B Yegyan, V Yoou, C Maurer, J De Camp, M Meli, Y Aviv, L Hearn, C Kraenzler, E Marlow, S McCarthy, K Mehta, A Meziane, M O'Donovan, P Schilz, R Sullivan, E Ginsburg, M Scharf, S Jellen, P Asegu, A Austin, J Bartels, M Berkman, Y Berkoski, P Brogan, F Delphin, E Demercado, G DiMango, A DePrisco, L Gonzales, J Gotthelf, J Herman, P Khan, A Mantinaos, M McKeon, K Mets, B Pearson, G Pfeffer, J Rossoff, L Sunshine, A Simonelli, P Stavrolakes, K Thomashow, B Vilotijevic, D Yip, C MacIntyre, N Davis, RD Howe, J Crouch, R Grichnik, K Harpole, D Krichman, A Lawlor, B McAdams, H Norten, J Rinaldo-Gallo, S Steele, M Tapson, V Hubmayr, R Deschamps, C Bartling, S Aughenbaugh, G Bradt, K Edgar, M Elliott, B Edell, E Garrett, J Hanson, K Hanson, L Harms, G Hartman, T Kalra, S Karsell, P Midthun, D Miller, D Mottram, C Odenbrett, K Swensen, S Sykes, AM Torres, N Utz, J Cherniack, R Make, B Gilmartin, M Buquor, B Canterbury, J Carlos, M Chetham, P Fernandez, E Geyman, L Lynch, D Newell, J Pomerantz, M Raymond, C Safilian, B Tolliver, R Whalen-Price, J Winner, K Zamora, M Diaz, P Ross, P Kelsey, M Dinant, S King, M Harter, R Mikelinich, E Rittenger, D Shaffer, S Naunheim, K Keller, C Osterloh, J Alvarez, F Borosh, S Bowen, C Frese, S Glockner, J Heidberg, E Hibbett, A Kleinhenz, ME McCain, D Ruppel, G Turnage, S Criner, G Furukawa, S Kuzman, AM Barnette, R Boiselle, P Brester, N D'Alonzo, G Gilmartin, M Keresztury, M Kish, L Lautensack, K Leonard, E Leyenson, V Lorenzon, M O'Brien, G O'Grady, T Rising, P Schartel, S Travaline, J Ries, A Kaplan, R Ramirez, C Brewer, N Colt, H Crawford, S Frankville, D Friedman, P Johnson, J Kapelanski, D Larsen, C Limberg, T Magliocca, M Olson, L Papatheofanis, J Prewitt, L Resnikoff, P Sassi-Dambron, D Krasna, M Orens, J Moskowitz, I Altemus, M Bochicchio, D Britt, J Cook, L Fessler, H Gaetani, D Gheorghiu, I Gilbert, T Hasnain, J Kearney, A Kim, S King, K Markus, S Miller, N Schneider, R Shade, D Silver, K Smith, K Turner, BS Weir, C Wheeler, J White, C Martinez, F Iannettoni, M Meldrum, C Alexander, J Bria, W Campbell, K Christensen, P Foss, C Gill, P Kazanjian, P Kazerooni, E Knieper, V Lowenbergh, N Meldrum, M Miller, R Ojo, T Pergentili, D Poole, L Qunt, L Rysso, P Spear, M True, M Woodcock, B Kaiser, L Hansen-Flaschen, J Wurster, A Alavi, A Alcorn, T Aronchick, J Arcasoy, S Aukberg, S Benedict, B Craemer, S Edelman, J Gefter, W Kotler-Klein, L Kotloff, R Manaker, S Mendez, J Miller, W Miller, W Palevsky, H Russell, W Simcox, R Snedeker, S Tino, G Keenan, R Sciurba, F George, E Ayres, G Bauldoff, G Brown, M Costello, P Donahoe, M Fuhrman, C Hoffman, R Holbert, M Johnson, P Kopp, T Lacomis, J Sexton, J Silfies, L Slivka, W Stroll, D Sullivan, E Tullock, W Benditt, J Wood, D Snyder, M Anable, K Battaglia, N Boitanao, L Bowdle, A Chan, L Chwalik, C Culver, B Godwin, D Golden, S Ibrahim, A Lockhart, D Marglin, S McDowell, P Nellum, K Van Norman, G Bosco, L Chiang, YP Clancy, C Handelsman, H Piantadosi, S Tonascia, J Belt, P Collins, K Collison, B Dawson, C Dawson, D Donithan, M Edmonds, V Harle, J Jackson, R Lee, S Levine, C Meinert, J Nowakowski, D Reshef, D Smith, M Simon, B Sternberg, A Van Natta, M Wise, R Kaplan, RM Chaing, YP Fahs, MC Fendrick, AM Moskowitz, AJ Pathak, D Ramsey, SD Richter, E Schwartz, JS Sheingold, S Shroyer, AL Wagner, J Yusen, R Waldhausen, J Bernard, G DeMets, D Hoover, E Levine, R Mahler, D McSweeney, AJ Wiener-Kronish, J Williams, OD Younes, M Sheingold, S McVearry, K Mone, C Proctor-Young, J Fishman, AP Weinmann, G Deshler, J Albert, P Hurd, S Kiley, J Wu, M CA Natl Emphysema Treatment Trial Res TI Rationale and design of the National Emphysema Treatment Trial - A prospective randomized trial of lung volume reduction surgery SO CHEST LA English DT Article DE emphysema; lung function; lung volume reduction surgery; maximum exercise capacity; median sternotomy; medical vs surgical treatment; pulmonary rehabilitation; randomized clinical trial; video-assisted thoracoscopic surgery ID OBSTRUCTIVE PULMONARY-DISEASE; QUESTIONNAIRE; METAANALYSIS; HEALTH; COPD AB The National Emphysema Treatment Trial is a multicenter, randomized clinical trial of medical therapy vs medical therapy plus lung volume reduction surgery (LVRS) for the treatment of patients with severe bilateral emphysema. LVRS will he accomplished by bilateral nl stapled excision via median sternotomy or video-assisted thoracoscopic surgery. Every patient will complete 6 to 10 weeks of pulmonary rehabilitation prior to randomization anti will participate in a maintenance program of pulmonary rehabilitation after randomization, The primary outcome to be assessed by the trial is survival. Additional outcomes to be assessed are maximum exercise capacity, pulmonary function, oxygen requirement, distance walked in 6 min, quality of life, respiratory symptoms, and health-care utilization and costs, In addition, selected clinics will evaluate lung mechanics and respiratory muscle function, partial and maximal flow-volume curves, gas exchange during maximal exercise, and right heart function, The trial is targeted to enroll patients with severe emphysema who have no significant comorbid conditions; each patient will be randomized to one of the two treatment groups. The study duration is 4.5 years with a close-out period of 6 months. C1 Baylor Coll Med, Ctr Clin, Houston, TX 77030 USA. Brigham & Womens Hosp, Ctr Clin, Boston, MA 02115 USA. Cedars Sinai Med Ctr, Ctr Clin, Los Angeles, CA 90048 USA. Cleveland Clin Fdn, Ctr Clin, Cleveland, OH 44195 USA. Columbia Univ, Ctr Clin, New York, NY USA. Duke Univ, Med Ctr, Ctr Clin, Durham, NC 27706 USA. Mayo Clin & Mayo Fdn, Ctr Clin, Rochester, MN 55905 USA. Natl Jewish Med & Res Ctr, Ctr Clin, Denver, CO USA. Ohio State Univ, Ctr Clin, Columbus, OH 43210 USA. St Louis Univ, Ctr Clin, St Louis, MO 63103 USA. Temple Univ, Ctr Clin, Philadelphia, PA 19122 USA. Univ Calif San Diego, Ctr Clin, San Diego, CA 92103 USA. Univ Maryland, Ctr Clin, Baltimore, MD 21201 USA. Univ Michigan, Ctr Clin, Ann Arbor, MI 48109 USA. Univ Penn, Ctr Clin, Philadelphia, PA 19104 USA. Univ Pittsburgh, Ctr Clin, Pittsburgh, PA 15260 USA. Univ Washington, Ctr Clin, Seattle, WA 98195 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Johns Hopkins Univ, Coordinating Ctr, Baltimore, MD 21218 USA. US Hlth Care Financing Adm, Baltimore, MD 21207 USA. Univ Penn, Off Chair Steering Comm, Philadelphia, PA 19104 USA. NHLBI, Project Off, Bethesda, MD 20892 USA. RP Espada, R (reprint author), Johns Hopkins Sch Hyg & Publ Hlth, Johns Hopkins Ctr Clin Trials, Natl Emphysema Treatement Trial Coordinat Ctr, Room 5010,615 N Wolfe St, Baltimore, MD 21205 USA. NR 40 TC 113 Z9 113 U1 1 U2 14 PU AMER COLL CHEST PHYSICIANS PI NORTHBROOK PA 3300 DUNDEE ROAD, NORTHBROOK, IL 60062-2348 USA SN 0012-3692 J9 CHEST JI Chest PD DEC PY 1999 VL 116 IS 6 BP 1750 EP 1761 PG 12 WC Critical Care Medicine; Respiratory System SC General & Internal Medicine; Respiratory System GA 266HC UT WOS:000084293700039 ER PT J AU Devers, KJ AF Devers, KJ TI How will we know "good" qualitative research when we see it? Beginning the dialogue in health services research SO HEALTH SERVICES RESEARCH LA English DT Article; Proceedings Paper CT Invitational Conference on Qualitative Methods in Health Services Research CY DEC 04, 1998 CL ROCKVILLE, MD SP Agcy Hlth Care Policy & Res, Robert Wood Johnson Fdn DE qualitative research and methods; mixed methods; standards; evaluation criteria ID QUANTITATIVE METHODS; CARE; MEDICINE; STRATEGIES AB Objective. To lay the foundation for an explicit review and dialogue concerning the criteria that should be used to evaluate qualitative health services research. Clear criteria are critical for the discipline because they provide a benchmark against which research can be assessed. Data Sources. Existing literature in the social sciences and health services research, particularly in primary care and medicine. Principal Findings. Traditional criteria for evaluating qualitative research are rooted in the philosophical perspective (positivism) most closely associated with quantitative research and methods. As a result, qualitative research and methods may not be used as frequently as they can be and research results generated from qualitative studies may not be disseminated as widely as possible. However, alternative criteria for evaluating qualitative research have been proposed that reflect a different philosophical perspective (post-positivism). Moreover, these criteria are tailored to the unique purposes for which qualitative research is used and the research designs traditionally employed. While criteria based on these two different philosophical perspectives have much in common, some important differences exist. Conclusion. The field of health services research must engage in a collective, "qualitative" process to determine which criteria to adopt (positivist or post-positivist), or whether some combination of the two is most appropriate. Greater clarity about the criteria used to evaluate qualitative research will strengthen the discipline by fostering a more appropriate and improved use of qualitative methods, a greater willingness to fund and publish "good" qualitative research, and the development of more informed consumers of qualitative research results. C1 Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. RP Devers, KJ (reprint author), Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, 2101 E Jefferson St,suite 605, Rockville, MD 20852 USA. NR 96 TC 126 Z9 128 U1 7 U2 23 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 1999 VL 34 IS 5 BP 1153 EP 1188 PN 2 PG 36 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 261NJ UT WOS:000084015000006 PM 10591278 ER PT J AU Selden, TM AF Selden, TM TI Premium subsidies for health insurance: excessive coverage vs. adverse selection SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE adverse selection ID WELFARE LOSS; MARKETS; INFORMATION; EQUILIBRIUM; ESSAY; CARE AB The tax subsidy for employment-related health insurance can lead to excessive coverage and excessive spending on medical care. Yet, the potential also exists for adverse selection to result in the opposite problem-insufficient coverage and underconsumption of medical care. This paper uses the model of Rothschild and Stiglitz (R-S) to show that a simple linear premium subsidy can correct market failure due to adverse selection. The optimal Linear subsidy balances welfare losses from excessive coverage against welfare gains from reduced adverse selection. Indeed, a capped premium subsidy may mitigate adverse selection without creating incentives for excessive coverage. Published by Elsevier Science B.V. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Selden, TM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. EM tselden@ahcpr.gov NR 28 TC 17 Z9 17 U1 0 U2 2 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD DEC PY 1999 VL 18 IS 6 BP 709 EP 725 DI 10.1016/S0167-6296(99)00031-4 PG 17 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 264BW UT WOS:000084161000002 PM 10847931 ER PT J AU Vargas, CM Manski, RJ AF Vargas, CM Manski, RJ TI Dental expenditures and source of payment by race/ethnicity and other sociodemographic characteristics SO JOURNAL OF PUBLIC HEALTH DENTISTRY LA English DT Article; Proceedings Paper CT Annual Meeting of the Hispanic-Dental-Association CY OCT, 1998 CL SAN FRANCISCO, CALIFORNIA SP Hispan Dent Assoc DE non-Hispanic blacks; dental expenditures; discretionary services; Hispanics; Medicaid; NMES; out-of-pocket; private dental insurance ID UNITED-STATES; PERMANENT DENTITION; CARIES; ACCESS; ADULTS; CARE AB Objective: This study presents race/ethnic-specific distributions of dental expenditures and their sources of payment by socioeconomic characteristics among US working-age adults. Methods: Data for persons aged 19-64 years from the 1987 National Medical Expenditure Survey (NMES) (n=18,696) were used to calculate mean dental expenditures and their 95 percent confidence intervals. Results: Dental expenditures were reported by 44.5 percent of participants. Non-Hispanic whites and persons with higher income were more likely to report dental expenditures than their counterparts. Among persons reporting expenditures, those with lower income had lower expenditures than higher-income persons. No differences in the amount of expenditures by race/ethnicity, sex, or employment status were observed. In all race/ethnic groups almost half the expenditures were paid out-of-pocket and one-third by dental insurance. Conclusion: While sociodemographic characteristics determined who had dental expenditures, they did not determine the amount or source of those expenditures. C1 Ctr Dis Control & Prevent, Natl Ctr Hlth Stat, Hyattsville, MD 20782 USA. Univ Maryland, College Pk, MD 20742 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Vargas, CM (reprint author), Ctr Dis Control & Prevent, Natl Ctr Hlth Stat, 6525 Belcrest Rd,Room 730, Hyattsville, MD 20782 USA. NR 26 TC 16 Z9 16 U1 0 U2 0 PU AAPHD NATIONAL OFFICE PI PORTLAND PA 3760 SW LYLE COURT, PORTLAND, OR 97221 USA SN 0022-4006 J9 J PUBLIC HEALTH DENT JI J. Public Health Dent. PD WIN PY 1999 VL 59 IS 1 BP 33 EP 38 DI 10.1111/j.1752-7325.1999.tb03232.x PG 6 WC Dentistry, Oral Surgery & Medicine; Public, Environmental & Occupational Health SC Dentistry, Oral Surgery & Medicine; Public, Environmental & Occupational Health GA 232CT UT WOS:000082348700005 PM 11396042 ER PT J AU Eisenberg, JM AF Eisenberg, JM TI Ten lessons for evidence-based technology assessment SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID LAPAROSCOPIC CHOLECYSTECTOMY; HEALTH-CARE; OUTCOMES; QUALITY C1 US Dept HHS, Agcy Hlth Care Policy & Res, Off Hlth Care Informat, Rockville, MD 20852 USA. RP Eisenberg, JM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Off Hlth Care Informat, 2101 E Jefferson St,Suite 501, Rockville, MD 20852 USA. NR 17 TC 57 Z9 61 U1 2 U2 2 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD NOV 17 PY 1999 VL 282 IS 19 BP 1865 EP 1869 DI 10.1001/jama.282.19.1865 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA 254MD UT WOS:000083615700031 PM 10573279 ER PT J AU Kindig, DA Dunham, NC Eisenberg, JM AF Kindig, DA Dunham, NC Eisenberg, JM TI Needs and challenges for health services research at academic health centers SO ACADEMIC MEDICINE LA English DT Article ID MEDICAL-CENTERS AB What are the institutional strategies used by academic health centres and other academic institutions to support and maintain the infrastructure that promises health services research? Using the findings from interviews conducted in late 1998 with health services researchers at ten health service research centres of several types and from several geographic areas, and with the directors of ten health service research centres, the authors address this key issue by examining four central infrastructure needs and challenges for health service research: (1) organizing core institutional resources (most centres received some level of core financial support from their parent organizations); (2) supporting career development of individual researchers (the more competitive health care system may diminish the ability of academic health centres and other institutions to give such support, but certain opportunities were noted); (3) supporting and enhancing training in health services research (such support comes from many different disciplines and organisations; the typical career path is in academic settings); and (4) establishing and supporting research partnerships (there are growing opportunities for such alliances). The authors reach a number of conclusions from their study, including the fact that there are a wide variety of models of successful health services research centers, with very different missions, organisational and interdisciplinary configurations, research and policy objectives, and collaborative relationships. Additional studies are needed to further specify those infrastructure elements that foster effective and productive health services research in academic health centers and other university settings. C1 Univ Wisconsin, Sch Med, Dept Prevent Med, Madison, WI 53705 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Kindig, DA (reprint author), Univ Wisconsin, Sch Med, Dept Prevent Med, 610 N Walnut St, Madison, WI 53705 USA. NR 6 TC 10 Z9 10 U1 0 U2 0 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1040-2446 J9 ACAD MED JI Acad. Med. PD NOV PY 1999 VL 74 IS 11 BP 1193 EP 1201 DI 10.1097/00001888-199911000-00011 PG 9 WC Education, Scientific Disciplines; Health Care Sciences & Services SC Education & Educational Research; Health Care Sciences & Services GA 256UE UT WOS:000083744100013 PM 10587680 ER PT J AU Fraser, I McNamara, P Lehman, GO Isaacson, S Moler, K AF Fraser, I McNamara, P Lehman, GO Isaacson, S Moler, K TI The pursuit of quality by business coalitions: A national survey SO HEALTH AFFAIRS LA English DT Article AB The extent to which business coalitions and their employer members are catalysts for improving quality of care is of interest to policymakers, who need to know where and under what circumstances the marketplace succeeds on its own in assuring quality, Using data from the 1998 National Business Coalition on Health annual survey, this paper indicates that. most coalitions have an infrastructure in place that could be tapped to advance quality goals. Although the survey data cannot tell us the extent to which coalitions are exercising their enhanced market influence specifically to improve quality, interviews with coalition leaders provide insights about how quality considerations can factor into coalition strategies. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. Natl Business Coalit Hlth, Washington, DC USA. US Dept HHS, Agcy Hlth Care Policy & Res, User Liaison Program, Off Hlth Care Informat, Rockville, MD 20852 USA. RP Fraser, I (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. NR 11 TC 6 Z9 6 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD NOV-DEC PY 1999 VL 18 IS 6 BP 158 EP 165 DI 10.1377/hlthaff.18.6.158 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 255UD UT WOS:000083687800015 PM 10650698 ER PT J AU Elixhauser, A Leidy, NK Meador, K Means, E Willian, MK AF Elixhauser, A Leidy, NK Meador, K Means, E Willian, MK TI The relationship between memory performance, perceived cognitive function, and mood in patients with epilepsy SO EPILEPSY RESEARCH LA English DT Article DE epilepsy; memory impairment; quality of life ID QUALITY-OF-LIFE; EVERYDAY MEMORY; COMPLAINTS; STROKE AB Objective: The low correlations between memory performance and subjective memory may be attributable to disparities between tasks in neuropsychological tests and cognitive experiences of day-to-day living. This study evaluated the relationship between everyday memory performance, perceived cognitive functioning, and mood among patients with epilepsy. Methods: From three epilepsy centers in the USA, 138 patients were recruited. Everyday memory performance was measured using the Rivermead Behavioural Memory Test (RBMT). Questionnaires assessed perceived cognitive function (cognitive domain, Quality of Life in Epilepsy Inventory, QOLIE-89) and mood (Profile of Mood States, POMS). Results: Memory performance scores were weakly correlated with perceived cognitive functioning (r = 0.22, P < 0.01). Perceived cognitive functioning was strongly correlated with mood (r = -0.75, P < 0.0001). Multiple regression analysis indicated memory performance (RBMT) and mood (POMS) were independent predictors of perceived cognitive functioning (P < 0.02); however, the explained variance for RBMT and POMS combined (R-2 = 0.58) is only slightly higher than the predictive value for the POMS score alone (R-2 = 0.56). Conclusions: Memory performance tests provide qualitatively different information than patients' self-reported cognitive difficulties, thus it is important to assess memory performance, perceived cognitive function, and mood separately because the constructs are related but not redundant. (C) 1999 Elsevier Science B.V. All rights reserved. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Med Coll Georgia, Dept Neurol, Augusta, GA 30912 USA. Janssen Pharmaceut, Titusville, NJ 08560 USA. RP Elixhauser, A (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, 2101 E Jefferson St,Suite 605, Rockville, MD 20852 USA. NR 31 TC 89 Z9 93 U1 1 U2 5 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0920-1211 J9 EPILEPSY RES JI Epilepsy Res. PD OCT PY 1999 VL 37 IS 1 BP 13 EP 24 DI 10.1016/S0920-1211(99)00036-4 PG 12 WC Clinical Neurology SC Neurosciences & Neurology GA 240VY UT WOS:000082848800003 PM 10515171 ER PT J AU Clancy, CM AF Clancy, CM TI Consumer preferences: Path to improvement? SO HEALTH SERVICES RESEARCH LA English DT Editorial Material ID HEALTH C1 Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness, Rocky River, OH USA. RP Clancy, CM (reprint author), Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness, Rocky River, OH USA. NR 6 TC 2 Z9 2 U1 0 U2 0 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD OCT PY 1999 VL 34 IS 4 BP 807 EP 811 PG 5 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 246TW UT WOS:000083181500001 PM 10536971 ER PT J AU Encinosa, WE Sappington, DEM AF Encinosa, WE Sappington, DEM TI Adjusted community rate reforms to promote HMO participation in Medicare plus Choice SO HEALTH CARE FINANCING REVIEW LA English DT Article AB The authors review the financial regulations imposed on health maintenance organizations (HMOs) that participate in the Medicare+Choice program and identify elements of the regulations that may discourage HMO participation in the program. Modifications of the regulations are proposed that could encourage the participation of HMOs without affording them excessive profit. The modifications include smoothing and bounding profit estimates and authorizing and encouraging expanded use of benefit stabilization funds. C1 Univ Florida, Dept Econ, Gainesville, FL 32611 USA. Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Sappington, DEM (reprint author), Univ Florida, Dept Econ, 224 Matherly Hall, Gainesville, FL 32611 USA. NR 17 TC 2 Z9 2 U1 0 U2 0 PU HEALTH CARE FINANCING REVIEW PI BALTIMORE PA 7500 SECURITY BLVD, C-3-11-07, BALTIMORE, MD 21224-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 1999 VL 21 IS 1 BP 19 EP 29 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 400MD UT WOS:000166874700002 PM 11481733 ER PT J AU Monheit, AC Vistnes, JP AF Monheit, AC Vistnes, JP TI Health insurance availability at the workplace - How important are worker preferences? SO JOURNAL OF HUMAN RESOURCES LA English DT Article ID MANDATED BENEFITS; MARKET; PREMIUMS; DEMAND AB Analysts have frequently interpreted the uneven distribution Of health insurance across firms of caving size as evidence of insurance market failure in the small group market. We explore an additional explanation by considering the relationship between employee preferences for health insurance and its availability at the workplace. We apply a simple model of job choice to data front the 1987 National Medical Expenditure Survey to examine whether,workers with weak preferences for health insurance sort themselves into jobs without coverage. Our results for a sample of single workers are consistent with such sorting behavior. C1 Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD USA. NR 38 TC 30 Z9 30 U1 0 U2 2 PU UNIV WISCONSIN PRESS PI MADISON PA JOURNAL DIVISION, 2537 DANIELS ST, MADISON, WI 53718 USA SN 0022-166X J9 J HUM RESOUR JI J. Hum. Resour. PD FAL PY 1999 VL 34 IS 4 BP 770 EP 785 DI 10.2307/146416 PG 16 WC Economics; Industrial Relations & Labor SC Business & Economics GA 263RK UT WOS:000084138900006 ER PT J AU Cook, LJ AF Cook, LJ TI The implications of protocol-based care on dental services in the military SO MILITARY MEDICINE LA English DT Article ID PERIODIC HEALTH EXAMINATION; PRACTICE PARAMETERS; PREVENTION; DENTISTRY; UPDATE AB Downsizing, limited resources, and increasing costs provide challenges to the military health system. Variations in the diagnosis and treatment of dental disease add to the demands on the delivery system to provide access and ensure quality for uniformed personnel. Evidence-based dentistry is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. An evidence-based practice combines individual clinical expertise with the best external evidence available from systematic review of research findings. It provides a scientific basis for patient care, planning and implementation of health services, and development of health policy. Practice guidelines formulated on scientific evidence can reduce variations in the diagnosis and treatment of various dental conditions. A risk assessment protocol for treating dental caries can reduce operative dental treatment recommended at the initial examination and decrease the need for restorative care during a. military career. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Cook, LJ (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, 6000 Execut Blvd,Suite 309, Rockville, MD 20852 USA. NR 30 TC 0 Z9 0 U1 0 U2 0 PU ASSN MILITARY SURG US PI BETHESDA PA 9320 OLD GEORGETOWN RD, BETHESDA, MD 20814 USA SN 0026-4075 J9 MIL MED JI Milit. Med. PD AUG PY 1999 VL 164 IS 8 BP 556 EP 561 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 226RM UT WOS:000082035300008 PM 10459264 ER PT J AU Doucette, WR Brooks, JM Sorofman, BA Wong, H AF Doucette, WR Brooks, JM Sorofman, BA Wong, H TI Market factors and the availability of community pharmacies SO CLINICAL THERAPEUTICS LA English DT Article DE pharmacy services; availability; rural health care; access; elderly AB The purpose of this study was to examine the relationships between the availability of community pharmacies and 4 types of market factors. A composite data set was created that linked, at the county level, data on: (1) type and number of pharmacies; (2) population characteristics; (3) payer variables; (4) health care system factors; and (5) competitive factors. In this exploratory study, secondary data were used to assess the association between the availability of community pharmacies and the influence of market factors. To assess the market in fluences on availability of community pharmacies, 2 regressions were performed. In 1 model, the number of community pharmacies per 10,000 population was the dependent variable, whereas the dependent variable in the other regression was the proportion of independently owned community pharmacies. The independent variables in each regression were the market factors-population characteristics, payer variables, health care system factors, and competitive variables. Squared terms were included for 8 of 15 market factors to account for nonlinearities in the relationships. Multiple market factors were correlated with both the number of community pharmacies and the proportion of independently owned pharmacies in an area. Several of the relationships were not linear and changed direction within the range of data. Counties with either a low or a high percentage of elderly people had fewer pharmacies and a lower proportion of independently owned pharmacies compared with counties with a moderate percentage of elderly people. Counties that were scarcely or highly rural had fewer community pharmacies but a higher proportion of independently owned pharmacies than counties that were moderately rural. Areas with a greater percentage of the population earning less than the poverty level had more pharmacies, especially independently owned ones. Fewer community pharmacies were found in areas with higher health maintenance organization penetration rates. The number of hospital admissions was positively associated with the number of pharmacies but negatively associated with the proportion of independently owned pharmacies. The availability of community pharmacies varies across the country. In light of the trend toward fewer independently owned pharmacies, potential problems in accessing pharmacy services could develop in certain areas, including those that are highly rural and those with a high percentage of people earning less than the poverty level. Future research and policy issues are identified. C1 Univ Iowa, Coll Pharm, Iowa City, IA 52242 USA. Agcy Hlth Care Policy & Res, Rockville, MD USA. RP Doucette, WR (reprint author), Univ Iowa, Coll Pharm, Iowa City, IA 52242 USA. NR 25 TC 12 Z9 12 U1 0 U2 4 PU EXCERPTA MEDICA INC PI NEW YORK PA 245 WEST 17TH STREET, NEW YORK, NY 10011 USA SN 0149-2918 J9 CLIN THER JI Clin. Ther. PD JUL PY 1999 VL 21 IS 7 BP 1267 EP 1279 DI 10.1016/S0149-2918(00)80029-6 PG 13 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 224ZR UT WOS:000081930600014 PM 10463523 ER PT J AU Shapiro, MF Morton, SC McCaffrey, DF Senterfitt, JW Fleishman, JA Perlman, JF Athey, LA Keesey, JW Goldman, DP Berry, SH Bozzette, SA AF Shapiro, MF Morton, SC McCaffrey, DF Senterfitt, JW Fleishman, JA Perlman, JF Athey, LA Keesey, JW Goldman, DP Berry, SH Bozzette, SA CA HCSUS Consortium TI Variations in the care of HIV-infected adults in the United States - Results from the HIV Cost and Services Utilization Study SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID ANTIRETROVIRAL THERAPY; MANAGED CARE; DRUG-USE; DISEASE; GROWTH; RECOMMENDATIONS; LESSONS; PANEL; RACE AB Context Studies of selected populations suggest that not all persons infected with human immunodeficiency virus (HIV) receive adequate care. Objective To examine variations in the care received by a national sample representative of the adult US population infected with HIV. Design Cohort study that consisted of 3 interviews from January 1996 to January 1998 conducted by the HIV Cost and Services Utilization Consortium. Patients and Setting Multistage probability sample of 2864 respondents (68% of those targeted for sampling), who represent the 231 400 persons at least 18 years old, with known HIV infection receiving medical care in the 48 contiguous United States in early 1996 in facilities other than emergency departments, the military, or prisons. The first follow-up consisted of 2466 respondents and the second had 2267 (65% of all surviving sampled subjects). Main Outcome Measures Service utilization (<2 ambulatory visits, at least 1 emergency department visit that did not lead to hospitalization, at least 1 hospitalization) and medication utilization (receipt of antiretroviral therapy and prophylaxis against Pneumocystis carinii pneumonia), Results Inadequate HIV care was commonly reported at the time of interviews conducted from early 1996 to early 1997 but declined to varying degrees by late 1997, Twenty-three percent of patients initially and 15% of patients subsequently had emergency department visits that did not lead to hospitalization, 30% initially and 26% subsequently of those who had CD4 cell counts below 0.20 x 10(9)/L did not receive P carinii pneumonia prophylaxis, and 41% initially and 15% subsequently of those who had CD4 cell counts below 0.50 x 10(9)/L did not receive antiretroviral therapy (protease inhibitor or nonnucleoside reverse transcriptase inhibitor). Inferior patterns of care were seen far many of these measures in blacks and Latinos compared with whites, the uninsured and Medicaid-insured compared with the privately insured, women compared with men, and other risk and/or exposure groups compared with men who had sex with men even after CD4 cell count adjustment. With multivariate adjustment, many differences remained statistically significant. Even by early 1998, fewer blacks, women, and uninsured and Medicaid-insured persons had started taking antiretroviral medication (CD4 cell count adjusted P Values <.001 to <.005). Conclusions Access to care improved from 1996 to 1998 but remained suboptimal. Blacks, Latinos, women, the uninsured, and Medicaid-insured all had less desirable patterns of care. Strategies to ensure optimal care for patients with HIV requires identifying the causes of deficiency and addressing these important shortcomings in care. C1 Rand Corp, HCSUS Off, Hlth Program, Santa Monica, CA 90407 USA. Rand Corp, Survey Res Grp, Santa Monica, CA 90407 USA. Univ Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res, Los Angeles, CA 90024 USA. Cty Los Angeles, AIDS Off, Los Angeles, CA USA. Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. Univ Chicago, Natl Opin Res Ctr, Survey Operat Ctr, Chicago, IL 60637 USA. Univ Calif San Diego, Sch Med, Dept Med, La Jolla, CA 92093 USA. Vet Affairs San Diego Healthcare Syst, Hlth Serv Res & Dev Unit, San Diego, CA USA. RP Shapiro, MF (reprint author), Rand Corp, HCSUS Off, Hlth Program, 1700 Main St, Santa Monica, CA 90407 USA. NR 24 TC 562 Z9 567 U1 2 U2 9 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 30 PY 1999 VL 281 IS 24 BP 2305 EP 2315 DI 10.1001/jama.281.24.2305 PG 11 WC Medicine, General & Internal SC General & Internal Medicine GA 207FN UT WOS:000080925600030 PM 10386555 ER PT J AU Bierman, AS Steiner, C Friedman, B Fillmore, CM Clancy, C AF Bierman, AS Steiner, C Friedman, B Fillmore, CM Clancy, C TI Epidemiology of preventable hospitalizations in the United States: Measuring socioeconomic inequalities in health, access, and quality. SO AMERICAN JOURNAL OF EPIDEMIOLOGY LA English DT Meeting Abstract C1 Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU JOHNS HOPKINS UNIV SCHOOL HYGIENE PUB HEALTH PI BALTIMORE PA 111 MARKET PLACE, STE 840, BALTIMORE, MD 21202-6709 USA SN 0002-9262 J9 AM J EPIDEMIOL JI Am. J. Epidemiol. PD JUN 1 PY 1999 VL 149 IS 11 SU S MA 177 BP S45 EP S45 PG 1 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 200EK UT WOS:000080526500177 ER PT J AU Simpson, L Osborne, J Eisenberg, JM AF Simpson, L Osborne, J Eisenberg, JM TI Planning and accountability at AHCPR: Applying the quality message at home SO HEALTH SERVICES RESEARCH LA English DT Article C1 US Dept HHS, Agcy Hlth Care Policy & Res, Washington, DC 20201 USA. RP Simpson, L (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Washington, DC 20201 USA. NR 1 TC 5 Z9 5 U1 0 U2 0 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD JUN PY 1999 VL 34 IS 2 BP 461 EP 483 PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 198ZZ UT WOS:000080455900001 PM 10357285 ER PT J AU Zuvekas, SH AF Zuvekas, SH TI Health insurance, health reform, and outpatient mental health treatment: Who benefits? SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID UNITED-STATES; ADDICTIVE-DISORDERS; MANAGED CARE; SERVICES; COVERAGE; DEMAND; INSTRUMENTS; PROBABILITY; PREVALENCE; REGRESSION AB This research examines how extending health insurance coverage to the previously uninsured impacts outpatient mental health treatment use among adults with different needs. Using data from the Epidemiologic Catchment Area Study and the 1987 National Medical Expenditure Survey, I develop simulations based on estimates of treatment demand. I find that insurance substantially increases demand by the mentally ill, but increased coverage alone cannot meet their treatment needs. Those in better mental health account for significant proportions of additional demand when coverage is expanded. Policies intended to increase access to mental health treatment among targeted groups should carefully consider the costs of increased use by other people. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Zuvekas, SH (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 38 TC 10 Z9 10 U1 1 U2 3 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SUM PY 1999 VL 36 IS 2 BP 127 EP 146 PG 20 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 227XF UT WOS:000082104700003 PM 10459369 ER PT J AU Pezzin, LE Schone, BS AF Pezzin, LE Schone, BS TI Intergenerational household formation, female labor supply and informal caregiving - A bargaining approach SO JOURNAL OF HUMAN RESOURCES LA English DT Article ID COLLECTIVE MODELS; ELDERLY PARENTS; ADULT CHILDREN; FAMILY; CARE; DECISIONS; MARRIAGE; ALLOCATION; TRANSFERS; BEHAVIOR AB Children's provision of in-kind services to their elderly parents (informal caregiving) represents an important form of economic transfers to the elderly. In this paper we develop and estimate a joint model of informal caregiving and labor force participation decisions of adult daughters who have a frail elderly parent in a broader framework of intergenerational household formation. Parent and daughter agree to a Nash bargaining rule as the solution to the household formation and intrahousehold decision making process. However; rather than severed relationships, the threat point is given by a noncooperative equilibrium defined in terms of voluntary contributions toward a public good the parental "well-being.'' Maximum likelihood parameter estimates derived front the simultaneous, multiequation, endogenous switching model are generally consistent with expectations. Our results indicate that competing demands on daughters' time reduce both coresidence and informal caregiving. We also find that intergenerational coresidence is an important mode of assistance to elderly per sons. A simulation bused on the estimated parameters suggests that public programs designed to meet the long-term care needs of elderly persons by subsiding formal horne care services may have substantial effects on intergenerational living and care arrangement decisions. C1 Johns Hopkins Univ, Sch Med, Baltimore, MD 21218 USA. Agcy Hlth Care Policy & Res, Rockville, MD 20854 USA. RP Pezzin, LE (reprint author), Johns Hopkins Univ, Sch Med, Baltimore, MD 21218 USA. NR 46 TC 83 Z9 83 U1 3 U2 14 PU UNIV WISCONSIN PRESS PI MADISON PA JOURNAL DIVISION, 1930 MONROE ST, 3RD FL, MADISON, WI 53711 USA SN 0022-166X J9 J HUM RESOUR JI J. Hum. Resour. PD SUM PY 1999 VL 34 IS 3 BP 475 EP 503 DI 10.2307/146377 PG 29 WC Economics; Industrial Relations & Labor SC Business & Economics GA 230VR UT WOS:000082272800003 ER PT J AU Manski, RJ Moeller, JF Maas, WR AF Manski, RJ Moeller, JF Maas, WR TI A comparison of dental care expenditures and office-based medical care expenditures, 1987 SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article AB Background. This article compares national estimates of utilization of and expenditures for dental care and office-based medical care. The comparison includes respondents in several socioeconomic and demographic categories. Methods. The focus of the analyses is on dental care and office-based medical care utilization during 1987. Specifically, the authors provide national estimates for numbers of dental and office-based medical visits made, expenditures for and sources of payment for each of several socioeconomic and demographic categories using household survey data from the 1987 National Medical Expenditure Survey, or NMES. Results. Data show that out-of-pocket expenditures are greater for dental care than for office-based medical care; that few Medicaid dollars are spent on dental care; that insurance is an important component of dental and office-based medical care;and that dentists provide greater amounts of unreimbursed care than do their office-based physician counterparts. Conclusions. NMES data show that dental care expenditures are considerable, almost as large as expenditures for office-based medical care, and are a significant component of all nonhospital health care expenditures for noninstitutionalized Americans. Practice Implications. U.S. dentists provide a significant amount of care. By understanding these analyses, practitioners will be better positioned to provide care and to better meet the dental needs of all Americans. C1 Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, Baltimore, MD 21201 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Manski, RJ (reprint author), Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, 666 W Baltimore St, Baltimore, MD 21201 USA. NR 16 TC 4 Z9 4 U1 0 U2 0 PU AMER DENTAL ASSN PI CHICAGO PA 211 E CHICAGO AVE, CHICAGO, IL 60611 USA SN 0002-8177 J9 J AM DENT ASSOC JI J. Am. Dent. Assoc. PD MAY PY 1999 VL 130 IS 5 BP 659 EP 666 PG 8 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 194PX UT WOS:000080203700015 PM 10332130 ER PT J AU Heil, MT Selden, TM AF Heil, MT Selden, TM TI Panel stationarity with structural breaks: carbon emissions and GDP SO APPLIED ECONOMICS LETTERS LA English DT Article ID UNIT-ROOT HYPOTHESIS AB This paper uses panel data methods to test for unit roots in data series for carbon dioxide emissions and gross domestic product. By allowing for a structural break in 1973, we reject the unit root hypothesis for both series. C1 American Univ, Dept Econ, Washington, DC 20016 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Selden, TM (reprint author), American Univ, Dept Econ, Washington, DC 20016 USA. NR 13 TC 34 Z9 34 U1 1 U2 3 PU ROUTLEDGE PI LONDON PA 11 NEW FETTER LANE, LONDON EC4P 4EE, ENGLAND SN 1350-4851 J9 APPL ECON LETT JI Appl. Econ. Lett. PD APR PY 1999 VL 6 IS 4 BP 223 EP 225 PG 3 WC Economics SC Business & Economics GA 198WK UT WOS:000080447100005 ER PT J AU Zuvekas, SH Weinick, RM AF Zuvekas, SH Weinick, RM TI Changes in access to care, 1977-1996: The role of health insurance SO HEALTH SERVICES RESEARCH LA English DT Article DE access to care; usual source of care; health insurance; Hispanic Americans; young adults AB Objective. To describe changes in Americans' access to care over the last 20 years focusing on the uninsured, Hispanic American, and young adult populations, and to analyze the factors underlying these changes with a particular focus on the role of health insurance. Data Sources/Study Setting. Data from the 1977 National Medical Care Expenditure Survey, the 1987 National Medical Expenditure Survey, and the 1996 Medical Expenditure Panel Survey. Study Design. Focusing on whether each individual has a usual source of health care, we present descriptive statistics and algebraic decompositions. Data Collection/Extraction Methods. We combine data from the household surveys with questions from access to care supplements that were administered each time. Principal Findings. Hispanic Americans and young adults age 18-24 are more likely to lack a usual source of care than other Americans; these inequalities increased over the period studied and cannot be explained solely by changes in health insurance coverage. Conclusions. Although increasing health insurance coverage will likely improve access to care among Hispanics and young adults, our findings suggest that the expansion of insurance coverage will not be sufficient to eliminate current disparities in access to care. C1 Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Zuvekas, SH (reprint author), Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 6 TC 70 Z9 70 U1 0 U2 1 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 1999 VL 34 IS 1 BP 271 EP 279 PN 2 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 180CY UT WOS:000079368800007 PM 10199674 ER PT J AU Zabinski, D Selden, TM Moeller, JF Banthin, JS AF Zabinski, D Selden, TM Moeller, JF Banthin, JS TI Medical savings accounts: microsimulation results from a model with adverse selection SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE insurance; adverse selection; medical savings accounts ID HEALTH-INSURANCE; MARKETS AB This paper examines medical savings accounts combined with high-deductible catastrophic health plans (MSA/CHPs), exploring the possible consequences of making tax preferred MSA/CHPs available to the entire employment-related health insurance market. The paper uses microsimulation methods to examine the equilibrium effects of MSA/CHPs on health care and non-health care expenditures, tax revenues, insurance premiums, and exposure to risk. if MSA/CHPs are offered alongside comprehensive plans, biased MSA/CHP enrollment can lead to premium spirals that drive out comprehensive coverage. Our estimates also raise concerns about equity, insofar as those who stand to lose the most tend to be poorer and in families with infant children. Published by Elsevier Science B.V. JEL classification: I11; H20; D80. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Zabinski, D (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. EM dzabinsk@ahcpr.gov NR 30 TC 24 Z9 24 U1 1 U2 4 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD APR PY 1999 VL 18 IS 2 BP 195 EP 218 DI 10.1016/S0167-6296(98)00038-1 PG 24 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 162RA UT WOS:000078359500004 PM 10346353 ER PT J AU Manski, RJ Moeller, JF Maas, WR AF Manski, RJ Moeller, JF Maas, WR TI Dental services: Use, expenditures and sources of payment, 1987 SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article AB Background This article pro rides per capita estimates of dental care utilization, expenditures mix of services and sources of payment for each of several socioeconomic and demographic categories. Methods. The focus of the analyses presented here is on dental cafe utilization by the U.S, population during 1987. Specifically, national estimates are provided for dental visits, expenditures, sources of payment and procedure type for each of several socioeconomic and demographic categories using household data from the 1987 National Medical Expenditure Survey, or NMES. Results. During 1987, less that 50 percent of Americans visited a dental office. Americans made approximately 292 million dental visits and received approximately $30 billion worth of dental care, of which $10 billion was paid by insurers, $17 billion was paid out of pocket and $1.6 billion was not reimbursed. Conclusions. These analyses establish the magnitude of the dental care market and the amounts paid by individual patients, private insurance companies and Medicaid. They also reveal that the type of care received varies among people in distinct socioeconomic and demographic groups. Practice Implications. Although the dental care market is substantial, many Americans do not visit a dentist. By understanding these analyses. practitioners will be better positioned to meet the dental needs of all Americans. C1 Univ Maryland, Sch Dent, Dept Oral Hlth Care Delivery, Baltimore, MD 21201 USA. RP Manski, RJ (reprint author), Agcy Hlth Care Policy & Res, Ctr Costs & Financing Studies, Rockville, MD 20854 USA. NR 17 TC 27 Z9 27 U1 1 U2 1 PU AMER DENTAL ASSN PI CHICAGO PA 211 E CHICAGO AVE, CHICAGO, IL 60611 USA SN 0002-8177 J9 J AM DENT ASSOC JI J. Am. Dent. Assoc. PD APR PY 1999 VL 130 IS 4 BP 500 EP 508 PG 9 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 183TX UT WOS:000079570500024 PM 10203900 ER PT J AU Fiscella, K Franks, P Clancy, CM Doescher, MP Banthin, JS AF Fiscella, K Franks, P Clancy, CM Doescher, MP Banthin, JS TI Does skepticism towards medical care predict mortality? SO MEDICAL CARE LA English DT Article DE attitude to health; mortality; cohort study ID NATIONAL-DEATH-INDEX; HEALTH PRACTICES; MYOCARDIAL-INFARCTION; TREATMENT ADHERENCE; RISK; OUTCOMES; INSURANCE; TRIAL; LIFE AB OBJECTIVES. Attitudes towards medical care have a strong effect on utilization and outcomes. However, there has been little attention to the impact on outcomes of doubts about the value of medical care. This study examines the impact of skepticism toward medical care on mortality using data from the 1987 National Medical Expenditure Survey (NMES). METHODS. A nationally representative sample from the United States comprising 18,240 persons (greater than or equal to 25 years) were surveyed. Skepticism was measured through an 8-item scale. Mortality at 5-year follow-up was ascertained through the National Death Index. RESULTS. In a proportional hazards survival analysis of 5-year mortality that controlled for age, sex, race, education, income, marital status, morbidity, and health status, skepticism toward medical care independently predicted subsequent mortality. That risk was attenuated after adjustment for health behaviors but not after adjustment for health insurance status. CONCLUSION. Medical skepticism may be a risk factor for early death. That effect may be mediated through higher rates of unhealthy behavior among the medically skeptical. Further studies using more reliable measures are needed. C1 Univ Rochester, Sch Med, Primary Care Inst, Rochester, NY USA. Univ Rochester, Sch Med, Dept Family Med, Rochester, NY USA. US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Primary Care Res, Rockville, MD 20852 USA. Univ Washington, Dept Family Med, Seattle, WA 98195 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing, Rockville, MD 20852 USA. RP Fiscella, K (reprint author), Family Med Ctr, 885 South Ave, Rochester, NY 14620 USA. EM kfiscella@highland.rochester.edu FU AHRQ HHS [R03 HS09522-01] NR 33 TC 29 Z9 29 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD APR PY 1999 VL 37 IS 4 BP 409 EP 414 DI 10.1097/00005650-199904000-00010 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 186KC UT WOS:000079727400010 PM 10213021 ER PT J AU Selden, TM Banthin, JS Cohen, JW AF Selden, TM Banthin, JS Cohen, JW TI Waiting in the wings: Eligibility and enrollment in the state children's health insurance program SO HEALTH AFFAIRS LA English DT Article C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Selden, TM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. NR 25 TC 38 Z9 38 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 1999 VL 18 IS 2 BP 126 EP 133 DI 10.1377/hlthaff.18.2.126 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 175FT UT WOS:000079083300014 PM 10091439 ER PT J AU Elixhauser, A Halpern, MT AF Elixhauser, A Halpern, MT TI Economic evaluations of gastric and pancreatic cancer SO HEPATO-GASTROENTEROLOGY LA English DT Article DE gastric cancer; stomach neoplasm; pancreatic cancer or neoplasm; cost-effectiveness analysis; cost-benefit analysis; cost of illness ID COST-BENEFIT; FOLLOW-UP; RESECTION; CHEMOTHERAPY AB The total cost of cancer care in the US is about $146 billion, of which pancreatic cancer comprises $2.6 billion (1.8% of the total) and gastric cancer comprises $1.8 billion (1.3%). We have reviewed published studies presenting economic analysis of treatment or follow-up for patients with pancreatic or gastric cancer. Relatively few studies report on economic evaluations of pancreatic cancer care. There are also few economic studies for gastric cancer, although we identified three cost-effectiveness analyses. In general, economic analyses in these areas are relatively unsophisticated relying on charge data or simple multipliers (e.g, average cost per day in the hospital multiplied by days in the hospital), and are often limited to in-hospital costs (particularly studies for pancreatic cancer). A wide range of costs is included in these studies and a variety of methodologies for assigning costs are used, making comparisons between studies difficult. Future health economics research in this area should evaluate the costs and effectiveness of alternative practice patterns for gastric and pancreatic cancer; conduct additional cost-effectiveness analyses of chemotherapeutic interventions; consider quality of life, survival, stage at diagnosis, patient-borne costs, and complications of therapy; and, take advantage of administrative data from large populations. C1 MEDTAP Int, Bethesda, MD 20814 USA. Ctr Org & Delivery Studies, Agcy Hlth Care Policy & Res, Rockville, MD USA. RP Halpern, MT (reprint author), MEDTAP Int, 7101 Wisconsin Ave,Suite 600, Bethesda, MD 20814 USA. NR 20 TC 16 Z9 16 U1 1 U2 1 PU H G E UPDATE MEDICAL PUBL LTD. PI ATHENS PA PO BOX 17160, ATHENS GR-10024, GREECE SN 0172-6390 J9 HEPATO-GASTROENTEROL JI Hepato-Gastroenterol. PD MAR-APR PY 1999 VL 46 IS 26 BP 1206 EP 1213 PG 8 WC Gastroenterology & Hepatology; Surgery SC Gastroenterology & Hepatology; Surgery GA 197HY UT WOS:000080360400107 PM 10370693 ER PT J AU Monheit, AC Schone, BS Taylor, AK AF Monheit, AC Schone, BS Taylor, AK TI Health insurance choices in two-worker households: Determinants of double coverage SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID MOBILITY AB Understanding how households make health insurance choices is of critical importance in evaluating issues of equity and efficiency in health care markets. We consider a largely neglected aspect of such decision making: the decision of families with two working spouses to obtain double coverage. Using data from the 1987 National Medical Expenditure Survey, we find that household decisions to obtain double coverage are especially sensitive to a couple's out-of-pocket premium costs. Our analysis also reveals that households with double coverage have more generous insurance, as reflected in their higher coverage rates for specific types of benefits. We also demonstrate that the presence of duplicate health benefits in double-covered households is not random, possibly reflecting a systematic attempt by working spouses to obtain more extensive coverage. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Monheit, AC (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 22 TC 11 Z9 11 U1 0 U2 0 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SPR PY 1999 VL 36 IS 1 BP 12 EP 29 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 195VK UT WOS:000080272700004 PM 10335308 ER PT J AU Friedman, B Steiner, C AF Friedman, B Steiner, C TI Does managed care affect the supply and use of ICU services? SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID INTENSIVE-CARE; UNITED-STATES; MEDICARE; DISEASE; COSTS AB This paper analyzes use of hospital intensive care units (ICUs) by adult patients who are under age 65 and not covered by Medicaid; it allows for variation in indicators of the patient's condition, severity of illness, type of admission, emergency status, and degree of constraint on the total hospital ICU supply. We use data for Massachusetts and Florida in 1992. In neither state is there a significant difference in ICU admission rates between managed care patients and other privately insured patients. In Massachusetts, we find that the length of stay in the ICU is somewhat less for managed care and uninsured patients than for other privately insured patients. In both states, a hospital's ratio of total annual supply of ICU services to expected demand has a strong effect. In Massachusetts, the differences across payer groups in length of stay disappear for hospitals where the total ICU supply is relatively constrained. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. RP Friedman, B (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, 2101 E Jefferson St,Suite 605, Rockville, MD 20852 USA. NR 24 TC 10 Z9 10 U1 0 U2 0 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SPR PY 1999 VL 36 IS 1 BP 68 EP 77 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 195VK UT WOS:000080272700008 PM 10335312 ER PT J AU Ray, NF Baraniuk, JN Thamer, M Rinehart, CS Gergen, PJ Kaliner, M Josephs, S Pung, YH AF Ray, NF Baraniuk, JN Thamer, M Rinehart, CS Gergen, PJ Kaliner, M Josephs, S Pung, YH TI Direct expenditures for the treatment of allergic rhinoconjunctivitis in 1996, including the contributions of related airway illnesses SO JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY LA English DT Article DE allergic rhinoconjunctivitis; allergic rhinitis; allergic conjunctivitis; cost of illness; health economics ID COST-EFFECTIVENESS; UNITED-STATES; RHINITIS; ASTHMA; RISK; RESPONSIVENESS; IMMUNIZATION; SINUSITIS; CHILDREN AB Background: Previous estimates of the national economic burden of allergic rhinoconjunctivitis (AR/AC) have relied on data analyses in which AR/AC was the primary International Classification of Diseases-ninth revision-Clinical Modification (ICD-9-CM)-coded diagnosis, These studies ignore the costs when AR/AC was a secondary diagnosis to other disorders such as asthma and sinusitis, Objective: We sought to determine the national direct cost of illness for AR/AC. Methods: An expert panel used the Delphi technique to estimate the proportion of visits coded by other primary ICD-9-CM diagnoses in which AR/AC was a significant secondary comorbid condition. The costs of this proportion,were deemed to be "attributable" to AR/AC and were added to the costs when allergic rhinitis and allergic conjunctivitis were the primary diagnoses. Results: The cost when AR/AC was the primary diagnosis was $1.9 billion (in 1996 dollars). The cost when AR/AC was a secondary diagnosis was estimated at $4.0 billion, giving an estimate of $5.9 billion for the overall direct medical expenditures attributable to AR/AC, Outpatient services (63%, $3.7 billion), medications (25%, $1.5 billion), and inpatient services (12%, $0.7 billion) accounted for the expenditures. Children 12 years and younger accounted for $2.3 billion (38.0%). Conclusion: Upper airway allergy is an expensive disease process because of its readily apparent manifestations as AR/AC and its contribution to other airway disorders. C1 Med Technol & Practice Patterns Inst, Washington, DC USA. Georgetown Univ, Sch Med, Washington, DC USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Washington Hosp Ctr, Inst Allergy & Asthma, Washington, DC 20010 USA. RP Ray, NF (reprint author), Medicare Payment Advisory Commiss, 1730 K St NW,Suite 800, Washington, DC 20006 USA. NR 34 TC 103 Z9 103 U1 0 U2 1 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0091-6749 J9 J ALLERGY CLIN IMMUN JI J. Allergy Clin. Immunol. PD MAR PY 1999 VL 103 IS 3 BP 401 EP 407 DI 10.1016/S0091-6749(99)70463-X PN 1 PG 7 WC Allergy; Immunology SC Allergy; Immunology GA 176WU UT WOS:000079175700007 PM 10069872 ER PT J AU Ray, NF Baraniuk, JN Thamer, M Rinehart, CS Gergen, PJ Kaliner, M Josephs, S Pung, YH AF Ray, NF Baraniuk, JN Thamer, M Rinehart, CS Gergen, PJ Kaliner, M Josephs, S Pung, YH TI Healthcare expenditures for sinusitis in 1996: Contributions of asthma, rhinitis, and other airway disorders SO JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY LA English DT Article DE sinusitis; asthma; otitis media; allergic rhinitis; cost of illness; health care expenditures ID ALLERGY AB Background: There have been no recent assessments of the economic burden of sinusitis in the peer-reviewed literature. Objective: We sought to estimate the 1996 total direct health care expenditures for the treatment of sinusitis. Methods: This study determined (I) direct expenditures of medical and surgical encounters in which sinusitis was the primary diagnosis and (2) attributable expenditures when related airway diseases were the primary diagnosis and sinusitis was a comorbid condition. An expert panel used the Delphi consensus-building technique to determine the proportions for the latter Results: Overall health care expenditures attributable to sinusitis in 1996 wore estimated at $5.8 billion, of which $1.8 billion (30.6%) was for children 12 gears or younger. A primary diagnosis of acute or chronic sinusitis accounted for 58.7% of all expenditures ($3.5 billion). About 12% each of the costs for asthma and chronic otitis media and eustachian tube disorders were attributed to diagnosis and treatment of comorbid sinusitis. Nearly 90% of all expenditures ($5.1 billion) were associated with ambulatory or emergency department services, Conclusion: The economic burden of sinusitis in the United States is significant However the limitations of this type of evaluation suggest the $5.8 billion amount may be an underestimate of the true direct casts. C1 Med Technol & Practice Patterns Inst, Washington, DC USA. Georgetown Univ, Med Ctr, Washington, DC 20007 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Washington Hosp Ctr, Inst Allergy & Asthma, Washington, DC 20010 USA. RP Ray, NF (reprint author), Medicare Payment Advisory Commiss, 1730 K St NW,Suite 800, Washington, DC 20006 USA. NR 21 TC 238 Z9 241 U1 0 U2 1 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0091-6749 J9 J ALLERGY CLIN IMMUN JI J. Allergy Clin. Immunol. PD MAR PY 1999 VL 103 IS 3 BP 408 EP 414 DI 10.1016/S0091-6749(99)70464-1 PN 1 PG 7 WC Allergy; Immunology SC Allergy; Immunology GA 176WU UT WOS:000079175700008 PM 10069873 ER PT J AU Eisenberg, JM AF Eisenberg, JM TI Agency for Health Care Policy and Research SO MEDICAL CARE LA English DT Editorial Material C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Eisenberg, JM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 1999 VL 37 IS 3 BP 217 EP 219 DI 10.1097/00005650-199903000-00001 PG 3 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 178DA UT WOS:000079250000001 PM 10098565 ER PT J AU Carman, KL Short, PF Farley, DO Schnaier, JA Elliott, DB Gallagher, PM AF Carman, KL Short, PF Farley, DO Schnaier, JA Elliott, DB Gallagher, PM TI Epilogue - Early lessons from CAHPS (TM) demonstrations and evaluations SO MEDICAL CARE LA English DT Article DE process evaluation; implementation; health care assessment; health plan assessment AB OBJECTIVES. The Consumer Assessment of Health Plans Study (CAHPS(TM)) was developed to provide an integrated set of tested, standardized surveys to obtain meaningful information from health plan enrollees and their experiences. Many organizations began to implement CAHPS(TM) in 1997. Formal evaluations of the experiences of three demonstration sites with implementing CAHPS(TM) (ie, process evaluations) and the impact of CAHPS(TM) on consumer's choices (ie, outcome evaluations) were conducted. This article reports on the early findings and feedback from our process evaluations about the sites' experiences with using CAHPS(TM). Results are presented from the first round demonstration sites, including the lessons learned during the demonstrations. Our plans for future demonstrations and evaluations are included. METHODS. A Similar evaluation design and instruments were used across demonstration sites. The process evaluation to monitor program intervention included on-site interviews, off-site review of documents, and focus groups with consumers. RESULTS. There are 4 early results from the CAHPS(TM) demonstrations: (1) the CAHPS(TM) survey covers topics of importance to sponsors, is of reasonable length, and can be administered quickly; (2) the report templates are being used effectively, but sponsors vary widely in their preferences for summarizing and presenting CAHPS(TM) ratings; (3) standardized or off-the-shelf products are aspects of CAHPS(TM) that sponsors value highly, while emphasizing need for further development; and (4) because surveys like CAHPS(TM) require multiple within-plan samples to make plan comparisons, they require a substantial investment and may be affordable only for large sponsors. CONCLUSION, The first round CAHPS(TM) demonstrations highlighted the strengths of the integrated surveys and the areas for improving the products and the implementation process. C1 Res Triangle Inst, Hlth & Social Policy Div, Washington, DC 20036 USA. Penn State Univ, Dept Hlth Policy & Adm, University Pk, PA 16802 USA. Rand Corp, Santa Monica, CA USA. US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. Univ Massachusetts, Survey Res Ctr, Boston, MA 02125 USA. RP Carman, KL (reprint author), Res Triangle Inst, Hlth & Social Policy Div, 1615 M St NW,Suite 740, Washington, DC 20036 USA. NR 1 TC 25 Z9 25 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 1999 VL 37 IS 3 SU S BP MS97 EP MS105 DI 10.1097/00005650-199903001-00011 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 183YE UT WOS:000079581700011 PM 10098564 ER PT J AU Crofton, C Lubalin, JS Darby, C AF Crofton, C Lubalin, JS Darby, C TI Consumer Assessment of Health Plans Study (CAHPS (TM)) - Foreword SO MEDICAL CARE LA English DT Editorial Material ID PATIENT SATISFACTION C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Qual Measurement & Improvement, Rockville, MD 20852 USA. Res Triangle Inst, Hlth & Social Policy Div, Washington, DC USA. RP Crofton, C (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Qual Measurement & Improvement, 2101 E Jefferson St,Room 501, Rockville, MD 20852 USA. NR 25 TC 75 Z9 75 U1 0 U2 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 1999 VL 37 IS 3 SU S BP MS1 EP MS9 DI 10.1097/00005650-199903001-00001 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 183YE UT WOS:000079581700001 PM 10098554 ER PT J AU Harris-Kojetin, LD Fowler, FJ Brown, JA Schnaier, JA Sweeny, SF AF Harris-Kojetin, LD Fowler, FJ Brown, JA Schnaier, JA Sweeny, SF TI The use of cognitive testing to develop and evaluate CAHPS (TM) 1.0 core survey items SO MEDICAL CARE LA English DT Article DE questionnaire design; questionnaire pretesting; cognitive testing; health care assessment; health plan assessment AB OEJECTIVES. The main goal of the Consumer Assessments of Health Plans Study (CAHPS(TM)) is to develop an integrated set of tested, standardized surveys to obtain meaningful information from health plan enrollees about their experiences. The CAHPS(TM) project benefits from the complementary strengths of psychometric and cognitive testing. METHODS. The CAHPS(TM) team conducted 150 cognitive interviews across three organizations in different geographic locations using multiple interview methods with different consumer populations. This article explains how cognitive testing was used in the CAHPS(TM) survey development process and shares the main findings from the cognitive interviews. RESULTS. A modified report format is more appropriate when asking about specific aspects of plan enrollees' experiences, whereas a rating format is useful for asking about overall assessments. Specifying a longer reference period is different explains multiple interview methods consumer populations. This preferable to asking about the most recent visit when capturing experiences with care, because some respondents get frustrated when they cannot include experiences other than the most recent visit. Explicit screeners and tailored inapplicable response categories are beneficial in mail questionnaires, so people know that they should not answer questions about which they have no relevant experience. CONCLUSION. Cognitive testing was integral in the development and refinement of the CAHPS(TM) instrument. The cognitive testing findings contributed to an improved instrument that should capture consumers' health care and plan experiences with less response error than one not subjected to such testing. The cognitive testing process and findings can be useful to other researchers with similar survey development goals. C1 Res Triangle Inst, Hlth & Social Policy Div, Washington, DC 20036 USA. Univ Massachusetts, Survey Res Ctr, Boston, MA 02125 USA. Rand Corp, Santa Monica, CA USA. Dept Hlth & Human Serv, Ctr Organ & Delivery Studies, Agcy Hlth Care Policy & Res, Rockville, MD USA. Res Triangle Inst, Div Stat, Res Triangle Pk, NC 27709 USA. RP Harris-Kojetin, LD (reprint author), Res Triangle Inst, Hlth & Social Policy Div, 1615 M St NW,Suite 740, Washington, DC 20036 USA. EM Lauren@rti.org NR 23 TC 59 Z9 60 U1 0 U2 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 1999 VL 37 IS 3 SU S BP MS10 EP MS21 DI 10.1097/00005650-199903001-00002 PG 12 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 183YE UT WOS:000079581700002 PM 10098555 ER PT J AU Schnaier, JA Sweeny, SF Williams, VSL Kosiak, B Lubalin, JS Hays, RD Harris-Kojetin, LD AF Schnaier, JA Sweeny, SF Williams, VSL Kosiak, B Lubalin, JS Hays, RD Harris-Kojetin, LD TI Special issues addressed in the CAHPS (TM) survey of Medicare managed care beneficiaries SO MEDICAL CARE LA English DT Article DE Medicare; questionnaire design; managed care; field testing; health care assessment; health plan assessment AB OBJECTIVES. This article describes the process through which the MMC survey was developed and examines issues in using this survey with Medicare beneficiaries that have implications for all CAHPS(TM) surveys. These include the ability of Medicare beneficiaries to use MMC navigational features, whether access measures are meaningful for this population, and whether beneficiaries' familiarity with managed care influences their health plan assessments. BACKGROUND. The Health Care Financing Administration (HCFA) is mandated to provide comparative plan information, based partly on consumer surveys, to Medicare beneficiaries. The Consumer Assessments of Health Plans Study (CAHPS(TM)) is an integrated set of tested, standardized surveys of health plan enrollees. To meet its goal, HCFA has invested in the development of a CAHPS(TM) survey of beneficiaries enrolled in Medicare Managed Care plans (MMC). METHODS, Cognitive interviews were completed with 31 Medicare beneficiaries. A field test also was conducted with beneficiaries to examine patterns of survey response. A sample of 956 eligible individuals was selected from six health plans. Using a combination of mail and telephone data collection, 663 (69%) questionnaires were completed. This article provides selective results from these tests. RESULTS. The use of screening questions, skip instructions, and tailored "not applicable" response options appeared to facilitate the response task. Some CAMPS(TM) access questions were not meaningful to Medicare beneficiaries. The data do not support the need to adjust for length of plan enrollment. CONCLUSION. Analyses suggested changes to improve the MMC survey and to make other CAHPS(TM) surveys consistent with these changes. C1 Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. Res Triangle Inst, Div Stat, Res Triangle Pk, NC 27709 USA. N Carolina Cent Univ, Dept Psychol, Durham, NC 27707 USA. Hlth Care Financing Adm, Ctr Beneficiary Serv, Baltimore, MD USA. Res Triangle Inst, Hlth & Social Policy Div, Washington, DC USA. Rand Corp, Hlth Program, Santa Monica, CA USA. Univ Calif Los Angeles, Dept Med, Los Angeles, CA 90024 USA. RP Schnaier, JA (reprint author), Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, 2101 E Jefferson St,Suite 605, Rockville, MD 20852 USA. RI Hays, Ronald/D-5629-2013 NR 20 TC 25 Z9 25 U1 1 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 1999 VL 37 IS 3 SU S BP MS69 EP MS78 DI 10.1097/00005650-199903001-00008 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 183YE UT WOS:000079581700008 PM 10098561 ER PT J AU Weinick, RM Monheit, AC AF Weinick, RM Monheit, AC TI Children's health insurance coverage and family structure, 1977-1996 SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article AB Using data from a series of nationally representative medical expenditure surveys, the authors document changes in children's health insurance coverage in a period of two decades. Overall, it is found that the proportion of children with private coverage declined, while the proportions publicly insured and uninsured increased. However, when the authors account for differences in family structure, they find striking disparities in children's insurance experiences. Contrary to overall trends, children in single-parent households made significant gains in private health insurance coverage after 1977 and experienced reductions in public insurance. Coincident with Medicaid expansions in the late 1980s, children in two-parent households experienced significant increases in public health insurance. It is found that the rise in the proportion of children who were uninsured in this period was largely a single-parent family phenomenon, and that parents' marital status, employment status, and family income are crucial factors associated with children's insurance status. C1 Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Weinick, RM (reprint author), Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 23 TC 21 Z9 21 U1 0 U2 5 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 J9 MED CARE RES REV JI Med. Care Res. Rev. PD MAR PY 1999 VL 56 IS 1 BP 55 EP 73 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 172XV UT WOS:000078951700004 PM 10189777 ER PT J AU Selden, TM Forrest, AS Lockhart, JE AF Selden, TM Forrest, AS Lockhart, JE TI Analyzing the reductions in US air pollution emissions: 1970 to 1990 SO LAND ECONOMICS LA English DT Article ID CARBON-DIOXIDE EMISSIONS; 10 OECD COUNTRIES; ENVIRONMENTAL-QUALITY; UNITED-STATES; MANUFACTURING SECTOR; ECONOMIC-GROWTH; CO2 EMISSIONS; ENERGY USE; DECOMPOSITION; INTENSITY AB Findings of inverted-U relationships between income and certain pollutants have generated considerable controversy, yet relatively little is known: about the factors underlying these relationships. U. S. emissions of several major air pollutants have begun to decline, mirroring trajectories found using data across countries and time. We examine U. S. emissions of sir air pollutants between 1970 and 1990, decomposing the changes into scale, composition, energy intensity, energy mix and other technique effects. Our results provide a case study of the relative importance of these effects for a country on the downward-sloping portions of its emissions-GDP trajectories for the pollutants examined. (JEL Q25). C1 Agcy Hlth Care Policy & Res, Rockville, MD 20854 USA. ELI, Washington, DC 20036 USA. George Washington Univ, Dept Econ, Washington, DC 20052 USA. RP Selden, TM (reprint author), Agcy Hlth Care Policy & Res, Rockville, MD 20854 USA. NR 59 TC 37 Z9 39 U1 2 U2 4 PU UNIV WISCONSIN PI MADISON PA SOCIAL SCIENCE BLDG, MADISON, WI 53706 USA SN 0023-7639 J9 LAND ECON JI Land Econ. PD FEB PY 1999 VL 75 IS 1 BP 1 EP 21 DI 10.2307/3146990 PG 21 WC Economics; Environmental Studies SC Business & Economics; Environmental Sciences & Ecology GA 188DB UT WOS:000079828900001 ER PT J AU Freund, D Lave, J Clancy, C Hawker, G Hasselblad, V Keller, R Schneiter, E Wright, J AF Freund, D Lave, J Clancy, C Hawker, G Hasselblad, V Keller, R Schneiter, E Wright, J TI Patient outcomes research teams: Contribution to outcomes and effectiveness research SO ANNUAL REVIEW OF PUBLIC HEALTH LA English DT Review DE meta analysis; claims data; health status measures ID ACUTE MYOCARDIAL-INFARCTION; MAINE LUMBAR SPINE; DISEASE-SPECIFIC MEASURES; SICKNESS IMPACT PROFILE; QUALITY-OF-LIFE; KNEE REPLACEMENT; HEALTH-STATUS; MEDICARE BENEFICIARIES; GEOGRAPHIC-VARIATION; CATARACT-SURGERY AB This paper describes the key methodological and substantive findings of Patient Outcomes Research Teams, the first outcomes and effectiveness research centers funded by the Agency for Health Care Policy and Research. Patient Outcomes Research Teams contributed to our increased understanding of how to perform meta analysis on nontrial data, use administrative data to characterize patterns of care, develop general and disease-specific outcome measures, and disseminate important outcome information to patients and physicians to reduce practice variation. Patient Outcomes Research Teams also influenced the development of outcomes measurement in the private sector. C1 Indiana Univ, Bowen Res Ctr, Indianapolis, IN 46202 USA. Univ Pittsburgh, Grad Sch Publ Hlth, Dept Hlth Serv Adm, Pittsburgh, PA 15261 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. Univ Toronto, Dept Med, Toronto, ON M5S 1B6, Canada. Womens Coll Hosp, Div Rheumatol, Toronto, ON M5S 1B6, Canada. Duke Univ, Duke Clin Res Inst, Durham, NC 27705 USA. Maine Med Assessment Fdn, Manchester, ME 04351 USA. Univ Toronto, Hosp Sick Children, Clin Epidemiol & Hlth Care Res Program, Toronto, ON M5G 1X8, Canada. RP Freund, D (reprint author), Indiana Univ, Bowen Res Ctr, Indianapolis, IN 46202 USA. NR 75 TC 24 Z9 24 U1 1 U2 1 PU ANNUAL REVIEWS INC PI PALO ALTO PA 4139 EL CAMINO WAY, PO BOX 10139, PALO ALTO, CA 94303-0139 USA SN 0163-7525 J9 ANNU REV PUBL HEALTH JI Annu. Rev. Public Health PY 1999 VL 20 BP 337 EP 359 DI 10.1146/annurev.publhealth.20.1.337 PG 23 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 198RW UT WOS:000080438800019 PM 10352862 ER PT S AU Cooper, PF Hagy, AP Vistnes, JP AF Cooper, PF Hagy, AP Vistnes, JP BE Haltiwanger, J Lane, JI Speltzer, JR Theeuwes, JJM Troske, KR TI The medical expenditure panel survey: Creation of a linked employer-employee database SO CREATION AND ANALYSIS OF EMPLOYER-EMPLOYEE MATCHED DATA SE CONTRIBUTIONS TO ECONOMIC ANALYSIS LA English DT Proceedings Paper CT International Symposium of Linked Employer Data CY 1999 CL WASHINGTON, D.C. ID INSURANCE BENEFITS C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 11 TC 0 Z9 0 U1 0 U2 0 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA SARA BURGERHARTSTRAAT 25, PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0573-8555 BN 0-444-50256-4 J9 CONTRIB TO ECON ANAL PY 1999 VL 241 BP 553 EP 568 PG 16 WC Economics; Industrial Relations & Labor SC Business & Economics GA BP13L UT WOS:000084216400023 ER PT J AU Clancy, CM Lurie, N AF Clancy, CM Lurie, N TI Concluding thoughts - Looking forward SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article ID CARE; PHYSICIANS C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. RP Clancy, CM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. NR 14 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JAN PY 1999 VL 14 SU 1 BP S63 EP S64 DI 10.1046/j.1525-1497.1999.00268.x PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 160NU UT WOS:000078237400011 PM 9933498 ER PT J AU Frank, E Clancy, C AF Frank, E Clancy, C TI US women physicians' assessment of the quality of healthcare they receive SO JOURNAL OF WOMENS HEALTH LA English DT Article ID SOCIOECONOMIC-STATUS; PATIENT SATISFACTION; MEDICAL-CARE; OUTCOMES AB Surveys of women's perceptions of quality and satisfaction with healthcare are widely administered and reported, yet no similar studies of women physicians' perceptions have been conducted. We analyzed related data from the Women Physicians' Health Study, a nationally representative sample of 4501 U.S. women physicians. Among U.S. women physicians, 39% thought the healthcare they personally received was excellent, 37% considered it to be very good, 19% good, 4% fair, and 1% judged their healthcare to be poor quality. Physicians may be especially rigorous judges of healthcare quality, and their assessment of the healthcare they receive is generally positive, an encouraging finding. However, as physicians are highly qualified to assess and potentially obtain high-quality healthcare and as they generally did not judge the care they received to be excellent, the findings also suggest that there are opportunities for improvements in the quality of women's healthcare. C1 Emory Univ, Sch Med, Dept Family & Prevent Med, Atlanta, GA 30306 USA. Agcy Hlth Care Policy & Res, Atlanta, GA USA. RP Frank, E (reprint author), Emory Univ, Sch Med, Dept Family & Prevent Med, 69 Butler St, Atlanta, GA 30306 USA. FU NHLBI NIH HHS [5T32-HL-07034] NR 21 TC 4 Z9 4 U1 1 U2 1 PU MARY ANN LIEBERT INC PUBL PI LARCHMONT PA 2 MADISON AVENUE, LARCHMONT, NY 10538 USA SN 1059-7115 J9 J WOMENS HEALTH JI J. Womens Health PD JAN-FEB PY 1999 VL 8 IS 1 BP 95 EP 102 DI 10.1089/jwh.1999.8.95 PG 8 WC Public, Environmental & Occupational Health; Medicine, General & Internal; Obstetrics & Gynecology; Women's Studies SC Public, Environmental & Occupational Health; General & Internal Medicine; Obstetrics & Gynecology; Women's Studies GA 174CH UT WOS:000079016200016 PM 10094086 ER PT J AU Altman, BM Cooper, PF Cunningham, PJ AF Altman, BM Cooper, PF Cunningham, PJ TI The case of disability in the family: Impact on health care utilization and expenditures for nondisabled members SO MILBANK QUARTERLY LA English DT Article; Proceedings Paper CT 123rd Annual Meeting of the American-Public-Health-Association CY OCT 29-NOV 03, 1995 CL SAN DIEGO, CALIFORNIA SP Amer Public Hlth Assoc ID MENTAL-RETARDATION; ILLNESS; ADULTS; CAREGIVERS; CHILDREN; MOTHERS; BURDEN; LIFE; SIBLINGS; SUPPORT AB Families with a disabled member undergo heightened emotional and financial stress, which can arise from caring for the person with one or more disabilities over the life course or at the end of life. Because health care resources are strained by the needs of the disabled family member, nondisabled members are often limited in health care access and utilization when they are most in need of care. This analysis uses the National Medical Expenditure Survey to describe families with disabled members, based on multiple definitions of disability, and to examine health care utilization and expenditures by nondisabled family members. Indications of higher use of medical care by adult, nondisabled members of such families support the frequent reports in the literature of stress occurring in these situations. The signals of a household rationing effect for families near and at poverty levels should alert policy makers to consider the needs of the whole family when creating or modifying assistance programs. C1 Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Altman, BM (reprint author), Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 47 TC 50 Z9 50 U1 3 U2 3 PU BLACKWELL PUBLISHERS PI MALDEN PA 350 MAIN STREET, STE 6, MALDEN, MA 02148 USA SN 0887-378X J9 MILBANK Q JI Milbank Q. PY 1999 VL 77 IS 1 BP 39 EP + DI 10.1111/1468-0009.00124 PG 38 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 180KP UT WOS:000079385300003 PM 10197027 ER PT J AU Moody, LE AF Moody, LE TI Living longer, dying longer: Nursing's opportunity to make a difference - Commentary SO NURSING OUTLOOK LA English DT Editorial Material C1 Univ S Florida, Dept Hlth & Human Serv, Agcy Hlth Care Policy & Res, Tampa, FL 33620 USA. Univ S Florida, Coll Nursing, Tampa, FL USA. RP Moody, LE (reprint author), Univ S Florida, Dept Hlth & Human Serv, Agcy Hlth Care Policy & Res, Tampa, FL 33620 USA. NR 1 TC 1 Z9 1 U1 2 U2 2 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0029-6554 J9 NURS OUTLOOK JI Nurs. Outlook PD JAN-FEB PY 1999 VL 47 IS 1 BP 41 EP 42 DI 10.1016/S0029-6554(99)90044-1 PG 2 WC Nursing SC Nursing GA 170EV UT WOS:000078794100010 PM 10070653 ER PT J AU Meyer, GS AF Meyer, GS TI Privacy versus progress: The international debate over medical records research SO NUTRITION LA English DT Editorial Material C1 US Dept HHS, Ctr Qual Measurement & Improvement, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA. RP Meyer, GS (reprint author), US Dept HHS, Ctr Qual Measurement & Improvement, Agcy Hlth Care Policy & Res, 2101 Jefferson St, Rockville, MD 20852 USA. NR 4 TC 0 Z9 0 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0899-9007 J9 NUTRITION JI Nutrition PD JAN PY 1999 VL 15 IS 1 BP 81 EP 82 DI 10.1016/S0899-9007(98)00147-6 PG 2 WC Nutrition & Dietetics SC Nutrition & Dietetics GA 154JC UT WOS:000077884900027 PM 9918078 ER PT J AU Bierman, AS Clancy, CM AF Bierman, AS Clancy, CM TI Women's health, chronic disease, and disease management: New words and old music? SO WOMENS HEALTH ISSUES LA English DT Article ID ACUTE MYOCARDIAL-INFARCTION; CARDIOVASCULAR PROCEDURES; PHARMACEUTICAL-INDUSTRY; ETHNIC-DIFFERENCES; CARE; OUTCOMES; IMPROVEMENT; PERFORMANCE; CAREGIVERS; VETERANS C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. RP Bierman, AS (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. NR 67 TC 11 Z9 11 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD JAN-FEB PY 1999 VL 9 IS 1 BP 2 EP 17 DI 10.1016/S1049-3867(98)00035-8 PG 16 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 160XG UT WOS:000078256900002 PM 9949693 ER PT J AU Bozzette, SA Berry, SH Duan, NJ Frankel, MR Leibowitz, AA Lefkowitz, D Emmons, CA Senterfitt, JW Berk, ML Morton, SC Shapiro, MF AF Bozzette, SA Berry, SH Duan, NJ Frankel, MR Leibowitz, AA Lefkowitz, D Emmons, CA Senterfitt, JW Berk, ML Morton, SC Shapiro, MF CA HIV Cost Services Utilization Study Consortium TI The care of HIV-infected adults in the United States SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID AIDS AB Background and Methods In order to elucidate the medical care of patients with human immunodeficiency virus (HIV) infection in the United States, we randomly sampled HIV-infected adults receiving medical care in the contiguous United States at a facility other than a military, prison, or emergency department facility during the first two months of 1996. We interviewed 76 percent of 4042 patients selected from among the patients receiving care from 145 providers in 28 metropolitan areas and 51 providers in 25 rural areas. Results During the first two months of 1996, an estimated 231,400 HIV-infected adults (95 percent confidence interval, 162,800 to 300,000) received care. Fifty-nine percent had the acquired immunodeficiency syndrome according to the case definition of the Centers for Disease Control and Prevention, and 91 percent had CD4+ cell counts of less than 500 per cubic millimeter. Eleven percent were 50 years of age or older, 23 percent were women, 33 percent were black, and 49 percent were men who had had sex with men. Forty-six percent had incomes of less than $10,000 per year, 68 percent had public health insurance or no insurance, and 30 percent received care at teaching institutions. The estimated annual direct expenditures for the care of the patients seen during the first two months of 1996 were $5.1 billion; the expenditures for the estimated 335,000 HIV-infected adults seen at least as often as every six months were $6.7 billion, which is about $20,000 per patient per year. Conclusions In this national survey we found that most HIV-infected adults who were receiving medical care had advanced disease. The patient population was disproportionately male, black, and poor. Many Americans with diagnosed or undiagnosed HIV infection are not receiving medical care at least as often as every six months. The total cost of medical care for HIV-infected Americans accounts for less than 1 percent of all direct personal health expenditures in the United States. (N Engl J Med 1998;339:1897-904.) (C) 1998, Massachusetts Medical Society. C1 Rand Corp, HCSUS Off, Hlth, Santa Monica, CA 90407 USA. Vet Affairs San Diego Healthcare Syst, San Diego, CA USA. Univ Calif San Diego, La Jolla, CA 92093 USA. Univ Calif Los Angeles, Los Angeles, CA USA. Univ Chicago, Natl Opin Res Ctr, Chicago, IL 60637 USA. CUNY Bernard M Baruch Coll, New York, NY 10010 USA. Project Hope, Bethesda, MD USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Bozzette, SA (reprint author), Rand Corp, HCSUS Off, Hlth, 1700 Main St, Santa Monica, CA 90407 USA. FU AHRQ HHS [U-01HS08578] NR 26 TC 349 Z9 355 U1 1 U2 7 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD DEC 24 PY 1998 VL 339 IS 26 BP 1897 EP 1904 DI 10.1056/NEJM199812243392606 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 150ZN UT WOS:000077696600006 PM 9862946 ER PT J AU Hsia, DC AF Hsia, DC TI Medications used for paediatric HIV infection in the USA, 1991-1992 SO AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV LA English DT Article ID IMMUNODEFICIENCY-VIRUS INFECTION; CHILDREN; THERAPY; AIDS AB Medications constituted the third largest health care expenditure for children infected with the human immunodeficiency, virus (HIV). Previous literature had not investigated volume or cost of pharmaceuticals consumed by, individual patients. The US Agency for Health Care Policy & Research (AHCPR) therefore sponsored the AIDS Cost & Services Utilization Survey (ACSUS) to measure utilization of health care services, including medications. Starting in 1991, it surveyed 100 children with AIDS and 41 HIV-infected children (iia adult proxies) six times at quarterly intervals and collected their outpatient bills. These children reported using 5,634 prescriptions and had 5,026 bills. Children with AIDS reported more prescriptions than HIV-infected children. On the basis of CD4 counts and age, 14.2% of children had indications for antiretrovirals, but did not receive them; and 17.7% warranted PCP prophylaxis bur did not receive it. Outpatient bills averaged $2,325 and inpatient bills averaged $7,725 per year. These amounts projected nationally to $48.2 million annually, mostly paid by Medicaid. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Hsia, DC (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, 2101 E Jefferson St, Rockville, MD 20852 USA. EM dhsia@ahcpr.gov NR 32 TC 0 Z9 0 U1 0 U2 0 PU CARFAX PUBL CO PI ABINGDON PA PO BOX 25, ABINGDON, OXFORDSHIRE, ENGLAND OX14 3UE SN 0954-0121 J9 AIDS CARE JI Aids Care-Psychol. Socio-Med. Asp. Aids/Hiv PD DEC PY 1998 VL 10 IS 6 BP 761 EP 770 DI 10.1080/09540129848370 PG 10 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychology, Multidisciplinary; Respiratory System; Social Sciences, Biomedical SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychology; Respiratory System; Biomedical Social Sciences GA 143NG UT WOS:000077261400010 PM 9924530 ER PT J AU Hellinger, FJ AF Hellinger, FJ TI Antitrust enforcement in the healthcare industry: The expanding scope of state activity SO HEALTH SERVICES RESEARCH LA English DT Article DE state action immunity; state-approved mergers; state healthcare antitrust exemption; state healthcare antitrust regulation; state healthcare policy ID COST-CONTAINMENT; COMPETITION; CALIFORNIA; BEHAVIOR AB Objective. To describe the landscape of state antitrust activity and review related research and policy issues. In particular, to examine state laws that attempt to immunize mergers among healthcare providers from state and federal antitrust prosecution and consent decrees issued by state attorneys general permitting healthcare providers to merge. Data Sources. State laws attempting to immunize collaborative activities from state and federal antitrust prosecution and consent decrees between state attorneys general and collaborating healthcare providers. Principal Findings. State antitrust agencies have been more willing than federal antitrust agencies to approve mergers that are contingent on the fulfillment of specific conditions that require continued oversight. Conclusions. Research is needed to inform policymakers about the consequences of state-approved mergers on market performance. C1 Ctr Org & Delivery Studies, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Hellinger, FJ (reprint author), Ctr Org & Delivery Studies, Agcy Hlth Care Policy & Res, Suite 500,2101 E Jefferson St, Rockville, MD 20852 USA. NR 35 TC 3 Z9 3 U1 0 U2 1 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 1998 VL 33 IS 5 BP 1477 EP 1494 PN 2 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 146UD UT WOS:000077449100006 PM 9865230 ER PT J AU Sills, ES Saini, J Steiner, CA McGee, M Gretz, HF AF Sills, ES Saini, J Steiner, CA McGee, M Gretz, HF TI Abdominal hysterectomy practice patterns in the United States SO INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS LA English DT Article DE surgical practice; trends; hysterectomy; supracervical ID ALTERNATIVE TECHNIQUES AB Objective: To describe nationwide practice trends for two principal techniques of abdominal hysterectomy in the United States, numbers and rates of total (TAH) and supracervical (SCH) hysterectomy were reviewed with charges for each operation. Methods: Practice patterns for all inpatient TAH and SCH discharges in the US from 1991 to 1994 were studied using HCUP-3 NIS, a nationwide hospital discharge database. Hysterectomies performed for malignant disease, vaginally or with laparoscopic assistance were not sampled. For each year studied, the number and rate of TAH and SCH, average length of stay (LOS), and mean institutional charge were evaluated. Results: From 1991 to 1994, the US TAH rate (cases/10 000 females) decreased significantly from 25.7 to 20.5 (P = 0.02). During the same interval the SCH rate increased significantly from 0.16 to 0.41 (P = 0.04). Nevertheless, TAH accounted for > 99% of all abdominal hysterectomies for each of the 4 years evaluated. The mean institutional charges for the two operations generally depicted SCH to be more costly than TAH. Conclusion: The national rates of TAH and SCH rates changed significantly in the United States from 1991 to 1994, with TAH declining and SCH increasing. This mix of cases continues to reflect a strong preference for TAH. Although hospital charges for both procedures increased during this study, these data show that SCH is more expensive than TAH. The much lower utilization of SCH renders nominal its impact on national healthcare expenditures, however. Further studies are needed to assess specific causative factors for these changes in US hysterectomy technique. (C) 1998 International Federation of Gynecology and Obstetrics. C1 Cornell Univ, Med Ctr, New York Hosp, Dept Obstet & Gynecol,Ctr Reprod Med & Infertil, New York, NY 10021 USA. NYU, Med Ctr, Dept Obstet & Gynecol, Div Reconstruct Pelv Surg & Urogynecol, New York, NY 10016 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Rockefeller Univ, Gen Clin Res Ctr, New York, NY 10021 USA. Cornell Univ, Med Ctr, New York Hosp, Dept Obstet & Gynecol, New York, NY 10021 USA. RP Sills, ES (reprint author), Ctr Reprod Hlth, 326 21st Ave N, Nashville, TN 37203 USA. EM dr.sills@reproductivehealthctr.com NR 30 TC 20 Z9 20 U1 0 U2 0 PU ELSEVIER SCI IRELAND LTD PI CLARE PA CUSTOMER RELATIONS MANAGER, BAY 15, SHANNON INDUSTRIAL ESTATE CO, CLARE, IRELAND SN 0020-7292 J9 INT J GYNECOL OBSTET JI Int. J. Gynecol. Obstet. PD DEC PY 1998 VL 63 IS 3 BP 277 EP 283 DI 10.1016/S0020-7292(98)00144-1 PG 7 WC Obstetrics & Gynecology SC Obstetrics & Gynecology GA 156AC UT WOS:000077978400007 PM 9989898 ER PT J AU Spector, WD Selden, TM Cohen, JW AF Spector, WD Selden, TM Cohen, JW TI The impact of ownership type on nursing home outcomes SO HEALTH ECONOMICS LA English DT Article DE nonprofit; nursing homes; outcomes ID MEDICAID REIMBURSEMENT; QUALITY; CARE; INDUSTRY; BEHAVE AB This paper examines the sorting of residents between for-profit and nonprofit nursing homes and the health outcomes of those residents conditional on ownership type. Using data from the 1987 National Medical Expenditure Survey, we find evidence of systematic sorting of residents by ownership type, and significant effects of ownership type on outcomes. These results are broadly consistent with the hypothesis that for-profit and nonprofit homes exploit their informational advantages to differing extents in a market characterized by asymmetric information. (C) 1998 John Wiley & Sons, Ltd. C1 Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Spector, WD (reprint author), Agcy Hlth Care Policy & Res, 210E Jefferson St,Suite 605, Rockville, MD 20852 USA. NR 38 TC 83 Z9 83 U1 3 U2 13 PU JOHN WILEY & SONS LTD PI W SUSSEX PA BAFFINS LANE CHICHESTER, W SUSSEX PO19 1UD, ENGLAND SN 1057-9230 J9 HEALTH ECON JI Health Econ. PD NOV PY 1998 VL 7 IS 7 BP 639 EP 653 DI 10.1002/(SICI)1099-1050(1998110)7:7<639::AID-HEC373>3.0.CO;2-0 PG 15 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 139TR UT WOS:000077046200008 PM 9845257 ER PT J AU Selden, TM AF Selden, TM TI Risk adjustment for health insurance: Theory and implications SO JOURNAL OF RISK AND UNCERTAINTY LA English DT Article ID ADVERSE SELECTION; MARKETS; INFORMATION; EQUILIBRIUM AB This paper explores the potential for welfare-improving public risk adjustment in health insurance markets characterized by adverse selection. The optimal risk adjustment system is derived in a theoretical model under a range of assumptions regarding government information and market equilibrium. Special attention is focused on the interaction br ta een risk adjustment and the private transfers that can occur in markets characterized by adverse selection. Risk adjustment has the potential to improve both equity and efficiency; however, it can also have the effect of crowding out private transfers. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Selden, TM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 22 TC 7 Z9 7 U1 0 U2 1 PU KLUWER ACADEMIC PUBL PI DORDRECHT PA SPUIBOULEVARD 50, PO BOX 17, 3300 AA DORDRECHT, NETHERLANDS SN 0895-5646 J9 J RISK UNCERTAINTY JI J. Risk Uncertain. PD NOV PY 1998 VL 17 IS 2 BP 167 EP 179 DI 10.1023/A:1007723730074 PG 13 WC Business, Finance; Economics SC Business & Economics GA 179KN UT WOS:000079326600005 ER PT J AU Clancy, CM Eisenberg, JM AF Clancy, CM Eisenberg, JM TI Health care policy - Outcomes research: Measuring the end results of health care SO SCIENCE LA English DT Editorial Material ID SMALL-AREA VARIATIONS; QUALITY; LIFE; SERVICES C1 US Dept HHS, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Clancy, CM (reprint author), US Dept HHS, Ctr Outcomes & Effectiveness Res, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 33 TC 189 Z9 195 U1 2 U2 9 PU AMER ASSOC ADVANCEMENT SCIENCE PI WASHINGTON PA 1200 NEW YORK AVE, NW, WASHINGTON, DC 20005 USA SN 0036-8075 J9 SCIENCE JI Science PD OCT 9 PY 1998 VL 282 IS 5387 BP 245 EP 246 DI 10.1126/science.282.5387.245 PG 2 WC Multidisciplinary Sciences SC Science & Technology - Other Topics GA 127VA UT WOS:000076370200031 ER PT J AU Schone, BS Weinick, RM AF Schone, BS Weinick, RM TI Health-related behaviors and the benefits of marriage for elderly persons SO GERONTOLOGIST LA English DT Article; Proceedings Paper CT Annual Meeting of the Population-Association-of-America CY MAY 08-12, 1996 CL NEW ORLEANS, LOUISIANA SP Populat Assoc Amer DE preventive health; marital states; gender; elderly persons ID MARITAL-STATUS; SOCIAL-CONTROL; BREAKFAST; GENDER; PROMOTION; MORTALITY; SMOKING; ADULTS; FAMILY; LIFE AB In this article, we investigate the relationship between health behaviors, marital status, and gender in the elderly population. We estimate logistic regression models to determine the factors that affect the likelihood of undertaking healthy behaviors. Using data from the 1987 National Medical Expenditure Survey, we find that marriage has positive impacts on health behaviors in the elderly population and that, when these effects differ by gender, they tend to be larger for elderly men than for elderly women. These results extend earlier findings showing that marriage encourages healthy behaviors for a younger population and demonstrate that these benefits continue later in life. C1 Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Schone, BS (reprint author), Agcy Hlth Care Policy & Res, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 39 TC 86 Z9 86 U1 0 U2 9 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 1998 VL 38 IS 5 BP 618 EP 627 PG 10 WC Gerontology SC Geriatrics & Gerontology GA 132RQ UT WOS:000076643900010 PM 9803650 ER PT J AU Eisenberg, JM AF Eisenberg, JM TI AHCPR focuses on information for health care decision makers SO HEALTH SERVICES RESEARCH LA English DT Article C1 US Dept HHS, Agcy Hlth Care Policy & Res, Washington, DC 20201 USA. RP Eisenberg, JM (reprint author), Ctr Hlth Informat Disseminat, 2101 E Jefferson St,Suite 501, Rockville, MD 20852 USA. NR 9 TC 0 Z9 0 U1 0 U2 0 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD OCT PY 1998 VL 33 IS 4 BP 767 EP 781 PN 1 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 126QF UT WOS:000076304100002 PM 9776935 ER PT J AU Rathore, SS McGreevey, JD Snihurowych, R Lee, S Schulman, KA Atkins, D AF Rathore, SS McGreevey, JD Snihurowych, R Lee, S Schulman, KA Atkins, D TI Mandated coverage for clinical preventive services: Whose guidelines do states follow? SO MEDICAL DECISION MAKING LA English DT Meeting Abstract C1 Georgetown Univ, Med Ctr, Clin Econ Res Unit, Washington, DC 20007 USA. Agcy Hlth Care Policy & Res, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 0272-989X J9 MED DECIS MAKING JI Med. Decis. Mak. PD OCT-DEC PY 1998 VL 18 IS 4 BP 484 EP 484 PG 1 WC Health Care Sciences & Services; Medical Informatics SC Health Care Sciences & Services; Medical Informatics GA 128TM UT WOS:000076422700191 ER PT J AU Cooper, JK AF Cooper, JK TI Measuring the health of seniors SO ARCHIVES OF FAMILY MEDICINE LA English DT Editorial Material C1 Agcy Hlth Care Policy & Res, Dept Hlth & Human Serv, Rockville, MD 20852 USA. RP Cooper, JK (reprint author), Agcy Hlth Care Policy & Res, Dept Hlth & Human Serv, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 4 TC 5 Z9 5 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 1063-3987 J9 ARCH FAM MED JI Arch. Fam. Med. PD SEP-OCT PY 1998 VL 7 IS 5 BP 415 EP 416 DI 10.1001/archfami.7.5.415 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 119TB UT WOS:000075912300006 PM 9755732 ER PT J AU Spector, WD Mukamel, DB AF Spector, WD Mukamel, DB TI Using outcomes to make inferences about nursing home quality SO EVALUATION & THE HEALTH PROFESSIONS LA English DT Article ID RESIDENT ASSESSMENT INSTRUMENT; MORTALITY-RATES; CARE; STATES; SYSTEM; UTILITY; MUSCLE; MODELS; RAI AB Recent concerns about containing the growth of public expenditures on nursing home care and the development of prospective and case-mix reimbursement systems,vith incentives for cast containment have increased the importance of monitoring quality in nursing homes. The current view is that quality assurance systems should include more outcome measures to improve quality This article discusses why it is difficult to develop facility-level outcome measures that can be used to evaluate and compare the quality of care of nursing homes. The article places the current interest in outcomes measures in its historical policy context and reviews important conceptual and methodological issues associated with outcome-based quality assessment The authors discuss the difficulty in isolating the facility effect when studying nursing home outcomes and implications of using different estimation approaches. In conclusion they discuss the need to integrate research with outcome-based quality assurance systems to allow ongoing evaluation and quality improvement. C1 Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Univ Rochester, Rochester, NY 14627 USA. RP Spector, WD (reprint author), Agcy Hlth Care Policy & Res, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 55 TC 25 Z9 25 U1 0 U2 2 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0163-2787 J9 EVAL HEALTH PROF JI Eval. Health Prof. PD SEP PY 1998 VL 21 IS 3 BP 291 EP 315 DI 10.1177/016327879802100301 PG 25 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 117WV UT WOS:000075806400001 PM 10350953 ER PT J AU Fraser, I Chait, E Brach, C AF Fraser, I Chait, E Brach, C TI Promoting choice: Lessons from managed Medicaid SO HEALTH AFFAIRS LA English DT Article ID INFORMATION; PROGRAMS; PLANS AB Drawing on the education, enrollment, and assignment experiences of seven states with mandatory Medicaid managed care programs, this paper finds that the vast majority of enrollees will choose their own health plan if the system is explicitly designed with this in mind (as in Minnesota and Oregon). These experiences provide lessons on ways to (1) align program design with state priorities; (2) increase the level of choice (by coordinating enrollment and eligibility processes, broad-based educational strategies, and personalized attention); (3) improve the quality of choice; and (4) design state contracting processes to support choice and continuity of care. C1 Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20854 USA. Hlth Syst Res Inc, Washington, DC USA. RP Fraser, I (reprint author), Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20854 USA. NR 24 TC 8 Z9 8 U1 1 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SEP-OCT PY 1998 VL 17 IS 5 BP 165 EP 174 DI 10.1377/hlthaff.17.5.165 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 120UA UT WOS:000075974700013 PM 9769580 ER PT J AU Stryer, DB AF Stryer, DB TI Discussing pharmaceutical gifts SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Letter C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. RP Stryer, DB (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. NR 2 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD SEP PY 1998 VL 13 IS 9 BP 648 EP 648 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 118RY UT WOS:000075854800012 PM 9754523 ER PT J AU Vargas, CM Crall, JJ Schneider, DA AF Vargas, CM Crall, JJ Schneider, DA TI Sociodemographic distribution of pediatric dental caries: NHANES III, 1988-1994 SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article ID CHILDREN; PREVALENCE AB This article examines the extent to which caries prevalence and untreated caries vary in children by ethnicity and household income level. Data from the Third National Health and Nutrition Examination Survey, 1988-1994, for 10,332 children 2 to 18 years of age indicate that lower-income children and Mexican-American and African-American children are more likely to have a higher prevalence of caries and more unmet treatment needs than their higher-income and non-Hispanic white counterparts. C1 Ctr Dis Control & Prevent, Off Anal Epidemiol & Hlth Promot, Natl Ctr Hlth Stat, Hyattsville, MD 20782 USA. Agcy Hlth Care Policy & Res, Rockville, MD 20854 USA. US Hlth Care Financing Adm, Off Medicaid & State Operat, Baltimore, MD 21207 USA. RP Vargas, CM (reprint author), Ctr Dis Control & Prevent, Off Anal Epidemiol & Hlth Promot, Natl Ctr Hlth Stat, 6525 Belcrest Rd,Room 730, Hyattsville, MD 20782 USA. NR 12 TC 236 Z9 241 U1 0 U2 7 PU AMER DENTAL ASSN PI CHICAGO PA 211 E CHICAGO AVE, CHICAGO, IL 60611 USA SN 0002-8177 J9 J AM DENT ASSOC JI J. Am. Dent. Assoc. PD SEP PY 1998 VL 129 IS 9 BP 1229 EP 1238 PG 10 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 118RK UT WOS:000075853600020 PM 9766104 ER PT J AU Baine, WB Yu, W Summe, JP Weis, KA AF Baine, WB Yu, W Summe, JP Weis, KA TI Epidemiologic trends in the evaluation and treatment of lower urinary tract symptoms in elderly male Medicare patients from 1991 to 1995 SO JOURNAL OF UROLOGY LA English DT Article DE aged; Medicare; prostatectomy; urodynamics; prostatic hypertrophy AB Purpose: We describe utilization of procedures to reveal recent epidemiologic trends in evaluation and management of benign prostatic hyperplasia (BPH). Materials and Methods: Medicare claims data reflect clinical practice in the vast majority of elderly Americans. The standard 5% beneficiary sample from Medicare claims files for 1991 to 1995 was searched to identify men 65 years old or older with invoices containing diagnostic and procedure codes indicative of prostate disease or lower urinary tract symptoms. Physician/supplier file claims for this sample of patients were used to identify diagnostic and therapeutic procedures relevant to BPH. Results: During these 5 years claims for uroflowmetry peaked in 1993, filling cystometry gradually declined and pressure flow studies increased. Transurethral resection of the prostate decreased 43%, with even steeper reductions for open prostatectomy. The proportion of transurethral resections performed in hospital inpatients ebbed from 96 to 88%. Age specific operative rates for transurethral resection were highest in the ninth decade, and during the 5 years operative rates generally declined more among white than black men of the same age. Although urethrocystoscopy and excretory urography explicitly for BPH decreased markedly, from 1992 to 1995 the proportion of transurethral resections preceded by urethrocystoscopy for any indication increased from 45 to 47%, while excretory urograms were still obtained before 36% of these operations in 1992 and decreased to 26% in 1995. Conclusions: Evaluation and treatment of lower urinary tract symptoms in elderly men in the United States changed rapidly between 1991 and 1995, with a sharp decline in invasive therapy for BPH. C1 US Dept HHS, Ctr Cost & Financing Studies, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Baine, WB (reprint author), US Dept HHS, Ctr Cost & Financing Studies, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 8 TC 19 Z9 20 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 USA SN 0022-5347 J9 J UROLOGY JI J. Urol. PD SEP PY 1998 VL 160 IS 3 BP 816 EP 820 DI 10.1016/S0022-5347(01)62794-0 PN 1 PG 5 WC Urology & Nephrology SC Urology & Nephrology GA 111RB UT WOS:000075450500049 PM 9720555 ER PT J AU Eisenberg, J AF Eisenberg, J TI Agency for Health Care Policy and Research SO ANNALS OF EPIDEMIOLOGY LA English DT Article C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Eisenberg, J (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 3 TC 2 Z9 2 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 1047-2797 J9 ANN EPIDEMIOL JI Ann. Epidemiol. PD JUL PY 1998 VL 8 IS 5 BP 283 EP 285 PG 3 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA ZX194 UT WOS:000074488800001 PM 9669609 ER PT J AU Eisenberg, JM AF Eisenberg, JM TI Samuel Preston Martin III - 1916-1996 SO PROCEEDINGS OF THE ASSOCIATION OF AMERICAN PHYSICIANS LA English DT Biographical-Item C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Eisenberg, JM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 1081-650X J9 P ASSOC AM PHYSICIAN JI Proc. Assoc. Am. Phys. PD JUL-AUG PY 1998 VL 110 IS 4 BP 371 EP 372 PG 2 WC Medicine, General & Internal; Medicine, Research & Experimental SC General & Internal Medicine; Research & Experimental Medicine GA 101KB UT WOS:000074867200012 ER PT J AU Grimes, DA Atkins, D AF Grimes, DA Atkins, D TI The US preventive services task force: Putting evidence-based medicine to work SO CLINICAL OBSTETRICS AND GYNECOLOGY LA English DT Article ID INTERMITTENT AUSCULTATION; INTRAPARTUM C1 Family Hlth Int, Res Triangle Pk, NC 27709 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Grimes, DA (reprint author), Family Hlth Int, POB 13950, Res Triangle Pk, NC 27709 USA. NR 17 TC 14 Z9 14 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA SN 0009-9201 EI 1532-5520 J9 CLIN OBSTET GYNECOL JI Clin. Obstet. Gynecol. PD JUN PY 1998 VL 41 IS 2 BP 332 EP 342 DI 10.1097/00003081-199806000-00013 PG 11 WC Obstetrics & Gynecology SC Obstetrics & Gynecology GA ZU820 UT WOS:000074238400011 PM 9646965 ER PT J AU McCoskey, SK Selden, TM AF McCoskey, SK Selden, TM TI Health care expenditures and GDP: panel data unit root test results SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE health care expenditures; panel data; stationarity; unit roots ID CONVERSION FACTOR INSTABILITY; INTERNATIONAL COMPARISONS; TIME-SERIES; DETERMINANTS; COUNTRIES AB This short paper presents unit root test results for time series on per capita national health care expenditures and gross domestic product in the OECD. Unlike the country-by-country test used by [Hansen, P., King, A., 1996, The determinants of health care expenditure: A cointegration approach. J. Health Econ, 15, 127-137], the test we employ exploits the panel nature of the OECD data. Using this approach, we are able to reject the null hypothesis that these series contain unit roots. No single test is likely to be definitive in this rapidly-evolving area of econometric research; however, our results help to mitigate concern that panel data analyses of national health care expenditures an misspecified. (C) 1998 Elsevier Science B.V. All rights reserved. C1 Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. USN Acad, Dept Econ, Annapolis, MD 21402 USA. RP Selden, TM (reprint author), Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 26 TC 69 Z9 70 U1 3 U2 7 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD JUN PY 1998 VL 17 IS 3 BP 369 EP 376 DI 10.1016/S0167-6296(97)00040-4 PG 8 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA ZW170 UT WOS:000074382700006 PM 10180923 ER PT J AU Tulman, L AF Tulman, L TI Interventions to improve women's functional status: A systematic research review SO JOURNAL OF WOMENS HEALTH LA English DT Meeting Abstract C1 Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU MARY ANN LIEBERT INC PUBL PI LARCHMONT PA 2 MADISON AVENUE, LARCHMONT, NY 10538 USA SN 1059-7115 J9 J WOMENS HEALTH JI J. Womens Health PD JUN PY 1998 VL 7 IS 5 BP 629 EP 629 PG 1 WC Public, Environmental & Occupational Health; Medicine, General & Internal; Obstetrics & Gynecology; Women's Studies SC Public, Environmental & Occupational Health; General & Internal Medicine; Obstetrics & Gynecology; Women's Studies GA ZW759 UT WOS:000074445500063 ER PT J AU Hellinger, FJ AF Hellinger, FJ TI Regulating the financial incentives facing physicians in managed care plans SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article AB Recent accounts of enrollees in managed care plans being denied access to potentially lifesaving services have heightened public anxiety about the impact of managed care on the accessibility and appropriateness of care, and this anxiety has been translated into legislative action. The present review focuses on an area of managed care operations that has received considerable attention in state legislatures and in Congress during the past 2 years: the financial relationship between managed care health plans and physicians. Twelve states now mandate that managed care plans disclose information about their financial relationship with physicians, and 11 states regulate the method used by managed care health plans to compensate physicians. Most laws that regulate methods of compensation prohibit health plans from providing physicians an inducement to reduce or limit the delivery of "medically necessary" services. Moreover, in 1996 the Health Care Financing Administration finalized its regulations governing the financial incentives facing physicians in plans that treat Medicaid or Medicare patients, and these regulations went into effect on January 1, 1997. These regulations also are examined in this study. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. RP Hellinger, FJ (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Suite 500,2101 E Jefferson St, Rockville, MD 20852 USA. NR 28 TC 10 Z9 10 U1 1 U2 2 PU AMER MED PUBLISHING, M W C COMPANY PI OLD BRIDGE PA 1816 ENGLISHTOWN RD, STE 101, OLD BRIDGE, NJ 08857 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD MAY PY 1998 VL 4 IS 5 BP 663 EP 674 PG 12 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA ZP656 UT WOS:000073775300002 PM 10179920 ER PT J AU Cooper, JK Clancy, CM AF Cooper, JK Clancy, CM TI Health services research agenda for clinical preventive services SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article DE preventive health services; Agency for Health Care Policy and Research (AHCPR); cost effectiveness; quality assessment (health care) ID UNITED-STATES; PRIMARY-CARE; CANCER; ADHERENCE; BARRIERS; PROGRAM; FUTURE; BREAST; WOMEN; TIME C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Primary Care Res, Rockville, MD 20852 USA. RP Cooper, JK (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Primary Care Res, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 26 TC 5 Z9 5 U1 1 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD MAY PY 1998 VL 14 IS 4 BP 331 EP 334 DI 10.1016/S0749-3797(97)00056-1 PG 4 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA ZT446 UT WOS:000074088700011 PM 9635079 ER PT J AU Atkins, D DiGuiseppi, CG AF Atkins, D DiGuiseppi, CG TI Broadening the evidence base for evidence-based guidelines - A research agenda based on the work of the US Preventive Services Task Force SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article DE counseling; behavior change; intervention studies; periodicity; patient participation; risk assessment; meta-analysis ID PROSTATE-SPECIFIC ANTIGEN; CORONARY HEART-DISEASE; PRIMARY-CARE SETTINGS; MEDICAL-PRACTICE; FICSIT TRIALS; CARDIOVASCULAR-DISEASE; GENERAL-PRACTICE; DOWNS-SYNDROME; UNITED-STATES; BETA-CAROTENE AB Evidence-based evaluations of clinical preventive services help define priorities for research in prevention as part of primary health care. In this article, we draw on our experiences with the U.S. Preventive Services Task Force (USPSTF) to outline some major areas where research is needed to define the appropriate use of specific screening tests, counseling interventions, immunizations, and chemoprophylaxis. Areas of particular importance included research to: (1) Identify effective and practical primary care interventions for modifying personal health practices of patients, especially around issues such as diet, exercise, alcohol and drug use, and risky sexual behavior; (2) Clarify the optimal periodicity for certain screening tests and counseling interventions; (3) Identify practical nays to allow patients to share decision-making about preventive care, especially for services of possible but uncertain benefit; (4) Examine the most sensitive and efficient ways to identify high-risk groups who may need different services than the average population; and (5) Expand the use of decision-analysis and cost-effectiveness analysis to help identify optimal use of clinical preventive services. Given the difficulty of large, prospective trials, we discuss the use of alternative research designs to fill in critical gaps in the evidence for the effectiveness of specific services. Finally, we note several issues of increasing importance that may need to be addressed by future work of the USPSTF: what are the most reliable and effective ways to (1) measure and (2) improve the delivery and quality of preventive care provided in the primary care setting. C1 US Dept HHS, Agcy Hlth Care Policy & Res, US Prevent Serv Task Force, Rockville, MD 20852 USA. RP Atkins, D (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, US Prevent Serv Task Force, 6000 Execut Blvd,Suite 310, Rockville, MD 20852 USA. NR 78 TC 14 Z9 14 U1 1 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 655 AVENUE OF THE AMERICAS, NEW YORK, NY 10010 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD MAY PY 1998 VL 14 IS 4 BP 335 EP 344 DI 10.1016/S0749-3797(97)00058-5 PG 10 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA ZT446 UT WOS:000074088700012 PM 9635080 ER PT J AU Ray, NF Thamer, M Fadillioglu, B Gergen, PJ AF Ray, NF Thamer, M Fadillioglu, B Gergen, PJ TI Race, income, urbanicity, and asthma hospitalization in California - A small area analysis SO CHEST LA English DT Article DE Asian; asthma; black; California; ethnicity; hospitalization; income; Los Angeles; Mexican-American; race; small area analysis ID NEW-YORK-CITY; CHILDHOOD ASTHMA; SOCIOECONOMIC-STATUS; CHANGING PATTERNS; MEXICAN-AMERICAN; UNITED-STATES; MEDICAL-CARE; CHILDREN; MORTALITY; HEALTH AB Study objectives: To explicate the interrelationship between asthma hospitalization and race/ethnicity and income. Design: Small area ecologic analysis using census and administrative data. Setting and participants: All asthma hospitalizations in California were identified using the 1993 California Hospital Discharge file. Small area analyses of Los Angeles (LA) were compared with published rates in New York City (NYC). Results: In 1993, the age-adjusted asthma hospitalization rate in California for nonelderly blacks was 42.5/10,000-approximately four times higher than other populations. Black rates remained fourfold higher after stratification by age, income, and urbanicity. Multivariate analyses suggest that the association between black race and asthma hospitalization is independent of income. Regardless of race, children and persons living in poverty were at increased risk for asthma hospitalization. Urbanicity was not a predictor for asthma hospitalization. Overall, asthma hospitalization rates in NYC were 2.8 times higher compared with rates in LA; while rates were similar among blacks (60 vs 40/10,000, respectively), Puerto Rican Hispanics in NYC had dramatically higher rates compared with Mexican Hispanics in LA. (63 vs 14/10,000, respectively). Conclusions: After controlling for socioeconomic status, notable differences in asthma hospitalization by race and ethnicity persist. The reasons for the significantly elevated risk of asthma morbidity among blacks remain unclear. C1 Med Technol & Practice Patterns Inst, Washington, DC USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Ray, NF (reprint author), MEDTAP Int, 7101 Wisconsin Ave,Suite 600, Bethesda, MD 20814 USA. NR 38 TC 94 Z9 95 U1 0 U2 2 PU AMER COLL CHEST PHYSICIANS PI NORTHBROOK PA 3300 DUNDEE ROAD, NORTHBROOK, IL 60062-2348 USA SN 0012-3692 J9 CHEST JI Chest PD MAY PY 1998 VL 113 IS 5 BP 1277 EP 1284 DI 10.1378/chest.113.5.1277 PG 8 WC Critical Care Medicine; Respiratory System SC General & Internal Medicine; Respiratory System GA ZM939 UT WOS:000073591500026 PM 9596306 ER PT J AU Selden, TM Banthin, JS Cohen, JW AF Selden, TM Banthin, JS Cohen, JW TI Medicaid's problem children: Eligible but not enrolled SO HEALTH AFFAIRS LA English DT Article ID INSURANCE C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Finance Studies, Rockville, MD 20852 USA. RP Selden, TM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Finance Studies, Rockville, MD 20852 USA. NR 21 TC 71 Z9 71 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAY-JUN PY 1998 VL 17 IS 3 BP 192 EP 200 DI 10.1377/hlthaff.17.3.192 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA ZU164 UT WOS:000074168700014 PM 9637975 ER PT J AU Buchmueller, TC Zuvekas, SH AF Buchmueller, TC Zuvekas, SH TI Drug use, drug abuse, and labour market outcomes SO HEALTH ECONOMICS LA English DT Article DE employment; illicit drug use; income; labour market ID ALCOHOL; WAGES; MARIJUANA; INCOME; ERROR AB This paper examines the relationship between illicit drug use and labour market success, and in doing so addresses two shortcomings of the previous literature. First, unlike many previous analyses, ours accounts for differences in intensity of use using clinically based diagnostic measures. Second, while recent studies focus only on young adults, we analyze a prime-age (30-45-year-olds) sample as well. Our results indicate that these differences are important. Similar to previous studies, we find evidence of a positive relationship between drug use and income for young workers. However, we also find some evidence of lower incomes for young workers reporting daily use of illicit drugs. For prime-age men, we find strong evidence that problematic drug use (as indicated by either a diagnosis of pathological use or dependence or by daily use) is negatively related to income. We also find a negative relationship between problematic use and employment among prime-age, but not younger, men. (C) 1998 John Wiley & Sons, Ltd. C1 Univ Calif Irvine, Grad Sch Management, Irvine, CA 92697 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Buchmueller, TC (reprint author), Univ Calif Irvine, Grad Sch Management, Irvine, CA 92697 USA. NR 34 TC 21 Z9 21 U1 1 U2 4 PU JOHN WILEY & SONS LTD PI W SUSSEX PA BAFFINS LANE CHICHESTER, W SUSSEX PO19 1UD, ENGLAND SN 1057-9230 J9 HEALTH ECON JI Health Econ. PD MAY PY 1998 VL 7 IS 3 BP 229 EP 245 DI 10.1002/(SICI)1099-1050(199805)7:3<229::AID-HEC315>3.0.CO;2-R PG 17 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA ZP189 UT WOS:000073726400004 PM 9639336 ER PT J AU Moy, E Bartman, BA Clancy, CM Cornelius, LJ AF Moy, E Bartman, BA Clancy, CM Cornelius, LJ TI Changes in usual sources of medical care between 1987 and 1992 SO JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED LA English DT Article DE health services accessibility; health services needs and demand; ambulatory care; health services research ID CITY MINORITY POPULATION; HEALTH-CARE; AMBULATORY CARE; REGULAR SOURCE; RISK-FACTORS; ACCESS; MAMMOGRAPHY; EMERGENCY; IMPACT; INSURANCE AB This study is a secondary analysis of data from the 1987 and 1992 National Health Interview Surveys. Analyses compared adults who do not have a usual source of care and those who identified usual sources of care in 1987 and 1992. Between these years, the estimated number of adult Americans without a usual source of care rose from 29.7 to 39.4 million. Adults were 0.75 rimes less likely to identify a physician's office and 1.8 times more likely to identify nit outpatient clinic as that source of cave in 1992 than they were in 1987. These changes were observed among Americans of all demographic and socioeconomic backgrounds. Increasing numbers of adult Americans without a usual source of care and shifts ill care from physicians' offices to outpatient clinics may reflect deteriorating access to care. This may affect quality and costs of medical care, demanding continued surveillance of sources and access to care. C1 Assoc Amer Med Coll, Ctr Assessment & Management Change Acad Med, Washington, DC 20037 USA. Univ Maryland, Sch Med, Organized Res Ctr Hlth Policy & Hlth Serv Res, Baltimore, MD 21201 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. Univ Maryland, Sch Social Work, Baltimore, MD 21201 USA. RP Moy, E (reprint author), Assoc Amer Med Coll, Ctr Assessment & Management Change Acad Med, 2450 N St NW, Washington, DC 20037 USA. NR 51 TC 17 Z9 17 U1 0 U2 0 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1049-2089 J9 J HEALTH CARE POOR U JI J. Health Care Poor Underserved PD MAY PY 1998 VL 9 IS 2 BP 126 EP 139 PG 14 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA ZK556 UT WOS:000073336800003 PM 10073198 ER PT J AU Clancy, CM AF Clancy, CM TI Continuous quality improvement and primary care SO MEDICAL CARE LA English DT Editorial Material C1 Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD USA. Agcy Hlth Care Policy & Res, Ctr Primary Care Res, Rockville, MD USA. RP Clancy, CM (reprint author), Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD USA. NR 9 TC 2 Z9 2 U1 1 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 1998 VL 36 IS 5 BP 619 EP 620 DI 10.1097/00005650-199805000-00001 PG 2 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA ZM940 UT WOS:000073591600001 PM 9596052 ER PT J AU Dillingham, TR Pezzin, LE Lauder, TD AF Dillingham, TR Pezzin, LE Lauder, TD TI Cervical paraspinal muscle abnormalities and symptom duration: A multivariate analysis SO MUSCLE & NERVE LA English DT Article; Proceedings Paper CT AAPM&R Annual Meeting CY 1995 CL ORLANDO, FLORIDA DE paraspinal muscles; cervical radiculopathy; electromyography; nerve conduction; neck pain AB The purpose of this study was to determine whether paraspinal and other major proximal and distal muscle spontaneous activity (SA) is related to cervical radiculopathy (CR) symptom duration. A multivariate analysis of 124 (retrospectively identified) electrodiagnostically confirmed CRs was used to test these hypotheses. The results showed no evidence of correlation between SA and symptom duration for any of the upper limb muscles analyzed. (C) 1998 John Wiley & Sons, Inc. C1 Johns Hopkins Univ, Dept Phys Med & Rehabil, Baltimore, MD 21239 USA. Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Madigan Army Med Ctr, Dept Phys Med & Rehabil, Tacoma, WA 98431 USA. RP Dillingham, TR (reprint author), 10352 Waverly Woods Dr, Ellicott City, MD 21042 USA. NR 14 TC 12 Z9 12 U1 0 U2 0 PU JOHN WILEY & SONS INC PI NEW YORK PA 605 THIRD AVE, NEW YORK, NY 10158-0012 USA SN 0148-639X J9 MUSCLE NERVE JI Muscle Nerve PD MAY PY 1998 VL 21 IS 5 BP 640 EP 642 DI 10.1002/(SICI)1097-4598(199805)21:5<640::AID-MUS11>3.0.CO;2-Z PG 3 WC Clinical Neurology; Neurosciences SC Neurosciences & Neurology GA ZJ453 UT WOS:000073217200011 PM 9572244 ER PT J AU Stryer, DB AF Stryer, DB TI Cardiac troponins in patients with chest pain SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Letter C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Stryer, DB (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 1 TC 6 Z9 6 U1 0 U2 0 PU MASS MEDICAL SOC PI BOSTON PA 10 SHATTUCK, BOSTON, MA 02115 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD APR 30 PY 1998 VL 338 IS 18 BP 1314 EP 1314 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA ZK547 UT WOS:000073335800021 PM 9565494 ER PT J AU Hellinger, FJ AF Hellinger, FJ TI The effect of managed care on quality - A review of recent evidence SO ARCHIVES OF INTERNAL MEDICINE LA English DT Review ID FEE-FOR-SERVICE; HEALTH MAINTENANCE ORGANIZATION; PREPAID GROUP-PRACTICE; MEDICAL OUTCOMES; SYSTEMS; PLANS; SPECIALTIES; ACCESS; TRIAL; HMOS AB This article reviews recent evidence about the relationship between managed care and quality. With one exception, the studies reviewed represent observation periods that extend through 1990 or a more recent year. The review has led to the conclusion that managed care has not decreased the overall effectiveness of care. However, evidence suggests that managed care may adversely affect the health of some vulnerable subpopulations. Evidence also suggests that enrollees in managed care plans are less satisfied with their care and have more problems accessing specialized services. In addition, younger, wealthier, and healthier persons were more satisfied with their health plans than older, poorer, and sicker persons, even after adjusting for the type of health plan. The findings of the studies reviewed do not provide definitive results about the effect of managed care on quality. Indeed, relatively few studies include data from the 1990s, and little is known about the newer types of health maintenance organizations that invest heavily in information systems and rely on financial incentives to alter practice patterns. Furthermore, managed care is not a uniform method that is applied identically by all health plans, and research studying the dimensions of managed care also is needed. C1 Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Hellinger, FJ (reprint author), Agcy Hlth Care Policy & Res, Suite 500,2102 E Jefferson St, Rockville, MD 20852 USA. NR 37 TC 67 Z9 67 U1 0 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0003-9926 J9 ARCH INTERN MED JI Arch. Intern. Med. PD APR 27 PY 1998 VL 158 IS 8 BP 833 EP 841 DI 10.1001/archinte.158.8.833 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA ZJ190 UT WOS:000073188500001 PM 9570168 ER PT J AU Reschovsky, JD AF Reschovsky, JD TI The demand for post-acute and chronic care in nursing homes SO MEDICAL CARE LA English DT Article DE long-term care; length of stay; Medicare; Medicaid; economic factors ID DETERMINANTS; LONG AB OBJECTIVES. Nursing homes provide care for persons with both post-acute and chronic conditions. In general, these two types of patients are associated with short and long stays, respectively. They also tend to be covered by different public or private insurance plans. The author investigated whether and how the demand for these two types of nursing home care differ. How alternative definitions of post-acute and chronic care nursing home stays affect estimates also was explored. METHODS. Data on a sample of elderly persons from the National Long-Term Care Channeling Demonstration was used. To account for market disequilibrium, demand was estimated using a bivariate probit with partial observability model. RESULTS. Differences were found in the demand for the two types of nursing home care. For instance, economic factors and functional and cognitive limitations were relatively more important in the demand for nursing home care for chronic conditions. Further, chronic care patients appeared more likely to face problems of access into nursing homes. Classifying nursing home stays by payer, rather than by length of stay, captured expectations at admission and appeared to reflect consumer behavior better. CONCLUSIONS. Differentiating post-acute and chronic care nursing home stays provides more meaningful information on consumer demand for nursing home care and will facilitate policy analysis in this area. C1 Ctr Studying Hlth Syst Change, Washington, DC 20024 USA. Agcy Hlth Care Policy & Res, Rockville, MD USA. RP Reschovsky, JD (reprint author), Ctr Studying Hlth Syst Change, 600 Maryland Ave SW,Suite 550, Washington, DC 20024 USA. NR 22 TC 11 Z9 11 U1 0 U2 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD APR PY 1998 VL 36 IS 4 BP 475 EP 490 DI 10.1097/00005650-199804000-00004 PG 16 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA ZF245 UT WOS:000072878200004 PM 9544588 ER PT J AU Fleishman, JA Crystal, S AF Fleishman, JA Crystal, S TI Functional status transitions and survival in HIV disease - Evidence from the AIDS costs and service utilization survey SO MEDICAL CARE LA English DT Article DE AIDS; functional status; health status; survival ID PLACEBO-CONTROLLED TRIAL; QUALITY-OF-LIFE; HEALTH-STATUS; INFECTION; ZIDOVUDINE AB OBJECTIVE. The authors examined the prevalence of limitations in physical functioning in a large sample of people with human immunodeficiency virus (HIV) infection and the patterns of change in their functional status with time. METHODS. Patients receiving treatment for HIV infection were sampled from 26 providers in 10 cities across the United States; the analytic sample included 1,784 adults with HIV infection. Functional status was measured three times during a 12-month period. Respondents indicated whether they were limited in their ability to perform six activities, ranging from vigorous activities to bathing and dressing. Responses to the six items were combined to form an index of physical functioning. Medical records were used to determine stage of HIV infection, and death records were used to determine vital status. Changes in functional status during a 1-year period were assessed; correlates of change were examined using multinomial logistic regression, with "deceased" included as an outcome state. RESULTS. Limitation was most prevalent for vigorous activities (55%) and least prevalent for activities of daily living (12%). For each activity, the prevalence of limitations rose with increasing disease severity. During 1 year, 43% of respondents did not change in functional status, whereas 42% became worse and 15% reported improved functioning. Controlling for prior functional status, multivariate analyses showed that declines in functioning were related to developing acquired immunodeficiency syndrome (AIDS), to prior reports of fatigue, and to poor self-rated health. These same variables also predicted mortality. CONCLUSIONS. Results suggest that the most prevalent types of home care assistance needed by those with HIV disease involve help with energy-demanding activities, such as shopping, and that nonuniform patterns of change in functioning necessitate flexible programs to meet frequently changing needs. C1 Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. Rutgers State Univ, Inst Hlth Hlth Care Policy & Aging Res, AIDS Res Grp, New Brunswick, NJ 08903 USA. RP Fleishman, JA (reprint author), Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 16 TC 25 Z9 25 U1 1 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 USA SN 0025-7079 J9 MED CARE JI Med. Care PD APR PY 1998 VL 36 IS 4 BP 533 EP 543 DI 10.1097/00005650-199804000-00009 PG 11 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA ZF245 UT WOS:000072878200009 PM 9544593 ER PT J AU Simpson, L Kamerow, D Fraser, I AF Simpson, L Kamerow, D Fraser, I TI Pediatric guidelines and managed care: Who is using what and what difference does it make? SO PEDIATRIC ANNALS LA English DT Article C1 US Dept HHS, Agcy Hlth Care Policy & Res, Washington, DC 20201 USA. RP Simpson, L (reprint author), 2101 E Jefferson St,Suite 600, Rockville, MD 20852 USA. NR 56 TC 3 Z9 4 U1 0 U2 0 PU SLACK INC PI THOROFARE PA 6900 GROVE RD, THOROFARE, NJ 08086 USA SN 0090-4481 J9 PEDIATR ANN JI Pediatr. Annu. PD APR PY 1998 VL 27 IS 4 BP 234 EP 240 PG 7 WC Pediatrics SC Pediatrics GA ZL555 UT WOS:000073446100009 PM 9589503 ER PT J AU Mecklenburg, RE AF Mecklenburg, RE TI Tobacco: Addiction, oral health, and cessation SO QUINTESSENCE INTERNATIONAL LA English DT Article C1 Natl Canc Inst, Smoking & Tobacco Control Program, Bethesda, MD 20892 USA. Agcy Hlth Care Policy & Res, Rockville, MD USA. RP Mecklenburg, RE (reprint author), 12304 Rivers Edge Dr, Potomac, MD 20854 USA. NR 0 TC 5 Z9 5 U1 0 U2 0 PU QUINTESSENCE PUBL CO INC PI CAROL STREAM PA 551 NORTH KIMBERLY DR, CAROL STREAM, IL 60188-1881 USA SN 0033-6572 J9 QUINTESSENCE INT JI Quintessence Int. PD APR PY 1998 VL 29 IS 4 BP 250 EP 252 PG 3 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA ZK702 UT WOS:000073352600013 PM 9643264 ER PT J AU Ommaya, AK Simpson, L Walker, E AF Ommaya, AK Simpson, L Walker, E TI More on assessing outcomes of emergency care SO ACADEMIC EMERGENCY MEDICINE LA English DT Article; Proceedings Paper CT Future of Emergency Medicine Research Conference CY MAR 06-07, 1997 CL WASHINGTON, D.C. SP Emergency Med Fdn, Soc Acad Emergency Med, Assoc Acad Chairs Emergency Med DE research; emergency medicine; outcomes C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Ommaya, AK (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 9 TC 2 Z9 2 U1 0 U2 0 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD MAR PY 1998 VL 5 IS 3 BP 269 EP 271 PG 3 WC Emergency Medicine SC Emergency Medicine GA ZA919 UT WOS:000072415200016 PM 9523940 ER PT J AU Clancy, CM Cooper, JK AF Clancy, CM Cooper, JK TI Approaches to primary care: Current realities and future visions SO AMERICAN JOURNAL OF MEDICINE LA English DT Editorial Material ID MEDICINE; REFORM C1 Agcy Hlth Care Policy & Res, Ctr Primary Care Res, Rockville, MD 20852 USA. RP Clancy, CM (reprint author), Agcy Hlth Care Policy & Res, Ctr Primary Care Res, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 14 TC 0 Z9 0 U1 0 U2 0 PU EXCERPTA MEDICA INC PI NEW YORK PA 245 WEST 17TH STREET, NEW YORK, NY 10011 USA SN 0002-9343 J9 AM J MED JI Am. J. Med. PD MAR PY 1998 VL 104 IS 3 BP 215 EP 218 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA ZE582 UT WOS:000072808600001 PM 9552082 ER PT J AU Dillingham, TR Pezzin, LE Lauder, TD AF Dillingham, TR Pezzin, LE Lauder, TD TI Relationship between muscle abnormalities and symptom duration in lumbosacral radiculopathies SO AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION LA English DT Article DE paraspinal muscles; lumbosacral radiculopathy; electromyography; nerve conduction; back pain ID QUANTIFIED NEEDLE ELECTROMYOGRAPHY; PARASPINAL MUSCLES; SCREEN; NUMBER AB A long held notion in the electrodiagnostic literature is that paraspinal muscles tend to show electromyographic abnormalities early on in a lumbosacral radiculopathy and that more distal muscles become abnormal later in the disease process. The purpose of this study was to determine whether paraspinal muscles and other major proximal and distal muscle abnormalities are related to lumbosacral radiculopathy symptom duration. A multivariate legit analysis of 139 patients (retrospectively identified) with electrodiagnostically confirmed lumbosacral radiculopathies was used to test these hypotheses. Maximum likelihood estimates showed no evidence of correlation between abnormal paraspinal muscles and symptom duration. Symptom duration was also insignificant for the remaining five lower limb muscles analyzed. We conclude that the probability of having electromyographic abnormalities is not related to symptom duration. A prospective study is needed to confirm these findings. Nonetheless, clinicians should use caution when interpreting electrodiagnostic findings based on symptom duration. C1 Johns Hopkins Univ, Dept Phys Med & Rehabil, Baltimore, MD USA. Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Madigan Army Med Ctr, Dept Phys Med & Rehabil, Tacoma, WA 98431 USA. RP Dillingham, TR (reprint author), 10352 Waverly Woods Dr, Ellicott City, MD 21042 USA. NR 29 TC 11 Z9 11 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 USA SN 0894-9115 J9 AM J PHYS MED REHAB JI Am. J. Phys. Med. Rehabil. PD MAR-APR PY 1998 VL 77 IS 2 BP 103 EP 107 DI 10.1097/00002060-199803000-00004 PG 5 WC Rehabilitation; Sport Sciences SC Rehabilitation; Sport Sciences GA ZH218 UT WOS:000073084800003 PM 9558009 ER PT J AU Ommaya, AK Simpson, L Walker, E AF Ommaya, AK Simpson, L Walker, E TI More on assessing outcomes of emergency care SO ANNALS OF EMERGENCY MEDICINE LA English DT Editorial Material AB New methods of assessing the outcomes of emergency department care are needed to provide information to purchasers, plans, providers, and patients to prove improvements in EMS sysytem organization, quality, efficiency, and patient satisfaction. This commentary expands on the important components of an outcomes research agenda for ED care. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Ommaya, AK (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 9 TC 3 Z9 3 U1 0 U2 0 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD MAR PY 1998 VL 31 IS 3 BP 301 EP 303 DI 10.1016/S0196-0644(98)70338-5 PG 3 WC Emergency Medicine SC Emergency Medicine GA YZ560 UT WOS:000072266300004 PM 9506485 ER PT J AU Dillingham, TR Pezzin, LE MacKenzie, EJ AF Dillingham, TR Pezzin, LE MacKenzie, EJ TI Incidence, acute care length of stay, and discharge to rehabilitation of traumatic amputee patients: An epidemiologic study SO ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION LA English DT Article ID LOWER-EXTREMITY AMPUTATIONS; LOWER-LIMB AMPUTATIONS AB Objective: To examine patterns of trauma-related amputations over time by age and gender of the patient and by level and type of amputation, and to explore factors affecting acute care length of stay and discharge to inpatient rehabilitation. Design: Population-based hospital discharge data for Maryland from 1979 through 1993. Participants: Patients (N = 6,069) discharged with either (1) a principal or secondary diagnosis of a trauma-related amputation to the upper or lower extremity or (2) a procedure code for a lower or upper limb amputation in combination with a principal diagnosis of an extremity injury or injury-related complication. Results: Incidence of major amputations declined 3.4% (p < .05) annually from 1.88 per 100,000 in 1979 to 1.07 per 100,000 in 1993. Incidence of minor amputations declined 4.8% (p < .05) annually from 10.8 per 100,000 in 1979 to 4.7 per 100,000 in 1993. Acute care length of stay for trauma-related amputations declined 40% over the study period and was significantly affected by the patient's payer source, amputation level, and injury characteristics. Of the patients with a major amputation, 15% were discharged to inpatient rehabilitation; 60% were discharged directly home. More proximal amputation levels, presence of severe injuries to other body systems, and acute care at a designated trauma center significantly increased the likelihood of disposition to inpatient rehabilitation. The leading causes of trauma-related amputation were injuries involving machinery (40.1%), powered tools and appliances (27.8%), firearms (8.5%), and motor vehicle crashes (8%). Conclusions: Findings suggest a substantial decline in incidence rates of both major and minor amputations over the 15-year study period, a low rate of disposition to inpatient rehabilitation services of patients sustaining major amputations, and an apparent role of firearms as a cause of trauma-related amputations in patients younger than 25 years of age. The consequences of increasingly shorter acute care hospital stays and low rates of discharge to inpatient rehabilitation on the long-term outcomes of persons who have had traumatic amputation should be examined. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. C1 Johns Hopkins Univ, Dept Phys Med & Rehabil, Baltimore, MD USA. Johns Hopkins Univ, Ctr Injury Res & Policy, Baltimore, MD USA. US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Dillingham, TR (reprint author), 10352 Waverly Woods Dr, Ellicott City, MD 21042 USA. FU PHS HHS [R49/CCR302486] NR 35 TC 66 Z9 67 U1 1 U2 6 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0003-9993 J9 ARCH PHYS MED REHAB JI Arch. Phys. Med. Rehabil. PD MAR PY 1998 VL 79 IS 3 BP 279 EP 287 DI 10.1016/S0003-9993(98)90007-7 PG 9 WC Rehabilitation; Sport Sciences SC Rehabilitation; Sport Sciences GA ZB671 UT WOS:000072495900008 PM 9523779 ER PT J AU Weinick, RM Weigers, ME Cohen, JW AF Weinick, RM Weigers, ME Cohen, JW TI Children's health insurance, access to care, and health status: New findings SO HEALTH AFFAIRS LA English DT Article C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Weinick, RM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 16 TC 88 Z9 88 U1 0 U2 3 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 1998 VL 17 IS 2 BP 127 EP 136 DI 10.1377/hlthaff.17.2.127 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA ZE338 UT WOS:000072782600012 PM 9558790 ER PT J AU Hellinger, FJ AF Hellinger, FJ TI Cost and financing of care for persons with HIV disease: An overview SO HEALTH CARE FINANCING REVIEW LA English DT Article ID QUALITY-OF-LIFE; UNITED-STATES; MEDICAL-CARE; INFECTION; HEALTH; AIDS; MARYLAND AB This article explores the impact of new combination drug therapies on the cost and financing of human immunodeficiency virus (HIV) disease. Evidence indicates that the proportion of costs attributable to drugs has increased significantly since the diffusion of new combination drug therapies, and that the proportion of costs attributable to hospital inpatient care has decreased. The absence of timely data is the major difficulty in analyzing the impact of recent changes. Only two studies have examined costs since the diffusion of new combination drug therapies, and there are no recent studies of the insurance status of Persons with HIV disease. C1 Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. RP Hellinger, FJ (reprint author), Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Suite 601,2101 E Jefferson St, Rockville, MD 20852 USA. NR 31 TC 13 Z9 13 U1 0 U2 0 PU HEALTH CARE FINANCING REVIEW PI BALTIMORE PA 7500 SECURITY BLVD, C-3-11-07, BALTIMORE, MD 21224-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 1998 VL 19 IS 3 BP 5 EP 18 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 140BR UT WOS:000077067300002 PM 10345413 ER PT J AU So, AD AF So, AD TI Free gifts - Redundancy or conundrum? SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material ID DRUG; PHYSICIANS; BEHAVIOR; POLICIES C1 Agcy Hlth Care Policy & Res, Washington, DC USA. RP So, AD (reprint author), Agcy Hlth Care Policy & Res, Washington, DC USA. NR 21 TC 3 Z9 3 U1 0 U2 0 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD MAR PY 1998 VL 13 IS 3 BP 213 EP 215 PG 3 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA ZC325 UT WOS:000072565900011 PM 9541380 ER PT J AU Stryer, DB AF Stryer, DB TI Physicians' use of lumbar spine imaging tests SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Letter C1 Ctr Outcomes & Effectiveness Res, Agcy Hlth Care Policy & Res, Rockville, MD USA. RP Stryer, DB (reprint author), Ctr Outcomes & Effectiveness Res, Agcy Hlth Care Policy & Res, Rockville, MD USA. NR 4 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD MAR PY 1998 VL 13 IS 3 BP 218 EP 219 DI 10.1007/s11606-998-0025-2 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA ZC325 UT WOS:000072565900015 PM 9541383 ER PT J AU Baine, WB Yu, W Weis, KA AF Baine, WB Yu, W Weis, KA TI Hospitalization for cardiac conduction disorders and arrhythmias in elderly Americans, 1991-1995. Application of Medicare claims data. SO JOURNAL OF INVESTIGATIVE MEDICINE LA English DT Meeting Abstract C1 Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU SLACK INC PI THOROFARE PA 6900 GROVE RD, THOROFARE, NJ 08086 USA SN 1081-5589 J9 J INVEST MED JI J. Invest. Med. PD MAR PY 1998 VL 46 IS 3 SU S BP 212A EP 212A PG 1 WC Medicine, General & Internal; Medicine, Research & Experimental SC General & Internal Medicine; Research & Experimental Medicine GA ZK545 UT WOS:000073335300131 ER PT J AU Stryer, DB AF Stryer, DB TI Affirmative action and special consideration admissions to medical school SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter ID MINORITY C1 Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. RP Stryer, DB (reprint author), Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. NR 6 TC 1 Z9 1 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD FEB 18 PY 1998 VL 279 IS 7 BP 508 EP 508 DI 10.1001/jama.279.7.508 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA YW470 UT WOS:000071938900020 PM 9480355 ER PT J AU Fitzmaurice, JM AF Fitzmaurice, JM TI A new twist in US health care data standards development: adoption of electronic health care transactions standards for administrative simplification SO INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS LA English DT Article; Proceedings Paper CT Meeting on Standardisation in Health Informatics - Towards Global Consensus and Cooperation CY SEP 11-13, 1997 CL HAMILTON, BERMUDA SP Int Med Informat Assoc, Working Grp 16 DE standards; informatics; health care data; HISB; HIPAA; computer-based patient record; AHCPR; privacy AB To reduce the costs of common administrative transactions, health plans, payers and providers encouraged the US Congress to legislate administrative simplification of specific electronic health data transactions. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 created incentives for a public-private partnership to develop and implement standards for the uniformity of health care data used in electronic administrative health transactions and standards for the privacy and security of individually identifiable health information. The standards' requirements of HIPAA and how they have been met by the US government hold promise for accelerating the uniform adoption of standards developed by accredited standards developing organizations. The transactions designated by Congress, the process of choosing the standards in the Department of Health and Human Services, the principles that guided these choices, and the actual choices, are presented here. A successful partnership for administrative health data standards can pave the way for success in clinical health data standards and their application in computer-based patient record systems. Published by Elsevier Science B.V. All rights reserved. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Informat Technol, Rockville, MD 20852 USA. RP Fitzmaurice, JM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Informat Technol, 2101 E Jefferson St,Suite 602, Rockville, MD 20852 USA. NR 6 TC 6 Z9 6 U1 1 U2 1 PU ELSEVIER SCI IRELAND LTD PI CLARE PA CUSTOMER RELATIONS MANAGER, BAY 15, SHANNON INDUSTRIAL ESTATE CO, CLARE, IRELAND SN 1386-5056 J9 INT J MED INFORM JI Int. J. Med. Inform. PD FEB PY 1998 VL 48 IS 1-3 BP 19 EP 28 DI 10.1016/S1386-5056(97)00104-4 PG 10 WC Computer Science, Information Systems; Health Care Sciences & Services; Medical Informatics SC Computer Science; Health Care Sciences & Services; Medical Informatics GA ZG242 UT WOS:000072981400004 PM 9600398 ER PT J AU Spector, WD Fortinsky, RH AF Spector, WD Fortinsky, RH TI Pressure ulcer prevalence in Ohio nursing homes - Clinical and facility correlates SO JOURNAL OF AGING AND HEALTH LA English DT Article ID RESIDENT ASSESSMENT; SORE RISK; MODELS; CARE; MDS AB Pressure ulcers remain a common medical problem in nursing homes, despite the development of clinical guidelines for prevention and treatment. Prevention involves low technology but vigilant care. If the disease progresses, infections can develop, and surgery may be necessary to prevent death. This article examines pressure ulcer correlates in a representative sample of 15,121 nursing home residents in 1994 in the state of Ohio, The prevalence of pressure ulcers was 12%, 8% for Stage 2 or greater. The study found that many nursing home residents remain at great risk of developing pressure ulcers. Important risk factors included a history of cured pressure ulcers, new admission and readmissions, dependencies in activities of daily living, weight loss and dehydration, diabetes, edema, and incontinence. After controlling for clinical factors, residents in rural facilities were less likely to have a pressure ulcer. These findings suggest that the quality of pressure ulcer care in nursing homes could improve. C1 Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. Case Western Reserve Univ, Cleveland, OH 44106 USA. RP Spector, WD (reprint author), Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Suite 500,2101 E Jefferson St, Rockville, MD 20852 USA. NR 32 TC 20 Z9 20 U1 0 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0898-2643 J9 J AGING HEALTH JI J. Aging Health PD FEB PY 1998 VL 10 IS 1 BP 62 EP 80 DI 10.1177/089826439801000104 PG 19 WC Gerontology; Health Policy & Services SC Geriatrics & Gerontology; Health Care Sciences & Services GA YV648 UT WOS:000071848800004 PM 10182418 ER PT J AU Fiscella, K Franks, P Clancy, CM AF Fiscella, K Franks, P Clancy, CM TI Skepticism toward medical care and health care utilization SO MEDICAL CARE LA English DT Article DE attitude to health; health behavior; health services ID PHYSICIAN UTILIZATION; FAMILY PHYSICIANS; SOCIAL-FACTORS; OUTCOMES; LIFE; INTERNISTS AB OBJECTIVES. AS health care moves toward systems that assume accountability for defined populations, there has been increasing emphasis on developing performance measures for those systems and their providers, with little attention given to patient demand or attitudinal factors. The impact of skepticism toward health care providers on health behavior and health care utilization was assessed using a cross-sectional analysis of data from the 1987 National Medical Expenditure Survey (NMES). METHODS. A nationally representative sample from the United States comprising 18,240 persons 25 years and older was surveyed. Skepticism, defined as doubts about the ability of conventional medical care to appreciably alter one's health status, was assessed through a 4-item scale. Outcome measures included health behavior, access (health care insurance, having a regular source of fare, and physician type), utilization (annual number of physician or emergency department visits and hospitalizations), total annual health care expenditures, and preventive health care behavior (having had a Pap smear within 3 years or ever having had a mammogram). RESULTS. In multivariate analyses, skepticism was associated with younger age, white race, lower income, less education, and higher health perceptions. After adjusting for these variables, skepticism was associated with less healthy behavior, with not having health insurance, not having one's own physician, choice of a physician, fewer physician and emergency department visits, less frequent hospitalizations, lower annual health care expenditures, and less prevention compliance. CONCLUSIONS. Medical skepticism represents a relevant patient demand factor that demonstrates significant associations with a variety of health care access and utilization measures with important policy implications. C1 Univ Rochester, Sch Med & Dent, Highland Hosp, Primary Care Inst, Rochester, NY USA. Univ Rochester, Sch Med & Dent, Dept Family Med, Rochester, NY USA. Agcy Hlth Care Policy & Res, Ctr Outcome & Effect Res, Rockville, MD USA. Agcy Hlth Care Policy & Res, Ctr Primary Care Res, Rockville, MD USA. RP Fiscella, K (reprint author), Family Med Ctr, 885 South Ave, Rochester, NY 14620 USA. NR 30 TC 100 Z9 100 U1 1 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 USA SN 0025-7079 J9 MED CARE JI Med. Care PD FEB PY 1998 VL 36 IS 2 BP 180 EP 189 DI 10.1097/00005650-199802000-00007 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA YW139 UT WOS:000071902200007 PM 9475472 ER PT J AU Gergen, PJ Fowler, JA Maurer, KR Davis, WW Overpeck, MD AF Gergen, PJ Fowler, JA Maurer, KR Davis, WW Overpeck, MD TI The burden of environmental tobacco smoke exposure on the respiratory health of children 2 months through 5 years of age in the United States: Third National Health and Nutrition Examination Survey, 1988 to 1994 SO PEDIATRICS LA English DT Article DE environmental tobacco smoke (ETS); asthma; wheeze; chronic bronchitis; children; attributable risk ID PASSIVE-SMOKING; CHILDHOOD ASTHMA; MATERNAL SMOKING; PARENTAL SMOKING; URINARY COTININE; 1ST YEAR; ILLNESS; INFANTS; FAMILY; LIFE AB Objective. To measure the effect of environmental tobacco smoke (ETS) on respiratory health in a national sample of young children. Methods. The study evaluated children 2 months through 5 years of age participating in the Third National Health and Nutrition Examination Survey, 1988 to 1994. The group was a representative sample of the US population (N = 7680). A parental report of household smoking or maternal smoking during pregnancy ascertained ETS exposure, Respiratory outcomes were based on parental report of wheezing, cough, upper respiratory infection, or pneumonia in the last 12 months and chronic bronchitis or physician-diagnosed asthma at any time. Logistic regression was used to adjust for age, sex, race/ethnicity, birth weight, day care, family history of allergy, breastfeeding, education level of head of household, and household size. Results. Approximately 38% of children were presently exposed to ETS in the home, whereas 23.8% were exposed by maternal smoking during pregnancy. ETS exposure increased chronic bronchitis and three or more episodes of wheezing among children 2 months to 2 years old and asthma among children 2 months to 5 years old. For household exposure, a consistent effect was seen only at greater than or equal to 20 cigarettes smoked per day. Adjusted odds ratios for increased risk (95% confidence interval) for household exposures greater than or equal to 20 cigarettes smoked per day vs none smoked) and maternal prenatal exposure (prenatal smoking vs no smoking), respectively, for children 2 months to 2 years old were chronic bronchitis, 2.5 (1.6, 4.1); 2.2, (1.6, 3); three or more episodes of wheezing, 2.7 (1.7, 4.2), 2.1 (1.5, 2.9); and for children 2 months to 5 years old were asthma, 2.1 (1.4, 3.2); 1.8 (1.3, 2.6). Reported use within the past month of prescription medications for asthma (beta-agonists or inhaled steroids) was not different between those with asthma reporting ETS exposure and those reporting no exposure; percent of patients with asthma reporting use of medication by household exposure was 0, 25.7%; 1 to 19 cigarettes smoked per day, 32.9%; and greater than or equal to 20 cigarettes smoked per day, 23.1%; percent of patients with asthma reporting use of medication by maternal smoking during pregnancy was no, 28.9%; yes, 22.7%. Among children 2 months to 2 years of age exposed to ETS, 40% to 60% of the cases of asthma, chronic bronchitis, and three or more episodes of wheezing were attributable to ETS exposure, For diagnosed asthma among children 2 months through 5 years old, there were 133 800 to 161 600 excess cases. Among exposed children 2 months through 2 years of age, there were 61 000 to 79 200 excess cases of chronic bronchitis and 126 700 to 172 000 excess cases of three or more episodes of wheezing. Conclusions. ETS exposure is common among children in the United States. The reported prevalence of asthma, wheezing, and chronic bronchitis was increased with ETS exposures. No statistically significant increase in the prevalence of upper respiratory infection, pneumonia, or cough was associated with ETS exposure. ETS exposure has little effect on the respiratory health of children between 3 and 5 years of age, with the exception of asthma. ETS appears to increase the prevalence of asthma rather than the severity as measured by medication use. These findings reinforce the need to reduce the exposure of young children to ETS. C1 CPCR, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. Klemm Anal Grp Inc, Hyattsville, MD USA. Ctr Dis Control & Prevent, Natl Ctr Hlth Care Stat, Hyattsville, MD USA. NICHHD, NIH, Bethesda, MD 20892 USA. RP Gergen, PJ (reprint author), CPCR, Agcy Hlth Care Policy & Res, Room 502,2101 E Jefferson St, Rockville, MD 20852 USA. NR 37 TC 154 Z9 158 U1 1 U2 5 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD FEB PY 1998 VL 101 IS 2 BP art. no. EP e8 DI 10.1542/peds.101.2.e8 PG 6 WC Pediatrics SC Pediatrics GA YU816 UT WOS:000071758100026 PM 9445518 ER PT J AU Hsia, DC Moscoe, LM Krushat, M AF Hsia, DC Moscoe, LM Krushat, M TI Epidemiology of carotid endarterectomy among Medicare beneficiaries - 1985-1996 update SO STROKE LA English DT Article DE carotid endarterectomy; cerebral ischemia; elderly; mortality; stroke management ID PROSPECTIVE-PAYMENT SYSTEM; EXTRACRANIAL ARTERIES; CEREBRAL-ISCHEMIA; STROKE; PERFORMANCE; PREVENTION; STENOSIS; ACCURACY; HEAD AB Background and Purpose-This article describes changes in the rate and outcome of carotid endarterectomies among Medicare beneficiaries. Methods-We analyzed Interventional Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes as shown on Medicare bills to calculate carotid endarterectomy frequency, rate, and perioperative mortality by patient demography and hospital characteristics. Results-After initially peaking at 61273 procedures (20.6 per 10000 beneficiaries) in 1985, the frequency of carotid endarterectomy among Medicare beneficiaries declined to 46571 (14.3 per 10000) in 1989 and then rose to 108275 (28.6 per 10000) in 1996. Patients were predominantly aged 65 to 74 years, male, and white; surgery occurred mainly in large, urban, nonprofit, and teaching hospitals. Perioperative mortality declined from 3.0% in 1985 to 1.6% in 1996. Conclusions-The frequency and rate of carotid endarterectomy showed prompt response to reports from clinical trials. Perioperative mortality both improved and converged over time but did not attain the rates reported by the trials. Patients aged 85+ years suffered twice the average perioperative mortality. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. US Dept HHS, Off Inspector Gen, Baltimore, MD USA. RP Hsia, DC (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, 2101 E Jefferson St, Rockville, MD 20852 USA. EM dhsia@ahcpr.gov NR 29 TC 76 Z9 77 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 USA SN 0039-2499 J9 STROKE JI Stroke PD FEB PY 1998 VL 29 IS 2 BP 346 EP 350 PG 5 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA YW406 UT WOS:000071932100002 PM 9472872 ER PT J AU Eisenberg, JM AF Eisenberg, JM TI AHCPR: Providing the foundation for improving health care SO ACADEMIC MEDICINE LA English DT Editorial Material C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Eisenberg, JM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1040-2446 J9 ACAD MED JI Acad. Med. PD JAN PY 1998 VL 73 IS 1 BP 68 EP 69 DI 10.1097/00001888-199801000-00014 PG 2 WC Education, Scientific Disciplines; Health Care Sciences & Services SC Education & Educational Research; Health Care Sciences & Services GA YT034 UT WOS:000071557400023 PM 9447204 ER PT J AU Pearson, KC AF Pearson, KC TI Role of evidence-based medicine and clinical practice guidelines in treatment decisions SO CLINICAL THERAPEUTICS LA English DT Article DE evidence-based medicine; clinical practice guidelines; Center for Practice and Technology Assessment; Agency for Health Care Policy and Research AB The Center for Practice and Technology Assessment (CPTA), which falls within the Agency for Health Care Policy and Research, was formed in 1997. By combining the Office of the Forum for Quality and Effectiveness in Health Care, which was responsible for the clinical practice guideline program, and the Center for Technology Assessment, CPTA was born. This paper discusses the roles of CPTA in the development of evidence-based medicine and clinical practice guidelines in treatment decisions. C1 Agcy Hlth Care & Policy & Res, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. RP Pearson, KC (reprint author), Agcy Hlth Care & Policy & Res, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 20 TC 2 Z9 2 U1 0 U2 0 PU EXCERPTA MEDICA INC PI NEW YORK PA 245 WEST 17TH STREET, NEW YORK, NY 10011 USA SN 0149-2918 J9 CLIN THER JI Clin. Ther. PY 1998 VL 20 SU C BP C80 EP C85 DI 10.1016/S0149-2918(98)80011-8 PG 6 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 156YK UT WOS:000078030300011 PM 9915093 ER PT J AU Spector, WD Fleishman, JA AF Spector, WD Fleishman, JA TI Combining activities of daily living with instrumental activities of daily living to measure functional disability SO JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES LA English DT Article; Proceedings Paper CT 123rd Annual Meeting of the American-Public-Health-Association CY OCT 29-NOV 03, 1995 CL SAN DIEGO, CALIFORNIA SP Amer Public Hlth Assoc ID INDEPENDENCE MEASURE; ELDERLY POPULATION; HIERARCHICAL STRUCTURE; HOME CARE; SCALE; ASSUMPTIONS; IMPAIRMENT; CRITERIA; INDEXES; MODELS AB Measures of functional disability typically contain items that reflect limitations in performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Combining IADL and ADL items together in the same scale would provide enhanced range and sensitivity of measurement. This article presents psychometric justification for a combined ADL/IADL scale. Data come from 2,977 disabled respondents in the 1989 National Long-Term Care Survey. Respondents indicated whether they received human help on 7 ADL items; they also indicated whether they were tenable to perform each of 9 IADL items due to health reasons. Factor analyses using tetrachoric correlations demonstrated that 15 of the 16 items reflected one major dimension. Item response theory (IRT) methods were used to calibrate the items; a one-parameter IRT model fit the data. Item calibrations showed that ADL and IADL items were not hierarchically related. Analyses showed that a simple sum of item responses could be used to derive a measure of functional disability. Implications of using a 15-item ADL/IADL scale for eligibility determination and for comparing groups are discussed. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. RP Spector, WD (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Suite 500,2101 E Jefferson St, Rockville, MD 20852 USA. NR 56 TC 140 Z9 141 U1 6 U2 10 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 1079-5014 J9 J GERONTOL B-PSYCHOL JI J. Gerontol. Ser. B-Psychol. Sci. Soc. Sci. PD JAN PY 1998 VL 53 IS 1 BP S46 EP S57 PG 12 WC Geriatrics & Gerontology; Gerontology; Psychology; Psychology, Multidisciplinary SC Geriatrics & Gerontology; Psychology GA YV016 UT WOS:000071780300013 PM 9469179 ER PT J AU Elixhauser, A Steiner, C Harris, DR Coffey, RN AF Elixhauser, A Steiner, C Harris, DR Coffey, RN TI Comorbidity measures for use with administrative data SO MEDICAL CARE LA English DT Article DE comorbidity; administrative data; hospital resources; in-hospital mortality ID HOSPITALIZED-PATIENTS; RISK-ADJUSTMENT; CO-MORBIDITY; CABG SURGERY; MORTALITY; SEVERITY; RATES; INDEX; DISEASE; COMPLICATIONS AB OBJECTIVES. This study attempts to develop a comprehensive set of comorbidity measures for use with large administrative inpatient datasets. METHODS. The study involved clinical and empirical review of comorbidity measures, development of a framework that attempts to segregate comorbidities from other aspects of the patient's condition, development of a comorbidity algorithm, and testing on heterogeneous and homogeneous patient groups. Data were drawn from all adult, nonmaternal inpatients from 438 acute care hospitals in California in 1992 (n = 1,779,167). Outcome measures were those commonly available in administrative data: length of stay, hospital charges, and in-hospital death. RESULTS. A comprehensive set of 30 comorbidity measures was developed. The comorbidities were associated with substantial increases in length of stay, hospital charges, and mortality both for heterogeneous and homogeneous disease groups. Several comorbidities are described that are important predictors of outcomes, yet commonly are not measured. These include mental disorders, drug and alcohol abuse, obesity, coagulopathy, weight loss, and fluid and electrolyte disorders. CONCLUSIONS. The comorbidities had independent effects on outcomes and probably should not be simplified as an index because they affect outcomes differently among different patient groups. The present method addresses some of the limitations of previous measures. It is based on a comprehensive approach to identifying comorbidities and separates them from the primary reason for hospitalization, resulting in an expanded set of comorbidities that easily is applied without further refinement to administrative data for a wide range of diseases. C1 MEDTAP Int Inc, Bethesda, MD 20814 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Ctr Org & Delivery Syst, Rockville, MD 20852 USA. WESTAT Inc, Rockville, MD USA. MEDSTAT Grp Inc, Washington, DC USA. RP Elixhauser, A (reprint author), MEDTAP Int Inc, 7101 Wisconsin Ave,Suite 600, Bethesda, MD 20814 USA. NR 32 TC 2844 Z9 2848 U1 9 U2 69 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JAN PY 1998 VL 36 IS 1 BP 8 EP 27 DI 10.1097/00005650-199801000-00004 PG 20 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA YN567 UT WOS:000071181500004 PM 9431328 ER PT B AU Fitzmaurice, JM AF Fitzmaurice, JM BE Nelson, R Gelish, A Mun, SK TI Telehealth research and evaluation: Implications for decision makers SO PACIFIC MEDICAL TECHNOLOGY SYMPOSIUM, PROCEEDINGS LA English DT Proceedings Paper CT Pacific Medical Technology Symposium (PACMEDTek) CY AUG 17-21, 1998 CL HONOLULU, HI SP Tripler Army Med Ctr AB Society must answer questions about health information technology applications, or telehealth, that lead to the best allocation of resources for maintaining and improving the health status of our population. These questions deal with the adoption and deployment of telehealth for improving the health and well-being of the members of society, compared with alternative means. From the less than overwhelming response to the "build it and they will come approach, we clearly have insufficient evidence of the medical effectiveness, cost effectiveness, and patient :and provider satisfaction with telehealth solutions. The Agency for Health Ch-re policy and Research (AHCPR) I is a federal research agency that supports research to find out what is effective in improving the quality; of and access to heath services in the community, what is the impact on patient outcomes, and what is the cost of obtaining those outcomes. Telehealth decision makers need studies of telehealth technologies that focus on specific clinical conditions in narrowly concentrated applications and that use scientific methods to compare outcomes and treatment costs for patients and physicians who do and those who do not receive telehealth services under controlled circumstances. AHCPR-funded studies are presented as examples of methods of scientific investigation into the use and acceptance of computerized decision support and telehealth services. C1 US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Fitzmaurice, JM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. NR 13 TC 1 Z9 1 U1 1 U2 2 PU IEEE COMPUTER SOC PI LOS ALAMITOS PA 10662 LOS VAQUEROS CIRCLE, PO BOX 3014, LOS ALAMITOS, CA 90720-1264 USA BN 0-8186-8667-7 PY 1998 BP 344 EP 352 DI 10.1109/PACMED.1998.769954 PG 3 WC Computer Science, Interdisciplinary Applications; Medical Informatics SC Computer Science; Medical Informatics GA BN33G UT WOS:000081642800059 ER PT J AU Williams, C AF Williams, C TI Dissemination of the Agency for Health Care Policy and Research guideline SO TOBACCO CONTROL LA English DT Article; Proceedings Paper CT National Conference on Addressing Tobacco in Managed Care - Partnering for Success CY FEB 03-04, 1998 CL ARLINGTON, VIRGINIA SP Robert Wood Johnson Fdn, Agcy Hlth Care Policy & Res, US Ctr Dis Control & Prevent C1 Agcy Hlth Care Policy & Res, Off Hlth Care Informat, Rockville, MD 20852 USA. RP Williams, C (reprint author), Agcy Hlth Care Policy & Res, Off Hlth Care Informat, 2101 E Jefferson St,Suite 501, Rockville, MD 20852 USA. NR 5 TC 2 Z9 2 U1 1 U2 1 PU BRITISH MED JOURNAL PUBL GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0964-4563 J9 TOB CONTROL JI Tob. Control PY 1998 VL 7 SU S BP S17 EP S18 PG 2 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 174KB UT WOS:000079032800008 PM 10093190 ER PT B AU Fitzmaurice, JM AF Fitzmaurice, JM BE Waegemann, CP TI AHCPR's computer decision support systems program for health providers to improve quality of care SO TOWARD AN ELECTRONIC PATIENT RECORD '98 CONFERENCE AND EXPOSITION, PROCEEDINGS - VOLS 1-3 LA English DT Proceedings Paper CT Electronic Patient Record 98 Conference and Exposition - Shaping the World of Electronic Health Records (TEPR 98) CY MAY 09-16, 1998 CL SAN ANTONIO, TX SP Med Records Inst DE decision support; computer-based patient record; AHCPR; information technology; health C1 US Dept HHS, Agcy Hlth Care Policy & Res, Washington, DC 20201 USA. RP Fitzmaurice, JM (reprint author), US Dept HHS, Agcy Hlth Care Policy & Res, Washington, DC 20201 USA. NR 8 TC 0 Z9 0 U1 0 U2 0 PU MEDICAL RECORDS INSTITUTE PI NEWTON PA 567 WALNUT ST, PO BOX 600770, NEWTON, MA 02160 USA BN 0-9640667-4-2 PY 1998 BP B84 EP B89 PG 4 WC Health Care Sciences & Services; Health Policy & Services; Medical Informatics SC Health Care Sciences & Services; Medical Informatics GA BM66J UT WOS:000079371400089 ER PT J AU Jamason, PF Kalkstein, LS Gergen, PJ AF Jamason, PF Kalkstein, LS Gergen, PJ TI A synoptic evaluation of asthma hospital admissions in New York City SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE LA English DT Article ID GRASS-POLLEN; THUNDERSTORMS; WEATHER; AIR AB An evaluation of weather/asthma relationships in the New York City Standard Metropolitan Statistical Area (SMSA) is developed using a synoptic climatological methodology. This procedure isolates ''air masses,'' or bodies of air that are homogeneous in meteorological character, and relates them to daily counts of overnight asthma hospital admissions. The synoptic procedure used here, known as the temporal synoptic index (TSI), can identify air masses in automated fashion for every day over many years. It is apparent that certain air masses are related to statistically significant increases in asthma hospital admissions. The impact varies seasonally, with weather having a particularly important impact on asthma admissions during fall and winter. It appears that air pollution has little impact on asthma during these two seasons, and the air masses associated with the highest admissions are not distinguished by high concentrations of pollutants. However, during spring and summer, the air masses associated with highest admissions are among those with high pollution concentrations. There is a strong interseasonal differential response to weather and air pollution by asthmatics in New York City. If these results can be replicated at other locations in future studies, it may be possible to develop an asthma/weather watch-warning system, based on the expected arrival of high-admissions air masses. C1 UNIV DELAWARE,DEPT GEOG,CTR CLIMAT RES,NEWARK,DE. US PHS,US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD. RP Jamason, PF (reprint author), UNIV CALIF SAN DIEGO,SCRIPPS INST OCEANOG,DCH & IM GREEN INST GEOPHYS & PLANET PHYS,LA JOLLA,CA 92093, USA. NR 24 TC 40 Z9 43 U1 0 U2 2 PU AMER LUNG ASSOC PI NEW YORK PA 1740 BROADWAY, NEW YORK, NY 10019 SN 1073-449X J9 AM J RESP CRIT CARE JI Am. J. Respir. Crit. Care Med. PD DEC PY 1997 VL 156 IS 6 BP 1781 EP 1788 PG 8 WC Critical Care Medicine; Respiratory System SC General & Internal Medicine; Respiratory System GA YK655 UT WOS:A1997YK65500012 PM 9412555 ER PT J AU Clancy, CM Eisenberg, JM AF Clancy, CM Eisenberg, JM TI Emergency medicine in population-based systems of care SO ANNALS OF EMERGENCY MEDICINE LA English DT Article ID HOSPITAL EMERGENCY; DEPARTMENTS; VISITS; ACCESS AB EDs and emergency physicians play a critical role in health care delivery-providing care to those with life-threatening conditions, as well as serving as provider of last resort to those without options for primary care. This diversity of functions provides unique opportunities for identifying important unmet community needs and developing solutions to address these needs. Future challenges for emergency medicine include assessing and improving the quality of care provided within the ED and identifying the role of the ED in systems of care. Health services research can help define the optimal functions of emergency medicine in enhancing population health. RP Clancy, CM (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,EOC 605,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 15 TC 23 Z9 23 U1 1 U2 1 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD DEC PY 1997 VL 30 IS 6 BP 800 EP 803 DI 10.1016/S0196-0644(97)70052-0 PG 4 WC Emergency Medicine SC Emergency Medicine GA YK227 UT WOS:A1997YK22700019 PM 9398777 ER PT J AU Fraser, I AF Fraser, I TI Introduction: Research on health care organizations and markets - The best and worst of times SO HEALTH SERVICES RESEARCH LA English DT Article ID FINANCIAL INCENTIVES; GROWTH RP Fraser, I (reprint author), AGCY HLTH CARE POLICY & RES,CTR ORG & DELIVERY STUDIES,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 25 TC 12 Z9 12 U1 0 U2 0 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 1997 VL 32 IS 5 BP 669 EP 678 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA YJ633 UT WOS:A1997YJ63300009 PM 9402907 ER PT J AU Vistnes, JP Banthin, JS AF Vistnes, JP Banthin, JS TI The demand for Medicare supplemental insurance benefits: The role of attitudes toward medical care and risk SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article; Proceedings Paper CT 1994 American-Public-Health-Association Meeting CY NOV 02, 1994 CL WASHINGTON, D.C. SP Amer Public Hlth Assoc ID HEALTH-INSURANCE; MEDIGAP INSURANCE; INFORMATION; POPULATION; KNOWLEDGE; SELECTION; COVERAGE; OPTIONS; MARKET AB This paper uses data from the 1987 National Medical Expenditure Survey to analyze the role that attitudes toward medical care and risk play in Medicare beneficiaries' demand for supplemental insurance. We investigate the factors affecting the demand for any supplemental insurance as well as specific Medigap benefits, such as coverage for Medicare's gaps in hospital and physician services, skilled nursing facility care, and prescription drug purchases. Our results indicate that attitudes significantly influence beneficiaries' decisions to purchase supplemental insurance and specific benefits with effects that are comparable in magnitude to those of self-reported health measures, education, and asset income. C1 Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Vistnes, JP (reprint author), Agcy Hlth Care Policy & Res, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 23 TC 13 Z9 13 U1 0 U2 1 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD WIN PY 1997 VL 34 IS 4 BP 311 EP 324 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA YY693 UT WOS:000072174200006 PM 9472230 ER PT J AU Clancy, CM Franks, P AF Clancy, CM Franks, P TI Utilization of specialty and primary care: The impact of HMO insurance and patient-related factors SO JOURNAL OF FAMILY PRACTICE LA English DT Article DE primary health care; specialties, medical; insurance health; managed care programs; sex; race ID MEDICAL OUTCOMES; HEALTH; REFORM; PHYSICIANS; DELIVERY; SYSTEMS AB BACKGROUND. Appropriate utilization of primary and specialty care has stimulated substantial debate, but the portion of the discussion focused on policies that restrict or discourage direct access to specialists has been largely uninformed by empirical analysis. Using data from the National Ambulatory Care Survey (1985 to 1992 surveys), we examined the associations of patient and physician demographics and health maintenance organization (HMO) insurance status with the utilization of primary compared with specialty care. METHODS. Office visits for adult patients seen by primary care physicians and specialists were analyzed for: (1) patient-initiated utilization of specialists (patient self-referral) compared with that of primary care physicians; and (2) utilization of specialists compared with that of primary care physicians, stratified by HMO insurance status. RESULTS. After multivariate adjustment, patient self-referral was less likely among black patients (adjusted odds ratio [AOR] = 0.67; 95% confidence interval [CI] = 0.59 to 0.76), self-pay (AOR = 0.81; 95% CI = 0.74 to 0.88), or patients with Medicaid (AOR = 0.51; 95% CI = 0.43 to 0.61), The proportion of non-HMO patients seeing specialists remained stable (44.9%). For HMO patients, the proportion of total visits made to specialists increased from 27.6% in 1985 to 41.3% in 1991, then dropped to 33.2% in 1992. Disparities in utilization of specialists by women, blacks, and patients with Medicaid observed among non-HMO patients were not found in the HMO population. Specialists were more likely to see HMO patients for follow-up of a known problem, whereas non-HMO patients were more likely to have specialist follow-up visits for new problems, CONCLUSIONS. The results suggest greater utilization of specialists by male, white, and privately insured patients. The findings may partially account for disparities in specialty procedure use, and suggest that HMO insurance may reduce some of these disparities, The less frequent and more selective use of specialists among HMO patients suggests an evolving role for specialists in managed care. C1 Agcy Hlth Care Policy & Res, Ctr Primary Care Res & Outcomes & Effect Res, Rockville, MD USA. Highland Hosp, Primary Care Inst, Rochester, NY USA. Univ Rochester, Dept Family Med, Rochester, NY USA. RP Franks, P (reprint author), Primary Care Inst, Family Med Ctr, 885 South Ave, Rochester, NY 14620 USA. NR 28 TC 29 Z9 29 U1 1 U2 2 PU APPLETON & LANGE PI E NORWALK PA 25 VAN ZANT ST, E NORWALK, CT 06855 USA SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD DEC PY 1997 VL 45 IS 6 BP 500 EP 508 PG 9 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA YM219 UT WOS:000071041700023 PM 9420586 ER PT J AU Selden, TM AF Selden, TM TI More on the economic efficiency of mixed public/private insurance SO JOURNAL OF PUBLIC ECONOMICS LA English DT Article DE health insurance; public catastrophic insurance ID MORAL HAZARD; ADVERSE SELECTION AB Blomqvist and Johansson (1996) criticize my results regarding Besley's (Besley, 1989) analysis of public catastrophic coverage. They concede that my analysis was correct under the assumptions I made, but they argue that a more general model than Besley or I used might yield different results. Unfortunately, Blomqvist and Johansson's analysis of the more general case is flawed. Whereas they claim to have provided a more general argument against the sort of public intervention Besley proposed, they have unwittingly discovered an example in which his original conjecture holds. (C) 1997 Elsevier Science S.A. C1 Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Selden, TM (reprint author), Agcy Hlth Care Policy & Res, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 13 TC 8 Z9 8 U1 0 U2 3 PU ELSEVIER SCIENCE SA PI LAUSANNE PA PO BOX 564, 1001 LAUSANNE, SWITZERLAND SN 0047-2727 J9 J PUBLIC ECON JI J. Public Econ. PD DEC PY 1997 VL 66 IS 3 BP 517 EP 523 DI 10.1016/S0047-2727(97)00045-5 PG 7 WC Economics SC Business & Economics GA YM034 UT WOS:000071021300009 ER PT J AU Black, HR Cohen, JD Kaplan, NM Ferdinand, KC Chobanian, AV Dustan, HP Gifford, RW Moser, M Sheps, SG Agodoa, L August, PA Bakris, GL Burt, V Busse, W Carter, BL Chesley, FD Cleeman, J Cohn, JN Cregler, LL Crespo, C Cushman, WC Cutler, J Darrow, MD DeQuattro, VL Devereux, RB Dworkin, LD Elliott, WJ Epstein, M Falkner, B Ferrario, CM Flack, JM Frishman, W Frohlich, ED Green, LA Grimm, RH Hagberg, JM Hall, WD Handler, J Havas, S Hill, MN Horan, MJ Hsueh, WA Hyman, BN Izzo, JL Jamerson, K Kiley, JP Kochar, MS Kolasa, KM Krakoff, LR Levy, D Lindheimer, MD Luepker, RV Malone, MEL Massie, B Materson, BJ Merchant, J Messerli, FH Miller, NH Moore, MA MustoneAlexander, L Oparil, S Perry, HM Pickering, TG Pratt, JH Ram, CVS Randall, OS Reed, JW Roberts, RW Roccella, EJ Rogus, SD Saunders, E Schron, E Schwartz, G Sibai, BM Snyder, D Sowers, JR Stamler, J Temple, R Textor, S Thom, T Vidt, DG Weber, M Weinberger, MH Weinshilboum, R Whelton, PK Whisnant, JP Wiebers, DO Winston, MC Wright, JT Lenfant, C Casser, L Colman, PJ Edwards, T Feeley, DM Gajewski, J Levine, D Manger, W Marshall, EC Nickey, WA Robert, RW Secrest, BG Singer, EH Whisnant, JP Wilson, GJ Young, JM Bachman, JW Campese, VM Carr, AA Hand, M Holden, DC Jamieson, MJ Julius, S Mensah, GA Prisant, M Sullivan, JM Wilson, DJ Morosco, G Anderson, DE Waugh, D AF Black, HR Cohen, JD Kaplan, NM Ferdinand, KC Chobanian, AV Dustan, HP Gifford, RW Moser, M Sheps, SG Agodoa, L August, PA Bakris, GL Burt, V Busse, W Carter, BL Chesley, FD Cleeman, J Cohn, JN Cregler, LL Crespo, C Cushman, WC Cutler, J Darrow, MD DeQuattro, VL Devereux, RB Dworkin, LD Elliott, WJ Epstein, M Falkner, B Ferrario, CM Flack, JM Frishman, W Frohlich, ED Green, LA Grimm, RH Hagberg, JM Hall, WD Handler, J Havas, S Hill, MN Horan, MJ Hsueh, WA Hyman, BN Izzo, JL Jamerson, K Kiley, JP Kochar, MS Kolasa, KM Krakoff, LR Levy, D Lindheimer, MD Luepker, RV Malone, MEL Massie, B Materson, BJ Merchant, J Messerli, FH Miller, NH Moore, MA MustoneAlexander, L Oparil, S Perry, HM Pickering, TG Pratt, JH Ram, CVS Randall, OS Reed, JW Roberts, RW Roccella, EJ Rogus, SD Saunders, E Schron, E Schwartz, G Sibai, BM Snyder, D Sowers, JR Stamler, J Temple, R Textor, S Thom, T Vidt, DG Weber, M Weinberger, MH Weinshilboum, R Whelton, PK Whisnant, JP Wiebers, DO Winston, MC Wright, JT Lenfant, C Casser, L Colman, PJ Edwards, T Feeley, DM Gajewski, J Levine, D Manger, W Marshall, EC Nickey, WA Robert, RW Secrest, BG Singer, EH Whisnant, JP Wilson, GJ Young, JM Bachman, JW Campese, VM Carr, AA Hand, M Holden, DC Jamieson, MJ Julius, S Mensah, GA Prisant, M Sullivan, JM Wilson, DJ Morosco, G Anderson, DE Waugh, D TI The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure SO ARCHIVES OF INTERNAL MEDICINE LA English DT Review ID CORONARY HEART-DISEASE; LEFT-VENTRICULAR HYPERTROPHY; ISOLATED SYSTOLIC HYPERTENSION; CONVERTING ENZYME-INHIBITION; RANDOMIZED CONTROLLED TRIALS; ACUTE MYOCARDIAL-INFARCTION; STAGE RENAL-DISEASE; FOLLOW-UP PROGRAM; ANTIHYPERTENSIVE THERAPY; CARDIOVASCULAR-DISEASE C1 NHLBI, INFORMAT CTR, NATL HIGH BLOOD PRESSURE EDUC PROGRAM, BETHESDA, MD 20894 USA. MAYO CLIN & MAYO FDN, MAYO MED SCH, ROCHESTER, MN 55905 USA. RUSH PRESBYTERIAN ST LUKES MED CTR, CHICAGO, IL 60612 USA. ST LOUIS UNIV, HLTH SCI CTR, ST LOUIS, MO 63103 USA. UNIV TEXAS, SW MED SCH, DALLAS, TX 75230 USA. HEARTBEATS LIFE CTR, NEW ORLEANS, LA USA. BOSTON UNIV, BOSTON, MA 02215 USA. UNIV VERMONT, COLL MED, BURLINGTON, VT 05405 USA. CLEVELAND CLIN FDN, CLEVELAND, OH 44195 USA. YALE UNIV, SCH MED, NEW HAVEN, CT 06520 USA. NIDDK, BETHESDA, MD USA. NEW YORK HOSP, NEW YORK, NY 10021 USA. NATL CTR HLTH STAT, HYATTSVILLE, MD 20782 USA. UNIV WISCONSIN, MADISON, WI 53706 USA. UNIV COLORADO, DENVER, CO 80202 USA. US DEPT HHS, AGCY HLTH CARE POLICY & RES, ROCKVILLE, MD 20852 USA. UNIV MINNESOTA, SCH MED, MINNEAPOLIS, MN 55455 USA. CUNY, SCH MED, NEW YORK, NY 10031 USA. UNIV TENNESSEE, COLL MED, MEMPHIS, TN USA. E CAROLINA UNIV, SCH MED, GREENVILLE, NC 27858 USA. UNIV SO CALIF, MED CTR, LOS ANGELES, CA 90089 USA. CORNELL UNIV, MED CTR, NEW YORK, NY 10021 USA. RHODE ISL HOSP, PROVIDENCE, RI USA. UNIV MIAMI, SCH MED, MIAMI, FL USA. ALLEGHENY UNIV HLTH SCI, PHILADELPHIA, PA 19102 USA. WAKE FOREST UNIV, BOWMAN GRAY SCH MED, WINSTON SALEM, NC USA. MONTEFIORE MED CTR, ALBERT EINSTEIN COLL MED, BRONX, NY 10467 USA. ALTON OCHSNER MED FDN & OCHSNER CLIN, NEW ORLEANS, LA 70121 USA. UNIV MICHIGAN, ANN ARBOR, MI 48109 USA. UNIV MARYLAND, COLLEGE PK, MD 20742 USA. EMORY UNIV, ATLANTA, GA 30322 USA. KAISER PERMANENTE, ANAHEIM, CA USA. UNIV MARYLAND, SCH MED, BALTIMORE, MD 21201 USA. JOHNS HOPKINS UNIV, BALTIMORE, MD 21218 USA. BAYLOR COLL MED, HOUSTON, TX 77030 USA. SUNY BUFFALO, BUFFALO, NY 14260 USA. MED COLL WISCONSIN, MILWAUKEE, WI 53226 USA. E CAROLINA UNIV, SCH MED, GREENVILLE, NC 27858 USA. ENGLEWOOD HOSP, ENGLEWOOD, CO USA. NHLBI, FRAMINGHAM HEART STUDY, BETHESDA, MD 20894 USA. UNIV CHICAGO HOSP, CHICAGO, IL 60637 USA. JEFFERSON COMMUNITY COLL, LOUISVILLE, KY USA. UNIV CALIF SAN FRANCISCO, SAN FRANCISCO, CA 94143 USA. HLTH CARE FINANCING ADM, WASHINGTON, DC USA. STANFORD CARDIAC REHABIL PROGRAM, PALO ALTO, CA USA. GEORGE WASHINGTON UNIV, SCH MED & HLTH SCI, WASHINGTON, DC 20052 USA. UNIV ALABAMA, BIRMINGHAM, AL USA. VET AFFAIRS MED CTR, WASHINGTON, DC 20422 USA. WASHINGTON UNIV, SCH MED, ST LOUIS, MO 63130 USA. INDIANA UNIV, SCH MED, INDIANAPOLIS, IN USA. UNIV TEXAS, SW MED CTR, DALLAS, TX USA. HOWARD UNIV HOSP, WASHINGTON, DC USA. MOREHOUSE SCH MED, ATLANTA, GA 30310 USA. VENCOR, LOUISVILLE, KY USA. US HLTH RESOURCES & SERV ADM, ROCKVILLE, MD 20857 USA. WAYNE STATE UNIV, DETROIT, MI 48202 USA. NORTHWESTERN UNIV, SCH MED, CHICAGO, IL USA. US FDA, ROCKVILLE, MD 20857 USA. BROOKDALE HOSP, BROOKLYN, NY USA. TULANE UNIV, SCH PUBL HLTH & TROP MED, NEW ORLEANS, LA 70118 USA. AMER HEART ASSOC, DALLAS, TX USA. CASE WESTERN RESERVE UNIV, CLEVELAND, OH 44106 USA. CTR DIS CONTROL & PREVENT, NATL CTR HLTH STAT, ATLANTA, GA 30333 USA. AMER OPTOMETR ASSOC, ST LOUIS, MO USA. US DEPT HHS, AGCY HLTH CARE POLICY & RES, ROCKVILLE, MD 20852 USA. AMER COLL PHYSICIANS, PHILADELPHIA, PA USA. AMER PODIATR MED ASSOC, BETHESDA, MD USA. NATL KIDNEY FDN, NEW YORK, NY USA. AMER RED CROSS, WASHINGTON, DC 20006 USA. NHLBI, AD HOC COMM MINOR POPULAT, BETHESDA, MD 20894 USA. AMER COLL CARDIOL, BETHESDA, MD USA. AMER MED ASSOC, CHICAGO, IL 60610 USA. AMER ACAD FAMILY PHYS, KANSAS CITY, MO USA. AMER PUBL HLTH ASSOC, WASHINGTON, DC 20005 USA. AMER ACAD OPHTHALMOL, SAN FRANCISCO, CA USA. AMER NURSES ASSOC, WASHINGTON, DC 20024 USA. AMER ACAD PHYS ASSISTANTS, ALEXANDRIA, VA 22314 USA. AMER OSTEOPATH ASSOC, CHICAGO, IL 60611 USA. US DEPT VET AFFAIRS, WASHINGTON, DC USA. AMER PHARMACEUT ASSOC, WASHINGTON, DC USA. AMER DENT ASSOC, CHICAGO, IL 60611 USA. AMER COLL CHEST PHYS, NORTHBROOK, IL 60062 USA. AMER DIABET ASSOC, ALEXANDRIA, VA USA. AMER ACAD NEUROL, MINNEAPOLIS, MN USA. AMER DIETET ASSOC, CHICAGO, IL USA. AMER COLL OCCUPAT & ENVIRONM MED, ARLINGTON HTS, IL 60005 USA. AUGUSTA PREVENT CARDIOL, CIRCULATORY DIS CTR, AUGUSTA, GA USA. UNIV TEXAS, HLTH SCI CTR, SAN ANTONIO, TX USA. MED COLL GEORGIA, AUGUSTA, GA 30912 USA. ROW SCI INC, ROCKVILLE, MD USA. NR 252 TC 4449 Z9 4570 U1 4 U2 67 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60654-0946 USA SN 0003-9926 EI 1538-3679 J9 ARCH INTERN MED JI Arch. Intern. Med. PD NOV 24 PY 1997 VL 157 IS 21 BP 2413 EP 2446 PG 34 WC Medicine, General & Internal SC General & Internal Medicine GA YH222 UT WOS:A1997YH22200004 ER PT J AU Clancy, CM AF Clancy, CM TI Ensuring health care quality: An AHCPR perspective SO CLINICAL THERAPEUTICS LA English DT Article; Proceedings Paper CT Conference on Ensuring Managed Health Care Quality - Areas of Consensus and Debate CY JAN 20-22, 1997 CL TUCSON, ARIZONA DE health care quality; managed care; quality measurement; quality improvement ID SMALL-AREA VARIATIONS; SERVICES AB This paper discusses the role of the Agency for Health Care Policy and Research (AHCPR) in identifying and solving problems within the health care industry. It reviews current AHCPR activities and details the results of the Consumer Assessment of Health Plans Survey, the recent poll of how people in the United States make choices about health care. A discussion of present quality measurement tools, such as CONQUEST, a database of existing performance measures, includes an outline of plans for developing new measures of quality and outcomes. Also explored are ideas for improving quality measurements, potential problems and risks, and the public role in health services research. C1 Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. RP Clancy, CM (reprint author), Agcy Hlth Care Policy & Res, Ctr Outcomes & Effectiveness Res, 2101 E Jefferson,Suite 605, Rockville, MD 20852 USA. NR 5 TC 11 Z9 11 U1 0 U2 0 PU EXCERPTA MEDICA INC PI NEW YORK PA 245 WEST 17TH STREET, NEW YORK, NY 10011 USA SN 0149-2918 J9 CLIN THER JI Clin. Ther. PD NOV-DEC PY 1997 VL 19 IS 6 BP 1564 EP 1571 DI 10.1016/S0149-2918(97)80028-8 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA YP586 UT WOS:000071292800028 PM 9444462 ER PT J AU Cooper, PF Schone, BS AF Cooper, PF Schone, BS TI More offers, fewer takers for employment-based health insurance: 1987 and 1996 SO HEALTH AFFAIRS LA English DT Article RP Cooper, PF (reprint author), AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD, USA. NR 16 TC 143 Z9 143 U1 0 U2 1 PU PROJECT HOPE-HEALTH AFFAIRS PI SYRACUSE PA PO BOX 8015, SYRACUSE, NY 13217 SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD NOV-DEC PY 1997 VL 16 IS 6 BP 142 EP 149 DI 10.1377/hlthaff.16.6.142 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA YH060 UT WOS:A1997YH06000020 PM 9444821 ER PT J AU Jackson, ME Spector, WD Rabins, PV AF Jackson, ME Spector, WD Rabins, PV TI Risk of behavior problems among nursing home residents in the United States SO JOURNAL OF AGING AND HEALTH LA English DT Article ID ALZHEIMERS-DISEASE; DISRUPTIVE BEHAVIORS; SENILE DEMENTIA; AGITATION; CARE; DISTURBANCE; PREVALENCE AB This study identified personal risk factors associated with behavior problems among nursing home residents using data based on a national survey of nursing home residents. Data are based on the Institutional Population Component of the 1987 National Medical Expenditure Survey and include nursing home residents living in licensed facilities on January 1, 1987. Multiple regression analyses were conducted to examine characteristics of residents that place them at risk of behavior problems. Independent variables include physical functioning, sensory impairment, cognitive impairment, psychiatric diagnoses, and demographics. Eleven behavior problems grouped into four categories based on factor analysis serve as dependent variables: wandering/safety, aggressive behaviors, collecting behaviors, and delusions/hallucinations. Risk factors emerging as predictors included sex (male), cognitive impairment, ADL dependency, incontinence, psychiatric history, receptive communication, walking, and difficulty seeing. Risk factors differ by type of behavior problem. Results suggest a multiple etiology in which biological, psychological, and sociocultural factors all play a role in generating behavior problems in the long-term care setting. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. JOHNS HOPKINS UNIV,BALTIMORE,MD 21218. FU NIA NIH HHS [AG10641] NR 39 TC 18 Z9 18 U1 0 U2 2 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 SN 0898-2643 J9 J AGING HEALTH JI J. Aging Health PD NOV PY 1997 VL 9 IS 4 BP 451 EP 472 DI 10.1177/089826439700900402 PG 22 WC Gerontology; Health Policy & Services SC Geriatrics & Gerontology; Health Care Sciences & Services GA YE953 UT WOS:A1997YE95300002 PM 10182388 ER PT J AU Yu, SM Kogan, MD Gergen, P AF Yu, SM Kogan, MD Gergen, P TI Vitamin-mineral supplement use among preschool children in the United States SO PEDIATRICS LA English DT Article DE vitamin-mineral supplements; preschool child; socioeconomic factors; National Maternal and Infant Health Survey ID INFANT HEALTH SURVEY AB Objective. To estimate the prevalence of recent supplement use in a national sample of preschool children and to examine the relationship of maternal and child characteristics, past maternal supplement use practices, familial, health services, and child health factors associated with supplement use. Methods. We used data on 8285 preschool children whose mothers were interviewed for the 1991 Longitudinal Follow-up to the 1988 National Maternal and infant Health Survey. Data collection was conducted either by telephone or personal interview. The sample is representative of the estimated 3.8 million US born children in 1988 and alive in 1991. The outcome measures are whether the child was given any vitamin and mineral supplements at least 3 days a week in the 30 days before the interview and the type of supplement received. Statistical techniques included bivariate and weighted multiple logistic regression analysis. Results. More than half of all US 3-year-olds (54.4%) were given some vitamin and mineral supplement. The most common supplements consumed were multivitamin-mineral with iron (59% of supplement users) and multivitamin-mineral without iron (26.4%). Children who received any supplements tended to have mothers who are non-Hispanic White, older, more educated, married, insured, receiving care from a private health care provider, have greater household income, and took supplements during pregnancy. Child health characteristics associated with supplement use included first birth order and having eating problems or poor appetites. Conclusions. More than half of US preschool children used vitamin and mineral supplements. The sociodemographic and health predictors identified for supplement use suggest that groups at risk for nonuse are likely the same groups whose circumstances may predispose a need for supplementation. C1 CTR DIS CONTROL & PREVENT, NATL CTR HLTH STAT, HYATTSVILLE, MD 20782 USA. US DEPT HHS, AGCY HLTH CARE POLICY & RES, ROCKVILLE, MD 20852 USA. RP Yu, SM (reprint author), US HLTH RESOURCES & SERV ADM, MATERNAL & CHILD HLTH BUR, 5600 FISHERS LANE, 18A-55, ROCKVILLE, MD 20857 USA. NR 27 TC 36 Z9 38 U1 1 U2 1 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD, ELK GROVE VILLAGE, IL 60007-1098 SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD NOV PY 1997 VL 100 IS 5 BP art. no. EP e4 DI 10.1542/peds.100.5.e4 PG 6 WC Pediatrics SC Pediatrics GA YD739 UT WOS:A1997YD73900021 PM 9346998 ER PT J AU Clancy, CM Gross, ML AF Clancy, CM Gross, ML TI Hospital restructuring in North America and Europe: Patient outcomes and workforce implications - Foreword SO MEDICAL CARE LA English DT Editorial Material RP Clancy, CM (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852, USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD OCT PY 1997 VL 35 IS 10 SU S BP OS5 EP OS6 DI 10.1097/00005650-199710001-00002 PG 2 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA YA757 UT WOS:A1997YA75700002 ER PT J AU Dor, A Duffy, S Wong, H AF Dor, A Duffy, S Wong, H TI Expense preference behavior and contract-management: Evidence from US hospitals SO SOUTHERN ECONOMIC JOURNAL LA English DT Article ID COST-FUNCTIONS; SAVINGS; BANKING; FIRM AB This paper reports on a study of expense preference behavior in a conditional sample of hospitals (before and after adoption of contract-management arrangements) using an extension of Mester's (1989) test. To identify expense preference parameters, input demand equations are considered in addition to the cost function and are estimated jointly with the cost function as a system of nonlinear equations. Based on this test, contract managers do not appear to be cost minimizers, although they tend to exhibit lower expense preference behavior than salaried managers. The importance of our results, however, goes beyond a single industry because we have shown that estimates of expense preference depend critically upon the particular input demand being studied. Studies that hitherto have relied on single input demand equations or on the cost function alone may have to be reinterpreted in this light. C1 COST REVIEW COMMISS,MARYLAND HLTH SERV,BALTIMORE,MD. US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. RP Dor, A (reprint author), CASE WESTERN RESERVE UNIV,WEATHERHEAD SCH MANAGEMENT,CLEVELAND,OH 44106, USA. NR 20 TC 6 Z9 6 U1 0 U2 3 PU UNIV NORTH CAROLINA PI CHAPEL HILL PA SOUTHERN ECONOMIC JOURNAL, CHAPEL HILL, NC 27514 SN 0038-4038 J9 SOUTHERN ECON J JI South. Econ. J. PD OCT PY 1997 VL 64 IS 2 BP 542 EP 554 DI 10.2307/1060866 PG 13 WC Economics SC Business & Economics GA YB853 UT WOS:A1997YB85300012 ER PT J AU Cohen, SB AF Cohen, SB TI An evaluation of alternative PC-based software packages developed for the analysis of complex survey data SO AMERICAN STATISTICIAN LA English DT Article DE complex survey data; NMES; Stata; SUDAAN; WesVarPC AB Data from complex survey designs require special consideration with regard to variance and data analysis as a consequence of significant departures from simple random sampling assumptions. Using data from the National Medical Expenditure Survey (NMES), which is characterized by a complex survey design, three programs developed for the analysis of complex survey data in a personal computing environment are compared: Stata, SUDAAN, and WesVarPC. The comparisons concentrate on user facility, computational efficiency, and program compatibilities. RP Cohen, SB (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR COST & FINANCING STUDIES,STAT RES & METHODS DIV,ROCKVILLE,MD 20852, USA. NR 16 TC 33 Z9 33 U1 0 U2 3 PU AMER STATISTICAL ASSOC PI ALEXANDRIA PA 1429 DUKE ST, ALEXANDRIA, VA 22314 SN 0003-1305 J9 AM STAT JI Am. Stat. PD AUG PY 1997 VL 51 IS 3 BP 285 EP 292 DI 10.2307/2684908 PG 8 WC Statistics & Probability SC Mathematics GA XQ965 UT WOS:A1997XQ96500019 ER PT J AU Brooks, JM Dor, A Wong, HS AF Brooks, JM Dor, A Wong, HS TI Hospital-insurer bargaining. An empirical investigation of appendectomy pricing SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE appendectomy; bargaining; hospital; insurer; prices ID INDUSTRY; POWER AB Employers' increased sensitivity to health care costs has forced insurers to seek ways to lower costs through effective bargaining with providers. What factors determine the prices negotiated between hospitals and insurers? The hospital-insurer interaction is captured in the context of a bargaining model, in which the gains from bargaining are explicitly defined. Appendectomy was chosen because it is a well-defined procedure with little clinical variation. Our results show that certain hospital institutional arrangements (e.g. hospital affiliations), HMO penetration, and greater hospital concentration improve hospitals' bargaining position. Furthermore, hospitals' bargaining effectiveness has diminished over time and Varies across states. (C) 1997 Elsevier Science B.V. C1 CASE WESTERN RESERVE UNIV,CLEVELAND,OH 44106. AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. RP Brooks, JM (reprint author), UNIV IOWA,COLL PHARM,S528 PHARM BLDG,IOWA CITY,IA 52242, USA. NR 24 TC 49 Z9 50 U1 1 U2 3 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD AUG PY 1997 VL 16 IS 4 BP 417 EP 434 DI 10.1016/S0167-6296(96)00536-X PG 18 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA XJ679 UT WOS:A1997XJ67900003 PM 10169099 ER PT J AU Franks, P Clancy, CM AF Franks, P Clancy, CM TI Referrals of adult patients from primary care: Demographic disparities and their relationship to HMO insurance SO JOURNAL OF FAMILY PRACTICE LA English DT Article DE primary health care; insurance, health; managed care programs; referral and consultation; Medicare; Medicaid ID MEDICAL-CARE; ACCESS; SELECTION; DELIVERY; REFORM AB BACKGROUND. Increasing enrollment in managed care organizations and dissatisfaction with policies to restrict direct access to specialists have intensified interest in referrals from primary care physicians to specialists. We examined the associations of demographic factors and insurance with referrals of adult patients by primary care physicians. METHODS. Office visits of adult patients to primary care physicians (general practitioners, family physicians, and internists) reported in the National Ambulatory Care Survey for the years 1985 through 1992 were used to examine referrals by primary care physicians. Regression analyses were adjusted for patient factors (age, sex, race, insurance, case mix, diagnostic category, new problem or not, new patient or not, and visit length), physician factors (age, sex, specialty, and degree of specialization), and practice factors (proportion of HMO patients, rural location, region, and study year). RESULTS. Overall, 4.5% of patients were referred compared with 7.5% of patients with HMO insurance. After adjustment, an increased likelihood of referral was associated with being a male patient, having fewer medications prescribed, not being seen before for the presenting problem, a longer visit, less physician specialization, seeing a female physician, seeing an internist, and seeing a physician with a greater proportion of patients with HMO insurance. Among patients with HMO insurance, no gender disparity in referral rate was observed, and patients who also had Medicaid or Medicare insurance were more likely to be referred. CONCLUSIONS. Male patients are more likely to be referred. HMO insurance may reduce this gender disparity and increase the access of patients with Medicaid and Medicare to specialty care. C1 UNIV ROCHESTER,HIGHLAND HOSP,PRIMARY CARE INST,ROCHESTER,NY. UNIV ROCHESTER,DEPT FAMILY MED,ROCHESTER,NY. AGCY HLTH CARE POLICY & RES,CTR PRIMARY CARE RES,ROCKVILLE,MD. AGCY HLTH CARE POLICY & RES,CTR OUTCOMES & EFFECTIVENESS RES,ROCKVILLE,MD. FU AHRQ HHS [HS09397-01] NR 31 TC 68 Z9 69 U1 0 U2 2 PU APPLETON & LANGE PI E NORWALK PA 25 VAN ZANT ST, E NORWALK, CT 06855 SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD JUL PY 1997 VL 45 IS 1 BP 47 EP 53 PG 7 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA XK683 UT WOS:A1997XK68300008 PM 9228914 ER PT J AU Franks, P Clancy, CM Nutting, PA AF Franks, P Clancy, CM Nutting, PA TI Defining primary care - Empirical analysis of the national ambulatory medical care survey SO MEDICAL CARE LA English DT Article DE primary care; primary care specialties ID SURGICAL SPECIALTIES; OBSTETRICIAN-GYNECOLOGISTS; PHYSICIAN; REFORM AB OBJECTIVES. Efforts to contain health care costs have increased interest in defining which specialties provide primary care and in developing tools to assess the delivery of primary care services. METHODS. Using data from the 1985-1991 National Ambulatory Medical Care Surveys, the authors examined the activities of 29 physician specialty groups to determine whether the recent Institute of Medicine definition of primary care could be operationalized. Ten elements were identified that addressed comprehensiveness (first-contact care, a Herfindahl Index, previous contact for other problems, prevention, and care through the life cycle), coordination (referrals), continuity (any previous contact), and accessibility (care provided to black patients, those on Medicaid, and patients in rural areas), RESULTS. Principal component and factor analyses suggested that each element, except care through the life cycle, contributed to the construct of primary care. Principal component analysis enabled ordering of specialties according to their ''primary careness,'' suggesting that specialties other than family/general practice, pediatrics, and internal medicine make significant contributions to primary care. Factor analysis suggested that two factors related to process and content underlie the definition of primary care and emphasize the importance of integration of services provided. This analysis provides a basis for further empirical work to develop measures of primary care performance. CONCLUSIONS. National surveys need to be modified;to provide a more comprehensive assessment of primary care in the United States. C1 UNIV ROCHESTER, DEPT FAMILY MED, ROCHESTER, NY USA. HIGHLAND HOSP, PRIMARY CARE INST, ROCHESTER, NY USA. US DEPT HHS, AGCY HLTH CARE POLICY & RES, DIV PRIMARY CARE, ROCKVILLE, MD 20852 USA. AMBULATORY SENTINEL PRACTICE NETWORK, DENVER, CO USA. UNIV COLORADO, DEPT FAMILY MED, DENVER, CO 80202 USA. NR 22 TC 36 Z9 37 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 EI 1537-1948 J9 MED CARE JI Med. Care PD JUL PY 1997 VL 35 IS 7 BP 655 EP 668 DI 10.1097/00005650-199707000-00001 PG 14 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA XJ684 UT WOS:A1997XJ68400001 PM 9219494 ER PT J AU Forrest, CB Simpson, L Clancy, C AF Forrest, CB Simpson, L Clancy, C TI Child health services research - Challenges and opportunities SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID EARLY DISCHARGE; UNITED-STATES; CHRONIC ILLNESS; SEXUAL ABUSE; CARE; PHYSICIAN; CONTINUITY; INSURANCE; PATTERNS; DISEASE AB The characteristics of childhood as a unique developmental stage of life, the continuity of child health with adult health, and a distinctive child health care system justify a separate focus of health services research on children. Child health services research (CHSR) currently lacks the tools necessary to monitor the impact of health system change on children's health and health care and to compare the effectiveness of alternative treatment modalities. There is an urgent need to build the research capacity of this field of inquiry. Ignoring or minimizing attention to CHSR is both shortsighted and ultimately costly for families and the entire nation. We present arguments for why children merit a separate focus in health services research, identify factors that have led to the failure of appropriate development of CHSR, and offer a set of strategies for how to build the research capacity of the field. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. RP Forrest, CB (reprint author), JOHNS HOPKINS UNIV,SCH PUBL HLTH,DEPT HLTH POLICY & MANAGEMENT,624 N BROADWAY,ROOM 689,BALTIMORE,MD 21205, USA. FU AHRQ HHS [R13 HS09320] NR 80 TC 127 Z9 127 U1 0 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 11 PY 1997 VL 277 IS 22 BP 1787 EP 1793 DI 10.1001/jama.277.22.1787 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA XC499 UT WOS:A1997XC49900032 PM 9178792 ER PT J AU Fleishman, JA AF Fleishman, JA TI Utilization of home care among people with HIV infection SO HEALTH SERVICES RESEARCH LA English DT Article DE home care utilization; HIV infection; AIDS; health insurance; functional status ID AIDS PATIENTS AB Objective. To examine factors affecting the utilization of formal and informal home care services by people with HIV infection. Data Sources and Study Setting. Study participants are adults with HIV infection receiving services at major providers of medical care in ten U.S. cities. Six interviews were conducted over an 18-month period (March 1991 to September 1992). Data Collection Methods. Data on home care utilization, personal background characteristics, insurance status, and functional status are based on self-report. Disease stage is based on medical record data. Study Design. This is an observational study using a panel survey design. Crosstabular and longitudinal regression analyses (N = 1,727) were conducted to determine the effects of sociodemographic factors, functional status, disease stage, and insurance status on the receipt of home care from nurses, paraprofessionals, other professional providers, household residents, nonresident family and friends, and volunteers. Principal Findings. Over a 12-month period, 16 percent of respondents received home nursing visits; 11 percent received paraprofessional care (e.g., nurse's aides, helpers); 4 percent received help from volunteers; 11 percent from non-resident family or friends, and 21 percent from household members. Among the subgroup with AIDS (n = 837), corresponding percentages were 29, 20, 7, 17, and 29 percent for each provider type. In multivariate analyses, illness stage and functional status had strong effects on odds of utilization. Blacks and Hispanics were less likely than whites to have nursing care, but racial/ethnic group did not affect receipt of informal care. Conclusions. Home care utilization is concentrated among people with AIDS, compared to those at less advanced disease stages. In addition to functional limitations, fatigue is associated with the use of home care. Nursing and non-nursing home care have somewhat different correlates. Medicaid may provide better coverage of personal care services than private insurance. RP Fleishman, JA (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR COST & FINANCING,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 21 TC 21 Z9 21 U1 0 U2 0 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD JUN PY 1997 VL 32 IS 2 BP 155 EP 175 PG 21 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA XC429 UT WOS:A1997XC42900003 PM 9180614 ER PT J AU Weinick, RM Beauregard, KM AF Weinick, RM Beauregard, KM TI Women's use of preventive screening services: A comparison of HMO versus fee-for-service enrollees SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article; Proceedings Paper CT Meeting of the American-Public-Health-Association CY NOV 20, 1996 CL NEW YORK, NY SP Amer Public Hlth Assoc ID HEALTH MAINTENANCE ORGANIZATION; MEDICAL-CARE; SELECTION AB Health maintenance organizations (HMOs) may relax some of the institutional barriers to using preventive screening services by requiring only a nominal copayment for such services and by promoting their use via educational programs. However, the gatekeeper system employed by HMOs may discourage the use of these services if referrals are required to access them. Using the 1987 National Medical Expenditure Survey and the 1992 National Health Interview Survey, the authors investigate whether HMO enrollment is associated with the use of preventive screening services for nonelderly, privately insured women. Employing models that control for self-selection into HMOs, the authors find that women who were enrolled in HMOs in 1987 were more likely to have received Pap smears and breast exams within the last year and to have ever received a mammogram when compared with women with fee-for-service coverage. By 1992, however, HMOs had lost this comparative advantage. RP Weinick, RM (reprint author), AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20854, USA. NR 46 TC 29 Z9 30 U1 1 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 SN 1077-5587 J9 MED CARE RES REV JI Med. Care Res. Rev. PD JUN PY 1997 VL 54 IS 2 BP 176 EP 199 DI 10.1177/107755879705400205 PG 24 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA XD736 UT WOS:A1997XD73600005 PM 9437164 ER PT J AU Pezzin, LE Schone, BS AF Pezzin, LE Schone, BS TI The allocation of resources in intergenerational households: Adult children and their elderly parents SO AMERICAN ECONOMIC REVIEW LA English DT Article; Proceedings Paper CT 109th Meeting of the American-Economic-Association CY JAN 04-06, 1997 CL NEW ORLEANS, LA SP Amer Econ Assoc ID MARRIAGE RP Pezzin, LE (reprint author), AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 9 TC 31 Z9 31 U1 0 U2 6 PU AMER ECONOMIC ASSOC PI NASHVILLE PA 2014 BROADWAY, STE 305, NASHVILLE, TN 37203 SN 0002-8282 J9 AM ECON REV JI Am. Econ. Rev. PD MAY PY 1997 VL 87 IS 2 BP 460 EP 464 PG 5 WC Economics SC Business & Economics GA XB091 UT WOS:A1997XB09100097 ER PT J AU Lang, LA Shannon, TE AF Lang, LA Shannon, TE TI Conference overview SO JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT LA English DT Article AB Background: The burgeoning topic of information for consumers on the quality of health care raises several questions: What kinds of information about qualify of care do Americans want and use? How do consumers use information about qualify to choose a health plan, hospital, or physician for themselves and their families? To whom do consumers turn for this information? How would we know if we have provided Americans the ''right'' information? To answer these questions, the Henry J. Kaiser Family Foundation and the Agency for Health Care Policy and Research of the U.S. Department of Health and Human Services convened a national conference, ''Value and Choice: Providing Consumers with Information on the Quality of Health Care'', in Arlington, Virginia, October 29-30, 1996. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR HLTH INFORMAT DISSEMINAT,RES & EVALUAT PROGRAM,ROCKVILLE,MD 20852. HENRY J KAISER FAMILY FDN,MENLO PK,CA. NR 0 TC 4 Z9 4 U1 0 U2 0 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 SN 1070-3241 J9 JOINT COMM J QUAL IM JI Jt. Comm. J. Qual. Improv. PD MAY PY 1997 VL 23 IS 5 BP 231 EP 238 PG 8 WC Health Policy & Services SC Health Care Sciences & Services GA XT105 UT WOS:A1997XT10500001 PM 9179714 ER PT J AU Robinson, S Brodie, M AF Robinson, S Brodie, M TI Understanding the quality challenge for health consumers: The Kaiser/AHCPR survey SO JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT LA English DT Article AB Background and purpose: ''Americans as Health Care Consumers: The Role of Quality Information:'' a nationally representative telephone survey of 2,006 adults, designed by the Henry J. Kaiser Family Foundation (Kaiser) and the Agency for Health Care Policy and Research (AHCPR) of the U.S. Department of Health and Human Services, was presented at the Kaiser/AHCPR conference ''Value and Choice: Providing Consumers with Information on the Quality of Care'' in Arlington, Virginia, October 29-30, 1996. The survey was conducted by Princeton Survey Research Associates between July 16 and September 5, 1996, and has a margin of error of plus or minus 3 percentage points. Results: The survey found that Americans value quality but that the use of quality indicators is likely to be only one factor in their decision making, given their reliance on and preference for quality information from their physicians, friends, and family. A plurality (42%) chose having high quality of care as their most important concern, but only 39% reported seeing information comparing health plans, and only about one-third of that group said they used this information themselves to make decisions. The following are possible explanations for why consumers don't use information on quality in making health care decisions: They trust friends, families, and physicians about all other sources for advice; They do not (at the time of the survey) have many health plan choices to make; or They lack familiarity with comparative health care quality information. C1 HENRY J KAISER FAMILY FDN,MENLO PK,CA. RP Robinson, S (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR QUAL MEASUREMENT & IMPROVEMENT,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 0 TC 80 Z9 81 U1 0 U2 4 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 SN 1070-3241 J9 JOINT COMM J QUAL IM JI Jt. Comm. J. Qual. Improv. PD MAY PY 1997 VL 23 IS 5 BP 239 EP 244 PG 6 WC Health Policy & Services SC Health Care Sciences & Services GA XT105 UT WOS:A1997XT10500002 PM 9179715 ER PT J AU Lanier, D Clancy, C AF Lanier, D Clancy, C TI Primary care research: Current challenges, future needs SO JOURNAL OF FAMILY PRACTICE LA English DT Editorial Material RP Lanier, D (reprint author), AGCY HLTH CARE POLICY & RES,CTR PRIMARY CARE RES,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 13 TC 5 Z9 5 U1 0 U2 0 PU APPLETON & LANGE PI E NORWALK PA 25 VAN ZANT ST, E NORWALK, CT 06855 SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD MAY PY 1997 VL 44 IS 5 BP 434 EP 438 PG 5 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA WY588 UT WOS:A1997WY58800007 PM 9152252 ER PT J AU Steiner, CA Powe, NR Anderson, GF Das, A AF Steiner, CA Powe, NR Anderson, GF Das, A TI Technology coverage decisions by health care plans and considerations by medical directors SO MEDICAL CARE LA English DT Article; Proceedings Paper CT Annual Meeting of the Association-for-Health-Services-Research CY JUN 04-10, 1995 CL CHICAGO, IL SP Assoc Hlth Serv Res DE health insurance; technology assessment; medical coverage decisions; health maintenance organizations; managed care; for-profit health care; lasers ID LASER CORONARY ANGIOPLASTY; INSURANCE COMPANIES; YAG LASER; REIMBURSEMENT; CANCER; COURT AB OBJECTIVES. Decisions made by private health care plans as to whether to cover new medical technology have a significant impact an access, diffusion, and costs. This study describes the variation in health plan coverage of different laser technologies and the types of considerations used in making coverage decisions for them. METHODS. In a cross-sectional national survey of medical directors at private plans, medical directors indicated current coverage of 15 different laser therapies, and then ranked the top five considerations both in favor and against recommending coverage far three of the laser therapies (angioplasty, discectomy, and photodynamic therapy). The influence of explicit clinical information and/or plan characteristics on coverage and the importance of considerations was examined through multivariate analyses (multiple logistic or linear regression analysis). RESULTS. Overall, 231 medical directors responded from plans representing 66% and 72% of persons in US health maintenance organization and indemnity plans, respectively, Current coverage for 13 of the 15 laser therapies varied between 20% and 90%, For-profit and indemnity plans covered approximately two more of the different laser technologies than nonprofit plans and health maintenance organizations, Considerations most frequently listed in favor of and against recommending coverage across the three laser technologies were clinical, economic, and regulatory. Legal, competitive, and compassionate concerns were listed less frequently Considerations were not uniform across laser therapies; they reflected the specifics of the technology under review Flan characteristics influenced the ranking of considerations as well. For instance, health maintenance organizations were two to three times more likely than indemnity plans to list potential for decreased cost in favor of recommending coverage. CONCLUSIONS. These findings demonstrate that there is substantial variation in coverage of new technologies, indicating that a large proportion of the population covered by private health plans are ineligible for treatments that are routinely available to others. A greater range of medical therapy may be available for persons enrolled in indemnity and for-profit plans should their physicians choose to prescribe if. Clinical and economic considerations, including cost-effectiveness, predominate in coverage decisions for new technologies. The importance of considerations appears sensitive not only to specific clinical information, however, but also to characteristics of: health plans. C1 JOHNS HOPKINS UNIV, SCH MED, DEPT MED, BALTIMORE, MD 21218 USA. AGCY HLTH CARE POLICY & RES, CTR ORG & DELIVERY STUDIES, ROCKVILLE, MD USA. JOHNS HOPKINS UNIV, SCH HYG & PUBL HLTH, DEPT HLTH POLICY & MANAGEMENT, BALTIMORE, MD USA. JOHNS HOPKINS UNIV, SCH HYG & PUBL HLTH, DEPT EPIDEMIOL, BALTIMORE, MD USA. JOHNS HOPKINS UNIV, SCH HYG & PUBL HLTH, DEPT BIOSTAT, BALTIMORE, MD USA. FU NCRR NIH HHS [5M01RR00722, RR0035] NR 37 TC 24 Z9 24 U1 0 U2 1 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 1997 VL 35 IS 5 BP 472 EP 489 DI 10.1097/00005650-199705000-00005 PG 18 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA WW599 UT WOS:A1997WW59900005 PM 9140336 ER PT J AU Kamerow, DB AF Kamerow, DB TI Before and after guidelines SO JOURNAL OF FAMILY PRACTICE LA English DT Editorial Material RP Kamerow, DB (reprint author), PUBL HLTH SERV,AGCY HLTH CARE POLICY & RES,6000 EXECUT BLVD,SUITE 310,ROCKVILLE,MD 20852, USA. NR 8 TC 5 Z9 5 U1 0 U2 0 PU APPLETON & LANGE PI E NORWALK PA 25 VAN ZANT ST, E NORWALK, CT 06855 SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD APR PY 1997 VL 44 IS 4 BP 344 EP 346 PG 3 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA WU012 UT WOS:A1997WU01200005 PM 9108829 ER PT J AU Murtaugh, CM Kemper, P Spillman, BC Carlson, BL AF Murtaugh, CM Kemper, P Spillman, BC Carlson, BL TI The amount, distribution, and timing of lifetime nursing home use SO MEDICAL CARE LA English DT Article; Proceedings Paper CT 121st Annual Meeting of the American-Public-Health-Association CY OCT 24-28, 1993 CL SAN FRANCISCO, CA SP Amer Public Hlth Assoc, Med Care Sect, NIMH DE nursing home use; long-term care; risk of institutionalization ID LONG-TERM CARE; PROSPECTIVE PAYMENT; DISABILITY; RISK AB OBJECTIVES. Information on lifetime nursing home use is needed to design and evaluate long-term care financing reforms. Whereas a number of studies have estimated mean lifetime use or its distribution, very little is known about variation in use among subgroups of the population, the timing of use, the number of distinct episodes of care experienced by nursing home users, and the risk and expected use at ages other than age 65. The purpose of the study was to fill these gaps in knowledge. METHODS. The study used a data base constructed to represent decedents who used nursing homes. The sample was derived from the sample of discharges collected as part of the 1985 National Nursing Home Survey. Weights were constructed for the purpose of making projections of remaining lifetime nursing home use at selected ages in 1995. RESULTS. There was considerable variation in lifetime use among demographic groups. Overall, estimates of the amount of use remaining at selected ages tended to be relatively constant at approximately 1 year. Mean years until nursing home admission, however, decreased sharply from almost 40 years at age 45 to approximately 5 years at age 85. CONCLUSIONS. The distribution of lifetime use was highly skewed, providing support for efforts to spread risk through public or private insurance. With roughly one quarter of all use occurring after 5 years of nursing home residence, however, a substantial share of use would exceed benefit maximums that are part of many proposals for public financing of long-term care as well as private insurance policies. C1 CTR STUDYING HLTH SYST CHANGE,WASHINGTON,DC. US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. MATH POLICY RES INC,PRINCETON,NJ. RP Murtaugh, CM (reprint author), VISITING NURSE SERV NEW YORK,CTR HOME CARE POLICY & RES,5 PENN PLAZA,NEW YORK,NY 10001, USA. NR 21 TC 44 Z9 44 U1 0 U2 3 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 1997 VL 35 IS 3 BP 204 EP 218 DI 10.1097/00005650-199703000-00003 PG 15 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA WM542 UT WOS:A1997WM54200002 PM 9071254 ER PT J AU Freiman, MP Cunningham, PJ AF Freiman, MP Cunningham, PJ TI Use of health care for the treatment of mental problems among racial/ethnic subpopulations SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article ID NATIONAL INSURED POPULATION; SERVICES; PROBABILITY; RACE AB This article analyzes the degree to which interactions between race/ethnicity and other characteristics of a person and their local area are important in determining the probability of any mental health care use. Separate equations are estimated for ''Blacks and Hispanics'' and ''Whites and other groups.'' Simulations are then performed where the probabilities of use are estimated for individuals in one racial/ethnic group, using coefficients estimated for another racial/ethnic group. These simulations show that the probability of use for Blacks and Hispanics would be similar to Whites if they were subject to the same behavioral patterns (regression coefficients) as Whites, and vice versa. The results indicate the limitations of simply using dummy variables to represent race/ethnicity and the value of learning more about how the health care system interacts with persons of different racial/ethnic backgrounds. Policies that directly affect the location, characteristics, and behavior of health care providers, as well as the behavior of consumers, may be as relevant to achieving equality of use or access as incremental changes in health coverage. RP Freiman, MP (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852, USA. NR 28 TC 17 Z9 17 U1 0 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 SN 1077-5587 J9 MED CARE RES REV JI Med. Care Res. Rev. PD MAR PY 1997 VL 54 IS 1 BP 80 EP 100 DI 10.1177/107755879705400105 PG 21 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA WM319 UT WOS:A1997WM31900005 PM 9437160 ER PT J AU Simpson, L Korenbrot, C Greene, J AF Simpson, L Korenbrot, C Greene, J TI Outcomes of enhanced prenatal services for Medicaid-eligible women in public and private settings SO PUBLIC HEALTH REPORTS LA English DT Article ID LOW-BIRTH-WEIGHT; NORTH-CAROLINA; CARE; PROVIDERS AB Objective. With changes in Medicaid, more low-income women are receiving prenatal care in private practice settings. The authors sought to determine whether private settings can provide the enhanced prenatal support services for low-income women that have been offered for decades in public settings. Methods. The authors analyzed birth outcomes of Medicaid-eligible women receiving care from public and private providers certified to deliver enhanced prenatal care services, which included assessments of nutritional, psychosocial, and health educational risks and individualized counseling along with clinical care. Birth outcomes were compared by type of provider setting using multivariate logistic regression models to adjust for differences in risks and use of care. Results. Among settings certified to deliver enhanced perinatal support services, private physicians' offices had the best risk-adjusted birth outcomes and public health department clinics the worst, while public hospital clinics had outcomes no different from private physicians' offices. Adjusted for prenatal care use, outcomes were still better for women seen in private physicians' offices than for women seen in public health department clinics, community clinics, or private hospital clinics. Conclusions. The findings suggest that given a certification process, private providers can provide enhanced support services as effectively as provider; in public practice settings. C1 UNIV CALIF SAN FRANCISCO,INST HLTH POLICY STUDIES,SCH MED,SAN FRANCISCO,CA 94109. UNIV CALIF SAN FRANCISCO,DEPT OBSTET GYNECOL & REPROD SCI,SCH MED,SAN FRANCISCO,CA 94109. US PHS,AGCY HLTH CARE POLICY & RES,WASHINGTON,DC 20201. RI Sandall, Jane/D-4146-2009 OI Sandall, Jane/0000-0003-2000-743X FU PHS HHS [MCJ 06-0620] NR 42 TC 11 Z9 12 U1 0 U2 0 PU US GOVERNMENT PRINTING OFFICE PI WASHINGTON PA SUPT OF DOCUMENTS, WASHINGTON, DC 20402-9325 SN 0033-3549 J9 PUBLIC HEALTH REP JI Public Health Rep. PD MAR-APR PY 1997 VL 112 IS 2 BP 122 EP 132 PG 11 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA WN191 UT WOS:A1997WN19100025 PM 9071274 ER PT J AU Short, PF Hahn, BA Beauregard, K Harvey, PH Wilets, ML AF Short, PF Hahn, BA Beauregard, K Harvey, PH Wilets, ML TI The effect of universal coverage on health expenditures for the uninsured SO MEDICAL CARE LA English DT Article DE health-care reform; financing; uninsured ID CARE; INSURANCE; SERVICES; IMPACT; DEMAND; COST AB OBJECTIVES. Universal coverage will trigger an increase in health-care spending, because the uninsured will use more services after they are insured. The effect of insurance status on expenditures is estimated here from a multivariate statistical model. METHODS. The model is estimated with data from the 1987 National Medical Expenditure Survey, aged to 1994 using population projections from the US Bureau of the Census and expenditure projections from the Health Care Financing Administration. RESULTS. Expenditures for the full-year uninsured increase by approximately $700 per person in 1994 as a result of universal coverage. Nearly half of the increase is because of a substantial increase in the likelihood of hospitalization. CONCLUSIONS. If the uninsured are enrolled in plans similar to those offered by employers currently, personal health-care spending increases by approximately $20 billion in 1994. There are other costs associated with universal coverage that are not included in this figure. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. NR 24 TC 6 Z9 6 U1 0 U2 2 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD FEB PY 1997 VL 35 IS 2 BP 95 EP 113 DI 10.1097/00005650-199702000-00001 PG 19 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA WG363 UT WOS:A1997WG36300001 PM 9017949 ER PT J AU Miller, ME Welch, WP Wong, HS AF Miller, ME Welch, WP Wong, HS TI Exploring the relationship between inpatient facility and physician services SO MEDICAL CARE LA English DT Article DE hospital costs; physician services; substitution; complementarity ID EXPENDITURES AB OBJECTIVES. Medicare hospitalizations involve both facility and physician services. Although several studies analyze hospital-level variations in Medicare inpatient facility end inpatient physician services per admission, few studies directly explore the relationship between these services. Theoretically, inpatient facility and physician services may be complements or substitutes. That is, an increase in facility services may lead to an increase or decrease in physician services and vice versa. This article contributes to the existing literature by exploring directly the relationship between facility and physician services. METHODS. Medicare physician claims were linked to inpatient hospital stays using data from Medicare hospital cost reports, the Medicare Patient Analysis and Review file, and the Medicare National Claims History System. RESULTS. In multi-variate regression analyses, the (partial) correlations between facility and physician services were positive, which is consistent with complementarity. Standardized regression coefficients indicate that physician services are the single most important determinant of facility services; however facility services are a less important determinant of physician services. A 10% increase in physician services is associated with at least a 3.0% increase in facility services. CONCLUSIONS. Proposals that reduce inpatient physician expenditures also would reduce facility expenditures in the long-run. C1 CONGRESS BUDGET OFF,WASHINGTON,DC 20515. URBAN INST,WASHINGTON,DC 20037. US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. NR 12 TC 1 Z9 1 U1 3 U2 3 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD FEB PY 1997 VL 35 IS 2 BP 114 EP 127 DI 10.1097/00005650-199702000-00002 PG 14 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA WG363 UT WOS:A1997WG36300002 PM 9017950 ER PT J AU Atkins, D AF Atkins, D TI Prostate cancer screening SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter RP Atkins, D (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852, USA. NR 6 TC 2 Z9 2 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 22 PY 1997 VL 277 IS 4 BP 299 EP 300 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA WC458 UT WOS:A1997WC45800027 PM 9002491 ER PT J AU Clancy, CM Cooper, JK AF Clancy, CM Cooper, JK TI Outcomes and effectiveness research in Alzheimer disease SO ALZHEIMER DISEASE & ASSOCIATED DISORDERS LA English DT Article; Proceedings Paper CT Conference on Defining and Measuring Outcomes in Alzheimers Disease - Do We Agree CY SEP 11-12, 1996 CL WASHINGTON, D.C. SP Alzheimers Assoc, Advisory Panel Alzheimers Dis, Agcy Hlth Care Policy & Res, Dept Vet Affairs, NIA, NIMH, NINR, Univ Hosp Cleveland DE Agency for Health Care Policy and Research; dementia; medical effectiveness; outcomes assessment; US Public Health Service ID SMALL-AREA VARIATIONS; HEALTH-CARE SERVICES; QUALITY-OF-LIFE AB "Outcomes and effectiveness research" is a relatively new clinical area, although the principles involved are not new. Outcomes and effectiveness research has grown in importance for several reasons. Changes in disease prevalence in the United States have led to more people with chronic disease, for which traditional treatment "success" measures such as cure or death are not relevant, and new measures of effectiveness are needed. In addition, results of clinical trials are not always generalizable, and information is needed about what can be expected in usual treatment circumstances. National interests, such as the desire to control costs, increase patient autonomy, and assure accountability, also are incentives for the outcomes and effectiveness movement. Important characteristics of outcomes and effectiveness research include selection of best measures and relevant domains and matching measures to those who would use the results. C1 Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. RP Clancy, CM (reprint author), Agcy Hlth Care Policy & Res, 2101 E Jefferson St,Suite 20852, Rockville, MD 20852 USA. NR 19 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 USA SN 0893-0341 J9 ALZ DIS ASSOC DIS JI Alzheimer Dis. Assoc. Dis. PY 1997 VL 11 SU 6 BP 7 EP 11 PG 5 WC Clinical Neurology; Pathology SC Neurosciences & Neurology; Pathology GA YN768 UT WOS:000071204600002 PM 9437442 ER PT J AU Spector, WD AF Spector, WD TI Measuring functioning in daily activities for persons with dementia SO ALZHEIMER DISEASE & ASSOCIATED DISORDERS LA English DT Article; Proceedings Paper CT Conference on Defining and Measuring Outcomes in Alzheimers Disease - Do We Agree CY SEP 11-12, 1996 CL WASHINGTON, D.C. SP Alzheimers Assoc, Advisory Panel Alzheimers Dis, Agcy Hlth Care Policy & Res, Dept Vet Affairs, NIA, NIMH, NINR, Univ Hosp Cleveland DE activities of daily living; dementia; instrumental activities of daily living; measurement; validity ID ALZHEIMERS-DISEASE; OLDER ADULTS; INDEPENDENCE MEASURE; PERFORMANCE-TEST; HEALTH; DISABILITY; SCALE; CAPACITY; PROXY; CARE AB The author reviews scales that include independent living tasks, with a special focus on scales designed to be used with demented persons. The main focus of the paper is evaluation of dementia-specific scales, both proxy report and performance scales. Criticisms of generic independent living measures are reviewed and approaches to dementia-specific scales are assessed. The overall state of the art of measuring functional disability for persons with dementia is reviewed, with special emphasis on validity, measurement bias, and scaling properties. The author attempts to clarify whether dementia-specific scales are measuring the disability consequences of cognitive impairments or the cognitive impairments themselves. C1 Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Rockville, MD 20052 USA. RP Spector, WD (reprint author), Agcy Hlth Care Policy & Res, Ctr Org & Delivery Studies, Suite 500,2101 E Jefferson St, Rockville, MD 20052 USA. NR 55 TC 12 Z9 12 U1 4 U2 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 USA SN 0893-0341 J9 ALZ DIS ASSOC DIS JI Alzheimer Dis. Assoc. Dis. PY 1997 VL 11 SU 6 BP 81 EP 90 PG 10 WC Clinical Neurology; Pathology SC Neurosciences & Neurology; Pathology GA YN768 UT WOS:000071204600012 PM 9437452 ER PT J AU Fortinsky, RH Hazuda, HP Larson, EB Lindeman, DA Mullican, CA Tetzloff, I Wetle, T AF Fortinsky, RH Hazuda, HP Larson, EB Lindeman, DA Mullican, CA Tetzloff, I Wetle, T TI Principles underlying selection of outcomes in Alzheimer disease research SO ALZHEIMER DISEASE & ASSOCIATED DISORDERS LA English DT Article; Proceedings Paper CT Conference on Defining and Measuring Outcomes in Alzheimers Disease - Do We Agree CY SEP 11-12, 1996 CL WASHINGTON, D.C. SP Alzheimers Assoc, Advisory Panel Alzheimers Dis, Agcy Hlth Care Policy & Res, Dept Vet Affairs, NIA, NIMH, NINR, Univ Hosp Cleveland C1 Case Western Reserve Univ, Sch Med WG37C, Dept Med, Cleveland, OH 44106 USA. Univ Texas, Dept Med, San Antonio, TX 78285 USA. Univ Washington, Med Ctr, Seattle, WA 98195 USA. Rush Presbyterian St Lukes Med Ctr, Rush Inst Aging, Chicago, IL 60612 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. US Adm Aging, Washington, DC USA. NIA, Bethesda, MD 20892 USA. RP Fortinsky, RH (reprint author), Case Western Reserve Univ, Sch Med WG37C, Dept Med, 10900 Euclid Ave, Cleveland, OH 44106 USA. NR 0 TC 2 Z9 1 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 USA SN 0893-0341 J9 ALZ DIS ASSOC DIS JI Alzheimer Dis. Assoc. Dis. PY 1997 VL 11 SU 6 BP 184 EP 185 PG 2 WC Clinical Neurology; Pathology SC Neurosciences & Neurology; Pathology GA YN768 UT WOS:000071204600026 PM 9437466 ER PT J AU Vistnes, JP AF Vistnes, JP TI Gender differences in days lost from work due to illness SO INDUSTRIAL & LABOR RELATIONS REVIEW LA English DT Article ID TEACHER ABSENTEEISM; HEALTH; ABSENCE; MODEL; CARE; TIME; REGRESSION; DEMAND AB The author uses data from the 1987 National Medical Expenditure Survey to investigate the extent and determinants of gender differences in days lost from work due to illness. She finds that for both men and women, health status measures, such as self-reported health status and medical events, more consistently explained absenteeism than did economic factors such as wages and the presence of sick leave. The presence of young children increased women's, but not men's, probability of missing work, as well as women's number of absences for those who missed work in 1987. Among men who were absent from work in 1987, however, the presence of children in dag care increased the number of days lost from work. In that regard, those men, most of whom were likely to be either single parents or married with a working wife, behaved more like mothers with young children than like other men. RP Vistnes, JP (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR COST & FINANCING STUDIES,ROCKVILLE,MD 20852, USA. NR 41 TC 67 Z9 68 U1 1 U2 6 PU INDUSTRIAL LABOR RELAT REV PI ITHACA PA CORNELL UNIV, ITHACA, NY 14851-0952 SN 0019-7939 J9 IND LABOR RELAT REV JI Ind. Labor Relat. Rev. PD JAN PY 1997 VL 50 IS 2 BP 304 EP 323 DI 10.2307/2525088 PG 20 WC Industrial Relations & Labor SC Business & Economics GA WB311 UT WOS:A1997WB31100007 ER PT J AU Fleishman, JA Schneider, DA Garcia, I Hardwick, K AF Fleishman, JA Schneider, DA Garcia, I Hardwick, K TI Dental service use among adults with human immunodeficiency virus infection SO MEDICAL CARE LA English DT Article ID ORAL LESIONS; DENTISTS ATTITUDES; LONGITUDINAL DATA; NATIONAL SURVEY; HIV-INFECTION; PREVALENCE; HEALTH; CARE; AIDS; BEHAVIOR C1 HLTH RESOURCES & SERV ADM,BUR HLTH RESOURCES DEV,ROCKVILLE,MD. NIDR,BETHESDA,MD 20892. RP Fleishman, JA (reprint author), AGCY HLTH CARE POLICY & RES,CTR COST & FINANCING,2101 E JEFFERSON ST,SUITE 502,ROCKVILLE,MD 20852, USA. NR 37 TC 10 Z9 10 U1 3 U2 3 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD JAN PY 1997 VL 35 IS 1 BP 77 EP 85 DI 10.1097/00005650-199701000-00007 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA WB739 UT WOS:A1997WB73900007 PM 8998205 ER PT J AU Cooper, JK AF Cooper, JK TI Preventing heat injury: Military versus civilian perspective SO MILITARY MEDICINE LA English DT Article ID STROKE PATIENTS; HYPERTHERMIA; EXERCISE; ILLNESS; FLUID AB Guidelines for preventing heat injury (HI) among military personnel are not directly applicable to civilian personnel. Military guidelines call for relatively large volumes of prophylactic water consumption and physical activity limitations depending on the met bulb globe temperature. However, in civilian populations, there is an increased prevalence of HI risk factors: older age, medication use, especially anticholinergic and psychotropic medications, obesity, previous HI, and skin disorders. Although dehydration is a major contributor to HI in military situations, it is unlikely in classical heat stroke among civilians. Civilian guidelines are based on the heat index, Activity levels must be restricted more for civilians, and prophylactic water consumption (beyond replacing loss from sweat) is not necessary. This review discusses the pathophysiology of heat injury, contrasts the military and civilian approach to prevention of HI, and describes appropriate field intervention for HI. RP Cooper, JK (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR PRIMARY CARE RES,ROCKVILLE,MD 20852, USA. NR 34 TC 5 Z9 6 U1 0 U2 3 PU ASSN MILITARY SURG US PI BETHESDA PA 9320 OLD GEORGETOWN RD, BETHESDA, MD 20814 SN 0026-4075 J9 MIL MED JI Milit. Med. PD JAN PY 1997 VL 162 IS 1 BP 55 EP 58 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA WB973 UT WOS:A1997WB97300016 PM 9002705 ER PT S AU McCormick, KA AF McCormick, KA BE Gerdin, U Tallberg, M Wainwright, P TI Improving nursing documentation to include outcomes of care in computerized information systems SO NURSING INFORMATICS: THE IMPACT OF NURSING KNOWLEDGE ON HEALTH CARE INFORMATICS SE STUDIES IN HEALTH TECHNOLOGY AND INFORMATICS LA English DT Proceedings Paper CT 6th Triennial International Congress of IMIA-NI on Nursing Informatics - The Impact of Nursing Knowledge on Health Care Informatics (NI 97) CY 1997 CL STOCKHOLM, SWEDEN SP Int Med Informat Assoc, Special Interest Grp Nursing Informat, No Nurses Federat, Swedish Nurses Assoc, Swedish Assoc Hlth Officers, Swedish Federat Cty Council, Stockholm Univ Coll Hlth Sci, Swedish Inst Hlth Serv Dev, S Stockholm Hlth Care Dist AB Oftentimes when models of information systems are developed, outcomes are either left out or described as an end product of treatment alone. However, in research demonstrating outcomes, evaluating whether outcomes are achieved can best be accomplished when the outcomes are integrated into the entire care process. This paper describes a model for nursing to consider when integrating outcomes during several components of nursing care delivery, and several nursing domains for achieving outcome of care. RP McCormick, KA (reprint author), AGCY HLTH CARE POLICY & RES,CTR INFORMAT TECHNOL,2101 E JEFFERSON ST,SUITE 602,ROCKVILLE,MD 20852, USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU I O S PRESS PI AMSTERDAM PA VAN DIEMENSTRAAT 94, 1013 CN AMSTERDAM, NETHERLANDS SN 0926-9630 BN 90-5199-362-5 J9 ST HEAL T PY 1997 VL 46 BP 105 EP 110 PG 6 WC Medical Informatics; Nursing SC Medical Informatics; Nursing GA BJ94F UT WOS:A1997BJ94F00018 PM 10175380 ER PT J AU Bartman, BA Clancy, CM Moy, E Langenberg, P AF Bartman, BA Clancy, CM Moy, E Langenberg, P TI Cost differences among women's primary care physicians SO HEALTH AFFAIRS LA English DT Article AB A secondary analysis of data from the 1987 National Medical Expenditure Survey revealed that women with distinct demographic and socio-economic economic characteristics identify different physician specialty groups as their usual source of care. The use of certain physician groups for primary care resulted in higher rates of use and expenditures, particularly for younger women. Identifying an internist, rather than a family/general practitioner or an obstetrician-gynecologist, as a usual source of care placed one at higher odds of making more visits and incurring higher total outpatient costs. C1 UNIV MARYLAND,SCH MED,DEPT EPIDEMIOL & PREVENT MED,BALTIMORE,MD 21201. AGCY HLTH CARE POLICY & RES,CTR OUTCOMES & EFFECTIVENESS RES,ROCKVILLE,MD. ASSOC AMER MED COLL,CTR ASSESSMENT & MANAGEMENT CHANGE ACAD MED,WASHINGTON,DC. RP Bartman, BA (reprint author), UNIV MARYLAND,SCH MED,DEPT MED,BALTIMORE,MD 21201, USA. NR 8 TC 8 Z9 8 U1 0 U2 0 PU PROJECT HOPE-HEALTH AFFAIRS PI SYRACUSE PA PO BOX 8015, SYRACUSE, NY 13217 SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD WIN PY 1996 VL 15 IS 4 BP 177 EP 182 DI 10.1377/hlthaff.15.4.177 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA VV019 UT WOS:A1996VV01900025 PM 8991273 ER PT J AU Cohen, JW Monheit, AC Beauregard, KM Cohen, SB Lefkowitz, DC Potter, DEB Sommers, JP Taylor, AK Arnett, RH AF Cohen, JW Monheit, AC Beauregard, KM Cohen, SB Lefkowitz, DC Potter, DEB Sommers, JP Taylor, AK Arnett, RH TI The medical expenditure panel survey: A national health information resource SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Statistical-Association CY AUG 04-08, 1996 CL CHICAGO, IL SP Amer Stat Assoc ID INSURANCE; CHILDREN; CARE AB This article describes the Medical Expenditure Panel Survey (MEPS), the third in a series of nationally representative surveys of medical care use and expenditures sponsored by the Agency for Health Care Policy and Research. The MEPS is designed to provide extensive data on the types of health care services American use, how frequently they use them, how much is paid for the services, and who pays for them. It also will provide information on the types and costs of private health insurance available to the U.S. population. The survey is unparalleled in its degree of detail, as well as its ability to link medical care use payments, and health insurance coverage to specific survey respondents and their families. It allows analysts to examine how individual and family characteristics, including the characteristics of their health insurance, affect medical care use and spending. This article discusses each of the MEPS components, focusing on design enhancements that have been made since the survey was last conducted nearly a decade ago. RP Cohen, JW (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR COST & FINANCING STUDIES,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 36 TC 195 Z9 195 U1 0 U2 2 PU BLUE CROSS BLUE SHIELD ASSOC PI CHICAGO PA 676 N ST CLAIR ST, CHICAGO, IL 60611 SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD WIN PY 1996 VL 33 IS 4 BP 373 EP 389 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA WG223 UT WOS:A1996WG22300010 PM 9031653 ER PT J AU McCormick, KA Cohen, E Reed, M Sparks, S Wasem, C AF McCormick, KA Cohen, E Reed, M Sparks, S Wasem, C TI Funding nursing informatics activities - Internet access to announcements of government funding SO COMPUTERS IN NURSING LA English DT Editorial Material ID HEALTH RP McCormick, KA (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852, USA. NR 10 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0736-8593 J9 COMPUT NURS JI Comput. Nurs. PD NOV-DEC PY 1996 VL 14 IS 6 BP 315 EP 322 PG 8 GA VU521 UT WOS:A1996VU52100006 PM 8972985 ER PT J AU Cohen, SS Mason, DJ Kovner, C Leavitt, JK Pulcini, J Sochalski, J AF Cohen, SS Mason, DJ Kovner, C Leavitt, JK Pulcini, J Sochalski, J TI Stages of nursing's political development: Where we've been and where we ought to go SO NURSING OUTLOOK LA English DT Article ID HEALTH-POLICY; PUBLIC-POLICY; CARE; STUDENTS AB How has nursing evolved as a body politic? A framework that conceptualizes the political development of the nursing profession in four stages is useful for analyzing previous accomplishments and planning future actions that will enhance the political involvement of nursing as it seeks to improve the health care delivery system. C1 PACE UNIV,LIENHARD SCH NURSING,PLEASANTVILLE,NY. NYU,DIV NURSING,NEW YORK,NY. US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. GENERAT UNITED,WASHINGTON,DC. CUNY,HUNTER BELLEVUE SCH NURSING,NEW YORK,NY 10021. UNIV PENN,SCH NURSING,PHILADELPHIA,PA 19104. RP Cohen, SS (reprint author), YALE UNIV,SCH NURSING,CTR HLTH POLICY,NEW HAVEN,CT 06536, USA. NR 66 TC 20 Z9 20 U1 0 U2 2 PU MOSBY-YEAR BOOK INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 SN 0029-6554 J9 NURS OUTLOOK JI Nurs. Outlook PD NOV-DEC PY 1996 VL 44 IS 6 BP 259 EP 266 DI 10.1016/S0029-6554(96)80081-9 PG 8 WC Nursing SC Nursing GA VZ270 UT WOS:A1996VZ27000002 PM 8981495 ER PT J AU Hellinger, FJ AF Hellinger, FJ TI The expanding scope of state legislation SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID HOSPITAL DISCHARGE; POSTPARTUM RP Hellinger, FJ (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR ORG & DELIVERY STUDIES,SUITE 502,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 38 TC 31 Z9 31 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD OCT 2 PY 1996 VL 276 IS 13 BP 1065 EP 1070 DI 10.1001/jama.276.13.1065 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA VK035 UT WOS:A1996VK03500028 PM 8847769 ER PT J AU Cunningham, PJ Freiman, MP AF Cunningham, PJ Freiman, MP TI Determinants of ambulatory mental health services use for school-age children and adolescents SO HEALTH SERVICES RESEARCH LA English DT Article DE child and adolescent mental health; mental health services; ambulatory care; access to care ID PHYSICIAN SERVICES; MEDICAL-CARE; PREVALENCE; SPECIALTY AB Objective. To analyze a comprehensive multivariate model of the use of mental health-related ambulatory care services by children ages 6-17. Study Setting. The 1987 National Medical Expenditure Survey, a national probability sample of the U.S. civilian noninstitutionalized population. Study Design. A cross-sectional survey of a national probability sample of the U.S. population. Key independent variables include person-level mental health status, health care coverage, family income, and use of mental health services by other family members. Data Collection. Four in-person interviews were conducted during 1987 using structured questionnaires. A designated family respondent was used to answer questions for other family members, including children. Principal Findings. Children with poor mental health in high-income families were more than three times as likely to have a mental health-related visit than children with poor mental health in low-income families. The number of mental health-related visits and the likelihood of seeing a mental health specialist also increased along with family income. Mental health use by other family members was strongly associated with use. Conclusions. The results from this study provide strong evidence that the socioeconomic status of children is an important factor in explaining unmet need for mental health services. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR COST & FINANCING STUDIES,ROCKVILLE,MD 20852. RP Cunningham, PJ (reprint author), CTR STUDYING HLTH SYST CHANGE,600 MARYLAND AVE SW,SUITE 550,WASHINGTON,DC 20024, USA. NR 28 TC 49 Z9 49 U1 2 U2 4 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD OCT PY 1996 VL 31 IS 4 BP 409 EP 427 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA VN722 UT WOS:A1996VN72200003 PM 8885856 ER PT J AU Merrick, N Davidson, B Fox, S AF Merrick, N Davidson, B Fox, S TI Treatment of acute gastroenteritis: Too much and too little care SO CLINICAL PEDIATRICS LA English DT Article ID ACUTE DIARRHEA; UNITED-STATES; VIRAL GASTROENTERITIS; ORAL REHYDRATION; CHILDREN; INFANTS; RATES; MANAGEMENT; MORTALITY; TODDLERS AB This paper reviews the health services literature regarding care for gastroenteritis in children, United States health care utilization, use of oral rehydration therapy (ORT), and quality of care considerations are described. The literature suggests that some US children mall receive too much care while others may not be getting enough and that physician practices continue to differ from expert recommendations. C1 VALUE HLTH SCI INC,SANTA MONICA,CA. AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD. RP Merrick, N (reprint author), MEDSTAT GRP,5425 HOLLISTER AVE,SUITE 140,SANTA BARBARA,CA 93111, USA. NR 38 TC 15 Z9 15 U1 0 U2 0 PU WESTMINSTER PUBL INC PI GLEN HEAD PA 708 GLEN COVE AVE, GLEN HEAD, NY 11545 SN 0009-9228 J9 CLIN PEDIATR JI Clin. Pediatr. PD SEP PY 1996 VL 35 IS 9 BP 429 EP 435 DI 10.1177/000992289603500901 PG 7 WC Pediatrics SC Pediatrics GA VG196 UT WOS:A1996VG19600002 PM 8877239 ER PT J AU Cooper, PF Nichols, LM Taylor, AK AF Cooper, PF Nichols, LM Taylor, AK TI Patient choice of physician: Do health insurance and physician characteristics matter? SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article; Proceedings Paper CT 1992 Annual Meeting of the Southern-Economic-Association CY NOV 22, 1992 CL WASHINGTON, DC SP So Econ Assoc ID MEDICAL-CARE; WELFARE LOSS; SERVICES; DEMAND AB Generous health insurance coverage is widely believed to have contributed to both high and rising health care costs. This paper tests the hypothesis that better insured patients will demand higher ''quality'' by choosing more often to visit specialists rather than generalist physicians. We model the conditional decision to seek care from a specialist physician as a function of health insurance status, physician characteristics, and other socioeconomic factors. Analysis of data from the 1987 National Medical Expenditure Survey and the American Medical Association suggests that the presence of insurance coverage does not affect choice of physician. The results do show that people enrolled in health maintenance organizations (HMOs) see specialists less often than other patients. C1 AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. URBAN INST,WASHINGTON,DC 20037. NR 26 TC 10 Z9 10 U1 0 U2 3 PU BLUE CROSS BLUE SHIELD ASSN PI CHICAGO PA 676 N ST CLAIR ST, CHICAGO, IL 60611 SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD FAL PY 1996 VL 33 IS 3 BP 237 EP 246 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA VM620 UT WOS:A1996VM62000005 PM 8883458 ER PT J AU Atkins, D AF Atkins, D TI Improving screening for cancer in the primary care setting - Where do we need to go and how can we get there? SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material RP Atkins, D (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852, USA. NR 10 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL SCIENCE INC PI CAMBRIDGE PA 238 MAIN ST, CAMBRIDGE, MA 02142 SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD SEP PY 1996 VL 11 IS 9 BP 563 EP 564 DI 10.1007/BF02599609 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA VP757 UT WOS:A1996VP75700013 PM 8905510 ER PT J AU Ball, JK Elixhauser, A AF Ball, JK Elixhauser, A TI Treatment differences between blacks and whites with colorectal cancer SO MEDICAL CARE LA English DT Article DE colorectal cancer; treatment differences; race ID CORONARY-ARTERY DISEASE; RACIAL-DIFFERENCES; MEDICARE PATIENTS; MORTALITY; RATES; RACE; MARYLAND; SURVIVAL; ACCURACY; SURGERY AB OBJECTIVES. The authors examine interracial variations in treatment for over 20,000 patients hospitalized with colorectal cancer in a national sample of hospitals. METHODS. To reduce clinical heterogeneity that could explain differences in treatment, hospitalizations were classified into relatively homogeneous subgroups based on diagnoses indicating primary colorectal tumor, oncologic sequelae, and metastasis. Procedures were classified into clinically relevant treatment types. Multivariate techniques controlled for differences in patient demographics, insurance status, other clinical factors, and provider characteristics. RESULTS. Blacks were more likely than whites to be hospitalized with oncologic sequelae, diagnoses indicating advanced disease, which may capture the effects of unmanaged or poorly managed cancer. Inpatient mortality was equivalent only for the most severely ill. Otherwise, the odds of inpatient mortality were 59% to 98% higher for blacks than whites. Treatment, in terms of procedure type, was equivalent only for the sickest patients. Among the less severely ill, blacks were less likely than whites to receive major therapeutic procedures. CONCLUSIONS. Multiple findings suggest that blacks with colorectal cancer were hospitalized with more severe conditions and treated less aggressively than whites. In an era of health-care reform, such differences, which are net of insurance effects, may require more than universal insurance coverage to be overcome. RP Ball, JK (reprint author), AGCY HLTH CARE POLICY & RES,DIV PROVIDER STUDIES,CTR INTRAMURAL RES,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 33 TC 105 Z9 106 U1 0 U2 1 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 1996 VL 34 IS 9 BP 970 EP 984 DI 10.1097/00005650-199609000-00008 PG 15 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA VF472 UT WOS:A1996VF47200008 PM 8792784 ER PT J AU Clancy, CM McAllister, JW AF Clancy, CM McAllister, JW TI Quality measurement and improvement among primary care practitioners - Results from a multisite, randomized, controlled test - Preface SO MEDICAL CARE LA English DT Editorial Material C1 AHCPR,CTR OUTCOMES & EFFECTIVENESS RES,ROCKVILLE,MD 20852. CTR INFORMAT TECHNOL,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. RP Clancy, CM (reprint author), AHCPR,CTR PRIMARY CARE RES,2101 E JEFFERSON ST,SUITE 502,ROCKVILLE,MD 20852, USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 1996 VL 34 IS 9 SU S BP SS1 EP SS2 PG 2 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA VG253 UT WOS:A1996VG25300001 ER PT J AU Hellinger, FJ AF Hellinger, FJ TI The impact of financial incentives on physician behavior in managed care plans: A review of the evidence SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article ID FEE-FOR-SERVICE; RESOURCE UTILIZATION; REIMBURSEMENT; PERFORMANCE; DECISIONS; OUTCOMES; PREPAID; CHARGES; TRIAL; HMOS AB This review examines the relationship between the financial incentives confronting physicians in managed care plans and the utilization of services. The primary conclusion of this review is that the financial incentives confronting physicians are a key element in explaining the lower utilization rates of enrollees in managed care plans. However, this conclusion is not definitive because it is based on studies that are subject to numerous sources of potential bias. To isolate the impact of financial incentives facing physicians on the performance of health plans, it is necessary to adjust for patient, physician, health plan, and market characteristics related to utilization, and most studies include little information about these characteristics. RP Hellinger, FJ (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852, USA. NR 31 TC 83 Z9 83 U1 0 U2 7 PU SAGE SCIENCE PRESS PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 SN 1077-5587 J9 MED CARE RES REV JI Med. Care Res. Rev. PD SEP PY 1996 VL 53 IS 3 BP 294 EP 314 DI 10.1177/107755879605300305 PG 21 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA VG938 UT WOS:A1996VG93800005 PM 10159930 ER PT J AU Franks, P Gold, MR Clancy, CM AF Franks, P Gold, MR Clancy, CM TI Use of care and subsequent mortality: The importance of gender SO HEALTH SERVICES RESEARCH LA English DT Article DE access; mortality; gender ID SELF-RATED HEALTH; CORONARY-ARTERY DISEASE; INITIAL FOLLOW-UP; MEDICAL-CARE; MYOCARDIAL-INFARCTION; SEX-DIFFERENCES; BYPASS-SURGERY; BIAS; SERVICES; ACCESS AB Objective. In light of recent discussions on access that have emphasized the need to relate access measures to outcomes, we examined the relationship between three self-reported utilization and access to care measures and the risk of subsequent mortality. Data Sources and Design. A nationally representative sample from the first National Health and Nutrition Examination Survey that included adults 25-64 years of age without publicly funded health insurance was followed prospectively from initial interview in 1971 through 1975. Data Collection. Complete baseline and follow-up information was obtained on 4,491 persons (90 percent). Baseline access and use was assessed with answers to three questions: having a usual source of care, obtaining a general checkup, and not obtaining needed care (or forgone care). The relationships between the access and use measures and mortality by 1987 in men and women were examined using survival analyses. The analyses adjusted for race, and for baseline age, education, income, residence, insurance status, employment status, the presence of morbidity on examination, self-rated health, smoking status, leisure exercise, alcohol consumption, and obesity. Principal Findings. After adjusting for all other baseline variables, not obtaining a general checkup was associated with higher mortality in women (hazard ratio = 1.64 [95% confidence interval = 1.16, 2.32]), but not in men (hazard ratio = 1.07 [95% confidence interval = 0.80, 1.42]). Reporting a usual source of care and forgone care were not related to subsequent mortality in either women or men. Conclusions. Reporting a general checkup is an outcome-related utilization measure in women only. Further development of access and use indicators should address gender differences in health care use. C1 UNIV ROCHESTER,DEPT FAMILY MED,ROCHESTER,NY 14620. OFF DIS PREVENT & HLTH PROMOT,WASHINGTON,DC. AGCY HLTH CARE POLICY & RES,CTR PRIMARY CARE RES,ROCKVILLE,MD. RP Franks, P (reprint author), UNIV ROCHESTER,HIGHLAND HOSP,PRIMARY CARE INST,885 SOUTH AVE,ROCHESTER,NY 14620, USA. NR 44 TC 24 Z9 24 U1 0 U2 0 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD AUG PY 1996 VL 31 IS 3 BP 347 EP 363 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA VB348 UT WOS:A1996VB34800006 PM 8698589 ER PT J AU Clancy, CM Kamerow, DB AF Clancy, CM Kamerow, DB TI Evidence-based medicine meets cost-effectiveness analysis SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 AGCY HLTH CARE POLICY & RES, OFF FORUM QUAL & EFFECTIVENESS HLTH CARE, ROCKVILLE, MD 20852 USA. RP Clancy, CM (reprint author), AGCY HLTH CARE POLICY & RES, CTR PRIMARY CARE RES, EOC 502, 2101 E JEFFERSON ST, ROCKVILLE, MD 20852 USA. NR 11 TC 20 Z9 20 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60654-0946 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUL 24 PY 1996 VL 276 IS 4 BP 329 EP 330 DI 10.1001/jama.276.4.329 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA UX583 UT WOS:A1996UX58300040 PM 8656547 ER PT J AU Thompson, JW Kamerow, DB AF Thompson, JW Kamerow, DB TI Put prevention into practice SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Editorial Material C1 US PHS,AGCY HLTH CARE POLICY & RES,WASHINGTON,DC 20201. RP Thompson, JW (reprint author), US PHS,OFF DIS PREVENT & HLTH PROMOT,200 INDEPENDENCE AVE SW,WASHINGTON,DC 20201, USA. NR 6 TC 5 Z9 5 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD JUL-AUG PY 1996 VL 12 IS 4 BP 219 EP 220 PG 2 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA VG163 UT WOS:A1996VG16300001 PM 8874679 ER PT J AU Dickey, LL Kamerow, DB AF Dickey, LL Kamerow, DB TI Primary care physicians use of office resources in the provision of preventive care SO ARCHIVES OF FAMILY MEDICINE LA English DT Article ID HEALTH PROMOTION; MEDICAL RECORDS; CANCER; SERVICES; RECOMMENDATIONS; PRACTITIONERS; PERFORMANCE; REMINDERS; DISEASE; PREACH AB Objectives: To assess (1) the extent to which office resources leg, chart aids, educational materials, office staff) are used by primary care physicians in the provision of preventive care; (2) the characteristics of physicians associated with this use; and (3) the relationship of office resource use to reported preventive service provision. Design: Survey. Randomly selected active members of the American Academy of Family Physicians, Kansas City, Mo, American Academy of Pediatrics, Elk Grove Village, Ill, American College of Obstetricians and Gynecologists, Washington, DC, and American College of Physicians, Philadelphia, Pa. Main Outcome Measures: Use rates for each of 14 types of office resources, and scores for total office resource use, total preventive service provision, and counseling, screening, and immunization provision. Results: Most types of office resources were used by less than 50% of the physicians. Physicians in small private practices reported less use of resources than those in other settings. The chart flow sheet was the resource that was most strongly and consistently related to preventive service provision. For all organizations, the total resource use score was significantly correlated with scores for total preventive service provision, and counseling and immunization provision. For most organizations, the total resource use score was more highly related to total preventive service provision than was the age or sex of the physician, the percentage of patients uninsured or with Medicaid coverage, or community size. Conclusions: The use of office resources is an important factor in the provision of preventive care. Intervention efforts to improve office resource use may benefit from targeting by resource type, practice setting, physician specialty, and other physician and practice characteristics. C1 PUBL HLTH SERV,OFF FORUM QUAL & EFFECTIVENESS HLTH CARE,AGCY HLTH CARE POLICY & RES,WASHINGTON,DC. RP Dickey, LL (reprint author), UNIV CALIF SAN FRANCISCO,DEPT FAMILY & COMMUNITY MED,BOX 0900,SAN FRANCISCO,CA 94143, USA. NR 47 TC 21 Z9 22 U1 1 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 SN 1063-3987 J9 ARCH FAM MED JI Arch. Fam. Med. PD JUL-AUG PY 1996 VL 5 IS 7 BP 399 EP 404 DI 10.1001/archfami.5.7.399 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA VA592 UT WOS:A1996VA59200011 PM 8664998 ER PT J AU Humphreys, BL Hole, WT McCray, AT Fitzmaurice, JM AF Humphreys, BL Hole, WT McCray, AT Fitzmaurice, JM TI Planned NLMI/AHCPR large-scale vocabulary test: Using UMLS technology to determine the extent to which controlled vocabularies cover terminology needed for health care and public health SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article AB The National Library of Medicine (NLM) and the Agency for Health Care Policy and Research (AHCPR) are sponsoring a test to determine the extent to which a combination of existing health-related terminologies covers vocabulary needed in health information systems. The test vocabularies are the 30 that are fully or partially represented in the 1996 edition of the Unified Medical Language System (UMLS) Metathesaurus, plus three planned additions: the portions of SNOMED International not in the 1996 Metathesaurus, the Read Clinical Classification, and the Logical Observations Identifiers, Names, and Codes (LOINC) system. These vocabularies are available to testers through a special interface to the Internet-based UMLS Knowledge Source Server. The test will determine the ability of the test vocabularies to serve as a source of controlled vocabulary for health data systems and applications. It should provide the basis for realistic resource estimates for developing and maintaining a comprehensive ''standard'' health vocabulary that is based on existing terminologies. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. RP Humphreys, BL (reprint author), NATL LIB MED,8600 ROCKVILLE PIKE,BETHESDA,MD 20894, USA. NR 13 TC 16 Z9 16 U1 1 U2 1 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD JUL-AUG PY 1996 VL 3 IS 4 BP 281 EP 287 PG 7 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Information Science & Library Science; Medical Informatics SC Computer Science; Information Science & Library Science; Medical Informatics GA UV434 UT WOS:A1996UV43400005 PM 8816351 ER PT J AU Gaus, CR Fraser, I AF Gaus, CR Fraser, I TI Shifting paradigms and the role of research SO HEALTH AFFAIRS LA English DT Editorial Material RP Gaus, CR (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR ORG & DELIVERY STUDIES,ROCKVILLE,MD 20852, USA. NR 13 TC 5 Z9 5 U1 0 U2 0 PU PROJECT HOPE-HEALTH AFFAIRS PI SYRACUSE PA PO BOX 8015, SYRACUSE, NY 13217 SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SUM PY 1996 VL 15 IS 2 BP 235 EP 242 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA VB839 UT WOS:A1996VB83900018 ER PT J AU Pezzin, LE Kemper, P Reschovsky, J AF Pezzin, LE Kemper, P Reschovsky, J TI Does publicly provided home care substitute for family care? Experimental evidence with endogenous living arrangements SO JOURNAL OF HUMAN RESOURCES LA English DT Article ID LONG-TERM-CARE; COMMUNITY AB This paper analyzes the extent to which publicly provided formal (paid) home care substitutes for unpaid care provided informally by family and friends, Unlike most previous research, we recognize that the choice among alternative combinations of formal and informal cave depends on the type of living arrangement chosen, and that these living arrangement choices in turn are influenced by the public provision of formal home care, Using data from a social experiment, we find that a generous public home care program significantly increases the probability that unmarried persons will live independently and reduces the probability of living in shared households or in nursing or personal care homes. However, any substitution effects-either direct effects on provision of informal care given living arrangement or indirect effects due to living arrangement changes-appear to be small. RP Pezzin, LE (reprint author), AGCY HLTH CARE POLICY & RES, CTR DELIVERY SYST RES, ROCKVILLE, MD USA. NR 29 TC 58 Z9 58 U1 1 U2 8 PU UNIV WISCONSIN PRESS PI MADISON PA JOURNAL DIVISION, 1930 MONROE ST, 3RD FL, MADISON, WI 53711 USA SN 0022-166X J9 J HUM RESOUR JI J. Hum. Resour. PD SUM PY 1996 VL 31 IS 3 BP 650 EP 676 DI 10.2307/146270 PG 27 WC Economics; Industrial Relations & Labor SC Business & Economics GA VA398 UT WOS:A1996VA39800009 ER PT J AU DiGuiseppi, CG Woolf, SH AF DiGuiseppi, CG Woolf, SH TI The family physician's role in adolescent idiopathic scoliosis SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID BRACE RP DiGuiseppi, CG (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852, USA. NR 8 TC 1 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD MAY 15 PY 1996 VL 53 IS 7 BP 2268 EP & PG 3 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA UM653 UT WOS:A1996UM65300001 PM 8638496 ER PT J AU Wilson, M Berwick, DM DiGuiseppi, C AF Wilson, M Berwick, DM DiGuiseppi, C TI The new edition of the Guide to Clinical Preventive Services SO PEDIATRICS LA English DT Editorial Material C1 HARVARD UNIV,SCH MED,DEPT PEDIAT,BOSTON,MA 02115. US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. RP Wilson, M (reprint author), JOHNS HOPKINS CHILDRENS CTR,DIV GEN PEDIAT,CMSC 144,600 N WOLFE ST,BALTIMORE,MD 21287, USA. NR 2 TC 2 Z9 2 U1 0 U2 0 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD, ELK GROVE VILLAGE, IL 60007-1098 SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD MAY PY 1996 VL 97 IS 5 BP 733 EP 735 PG 3 WC Pediatrics SC Pediatrics GA UH758 UT WOS:A1996UH75800023 PM 8628617 ER PT J AU Elixhauser, A Kitzmiller, JL Weschler, JM AF Elixhauser, A Kitzmiller, JL Weschler, JM TI Short-term cost benefit of pre-conception care for diabetes SO DIABETES CARE LA English DT Letter ID PRECONCEPTION CARE; WOMEN C1 HOSP GOOD SAMARITAN,SAN JOSE,CA. RP Elixhauser, A (reprint author), CTR DELIVERY SYST RES,AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 4 TC 8 Z9 8 U1 0 U2 2 PU AMER DIABETES ASSOC PI ALEXANDRIA PA 1660 DUKE ST, ALEXANDRIA, VA 22314 SN 0149-5992 J9 DIABETES CARE JI Diabetes Care PD APR PY 1996 VL 19 IS 4 BP 384 EP 384 PG 1 WC Endocrinology & Metabolism SC Endocrinology & Metabolism GA UB885 UT WOS:A1996UB88500016 PM 8729166 ER PT J AU Goldfarb, MG Bazzoli, GJ Coffey, RM AF Goldfarb, MG Bazzoli, GJ Coffey, RM TI Trauma systems and the costs of trauma care SO HEALTH SERVICES RESEARCH LA English DT Article DE trauma services; hospital charges; hospital costs; injury severity score ID INJURY SEVERITY SCORE; ORANGE COUNTY; CASE-MIX; DISEASE; IMPACT; DRGS; REGIONALIZATION; PATIENT AB Objective. This study examines the cost of providing trauma services in trauma centers organized by publicly administered trauma systems, compared to hospitals not part of a formal trauma system. Data Sources and Study Setting. Secondary administrative discharge abstracts for a national sample of severely injured trauma patients in 44 trauma centers and 60 matched control hospitals for the year 1987 were used. Study Design. Retrospective univariate and multivariate analyses were conducted to examine the impact of formal trauma systems and trauma center designation on the costs of treating trauma patients. Key dependent variables included length of stay, charge per day per patient, and charge per hospital stay. Key impact variables were type of trauma system and level of trauma designation. Control variables included patient, hospital, and community characteristics. Data Collection/Extraction Methods. Data were selected for hospitals based on (1) a large national hospital discharge database, the Hospital Cost and Utilization Project, 1980-1987 (HCUP-2) and (2) a special survey of trauma systems and trauma designation undertaken by the Hospital Research and Educational Trust of the American Hospital Association. Principal Findings. The results show that publicly designated Level I trauma centers, which are the focal point of most trauma systems, have the highest charge per case, the highest average charge per day, and similar or longer average lengths of stay than other hospitals. These findings persist after controlling for patient injury and health status, and for demographic characteristics and hospital and community characteristics. Conclusions. Prior research shows that severely injured trauma patients have greater chances of survival when treated in specialized trauma centers. However, findings here should be of concern to the many states developing trauma systems since the high costs of Level I centers support limiting the number of centers designated at this level and/or reconsidering the requirements placed on these centers. C1 UNIV MARYLAND,HOSP RES & EDUC TRUST,BALTIMORE,MD 21228. RP Goldfarb, MG (reprint author), UNIV MARYLAND,DEPT ECON,AGCY HLTH CARE POLICY & RES,CTR INTRAMURAL RES,DIV PROVIDER STUDIES,BALTIMORE,MD 21228, USA. NR 31 TC 34 Z9 34 U1 0 U2 0 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 1996 VL 31 IS 1 BP 71 EP 95 PG 25 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA UG616 UT WOS:A1996UG61600006 PM 8617611 ER PT J AU Wong, HS AF Wong, HS TI Market structure and the role of consumer information in the physician services industry: An empirical test SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE consumer information; market structure; physician services ID ALTERNATIVE HYPOTHESES; MODEL-SPECIFICATION; COMPETITION; EQUILIBRIUM; PRICE AB This paper applies Panzar and Rosse's (1987) econometric test of market structure to examine two long-debated issues: What is the market structure for physician services? Do more physicians in a market area raise the search cost of obtaining consumer information and increase prices (Satterthwaite, 1979, 1985)? For primary care and general and family practice physicians, the monopolistically competitive model prevailed over the competing hypotheses-monopoly, perfect competition, and monopolistic competition characterized by consumer informational confusion. Although less conclusive, there is some evidence to support the monopolistically competitive model for surgeons and the consumer informational confusion model for internal medicine physicians. RP Wong, HS (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 52 TC 7 Z9 7 U1 5 U2 7 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD APR PY 1996 VL 15 IS 2 BP 139 EP 160 DI 10.1016/0167-6296(95)00035-6 PG 22 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA UX988 UT WOS:A1996UX98800001 PM 10159107 ER PT J AU Newman, SJ Reschovsky, JD AF Newman, SJ Reschovsky, JD TI Neighborhood locations of Section 8 housing certificate users without mental illness SO PSYCHIATRIC SERVICES LA English DT Article ID SEEKING; AMERICANS; BLACK AB Objective: The study examined whether participants with mental illness in the federal Section 8 housing subsidy program settle in neighborhoods different from those of Section 8 participants without mental illness, The nature of these differences and the reasons they occur were also examined. Methods: Data sources included the Section 8 survey for Baltimore and Cincinnati of the national evaluation of the Robert Wood Johnson Foundation Program on Chronic mental Illness, police records, and 1990 census tract files, supplemented with the addresses of all Section 8 users and mental health services in both cities. Analyses consisted of calculations of dissimilarity indexes, comparisons of means, and multiple regressions. Results: Dissimilarity index scores were .54 for Baltimore and .48 for Cincinnati, indicating that roughly half of all Section 8 users with mental illness would have to move to eliminate neighborhood disparities between them and Section 8 users without mental illness, Section 8 users with mental illness settled in somewhat better neighborhoods than those without mental illness, This finding was larger attributable to the sizable disparities in the racial composition of the two groups of Section 8 users: a greater proportion of users with mental illness were white, Conclusions: The neighborhood quality of Section 8 users with mental illness was found to be at least as high as that for users without mental illness, It is not clear whether the Section 8 program of the Program on Chronic Mental Illness disproportionately served whites, although the racial composition of the Section a program in both cities is disproportionately black. C1 JOHNS HOPKINS UNIV,DEPT GEOG & ENVIRONM ENGN,BALTIMORE,MD 21218. US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. RP Newman, SJ (reprint author), JOHNS HOPKINS UNIV,INST POLICY STUDIES,WIJMAN BLDG,3400 N CHARLES ST,BALTIMORE,MD 21218, USA. FU NIMH NIH HHS [1-P50-MH49454-01] NR 25 TC 8 Z9 8 U1 0 U2 2 PU AMER PSYCHIATRIC ASSOCIATION PI WASHINGTON PA 1400 K ST NW, WASHINGTON, DC 20005 SN 1075-2730 J9 PSYCHIATR SERV JI Psychiatr. Serv. PD APR PY 1996 VL 47 IS 4 BP 392 EP 397 PG 6 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychiatry SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychiatry GA UC753 UT WOS:A1996UC75300012 PM 8689370 ER PT J AU Handelsman, H AF Handelsman, H TI Haematopoietic stem-cell transplantation in multiple myeloma SO CANCER TREATMENT REVIEWS LA English DT Review ID BONE-MARROW TRANSPLANTATION; PROGNOSTIC FACTORS; MELPHALAN RP Handelsman, H (reprint author), AGCY HLTH CARE POLICY & RES,CTR HLTH CARE TECHNOL,6000 EXECUT BLVD,SUITE 309,ROCKVILLE,MD 20852, USA. NR 41 TC 4 Z9 4 U1 0 U2 0 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0305-7372 J9 CANCER TREAT REV JI Cancer Treat. Rev. PD MAR PY 1996 VL 22 IS 2 BP 119 EP 125 DI 10.1016/S0305-7372(96)90031-6 PG 7 WC Oncology SC Oncology GA UT733 UT WOS:A1996UT73300003 PM 8665564 ER PT J AU Reschovsky, JD AF Reschovsky, JD TI Demand for and access to institutional long-term care: The role of Medicaid in nursing home markets SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID COST; ADMISSIONS; DISABILITY; QUALITY; HAZARD AB Economists long have speculated that Medicaid subsidies and related policies cause many nursing home markets to operate under conditions of permanent excess demand, resulting in access problems for Medicaid-eligible persons. If observations on nursing home use represent constrained supply instead of demand, estimation of unbiased demand parameters is difficult. In this paper, I estimate bivariate probits with partial observability on data from the National Long-Term Care Channeling Demonstration. The technique provides both unbiased demand parameters and direct tests of excess demand. The findings indicate that economic variables do not substantially effect decisions to seek nursing home care. Differential access to nursing home care by Medicaid eligibles and private payers provides empirical support for the excess demand hypothesis. RP Reschovsky, JD (reprint author), AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 33 TC 22 Z9 22 U1 0 U2 1 PU BLUE CROSS BLUE SHIELD ASSN PI CHICAGO PA 676 N ST CLAIR ST, CHICAGO, IL 60611 SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SPR PY 1996 VL 33 IS 1 BP 15 EP 29 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA UF583 UT WOS:A1996UF58300005 PM 8774371 ER PT J AU Lanier, DC Clancy, CM AF Lanier, DC Clancy, CM TI The changing interface of primary and specialty care SO JOURNAL OF FAMILY PRACTICE LA English DT Editorial Material ID REFERRAL PATTERNS; CONSULTATION; PHYSICIAN RP Lanier, DC (reprint author), AGCY HLTH CARE POLICY & RES,CTR PRIMARY CARE RES,2101 E JEFFERSON ST,SUITE 502,ROCKVILLE,MD 20852, USA. NR 19 TC 6 Z9 7 U1 0 U2 0 PU APPLETON & LANGE PI E NORWALK PA 25 VAN ZANT ST, E NORWALK, CT 06855 SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD MAR PY 1996 VL 42 IS 3 BP 303 EP 305 PG 3 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA UA374 UT WOS:A1996UA37400011 PM 8636683 ER PT J AU Freedman, VA AF Freedman, VA TI Family structure and the risk of nursing home admission SO JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES LA English DT Article ID LONG-TERM-CARE; SOCIAL SUPPORT; INSTITUTIONALIZATION; CAREGIVERS; PLACEMENT; ADULTS; DEATH AB Given the high costs associated with institutionalization, understanding factors related to nursing home admissions is of considerable interest. The family is particularly relevant to a discussion of nursing home admission, given its critical role in providing care to older disabled persons. Using data from the New Haven EPESE, we examine the relationship between family structure and the risk of first nursing home admission. Family structure is defined more broadly than in most previous studies and includes not only the spouse, but also sons, daughters, and siblings. Because of the relatively lengthy follow up period of the EPESE, we are able to depart from previous methodological conventions, adopting a continuous time survival model with age at admission as the outcome and time-varying measures of family structure and health. Results show that married older persons have about half the risk of nursing home admission of unmarried persons, and that having at least one daughter or sibling reduces an older person's chances of admission by about one-fourth. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. YALE UNIV,SCH MED,DEPT EPIDEMIOL & PUBL HLTH,NEW HAVEN,CT 06520. NR 42 TC 93 Z9 93 U1 7 U2 9 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 SN 1079-5014 J9 J GERONTOL B-PSYCHOL JI J. Gerontol. Ser. B-Psychol. Sci. Soc. Sci. PD MAR PY 1996 VL 51 IS 2 BP S61 EP S69 PG 9 WC Geriatrics & Gerontology; Gerontology; Psychology; Psychology, Multidisciplinary SC Geriatrics & Gerontology; Psychology GA UB201 UT WOS:A1996UB20100010 PM 8785694 ER PT J AU Leopold, N Cooper, J Clancy, C AF Leopold, N Cooper, J Clancy, C TI Sustained partnership in primary care SO JOURNAL OF FAMILY PRACTICE LA English DT Article DE physician-patient relations; family physicians; primary health care ID MEDICAL-CARE; PATIENT SATISFACTION; DECISION-MAKING; INFORMATION; OUTCOMES; PHYSICIANS; INTERVIEW; COMMUNICATION; INVOLVEMENT; CONTINUITY AB In 1994, the Institute of Medicine (IOM) convened the Committee on the Future of Primary Care to provide a clearer understanding of the essential and desirable attributes of primary care. Perhaps the committee's most striking addition to the IOM's 1978 definition was the concept that primary care includes a sustained partnership with patients. Development of the partnership is considered an explicit responsibility of the primary care clinician. Although there is an extensive and growing body of literature on the effects of clinician-patient communication on outcomes such as patient satisfaction, adherence, symptom abatement, and physiological measures of health status, the impact of a sustained partnership in a clinician-patient relationship remains largely unstudied. There is also no consensus regarding either the definition or achievement of a sustained partnership. This paper reviews selected relevant literature and proposes a theoretical basis for assessing the existence, antecedents, and outcomes of sustained partnerships between clinicians and patients. At a time when there is increased discussion and clarification of optimal clinician and patient roles in a rapidly evolving health care delivery system, we believe this model can provide guidance to clinicians and provider organizations seeking to improve the quality of primary care. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. NR 58 TC 59 Z9 59 U1 1 U2 1 PU APPLETON & LANGE PI E NORWALK PA 25 VAN ZANT ST, E NORWALK, CT 06855 SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD FEB PY 1996 VL 42 IS 2 BP 129 EP 137 PG 9 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA TV376 UT WOS:A1996TV37600007 PM 8606302 ER PT J AU Cohen, JW Spector, WD AF Cohen, JW Spector, WD TI The effect of Medicaid reimbursement on quality of care in nursing homes SO JOURNAL OF HEALTH ECONOMICS LA English DT Article; Proceedings Paper CT 44th Annual Meeting of the Gerontological-Society-of-America CY NOV 22-26, 1991 CL SAN FRANCISCO, CA SP Gerontol Soc Amer DE nursing homes; Medicaid; reimbursement; quality; outcomes; nursing staff ID EXCESS-DEMAND; BEHAVIOR; STATES AB This study uses a nationally representative sample of nursing homes and nursing home residents to examine the effect of Medicaid reimbursement on quality of care. The analysis shows that both reimbursement approach and level affect nursing home quality, as measured by case-mix adjusted staff to resident ratios, The analysis also shows that staffing ratios have a significant impact on resident outcomes, and these impacts vary by professional category of staff. Reimbursement does not have a significant impact on outcomes, however. RP Cohen, JW (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,SUITE 500,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 40 TC 154 Z9 157 U1 3 U2 8 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD FEB PY 1996 VL 15 IS 1 BP 23 EP 48 DI 10.1016/0167-6296(95)00030-5 PG 26 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA UH844 UT WOS:A1996UH84400002 PM 10157427 ER PT B AU Cohen, SB AF Cohen, SB GP AMER STAT ASSOC TI Sample design of the meps medical provider survey SO AMERICAN STATISTICAL ASSOCIATION - 1996 PROCEEDINGS OF THE SECTION ON GOVERNMENT STATISTICS LA English DT Proceedings Paper CT Conference of the Section-on-Government-Statistics, at the Annual Meeting of the American-Statistical-Association CY AUG 04-08, 1996 CL CHICAGO, IL SP Amer Stat Assoc, Sect Govt Stat DE MEPS; medical expenditures; validation study RP Cohen, SB (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER STATISTICAL ASSOC PI ALEXANDRIA PA 1429 DUKE ST, ALEXANDRIA, VA 22314 BN 1-883276-44-6 PY 1996 BP 152 EP 157 PG 6 WC Public Administration; Statistics & Probability SC Public Administration; Mathematics GA BJ01E UT WOS:A1996BJ01E00029 ER PT B AU Potter, DEB AF Potter, DEB GP AMER STAT ASSOC TI The MEPS 1996 national nursing home expenditure survey: Design and preliminary round 1 field progress SO AMERICAN STATISTICAL ASSOCIATION - 1996 PROCEEDINGS OF THE SECTION ON GOVERNMENT STATISTICS LA English DT Proceedings Paper CT Conference of the Section-on-Government-Statistics, at the Annual Meeting of the American-Statistical-Association CY AUG 04-08, 1996 CL CHICAGO, IL SP Amer Stat Assoc, Sect Govt Stat DE questionnaire design; CAPI; health care use and expenditures; establishment surveys; prescribed medicine use; multi-stage probability design; Keyfitz procedure; institutional population RP Potter, DEB (reprint author), AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER STATISTICAL ASSOC PI ALEXANDRIA PA 1429 DUKE ST, ALEXANDRIA, VA 22314 BN 1-883276-44-6 PY 1996 BP 158 EP 163 PG 6 WC Public Administration; Statistics & Probability SC Public Administration; Mathematics GA BJ01E UT WOS:A1996BJ01E00030 ER PT B AU Schwartz, H Kunitz, S Jaro, M Theriault, G Kozloff, R AF Schwartz, H Kunitz, S Jaro, M Theriault, G Kozloff, R GP AMER STAT ASSOC TI Studying treatment variation among minority populations via linked administrative and clinical data sets SO AMERICAN STATISTICAL ASSOCIATION - 1996 PROCEEDINGS OF THE SOCIAL STATISTICS SECTION LA English DT Proceedings Paper CT Conference of the Social-Statistics-Section, at the Annual Meeting of the American-Statistical-Association CY AUG 04-08, 1996 CL CHICAGO, IL SP Amer Stat Assoc, Social Stat Sect DE race; ethnicity; health RP Schwartz, H (reprint author), AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 602,ROCKVILLE,MD 20852, USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER STATISTICAL ASSOC PI ALEXANDRIA PA 1429 DUKE ST, ALEXANDRIA, VA 22314 BN 1-883276-48-9 PY 1996 BP 68 EP 73 PG 6 WC Social Sciences, Mathematical Methods; Statistics & Probability SC Mathematical Methods In Social Sciences; Mathematics GA BJ01F UT WOS:A1996BJ01F00014 ER PT J AU Woolf, SH DiGuiseppi, CG Atkins, D Kamerow, DB AF Woolf, SH DiGuiseppi, CG Atkins, D Kamerow, DB TI Developing evidence-based clinical practice guidelines: Lessons learned by the US preventive services task force SO ANNUAL REVIEW OF PUBLIC HEALTH LA English DT Review DE preventive services; practice guidelines; health promotion; effectiveness; outcomes research ID URINARY-TRACT DISORDERS; ASYMPTOMATIC ADULTS; COST-EFFECTIVENESS; MEDICAL-PRACTICE; HEALTH-CARE; RECOMMENDATIONS; CANCER; QUALITY; DENTISTRY; INJURY AB The US Preventive Services Task Force is an expert panel established by the federal government in 1984 to develop evidence-based practice guidelines on screening tests and other preventive services. Its recommendations are published elsewhere. This article explores the lessons learned in the process of developing and disseminating the recommendations. Topics include project organization (analytic philosophy, project sponsorship, panel composition, topic selection); the review of evidence (selecting outcome measures for judging effectiveness, constructing ''causal pathways,'' searching the literature, rating the evidence, synthesizing the results); crafting recommendations (extrapolation, assessing magnitude, balancing risks and benefits, addressing costs, dealing with insufficient data, separating science from policy); peer review; collaboration with other groups; evaluating impact on clinicians' knowledge, attitudes, and behavior; updating recommendations; and defining a research agenda. The lessons learned suggest potential refinements in the future work of the task force and other groups engaged in guideline development. C1 US DEPT HHS, AGCY HLTH CARE POLICY & RES, OFF FORUM QUAL & EFFECTIVENESS HLTH CARE, ROCKVILLE, MD 20852 USA. RP Woolf, SH (reprint author), VIRGINIA COMMONWEALTH UNIV MED COLL VIRGINIA, DEPT FAMILY PRACTICE, 3712 CHARLES STEWART DR, FAIRFAX, VA 22033 USA. NR 105 TC 88 Z9 91 U1 0 U2 7 PU ANNUAL REVIEWS PI PALO ALTO PA 4139 EL CAMINO WAY, PO BOX 10139, PALO ALTO, CA 94303-0139 USA SN 0163-7525 EI 1545-2093 J9 ANNU REV PUBL HEALTH JI Annu. Rev. Public Health PY 1996 VL 17 BP 511 EP 538 PG 28 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA UK766 UT WOS:A1996UK76600027 PM 8724238 ER PT J AU Smith, TJ Desch, CE Grasso, MA McCue, MJ Buonaiuto, D Grasso, K Johantgen, ME Hackney, MH Shaw, JE Simonson, CJ AF Smith, TJ Desch, CE Grasso, MA McCue, MJ Buonaiuto, D Grasso, K Johantgen, ME Hackney, MH Shaw, JE Simonson, CJ TI The rural cancer outreach program: Clinical and financial analysis of palliative and curative care for an underserved population SO CANCER TREATMENT REVIEWS LA English DT Article; Proceedings Paper CT International Workshop on Goals of Palliative Cancer Therapy II CY MAR 13-16, 1995 CL REISENSBURG CASTLE, GERMANY SP German Minist Hlth, State Baden Wurttemberg, Minist Sci & Art, Deut Forschungsgemeinsch, Boehringer Ingelheim, Germany ID SOCIOECONOMIC-STATUS; GEOGRAPHIC-VARIATION; BREAST-CANCER; QUALITY C1 VIRGINIA COMMONWEALTH UNIV,MED COLL VIRGINIA,MASSEY CANC CTR,RICHMOND,VA 23298. US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. RP Smith, TJ (reprint author), VIRGINIA COMMONWEALTH UNIV,MED COLL VIRGINIA,SCH HLTH ADM,RICHMOND,VA 23298, USA. FU AHRQ HHS [R01 HS 0659-01A1]; NCI NIH HHS [RFP CO 94388-63] NR 13 TC 13 Z9 13 U1 0 U2 0 PU W B SAUNDERS CO LTD PI LONDON PA 24-28 OVAL RD, LONDON, ENGLAND NW1 7DX SN 0305-7372 J9 CANCER TREAT REV JI Cancer Treat. Rev. PD JAN PY 1996 VL 22 SU A BP 97 EP 101 DI 10.1016/S0305-7372(96)90069-9 PG 5 WC Oncology SC Oncology GA UJ766 UT WOS:A1996UJ76600013 PM 8625355 ER PT B AU Bosco, LA AF Bosco, LA BE Gotto, AM Paoletti, R Smith, LC Catapano, AL Jackson, AS TI Objectives of the agency for health care policy and research and clinical trials SO DRUGS AFFECTING LIPID METABOLISM: RISK FACTORS AND FUTURE DIRECTIONS SE MEDICAL SCIENCE SYMPOSIA SERIES LA English DT Proceedings Paper CT XII International Symposium of Drugs Affecting Lipid Metabolism (DALM XII) CY NOV 06-10, 1995 CL HOUSTON, TX SP Fdn Giovanni Lorenzini, Milan, Giovanni Lorenzini Med Fdn, Houston C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR OUTCOMES & EFFECTIVENESS RES,ROCKVILLE,MD 20852. NR 0 TC 0 Z9 0 U1 0 U2 0 PU KLUWER ACADEMIC PUBL PI DORDRECHT PA PO BOX 17, 3300 AA DORDRECHT, NETHERLANDS BN 0-7923-4167-8 J9 MED SCI SYMP SER PY 1996 VL 10 BP 175 EP 180 PG 6 WC Cardiac & Cardiovascular Systems; Pharmacology & Pharmacy SC Cardiovascular System & Cardiology; Pharmacology & Pharmacy GA BG62C UT WOS:A1996BG62C00021 ER PT J AU Arno, PS Bonuck, KA Green, J Fleishman, J Bennett, CL Fahs, MC Maffeo, C Drucker, E AF Arno, PS Bonuck, KA Green, J Fleishman, J Bennett, CL Fahs, MC Maffeo, C Drucker, E TI The impact of housing status on health care utilization among persons with HIV disease SO JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED LA English DT Article DE housing; homelessness; HIV disease; AIDS; health care utilization ID INTRAVENOUS-DRUG-USERS; TUBERCULOSIS; AIDS AB This study sought to identify the prevalence of unstable housing situations, and for whom they occurred, and to examine differences in health cave utilization by housing status. Housing status and inpatient and outpatient health care utilization of 1,851 HIV-infected individuals was ascertained through interviews. Nine percent of respondents were in unstable housing situations. Unstable housing was associated with significantly lower functional status. The unstably housed were more likely to visit an emergency room (p < 0.05) and had fewer ambulatory visits than persons with stable housing (p < 0.03). They incurred nearly five more hospital days and their average hospitalization was approximately 1.5 days longer than the stably housed, although these differences were not significant. Utilization of ambulatory care is lower among unstably housed persons with HIV disease, which may have led to their increased reliance upon emergency rooms and hospitals. Helping HIV- infected individuals maintain adequate housing could reverse this pattern. C1 NYU,NEW YORK,NY 10012. US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. NORTHWESTERN UNIV,MED CTR,EVANSTON,IL 60208. MT SINAI SCH MED,NEW YORK,NY. RP Arno, PS (reprint author), ALBERT EINSTEIN COLL MED,MONTEFIORE MED CTR,DEPT EPIDEMIOL & SOCIAL MED,111 E 210TH ST,BRONX,NY 10467, USA. RI Bennett, Charles/C-2050-2008 NR 24 TC 41 Z9 41 U1 0 U2 2 PU SAGE SCIENCE PRESS PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 SN 1049-2089 J9 J HEALTH CARE POOR U JI J. Health Care Poor Underserved PY 1996 VL 7 IS 1 BP 36 EP 49 PG 14 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA TR008 UT WOS:A1996TR00800004 PM 8645784 ER PT J AU Spector, WD Reschovsky, JD Cohen, JW AF Spector, WD Reschovsky, JD Cohen, JW TI Appropriate placement of nursing-home residents in lower levels of care SO MILBANK QUARTERLY LA English DT Article ID PROSPECTIVE PAYMENT SYSTEM AB Too often individuals with long-term-care needs are placed in nursing homes when they might well be better served at a lower level of care. The uneven distribution of residents across settings stems from interacting factors of supply and demand: clinical need; lack of consensus among physicians about what constitutes the best setting for their patients; regulations restricting services in personal care homes. Three sets of clinical criteria identify nursing-home residents according to their appropriateness for lower levels of care. Factors like cost and ability of the patient's family to make informed decisions affect placement as well. Policies for shifting patients to lower levels of care muse be carefully designed in order to save costs and ensure that quality of care is retained. RP Spector, WD (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,SUITE 500,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 27 TC 29 Z9 28 U1 0 U2 2 PU BLACKWELL PUBLISHERS PI CAMBRIDGE PA 350 MAIN STREET, STE 6, CAMBRIDGE, MA 02148-5023 SN 0887-378X J9 MILBANK Q JI Milbank Q. PY 1996 VL 74 IS 1 BP 139 EP & DI 10.2307/3350436 PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA UB321 UT WOS:A1996UB32100009 PM 8596519 ER PT J AU Hahn, BA Schone, BS AF Hahn, BA Schone, BS TI Maternal psychological distress: The role of children's health SO WOMEN & HEALTH LA English DT Article ID MARITAL-STATUS; MENTAL-HEALTH; CYSTIC-FIBROSIS; DEPRESSION; STRESS; ADJUSTMENT; DEFINITION; GENDER; WOMEN C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR GEN HLTH SERV INTRAMURAL RES,ROCKVILLE,MD 20852. RP Hahn, BA (reprint author), GLAXO WELLCOME RES INST,INT PHARMACOECON RES,5 MOORE DR,RES TRIANGLE PK,NC 27709, USA. NR 34 TC 5 Z9 5 U1 0 U2 0 PU HAWORTH PRESS INC PI BINGHAMTON PA 10 ALICE ST, BINGHAMTON, NY 13904-1580 SN 0363-0242 J9 WOMEN HEALTH JI Women Health PY 1996 VL 24 IS 1 BP 59 EP 75 DI 10.1300/J013v24n01_04 PG 17 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA VG987 UT WOS:A1996VG98700004 PM 8883371 ER PT J AU Hellinger, FJ AF Hellinger, FJ TI Any-willing-provider and freedom-of-choice laws: An economic assessment SO HEALTH AFFAIRS LA English DT Editorial Material RP Hellinger, FJ (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR COST & FINANCING,ROCKVILLE,MD 20852, USA. NR 19 TC 13 Z9 14 U1 0 U2 0 PU PROJECT HOPE-HEALTH AFFAIRS PI SYRACUSE PA PO BOX 8015, SYRACUSE, NY 13217 SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD WIN PY 1995 VL 14 IS 4 BP 297 EP 302 DI 10.1377/hlthaff.14.4.297 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA TQ458 UT WOS:A1995TQ45800029 PM 8690354 ER PT J AU Monheit, AC Nichols, LM Selden, TM AF Monheit, AC Nichols, LM Selden, TM TI How are net health insurance benefits distributed in the employment-related insurance market? SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID TAXATION AB The recent health care reform debate has questioned whether the health insurance market effectively pools risks and transfers income across states of health. We use data from the 1987 National Medical Expenditure Survey to examine how net health insurance benefits are distributed in the employment-related insurance market. We find this market to transfer income from those in good health to those with health problems and the tax subsidy from employer health insurance contributions to be a crucial determinant of the net benefit distribution, To the extent society views these transfers as meritorious, our findings suggest caution regarding initiatives to limit or eliminate the tax subsidy. C1 URBAN INST,WASHINGTON,DC 20037. RP Monheit, AC (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR HLTH EXPENDITURES & INSURANCE STUDIES,ROCKVILLE,MD 20852, USA. NR 23 TC 11 Z9 11 U1 0 U2 0 PU BLUE CROSS BLUE SHIELD ASSN PI CHICAGO PA 676 N ST CLAIR ST, CHICAGO, IL 60611 SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD WIN PY 1995 VL 32 IS 4 BP 379 EP 391 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA TT316 UT WOS:A1995TT31600005 PM 8567076 ER PT J AU SHORT, PF BANTHIN, JS AF SHORT, PF BANTHIN, JS TI NEW ESTIMATES OF THE UNDERINSURED YOUNGER THAN 65 YEARS SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article AB We estimate that at least 29 million Americans with private insurance are underinsured. That figure identifies the underinsured younger than 65 years by the risk of large out-of-pocket expenditures for an unusually expensive, catastrophic illness. A slightly smaller number, about 25 million, are underinsured by an alternate definition: they have insurance that pays a smaller proportion of claims than the plan with the largest enrollment in the federal employee program. The federal employee plan was the insurance standard proposed in several recent health system reform bills. Our estimate of the number of people who are underinsured for catastrophic illness is almost half again larger than the number that was widely cited during last year's debates on health system reform. That estimate was based on the same concept but was projected from a study published 10 years ago. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR INTRAMURAL RES,ROCKVILLE,MD 20852. NR 15 TC 66 Z9 66 U1 0 U2 2 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD OCT 25 PY 1995 VL 274 IS 16 BP 1302 EP 1306 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA TA104 UT WOS:A1995TA10400027 PM 7563537 ER PT J AU HERRERA, CR DAGOSTINO, RB GERSTMAN, BB BOSCO, LA BELANGER, AJ AF HERRERA, CR DAGOSTINO, RB GERSTMAN, BB BOSCO, LA BELANGER, AJ TI BALDNESS AND CORONARY HEART-DISEASE RATES IN MEN FROM THE FRAMINGHAM-STUDY SO AMERICAN JOURNAL OF EPIDEMIOLOGY LA English DT Note DE ALOPECIA; CARDIOVASCULAR DISEASES; CORONARY DISEASE; MEN; MORTALITY; RISK FACTORS AB The authors assessed the relation between the extent and progression of baldness and coronary heart disease. Baldness was assessed twice, in 1956 and in 1962, in a cohort of 2,017 men from Framingham, Massachusetts. Extent of baldness was classified in terms of number of bald areas: no areas bald (n = 153), one area bald (n = 420), two areas bald (n = 587), and all areas bald (n = 857). Men who were assessed both times and who had two or fewer bald areas during the first evaluation were classified into one of three groups: ''mild or no progression,'' ''moderate progression,'' or ''rapid progression.'' The cohort was followed for up to 30 years for new occurrences of coronary heart disease, coronary heart disease death, cardiovascular disease, and death due to any cause. The relations between the extent and progression of baldness and the aforementioned outcomes were assessed using a Cox proportional hazards model, adjusting for age and other known cardiovascular disease risk factors. Extent of baldness was not associated with any of the outcomes. However, the amount of progression of baldness was associated with coronary heart disease occurrence (relative risk(RR) = 2.4, 95% confidence interval (CI) 1.3-4.4), coronary heart disease mortality (RR = 3.8, 95% CI 1.9-7.7), and all-cause mortality (RR = 2.4, 95% CI 1.5-3.8), Rapid hair loss may be a marker for coronary heart disease. C1 BOSTON UNIV,DEPT MATH,BOSTON,MA 02215. SAN JOSE STATE UNIV,DEPT HLTH SCI,SAN JOSE,CA. AGCY HLTH CARE POLICY & RES,CTR OUTCOMES & EFFECTIVENESS RES,ROCKVILLE,MD. RP HERRERA, CR (reprint author), UNIV TEXAS,SCH MED,DEPT INTERNAL MED,HOUSTON,TX, USA. FU NHLBI NIH HHS [R0I-HL 40423-04] NR 19 TC 52 Z9 53 U1 0 U2 2 PU AMER J EPIDEMIOLOGY PI BALTIMORE PA 624 N BROADWAY RM 225, BALTIMORE, MD 21205 SN 0002-9262 J9 AM J EPIDEMIOL JI Am. J. Epidemiol. PD OCT 15 PY 1995 VL 142 IS 8 BP 828 EP 833 PG 6 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA TA756 UT WOS:A1995TA75600007 PM 7572959 ER PT J AU JOHANTGEN, ME COFFEY, RM HARRIS, R LEVY, H CLINTON, JJ AF JOHANTGEN, ME COFFEY, RM HARRIS, R LEVY, H CLINTON, JJ TI TREATING EARLY-STAGE BREAST-CANCER - HOSPITAL CHARACTERISTICS ASSOCIATED WITH BREAST-CONSERVING SURGERY SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID GEOGRAPHIC-VARIATION; RADIATION; CARCINOMA; THERAPY AB Despite growing acceptance of the fact that women with early-stage breast cancer have similar outcomes with lumpectomy plus radiation as with mastectomy, many studies have revealed the uneven adoption of such breast-conserving surgery. Discharge data from the Hospital Cost and Utilization Project, representing multiple payers, locations, and hospital types, demonstrate increasing trends in breast-conserving surgery as a proportion of breast cancer surgeries from 1981 to 1987. Women with axillary node involvement were less likely to have a lumpectomy, even though consensus recommendations do not preclude this form of treatment when local metastases are present. Non-White race, urban hospital location, and hospital teaching were associated with an increased likelihood of having breast-conserving surgery. RP JOHANTGEN, ME (reprint author), AGCY HLTH CARE POLICY & RES,CTR GEN HLTH SERV INTRAMURAL RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 17 TC 58 Z9 58 U1 0 U2 1 PU AMER PUBLIC HEALTH ASSN INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD OCT PY 1995 VL 85 IS 10 BP 1432 EP 1434 DI 10.2105/AJPH.85.10.1432 PG 3 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA RY405 UT WOS:A1995RY40500022 PM 7573632 ER PT J AU FRANKS, P CLANCY, CM NAUMBURG, EH AF FRANKS, P CLANCY, CM NAUMBURG, EH TI SEX, ACCESS, AND EXCESS SO ANNALS OF INTERNAL MEDICINE LA English DT Editorial Material ID MEDICAL-CARE; DISEASE; GENDER; OUTCOMES; WOMEN; BIAS; MEN C1 UNIV ROCHESTER,ROCHESTER,NY 14620. AGCY HLTH CARE POLICY & RES,DIV PRIMARY CARE,ROCKVILLE,MD 20852. NR 20 TC 16 Z9 16 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD OCT 1 PY 1995 VL 123 IS 7 BP 548 EP 550 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA RW495 UT WOS:A1995RW49500012 PM 7661501 ER PT J AU MARCONI, KM RUDZINSKI, KA AF MARCONI, KM RUDZINSKI, KA TI A FORMATIVE MODEL TO EVALUATE HEALTH-SERVICES RESEARCH SO EVALUATION REVIEW LA English DT Article ID CARE; AIDS AB The authors propose a formative evaluation model for use by administrators of large health services research grant programs. The model will assist them in assessing the purpose, methodology, and level of analysis of funded research projects to identify content areas currently being addressed and areas that may require more directed research. This model is applied to one area of health services research, HIV/AIDS care. C1 AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD. RP MARCONI, KM (reprint author), US HLTH RESOURCE & SERV ADM,OFF SCI & EPIDEMIOL,WASHINGTON,DC 20201, USA. NR 27 TC 2 Z9 2 U1 0 U2 2 PU SAGE PUBL INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 SN 0193-841X J9 EVALUATION REV JI Eval. Rev. PD OCT PY 1995 VL 19 IS 5 BP 501 EP 510 DI 10.1177/0193841X9501900501 PG 10 WC Social Sciences, Interdisciplinary SC Social Sciences - Other Topics GA TC428 UT WOS:A1995TC42800001 ER PT J AU CATZ, C HANSON, JW SIMPSON, L YAFFE, SJ AF CATZ, C HANSON, JW SIMPSON, L YAFFE, SJ TI SUMMARY OF WORKSHOP - EARLY DISCHARGE AND NEONATAL HYPERBILIRUBINEMIA SO PEDIATRICS LA English DT Article C1 NICHHD,CTR RES MOTHERS & CHILDREN,BETHESDA,MD 20892. US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. NR 15 TC 48 Z9 50 U1 0 U2 0 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD, ELK GROVE VILLAGE, IL 60007-1098 SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD OCT PY 1995 VL 96 IS 4 BP 743 EP 745 PN 1 PG 3 WC Pediatrics SC Pediatrics GA RY677 UT WOS:A1995RY67700025 PM 7567342 ER PT J AU MURTAUGH, CM KEMPER, P SPILLMAN, BC AF MURTAUGH, CM KEMPER, P SPILLMAN, BC TI RISKY BUSINESS - LONG-TERM-CARE INSURANCE UNDERWRITING SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID NURSING-HOME CARE; PRIVATE; INSTITUTIONALIZATION; COSTS AB Private insurance is one strategy for financing the large and growing cost of long-term care. Little is known, however, about the extent to which medical underwriting may limit the potential of private insurance to cover nursing home care, or whether the underwriting criteria used in this relatively new market successfully identify high-cost groups. This paper uses data from the National Mortality Followback Survey to address these two questions. We estimate that between 12% and 23% of the population would be rejected for private long-term care insurance because of their health if everyone applied at age 65. These figures rise to between 20% and 31% at age 75. Our simulation results suggest that long-term care insurance underwriting criteria identify individuals who vary substantially in the financial risk they pose to insurers. In most cases, whether a criterion identifies a high-cost group is sensitive to the policy individuals are assumed to buy. C1 AGCY HLTH CARE POLICY & RES,BETHESDA,MD. RP MURTAUGH, CM (reprint author), MED TECHNOL & PRACTICE PATTERNS INST,2121 WISCONSIN AVE,NW,SUITE 220,WASHINGTON,DC 20007, USA. NR 38 TC 19 Z9 19 U1 1 U2 3 PU BLUE CROSS BLUE SHIELD ASSN PI CHICAGO PA 676 N ST CLAIR ST, CHICAGO, IL 60611 SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD FAL PY 1995 VL 32 IS 3 BP 271 EP 284 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA TA494 UT WOS:A1995TA49400006 PM 7591041 ER PT J AU MOELLER, JF AF MOELLER, JF TI GAINERS AND LOSERS UNDER A TAX-BASED HEALTH-CARE REFORM PLAN SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article AB Currently, it appears that health care for the nonpoor and nonelderly in the United States will continue to be financed primarily through a private insurance market rather than a public insurance program. Even if this market-based system achieves maximum efficiency, a premium subsidy for low-income, non-Medicaid-eligible individuals likely will be required to make health insurance affordable for all Americans. There are advantages to carrying out that redistribution at the federal, rather than state or local, level, possibly using credits or deductions within the federal personal income tax system. Which individuals decide to claim these tax credits or deductions, and how much the tax subsidies would have cost in 1993, are examined in this paper. A tax on employer-provided health benefits finances the subsidy, and the paper analyzes characteristics of gainers and losers under the reform. The study uses data from the 1987 National Medical Expenditure Survey (NMES) to develop a microsimulation model of the federal personal income tax system. RP MOELLER, JF (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR HLTH EXPENDITURES & INSURANCE STUDIES,ROCKVILLE,MD 20852, USA. NR 13 TC 3 Z9 3 U1 0 U2 1 PU BLUE CROSS BLUE SHIELD ASSN PI CHICAGO PA 676 N ST CLAIR ST, CHICAGO, IL 60611 SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD FAL PY 1995 VL 32 IS 3 BP 285 EP 299 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA TA494 UT WOS:A1995TA49400007 PM 7591042 ER PT J AU CUMMINGS, MA GREENE, R LAND, S PAGANINI, JM DENORONHA, JC AF CUMMINGS, MA GREENE, R LAND, S PAGANINI, JM DENORONHA, JC TI BUILDING HEALTH-CARE QUALITY NETWORKS AT LOCAL-LEVELS - MEETING HELD IN RIO-DE-JANEIRO, BRAZIL - (26-28 APRIL 1995) - QUALITY HEALTH-CARE - AN INTERNATIONAL ISSUE SO INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE LA English DT Editorial Material C1 PAN AMER HLTH ORG,DIV HLTH SYST & SERV DEV,WASHINGTON,DC. INST SOCIAL MED,RIO JANEIRO,BRAZIL. RP CUMMINGS, MA (reprint author), AGCY HLTH CARE POLICY & RES,CTR OUTCOMES & EFFECT RES,ROCKVILLE,MD, USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD, ENGLAND OX5 1GB SN 1353-4505 J9 INT J QUAL HEALTH C JI Int. J. Qual. Health Care PD SEP PY 1995 VL 7 IS 3 BP 291 EP 292 PG 2 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA TH061 UT WOS:A1995TH06100017 ER PT J AU SELDEN, TM SONG, DQ AF SELDEN, TM SONG, DQ TI NEOCLASSICAL GROWTH, THE J-CURVE FOR ABATEMENT, AND THE INVERTED U-CURVE FOR POLLUTION SO JOURNAL OF ENVIRONMENTAL ECONOMICS AND MANAGEMENT LA English DT Article ID ECONOMIC-GROWTH; RESOURCES AB This paper reexamines the neoclassical environmental growth model of Forster to gain insights into the dynamic relationships among pollution, abatement effort, and economic development. Whereas the model has heretofore been used to examine steady-state levels of capital, consumption, and environmental quality, it also provides a theoretical basis for recent empirical research on J curves for abatement effort and inverted U curves for pollution. (C) 1995 Academic Press, Inc. C1 SYRACUSE UNIV, MAXWELL SCH, DEPT ECON, SYRACUSE, NY 13244 USA. RP SELDEN, TM (reprint author), US DEPT HHS, AGCY HLTH CARE POLICY & RES, CTR INTRAMURAL RES, ROCKVILLE, MD 20852 USA. NR 16 TC 127 Z9 137 U1 2 U2 12 PU ACADEMIC PRESS INC ELSEVIER SCIENCE PI SAN DIEGO PA 525 B ST, STE 1900, SAN DIEGO, CA 92101-4495 USA SN 0095-0696 J9 J ENVIRON ECON MANAG JI J.Environ.Econ.Manage. PD SEP PY 1995 VL 29 IS 2 BP 162 EP 168 DI 10.1006/jeem.1995.1038 PG 7 WC Business; Economics; Environmental Studies SC Business & Economics; Environmental Sciences & Ecology GA RU185 UT WOS:A1995RU18500003 ER PT J AU TAYLOR, AK BEAUREGARD, KM VISTNES, JP AF TAYLOR, AK BEAUREGARD, KM VISTNES, JP TI WHO BELONGS TO HMOS - A COMPARISON OF FEE-FOR-SERVICE VERSUS HMO ENROLLEES SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article ID ENROLLMENT AB As employers have turned to managed care to curtail the rising cost of health care benefits, the number of HMO enrollees has proliferated. Between 1984 and 1994, HMO enrollment increased from approximately 15 million to over 49 million individuals. Although research has indicated that HMOs have been effective in limiting medical costs, there is mixed evidence in the literature on how they achieve these savings. This article uses data from the 1987 National Medical Expenditure Survey to examine one hypothesis for these patterns: that HMOs enroll a healthier population than fee-for-service plans. To test this hypothesis we examine HMO and fee-for-service enrollees with respect to socioeconomic variables such as age, race, sex, income, education, health status, and location. Our results indicate that HMOs tend to enroll a younger but not much healthier population than; traditional fee-for-service plans, suggesting that self-selection is not a major contributor to HMO cost savings. RP TAYLOR, AK (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,STE 500,ROCKVILLE,MD 20852, USA. NR 27 TC 20 Z9 20 U1 0 U2 0 PU SAGE PUBL INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 SN 1077-5587 J9 MED CARE RES REV JI Med. Care Res. Rev. PD SEP PY 1995 VL 52 IS 3 BP 389 EP 408 DI 10.1177/107755879505200304 PG 20 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA RT427 UT WOS:A1995RT42700004 PM 10144870 ER PT J AU FREIMAN, MP MURTAUGH, CM AF FREIMAN, MP MURTAUGH, CM TI INTERACTIONS BETWEEN HOSPITAL AND NURSING-HOME USE SO PUBLIC HEALTH REPORTS LA English DT Article ID PROSPECTIVE PAYMENT; CARE; RESIDENTS; TRANSFERS AB NATIONAL ESTIMATES ARE provided, for the first time, of the number of hospitalizations in a year for elderly persons who also experience some nursing home use, and patterns far this interaction are described. In 1987, 816,000 persons were transferred from nursing homes to hospitals, constituting 8.5 percent of ail Medicare hospital admissions for persons ages 65 and older. Another 347,000 hospital stays involved people admitted from the community and discharged to a nursing home. The reporting of discharge destination on Medicare hospital bill data in 1987 also is analyzed. It was found that these data may have underreported a nursing home as the destination by between 15 and 20 percent. The magnitude of hospitalizations of nursing home residents suggests that programs aimed at improving nursing home care might have an important impact on total days of hospital care, and that it is important to learn more about the optimal use of expensive hospital care. C1 MED TECHNOL & PRACTICE PATTERNS INST INC,WASHINGTON,DC. RP FREIMAN, MP (reprint author), PUBL HLTH SERV,AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 21 TC 12 Z9 12 U1 0 U2 0 PU US GOVERNMENT PRINTING OFFICE PI WASHINGTON PA SUPT OF DOCUMENTS, WASHINGTON, DC 20402-9325 SN 0033-3549 J9 PUBLIC HEALTH REP JI Public Health Rep. PD SEP-OCT PY 1995 VL 110 IS 5 BP 546 EP 554 PG 9 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA TC729 UT WOS:A1995TC72900006 PM 7480608 ER PT J AU CLANCY, CM BRODY, H AF CLANCY, CM BRODY, H TI MANAGED CARE - ETHICAL ISSUES - REPLY SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 MICHIGAN STATE UNIV,E LANSING,MI 48824. RP CLANCY, CM (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852, USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD AUG 23 PY 1995 VL 274 IS 8 BP 611 EP 611 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA RP702 UT WOS:A1995RP70200021 ER PT J AU BROWN, RE MILLER, B TAYLOR, WR PALMER, C BOSCO, L NICOLA, RM ZELINGER, J SIMPSON, K AF BROWN, RE MILLER, B TAYLOR, WR PALMER, C BOSCO, L NICOLA, RM ZELINGER, J SIMPSON, K TI HEALTH-CARE EXPENDITURES FOR TUBERCULOSIS IN THE UNITED-STATES SO ARCHIVES OF INTERNAL MEDICINE LA English DT Article ID RESISTANT MYCOBACTERIUM-TUBERCULOSIS; HUMAN-IMMUNODEFICIENCY-VIRUS; OUTBREAK; TRANSMISSION; RISK AB Background: The resurgence of tuberculosis (TB) and the increase in multidrug-resistant TB prompted this study, which estimates direct expenditures for TB treatment and public health activities in the United States. Methods: This retrospective cost of illness study estimated 1991 direct expenditures for TB-related outpatient and inpatient diagnosis and treatment, screening, preventive therapy, contact investigations, surveillance, and outbreak investigations. Existing databases at the Centers for Disease Control and Prevention (Atlanta, Ga) and the Codman Research Group, Lebanon, NH, were supplemented by surveys of state and local TB programs and interviews of organizations that conduct large-scale screening. No estimates of indirect costs were made. Results: The direct medical expenditures for TB in 1991 were estimated at $703.1 million. This cost includes $423.8 million for inpatient care, $182.3 million for outpatient care, $72.1 million for screening, $3.4 million for contact investigations, $17.9 for preventive therapy, and $3.6 million for surveillance and outbreak investigations. Sensitivity analyses yielded a range of expenditures between $515.7 million and $934.5 million. Conclusions: Treatment accounted for more than 86% of all TB-related expenditures; inpatient treatment accounted for 60% of the to tal. Prevention activities made up only 14% of all costs. Direct medical expenditures may be underestimated because of limitations in the database on hospital expenditures and health department cost-accounting systems and because of the lack of a national database on screening activities. Greater emphasis should be placed on outpatient treatment and prevention in high-risk populations, and improved cost-accounting systems should be developed in state and local health department TB control programs to facilitate economic evaluation and improve the allocation of health dollars. C1 CTR DIS CONTROL & PREVENT,DIV TB ELIMINAT,ATLANTA,GA 30333. BATTELLE CTR PUBL HLTH RES & EVALUAT,ARLINGTON,VA. AGCY HLTH CARE POLICY & RES,CTR MED EFFECT RES,BALTIMORE,MD. HLTH CARE FINANCING ADM,BUR MEDICAID,BALTIMORE,MD. NR 27 TC 112 Z9 113 U1 0 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 SN 0003-9926 J9 ARCH INTERN MED JI Arch. Intern Med. PD AUG 7 PY 1995 VL 155 IS 15 BP 1595 EP 1600 DI 10.1001/archinte.155.15.1595 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA RL485 UT WOS:A1995RL48500005 PM 7618981 ER PT J AU KAPLAN, JE MASUR, H HOLMES, KK WILFERT, CM SPERLING, R BAKER, SA TRAPNELL, CB FREEDBERG, KA COTTON, D POWDERLY, WG JAFFE, HW LANIER, D SCHRAM, N COOPER, E MAYER, K BLINKHORN, R ELLNER, J ANGULO, J BERKELMAN, R BREIMAN, R BRYAN, R BEUHLER, J CALDWELL, B CASTRO, K CHILDS, JE CHU, S CIESIELSKI, C DROTMAN, DP EDLIN, B ELLERBROCK, T FLEMING, P GEITER, L HAJJEH, R HANSON, D HOLMBERG, S HUGHES, J JAFFE, H JONES, J JURANEK, D KELLER, D MARTONE, W MCNEIL, MM MILLER, B NAVIN, T NESLUND, V OSTROFF, S PELLETT, PE PINNER, R REEF, S REEVES, WC REGNERY, R RICHARDS, F ROGERS, M SCHONBERGER, LB SIMONDS, RJ SIMONE, P SMITH, D SOLOMON, S SPIEGEL, R STEWART, J SWERDLOW, D VERNON, S WARD, J NEAL, J SCHLECH, W WILFERT, C HORSBURGH, R MCGOWAN, J RIMLAND, D GOLDBERGER, M BARR, D TORRES, G STETLER, H GROSS, P ELSADR, W GREAVES, W BARTLETT, J CHAISON, R FEINBERG, J QUINN, T HORMAN, J MACDONALD, K WILSON, M AVANDANO, A BAKER, AC KALICA, A KOVACS, J POLIS, M SCHNITTMAN, S NELSON, C PHAIR, J BENSON, C WOOD, B HUGHES, W LUFT, B HYSLOP, N WHITLEY, R AMPEL, N DREW, WL KOEHLER, J WOFSY, C AF KAPLAN, JE MASUR, H HOLMES, KK WILFERT, CM SPERLING, R BAKER, SA TRAPNELL, CB FREEDBERG, KA COTTON, D POWDERLY, WG JAFFE, HW LANIER, D SCHRAM, N COOPER, E MAYER, K BLINKHORN, R ELLNER, J ANGULO, J BERKELMAN, R BREIMAN, R BRYAN, R BEUHLER, J CALDWELL, B CASTRO, K CHILDS, JE CHU, S CIESIELSKI, C DROTMAN, DP EDLIN, B ELLERBROCK, T FLEMING, P GEITER, L HAJJEH, R HANSON, D HOLMBERG, S HUGHES, J JAFFE, H JONES, J JURANEK, D KELLER, D MARTONE, W MCNEIL, MM MILLER, B NAVIN, T NESLUND, V OSTROFF, S PELLETT, PE PINNER, R REEF, S REEVES, WC REGNERY, R RICHARDS, F ROGERS, M SCHONBERGER, LB SIMONDS, RJ SIMONE, P SMITH, D SOLOMON, S SPIEGEL, R STEWART, J SWERDLOW, D VERNON, S WARD, J NEAL, J SCHLECH, W WILFERT, C HORSBURGH, R MCGOWAN, J RIMLAND, D GOLDBERGER, M BARR, D TORRES, G STETLER, H GROSS, P ELSADR, W GREAVES, W BARTLETT, J CHAISON, R FEINBERG, J QUINN, T HORMAN, J MACDONALD, K WILSON, M AVANDANO, A BAKER, AC KALICA, A KOVACS, J POLIS, M SCHNITTMAN, S NELSON, C PHAIR, J BENSON, C WOOD, B HUGHES, W LUFT, B HYSLOP, N WHITLEY, R AMPEL, N DREW, WL KOEHLER, J WOFSY, C TI USPHS/IDSA GUIDELINES FOR THE PREVENTION OF OPPORTUNISTIC INFECTIONS IN PERSONS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - AN OVERVIEW SO CLINICAL INFECTIOUS DISEASES LA English DT Article ID RECOMMENDATIONS; CONSEQUENCES; TUBERCULOSIS; PROPHYLAXIS; PREGNANCY; THERAPY; PEOPLE; TYPE-1; DRUGS; WOMEN C1 NIH, BETHESDA, MD 20892 USA. UNIV WASHINGTON, SEATTLE, WA 98195 USA. US DEPT HHS, AGCY HLTH CARE POLICY & RES, ROCKVILLE, MD 20852 USA. AMER ASSOC PHYSICIANS HUMAN RIGHTS, SAN FRANCISCO, CA USA. AMER FDN AIDS RES, ROCKVILLE, MD USA. BOSTON UNIV, SCH MED, BOSTON, MA 02118 USA. BROWN UNIV, PROVIDENCE, RI 02912 USA. CASE WESTERN RESERVE UNIV, CLEVELAND, OH 44106 USA. COUNCIL STATE & TERR EPIDEMIOLGISTS, ATLANTA, GA USA. DALHOUSIE UNIV, HALIFAX, NS, CANADA. DUKE UNIV, DURHAM, NC USA. EMORY UNIV, ATLANTA, GA 30322 USA. US FDA, ROCKVILLE, MD 20857 USA. GAY MENS HLTH CRISIS INC, NEW YORK, NY USA. GEORGIA DEPT HUMAN RESOURCES, ATLANTA, GA USA. HACKENSACK MED CTR, HACKENSACK, NJ 07604 USA. HARLEM HOSP MED CTR, NEW YORK, NY USA. HARVARD UNIV, SCH MED, BOSTON, MA USA. HOWARD UNIV, WASHINGTON, DC 20059 USA. JOHNS HOPKINS UNIV, BALTIMORE, MD USA. MARYLAND DEPT HLTH, BALTIMORE, MD USA. MINNESOTA DEPT PUBL HLTH, MINNEAPOLIS, MN USA. MT AUBURN HOSP, CAMBRIDGE, MA USA. MT SINAI MED CTR, NEW YORK, NY 10029 USA. NATL ASSOC PERSONS AIDS, WASHINGTON, DC USA. NHLBI, BETHESDA, MD 20892 USA. NIAID, BETHESDA, MD 20892 USA. NATL MINOR AIDS COUNCIL, WASHINGTON, DC USA. NORTHWESTERN UNIV, CHICAGO, IL 60611 USA. RUSH MED COLL, CHICAGO, IL 60612 USA. SEATTLE KING CTY DEPT HLTH, SEATTLE, WA USA. ST JUDE CHILDRENS RES HOSP, MEMPHIS, TN 38105 USA. SUNY STONY BROOK, STONY BROOK, NY 11794 USA. TULANE UNIV, NEW ORLEANS, LA 70118 USA. UNIV ALABAMA, BIRMINGHAM, AL USA. UNIV ARIZONA, TUCSON, AZ USA. UNIV CALIF SAN FRANCISCO, SAN FRANCISCO, CA 94143 USA. UNIV MINNESOTA, MINNEAPOLIS, MN 55455 USA. UNIV SO CALIF, LOS ANGELES, CA USA. UNIV WASHINGTON, ST LOUIS, MO USA. RP KAPLAN, JE (reprint author), CTR DIS CONTROL & PREVENT, DIV HIV AIDS, MAILSTOP G-29, ATLANTA, GA 30333 USA. RI Childs, James/B-4002-2012; mcgowan jr, john/G-5404-2011 NR 56 TC 52 Z9 52 U1 0 U2 3 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 1058-4838 J9 CLIN INFECT DIS JI Clin. Infect. Dis. PD AUG PY 1995 VL 21 SU 1 BP S12 EP S31 PG 20 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA RN616 UT WOS:A1995RN61600002 PM 8547500 ER PT J AU KAPLAN, JE MASUR, H HOLMES, KK LANIER, D SCHRAM, N COOPER, E FREEDBERG, KA MAYER, K BLINKHORN, R ELLNER, J ANGULO, F BERKELMAN, R BREIMAN, R BRYAN, R BUEHLER, J CALDWELL, B CASTRO, K CHILDS, JE CHU, S CIESIELSKI, C DROTMAN, DP EDLIN, B ELLERBROCK, T FLEMING, P GEITER, L HAJJEH, R HANSON, D HOLMBERG, S HUGHES, J JAFFE, H JONES, J JURANEK, D KELLER, D MARTONE, W MCNEIL, MM MILLER, B NAVIN, T NESLUND, V OSTROFF, S PELLETT, PE PINNER, R REEF, S REEVES, WC REGNERY, R RICHARDS, F ROGERS, M SCHONBERGER, LB SIMONDS, RJ SIMONE, P SMITH, D SOLOMON, S SPIEGEL, R STEWART, J SWERDLOW, D VERNON, S WARD, J NEAL, J SCHLECH, W WILFERT, C HORSBURGH, R MCGOWAN, J RIMLAND, D GOLDBERGER, M TRAPNELL, CB BARR, D TORRES, G STETLER, H GROSS, P ELSADR, W COTTON, D GREAVES, W BARTLETT, J CHAISSON, R FEINBERG, J QUINN, T HORMAN, J MACDONALD, K WILSON, M SPERLING, R AVANDANO, A BAKER, AC KALICA, A KOVACS, J POLIS, M SCHNITTMAN, S NELSON, C PHAIR, J BENSON, C WOOD, B HUGHES, W LUFT, B HYSLOP, N WHITLEY, R AMPEL, N DREW, WL KOEHLER, J WOFSY, C AF KAPLAN, JE MASUR, H HOLMES, KK LANIER, D SCHRAM, N COOPER, E FREEDBERG, KA MAYER, K BLINKHORN, R ELLNER, J ANGULO, F BERKELMAN, R BREIMAN, R BRYAN, R BUEHLER, J CALDWELL, B CASTRO, K CHILDS, JE CHU, S CIESIELSKI, C DROTMAN, DP EDLIN, B ELLERBROCK, T FLEMING, P GEITER, L HAJJEH, R HANSON, D HOLMBERG, S HUGHES, J JAFFE, H JONES, J JURANEK, D KELLER, D MARTONE, W MCNEIL, MM MILLER, B NAVIN, T NESLUND, V OSTROFF, S PELLETT, PE PINNER, R REEF, S REEVES, WC REGNERY, R RICHARDS, F ROGERS, M SCHONBERGER, LB SIMONDS, RJ SIMONE, P SMITH, D SOLOMON, S SPIEGEL, R STEWART, J SWERDLOW, D VERNON, S WARD, J NEAL, J SCHLECH, W WILFERT, C HORSBURGH, R MCGOWAN, J RIMLAND, D GOLDBERGER, M TRAPNELL, CB BARR, D TORRES, G STETLER, H GROSS, P ELSADR, W COTTON, D GREAVES, W BARTLETT, J CHAISSON, R FEINBERG, J QUINN, T HORMAN, J MACDONALD, K WILSON, M SPERLING, R AVANDANO, A BAKER, AC KALICA, A KOVACS, J POLIS, M SCHNITTMAN, S NELSON, C PHAIR, J BENSON, C WOOD, B HUGHES, W LUFT, B HYSLOP, N WHITLEY, R AMPEL, N DREW, WL KOEHLER, J WOFSY, C TI USPHS/IDSA GUIDELINES FOR THE PREVENTION OF OPPORTUNISTIC INFECTIONS IN PERSONS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - DISEASE-SPECIFIC RECOMMENDATIONS SO CLINICAL INFECTIOUS DISEASES LA English DT Article C1 UNIV WASHINGTON, SEATTLE, WA 98195 USA. US DEPT HHS, AGCY HLTH CARE POLICY & RES, ROCKVILLE, MD 20852 USA. AMER ASSOC PHYSICIANS HUMAN RIGHTS, SAN FRANCISCO, CA USA. AMER FDN AIDS RES, ROCKVILLE, MD USA. BOSTON UNIV, SCH MED, BOSTON, MA 02118 USA. BROWN UNIV, PROVIDENCE, RI 02912 USA. CASE WESTERN RESERVE UNIV, CLEVELAND, OH 44106 USA. COUNCIL STATE & TERR EPIDEMIOLOGISTS, ATLANTA, GA USA. DALHOUSIE UNIV, HALIFAX, NS B3H 3J5, CANADA. DUKE UNIV, DURHAM, NC 27706 USA. EMORY UNIV, ATLANTA, GA 30322 USA. US FDA, ROCKVILLE, MD 20857 USA. GAY MENS HLTH CRISIS INC, NEW YORK, NY USA. GEORGIA DEPT HUMAN RESOURCES, ATLANTA, GA USA. HACKENSACK MED CTR, HACKENSACK, NJ 07604 USA. HARLEM HOSP MED CTR, NEW YORK, NY USA. HARVARD UNIV, SCH MED, BOSTON, MA USA. HOWARD UNIV, WASHINGTON, DC 20059 USA. JOHNS HOPKINS UNIV, BALTIMORE, MD 21218 USA. MINNESOTA DEPT PUBL HLTH, MINNEAPOLIS, MN USA. MT AUBURN HOSP, CAMBRIDGE, MA USA. MT SINAI MED CTR, NEW YORK, NY 10029 USA. NATL ASSOC PERSONS AIDS, WASHINGTON, DC USA. NHLBI, BETHESDA, MD 20892 USA. NIAID, BETHESDA, MD 20892 USA. NORTHWESTERN UNIV, CHICAGO, IL 60611 USA. RUSH MED COLL, CHICAGO, IL 60612 USA. SEATTLE KING CTY DEPT HLTH, SEATTLE, WA USA. ST JUDE CHILDRENS RES HOSP, MEMPHIS, TN 38105 USA. SUNY STONY BROOK, STONY BROOK, NY 11794 USA. TULANE UNIV, NEW ORLEANS, LA 70118 USA. UNIV ALABAMA, BIRMINGHAM, AL USA. UNIV ARIZONA, TUCSON, AZ 85721 USA. UNIV SAN FRANCISCO, SAN FRANCISCO, CA 94117 USA. UNIV MINNESOTA, MINNEAPOLIS, MN 55455 USA. UNIV SO CALIF, LOS ANGELES, CA 90089 USA. WASHINGTON UNIV, ST LOUIS, MO 63130 USA. MARYLAND DEPT HLTH, BALTIMORE, MD USA. NATL MINOR AIDS COUNCIL, WASHINGTON, DC USA. RP KAPLAN, JE (reprint author), CTR DIS CONTROL & PREVENT, DIV HIV AIDS, MAILSTOP G-29, ATLANTA, GA 30333 USA. RI Childs, James/B-4002-2012; mcgowan jr, john/G-5404-2011 NR 8 TC 3 Z9 3 U1 0 U2 5 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 1058-4838 J9 CLIN INFECT DIS JI Clin. Infect. Dis. PD AUG PY 1995 VL 21 SU 1 BP S32 EP S43 PG 12 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA RN616 UT WOS:A1995RN61600003 ER PT J AU KAPLAN, JE MASUR, H HOLMES, KK MCNEIL, MM SCHONBERGER, LB NAVIN, TR HANSON, DL GROSS, PA JAFFE, HW LANIER, D SCHRAM, N COOPER, E FREEDBERG, KA MAYER, K BLINKHORN, R ELLNER, J ANGULO, F BERKELMAN, R BREIMAN, R BRYAN, R BUEHLER, J CLADWELL, B CASTRO, K CHILDS, JE CHU, S CIESIELSKI, C DROTMAN, DP EDLIN, B ELLERBROCK, T FLEMING, P GEITER, L HAJJEH, R HANSON, D HOLMBERG, S HUGHES, J JAFFE, H JONES, J JURANEK, D KAPLAN, JE KELLER, D MARTONE, W MILLER, B NAVIN, T NESLUND, V OSTROFF, S PELLETT, PE PINNER, R REEF, S REEVES, WC REGNERY, R RICHARDS, F ROGERS, M SIMONDS, RJ SIMONE, P SMITH, D SOLOMON, S SPIEGEL, R STEWART, J SWERDLOW, D VERNON, S WARD, J NEAL, J SCHLECH, W WILFERT, C HORSBURGH, R MCGOWAN, J RIMLAND, D GOLDBERGER, M TRAPNELL, CB BARR, D TORRES, G STETLER, H GROSS, P ELSADAR, W COTTON, D GREAVES, W BARTLETT, J CHAISSON, R FEINBERG, J QUINN, T HORMAN, J MACDONALD, K WILSON, M SPERLING, R AVANDANO, A BAKER, AC KALICA, A KOVACS, J POLIS, M SCHNITTMAN, S NELSON, C PHAIR, J BENSON, C WOOD, B HUGHES, W LUFT, B HYSLOP, N WHITLEY, R AMPEL, N DREW, WL KOEHLER, J WOFSY, C AF KAPLAN, JE MASUR, H HOLMES, KK MCNEIL, MM SCHONBERGER, LB NAVIN, TR HANSON, DL GROSS, PA JAFFE, HW LANIER, D SCHRAM, N COOPER, E FREEDBERG, KA MAYER, K BLINKHORN, R ELLNER, J ANGULO, F BERKELMAN, R BREIMAN, R BRYAN, R BUEHLER, J CLADWELL, B CASTRO, K CHILDS, JE CHU, S CIESIELSKI, C DROTMAN, DP EDLIN, B ELLERBROCK, T FLEMING, P GEITER, L HAJJEH, R HANSON, D HOLMBERG, S HUGHES, J JAFFE, H JONES, J JURANEK, D KAPLAN, JE KELLER, D MARTONE, W MILLER, B NAVIN, T NESLUND, V OSTROFF, S PELLETT, PE PINNER, R REEF, S REEVES, WC REGNERY, R RICHARDS, F ROGERS, M SIMONDS, RJ SIMONE, P SMITH, D SOLOMON, S SPIEGEL, R STEWART, J SWERDLOW, D VERNON, S WARD, J NEAL, J SCHLECH, W WILFERT, C HORSBURGH, R MCGOWAN, J RIMLAND, D GOLDBERGER, M TRAPNELL, CB BARR, D TORRES, G STETLER, H GROSS, P ELSADAR, W COTTON, D GREAVES, W BARTLETT, J CHAISSON, R FEINBERG, J QUINN, T HORMAN, J MACDONALD, K WILSON, M SPERLING, R AVANDANO, A BAKER, AC KALICA, A KOVACS, J POLIS, M SCHNITTMAN, S NELSON, C PHAIR, J BENSON, C WOOD, B HUGHES, W LUFT, B HYSLOP, N WHITLEY, R AMPEL, N DREW, WL KOEHLER, J WOFSY, C TI USPHS/IDSA GUIDELINES FOR THE PREVENTION OF OPPORTUNISTIC INFECTIONS IN PERSONS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - INTRODUCTION SO CLINICAL INFECTIOUS DISEASES LA English DT Review ID IMMUNE-DEFICIENCY-SYNDROME; MYCOBACTERIUM-AVIUM COMPLEX; PNEUMOCYSTIS-CARINII PNEUMONIA; HIV-SEROPOSITIVE PATIENTS; HYDROPHILA-ASSOCIATED COLITIS; CENTRAL-NERVOUS-SYSTEM; ACQUIRED-IMMUNODEFICIENCY; AIDS PATIENT; TRIMETHOPRIM-SULFAMETHOXAZOLE; PULMONARY CRYPTOCOCCOSIS C1 NIH, BETHESDA, MD 20892 USA. WASHINGTON UNIV, SEATTLE, WA USA. US DEPT HHS, AGCY HLTH CARE POLICY & RES, ROCKVILLE, MD 20852 USA. AMER ASSOC PHYSICIANS HUMAN RIGHTS, SAN FRANCISCO, CA USA. AMER FDN AIDS RES, ROCKVILLE, MD USA. BOSTON UNIV, SCH MED, BOSTON, MA 02118 USA. BROWN UNIV, PROVIDENCE, RI 02912 USA. CASE WESTERN RESERVE UNIV, CLEVELAND, OH 44106 USA. COUNCIL STATE & TERR EPIDEMIOLOGISTS, ATLANTA, GA USA. DALHOUSIE UNIV, HALIFAX, NS, CANADA. DUKE UNIV, DURHAM, NC USA. EMORY UNIV, ATLANTA, GA 30322 USA. US FDA, ROCKVILLE, MD 20857 USA. GAY MENS HLTH CRISIS INC, NEW YORK, NY USA. GEORGIA DEPT HUMAN RESOURCES, ATLANTA, GA USA. HACKENSACK MED CTR, HACKENSACK, NJ 07604 USA. HARLEM HOSP MED CTR, NEW YORK, NY USA. HARVARD UNIV, SCH MED, BOSTON, MA USA. HOWARD UNIV, WASHINGTON, DC 20059 USA. JOHNS HOPKINS UNIV, BALTIMORE, MD USA. MARYLAND DEPT HLTH, BALTIMORE, MD USA. MINNESOTA DEPT PUBL HLTH, MINNEAPOLIS, MN USA. MT AUBURN HOSP, CAMBRIDGE, MA 02238 USA. MT SINAI MED CTR, NEW YORK, NY 10029 USA. NATL ASSOC PERSONS AIDS, WASHINGTON, DC USA. NHLBI, BETHESDA, MD 20892 USA. NIAID, BETHESDA, MD 20892 USA. NATL MINOR AIDS COUNCIL, WASHINGTON, DC USA. NORTHWESTERN UNIV, CHICAGO, IL 60611 USA. RUSH MED COLL, CHICAGO, IL 60612 USA. SEATTLE KING CTY DEPT HLTH, SEATTLE, WA USA. ST JUDE CHILDRENS RES HOSP, MEMPHIS, TN 38105 USA. SUNY STONY BROOK, STONY BROOK, NY 11794 USA. TULANE UNIV, NEW ORLEANS, LA 70118 USA. UNIV ALABAMA, BIRMINGHAM, AL USA. UNIV ARIZONA, TUCSON, AZ USA. UNIV CALIF SAN FRANCISCO, SAN FRANCISCO, CA 94143 USA. UNIV MINNESOTA, MINNEAPOLIS, MN 55455 USA. UNIV SO CALIF, LOS ANGELES, CA USA. UNIV WASHINGTON, ST LOUIS, MO USA. RP KAPLAN, JE (reprint author), CTR DIS CONTROL & PREVENT, NATL IMMUNIZATION PROGRAM, DIV HIV AIDS, MAILSTOP G-29, ATLANTA, GA 30333 USA. RI Childs, James/B-4002-2012 NR 172 TC 42 Z9 42 U1 1 U2 4 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 1058-4838 EI 1537-6591 J9 CLIN INFECT DIS JI Clin. Infect. Dis. PD AUG PY 1995 VL 21 SU 1 BP S1 EP S11 PG 11 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA RN616 UT WOS:A1995RN61600001 PM 8547495 ER PT J AU FREEDMAN, VA WOLF, DA AF FREEDMAN, VA WOLF, DA TI A CASE-STUDY ON THE USE OF MULTIPLE IMPUTATION SO DEMOGRAPHY LA English DT Article AB Multiple imputation is a relatively new technique for dealing with missing values on items from survey data. Rather than deleting observations for which a value is missing, or assigning a single value to incomplete observations, one replaces each missing item with two or more values. Inferences then can be made with the complete data set. This paper presents an application of multiple imputation using the 1987-1988 National Survey of Families and Households. We impute several binary indicators of whether the respondent's elderly mother/mother-in-law is married. Descriptive statistics are then presented for the sample of adult children with an unmarried mother or mother-in-law. C1 SYRACUSE UNIV,CTR POLICY RES,SYRACUSE,NY 13244. RP FREEDMAN, VA (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. FU NIA NIH HHS [R01 AG08651-01] NR 11 TC 14 Z9 14 U1 0 U2 1 PU POPULATION ASSN AMER PI WASHINGTON PA 1722 N ST NW, WASHINGTON, DC 20036 SN 0070-3370 J9 DEMOGRAPHY JI Demography PD AUG PY 1995 VL 32 IS 3 BP 459 EP 470 DI 10.2307/2061691 PG 12 WC Demography SC Demography GA RZ779 UT WOS:A1995RZ77900010 PM 8829977 ER PT J AU FLEISHMAN, JA MOR, V LALIBERTE, LL AF FLEISHMAN, JA MOR, V LALIBERTE, LL TI LONGITUDINAL PATTERNS OF MEDICAL-SERVICE USE AND COSTS AMONG PEOPLE WITH AIDS SO HEALTH SERVICES RESEARCH LA English DT Article DE AIDS; SERVICE UTILIZATION; COST; TERMINAL CARE ID HIV; MODELS; CARE; ZIDOVUDINE; TRENDS AB Objective. This study examines the effects of race, HIV transmission group, and decedent status on the use and cost of inpatient and outpatient care among people with AIDS. Data Sources. Data come from 914 people with AIDS who were receiving services in nine cities across the United States in 1990-1991 and who indicated that a hospital clinic was their usual source of care. Review of hospital medical and billing records provided data on use and costs of medical services over an 18-month period. Vital status was determined from hospital records and death certificates. Study Design. Data from each respondent were aggregated into three-month intervals, beginning with the last quarter of data and working backward. Regression analyses using random-effect models and generalized estimating equations were conducted to assess temporal patterns of inpatient and outpatient use and costs. Principal Findings. Inpatient utilization and costs were higher for decedents than for nondecedents. However, differences between decedents and nondecedents varied as a function of race. Nonwhites had more inpatient use and higher costs than whites, but lower outpatient use, and these differences were greater among decedents. Inpatient nights and costs rose sharply in the six months prior to death. Outpatient use and costs did not display as strong a temporal trend. Conclusions. Much of the cost of treating HIV infection is concentrated in the period immediately preceding death. The intensity of service use in the terminal period should be considered when developing estimates of annual costs of care and when designing programs to provide community-based treatment. C1 BROWN UNIV,CTR GERONTOL & HLTH CARE RES,PROVIDENCE,RI 02912. BROWN UNIV,CTR GERONTOL,PROVIDENCE,RI 02912. RP FLEISHMAN, JA (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 502,ROCKVILLE,MD 20852, USA. FU AHRQ HHS [HS06214] NR 29 TC 35 Z9 35 U1 0 U2 0 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD AUG PY 1995 VL 30 IS 3 BP 403 EP 424 PG 22 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA RX602 UT WOS:A1995RX60200001 PM 7649749 ER PT J AU FRIEDMAN, B FARLEY, D AF FRIEDMAN, B FARLEY, D TI STRATEGIC RESPONSES BY HOSPITALS TO INCREASED FINANCIAL RISK IN THE 1980S SO HEALTH SERVICES RESEARCH LA English DT Article DE COST-SHIFTING; SERVICE MIX; PROSPECTIVE PAYMENT SYSTEM; RATE REGULATION PROGRAMS; HOSPITAL PRICES; FINANCIAL RISK ID MEDICARE PROSPECTIVE PAYMENT; DISEASE; MARKET AB Objective. This research addresses the following types of responses by hospitals to increased financial risk: (a) increases in prices to privately insured patients (testing separately the effects of risk from the effects of ''cost-shifting'' that depends on level of Medicare payment in relation to case mix-adjusted cost); (b) changes in service mix offered and selectivity in acceptance of patients to reduce risk; and (c) efforts to reduce variation in resource use for those patients admitted. Data Sources. The database includes a national panel of over 400 hospitals providing information from patient discharge abstracts, hospital financial reports, and county level information over the period 1980-1987. Study Design. Econometric methods suitable to panel data are implemented, with tests for pooling, hospital-specific fixed effects, and possible problems of selection bias. Principal Findings. The prices paid by private insurers to a particular hospital were affected by the changes in risk imposed by Medicare prospective payment, the generosity of Medicare payment, state rate regulation, and ability of the hospital to bear risk. The risk-weighted measure of case mix did not respond to changes in payment policy, but other variables reflecting the management of care after admission to reduce risk did change in the predicted directions. Conclusions. Some of the findings in this article are relevant to current Medicare policies that involve risk-sharing, for instance, special allowances for ''outlier'' patients with unusually high cost, and for sole community hospitals. The first type of allowance appears successful in preserving access to care, while the second type is not well justified by the findings. State rate regulation programs were associated not only with lower hospital prices but also with less risk reduction behavior by hospitals. The design of regulation as a sort of risk-pooling arrangement across payers and hospitals may be attractive to hospitals and help explain their support for regulation in some states. RP FRIEDMAN, B (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON,SUITE 500,ROCKVILLE,MD 20852, USA. NR 20 TC 8 Z9 8 U1 1 U2 3 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD AUG PY 1995 VL 30 IS 3 BP 467 EP 488 PG 22 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA RX602 UT WOS:A1995RX60200004 PM 7649752 ER PT J AU COOPER, JK AF COOPER, JK TI MANAGED CARE AND RURAL AMERICA SO JOURNAL OF FAMILY PRACTICE LA English DT Article RP COOPER, JK (reprint author), US DEPT HLTH & HUMAN RESOURCES,AGCY HLTH CARE POLICY & RES,DIV PRIMARY CARE,ROCKVILLE,MD 20852, USA. NR 15 TC 3 Z9 3 U1 0 U2 0 PU APPLETON & LANGE PI E NORWALK PA 25 VAN ZANT ST, E NORWALK, CT 06855 SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD AUG PY 1995 VL 41 IS 2 BP 115 EP 117 PG 3 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA RN979 UT WOS:A1995RN97900001 PM 7636449 ER PT J AU GAUS, CR DELEON, PH AF GAUS, CR DELEON, PH TI THINKING BEYOND THE LIMITATIONS OF MENTAL-HEALTH-CARE SO PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE LA English DT Editorial Material RP GAUS, CR (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852, USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU AMER PSYCHOLOGICAL ASSOC PI WASHINGTON PA 750 FIRST ST NE, WASHINGTON, DC 20002-4242 SN 0735-7028 J9 PROF PSYCHOL-RES PR JI Prof. Psychol.-Res. Pract. PD AUG PY 1995 VL 26 IS 4 BP 339 EP 340 PG 2 WC Psychology, Multidisciplinary SC Psychology GA RL505 UT WOS:A1995RL50500001 ER PT J AU GAUS, CR AF GAUS, CR TI HEALTH-SERVICES RESEARCH - NOW MORE THAN EVER SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material RP GAUS, CR (reprint author), AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD, USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUL 12 PY 1995 VL 274 IS 2 BP 108 EP 108 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA RH222 UT WOS:A1995RH22200005 PM 7595988 ER PT J AU FRIEDMAN, B ELIXHAUSER, A AF FRIEDMAN, B ELIXHAUSER, A TI THE CHANGING DISTRIBUTION OF A MAJOR SURGICAL-PROCEDURE ACROSS HOSPITALS - WERE SUPPLY SHIFTS AND DISEQUILIBRIUM IMPORTANT SO HEALTH ECONOMICS LA English DT Article DE TOTAL HIP REPLACEMENT SURGERY; PATIENT MIX; SUPPLY AND DEMAND SHIFTS; VOLUME ID INDUCED DEMAND; VOLUME AB This paper describes and analyzes the changing distribution across hospitals in the U.S. of total hip replacement surgery (THR) for the period 1980-1987. THR is one of the most costly single procedures contributing to health care expenses. Also, the use of THR exhibits a particularly high degree of geographic variation. Recent research pointed to shifts in demand as one plausible economic explanation for increasing use of THR. This paper questions whether shifts in supply may have been large enough to explain changes in patient mix and the relationship of patient mix to the number of procedures performed at a particular hospital. In addition, the relationship between total use of THR and the local availability of orthopaedic surgeons as well as the average allowable Medicare fee for standardized physician services is analyzed. These relationships might yield evidence to support a scenario of induced demand beyond the optimum for patients' welfare, or evidence of supply increase within a disequilibrium scenario. This study, using data for all THR patients in a large sample of hospitals, tends to reject the formulation of a market with independent supply and demand shifts where the supply shifts were the dominant forces. Hospitals with a larger number of THRs performed did not see a higher percentage of older, sicker, and lower income patients. It was more likely that demand shifts generated increases in capacity for surgical services. Moreover, there was little evidence for a persistent disequilibrium and only weak evidence for inducement. Also, we found little evidence that hospitals responded to financial incentives inherent in the Medicare payment system after 1983 to select among THR candidates in favour of those with below average expected cost. We did observe increased concentration over time of THR procedures in facilities with high volume-suggesting plausible demand shifts towards hospitals with a priori quality and cost advantages or who obtained those advantages with a high volume of patients. C1 AGCY HLTH CARE POLICY & RES,CTR INTRAMURAL RES,DIV PROVIDER STUDIES,ROCKVILLE,MD. NR 22 TC 6 Z9 6 U1 0 U2 2 PU JOHN WILEY & SONS LTD PI W SUSSEX PA BAFFINS LANE CHICHESTER, W SUSSEX, ENGLAND PO19 1UD SN 1057-9230 J9 HEALTH ECON JI Health Econ. PD JUL-AUG PY 1995 VL 4 IS 4 BP 301 EP 314 PG 14 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA RT525 UT WOS:A1995RT52500006 PM 8528432 ER PT J AU OSUCH, JR ANTHONY, M BASSETT, LW DEBOR, M DORSI, C HENDRICK, RE LINVER, M SMITH, R AF OSUCH, JR ANTHONY, M BASSETT, LW DEBOR, M DORSI, C HENDRICK, RE LINVER, M SMITH, R TI A PROPOSAL FOR A NATIONAL MAMMOGRAPHY DATABASE - CONTENT, PURPOSE, AND VALUE SO AMERICAN JOURNAL OF ROENTGENOLOGY LA English DT Article ID COST SCREENING MAMMOGRAPHY; MEDICAL AUDIT; QUALITY ASSURANCE; BREAST; PROGRAM AB A national mammography database is a centralized, computerized method of data collection consisting of two possible parts: a national mammography audit and a system for monitoring and tracking patients. A national mammography audit refers to collecting and analyzing medical audit data of individual mammography practices at a national level and is a critical step in Improving the interpretive component of mammography. The monitoring and tracking component refers to a centralized system that provides women and physicians with a recruitment and follow-up mechanism to optimize participation in mammography services. Both parts of a national mammography database represent important components in the improvement of mammography quality. However, unique scientific, legal, and fiscal concerns are important to consider before establishing a national mammography database. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,OFF FORUM QUAL & EFFECT HLTH CARE,ROCKVILLE,MD 20852. UNIV CALIF LOS ANGELES,SCH MED,DEPT RADIOL SCI,LOS ANGELES,CA 90024. UNIV MASSACHUSETTS,MED CTR,DEPT RADIOL,WORCESTER,MA 01655. UNIV COLORADO,HLTH SCI CTR,DEPT RADIOL,DENVER,CO 80262. AMER CANC SOC,ATLANTA,GA 30329. XRAY ASSOCIATES NEW MEXICO,PC,ALBUQUERQUE,NM 87102. RP OSUCH, JR (reprint author), MICHIGAN STATE UNIV,DEPT SURG,E LANSING,MI 48824, USA. NR 38 TC 22 Z9 23 U1 0 U2 0 PU AMER ROENTGEN RAY SOC PI RESTON PA 1891 PRESTON WHITE DR SUBSCRIPTION FULFILLMENT, RESTON, VA 22091 SN 0361-803X J9 AM J ROENTGENOL JI Am. J. Roentgenol. PD JUN PY 1995 VL 164 IS 6 BP 1329 EP 1334 PG 6 WC Radiology, Nuclear Medicine & Medical Imaging SC Radiology, Nuclear Medicine & Medical Imaging GA QZ542 UT WOS:A1995QZ54200003 PM 7754870 ER PT J AU GOODWIN, PE SMYER, MA LAIR, TI AF GOODWIN, PE SMYER, MA LAIR, TI TI DECISION-MAKING INCAPACITY AMONG NURSING-HOME RESIDENTS - RESULTS FROM THE 1987 NMES SURVEY SO BEHAVIORAL SCIENCES & THE LAW LA English DT Article; Proceedings Paper CT 45th Annual Scientific Meeting of the Gerontological-Society-of-America CY NOV 20-21, 1992 CL WASHINGTON, DC SP Gerontol Soc Amer ID SELF-DETERMINATION ACT; ADVANCE DIRECTIVES; CONSENT; FAMILIES; CARE; PEOPLE; LIFE AB Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NIMES) to examine rates of incapacity for health care decisionmaking among nursing home residents. Elements of the Oklahoma statute were used to operationalize decisionmaking incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents. C1 BOSTON COLL,GRAD SCH ARTS & SCI,BOSTON,MA. US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. RP GOODWIN, PE (reprint author), PENN STATE UNIV,DEPT HUMAN DEV & FAMILY STUDIES,S-115 HENDERSON BLDG,UNIVERSITY PK,PA 16802, USA. NR 39 TC 5 Z9 5 U1 0 U2 0 PU JOHN WILEY & SONS LTD PI W SUSSEX PA BAFFINS LANE CHICHESTER, W SUSSEX, ENGLAND PO19 1UD SN 0735-3936 J9 BEHAV SCI LAW JI Behav. Sci. Law PD SUM PY 1995 VL 13 IS 3 BP 405 EP 414 DI 10.1002/bsl.2370130308 PG 10 WC Psychology, Applied; Law SC Psychology; Government & Law GA RQ868 UT WOS:A1995RQ86800008 PM 10155259 ER PT J AU SUSSMAN, KE GREENE, RJ PAGANINI, JM AF SUSSMAN, KE GREENE, RJ PAGANINI, JM TI QUALITY ASSESSMENT AND IMPROVEMENT IN DIABETES HEALTH-CARE - AN ISSUE NOW AND FOR THE FUTURE SO DIABETES RESEARCH AND CLINICAL PRACTICE LA English DT Editorial Material C1 PAN AMER HLTH ORG,DIV HLTH SYST & SERV,WASHINGTON,DC 20037. US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR MED EFFECTIVENESS,ROCKVILLE,MD 20852. RP SUSSMAN, KE (reprint author), UNIV COLORADO,VET ADM MED CTR,1055 CLERMONT ST,DENVER,CO 80220, USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU ELSEVIER SCI PUBL IRELAND LTD PI CLARE PA CUSTOMER RELATIONS MANAGER, BAY 15, SHANNON INDUSTRIAL ESTATE CO, CLARE, IRELAND SN 0168-8227 J9 DIABETES RES CLIN PR JI Diabetes Res. Clin. Pract. PD JUN PY 1995 VL 28 IS 3 BP 149 EP 150 DI 10.1016/0168-8227(95)01098-X PG 2 WC Endocrinology & Metabolism SC Endocrinology & Metabolism GA RX132 UT WOS:A1995RX13200001 PM 8529492 ER PT J AU GAUS, CR SIMPSON, L AF GAUS, CR SIMPSON, L TI REINVENTING HEALTH-SERVICES RESEARCH SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Editorial Material RP GAUS, CR (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852, USA. NR 3 TC 3 Z9 3 U1 0 U2 0 PU BLUE CROSS BLUE SHIELD ASSN PI CHICAGO PA 676 N ST CLAIR ST, CHICAGO, IL 60611 SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SUM PY 1995 VL 32 IS 2 BP 130 EP 134 PG 5 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA RJ723 UT WOS:A1995RJ72300003 PM 7601510 ER PT J AU HELLINGER, FJ AF HELLINGER, FJ TI SELECTION BIAS IN HMOS AND PPOS - A REVIEW OF THE EVIDENCE SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID CARE; REGRESSION; CHOICE AB Early studies of selection bias found that group and staff model health maintenance organizations (HMOs) enjoyed favorable selection (i.e., attracted healthier enrollees) among the nonelderly population. This review concludes that all health plans which restrict an enrollee's choice of provider-that is, group, staff; and individual practice association (IPA) HMOs and exclusive provider organizations (EPOs)-enjoy favorable selection among both the nonelderly and elderly populations. This suggests that the most important reason HMOs and EPOs experience favorable selection is that individuals who consume large amounts of health resources often are unwilling to sever ties with their health care providers. RP HELLINGER, FJ (reprint author), AGCY HLTH CARE POLICY & RES,CTR GEN HLTH SERV EXTRAMURAL RES,DIV COST & FINANCE,SUITE 502,ROCKVILLE,MD 20852, USA. NR 30 TC 83 Z9 84 U1 0 U2 1 PU BLUE CROSS BLUE SHIELD ASSN PI CHICAGO PA 676 N ST CLAIR ST, CHICAGO, IL 60611 SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SUM PY 1995 VL 32 IS 2 BP 135 EP 142 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA RJ723 UT WOS:A1995RJ72300004 PM 7601511 ER PT J AU COOPER, JK AF COOPER, JK TI ACCOUNTABILITY FOR CLINICAL PREVENTIVE SERVICES SO MILITARY MEDICINE LA English DT Article AB Clinical preventive services are important in both the civilian and military health care systems. In the civilian sector, preventive services have been included in the movement for more accountability for health care services, Four civilian accountability models have at least some preventive services evaluation. DEMPAQ is a program developed for Medicare, and collects data both from claims records and from office medical records, PROSPER is an example of another type of model, and uses patient questionnaires to collect information, A third model, HEDIS, produces the popularly-called ''report cards.'' HEDIS relies on administrative data generally available in managed care organizations, ''Passports'' is yet another model that offers the potential for perhaps the most efficient way to evaluate preventive services, but it is still developmental, None of these civilian models is directly applicable to today's military care system. However, the Composite Health Care System, a computer system widely used in military treatment facilities, offers a possible mechanism to provide local accountability for clinical preventive services that should be easy and efficient. RP COOPER, JK (reprint author), AGCY HLTH CARE POLICY & RES,EOC 501,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 0 TC 3 Z9 3 U1 0 U2 0 PU ASSN MILITARY SURG US PI BETHESDA PA 9320 OLD GEORGETOWN RD, BETHESDA, MD 20814 SN 0026-4075 J9 MIL MED JI Milit. Med. PD JUN PY 1995 VL 160 IS 6 BP 297 EP 299 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA RJ152 UT WOS:A1995RJ15200009 PM 7659228 ER PT J AU VISTNES, JP HAMILTON, V AF VISTNES, JP HAMILTON, V TI THE TIME AND MONETARY COSTS OF OUTPATIENT CARE FOR CHILDREN SO AMERICAN ECONOMIC REVIEW LA English DT Article; Proceedings Paper CT 107th Annual Meeting of the American-Economic-Association CY JAN 05-08, 1995 CL WASHINGTON, DC SP Amer Econ Assoc ID PHYSICIAN SERVICES; MEDICAL-CARE; DEMAND; PRICE C1 MCGILL UNIV,MONTREAL,PQ H3G 1A4,CANADA. MONTREAL GEN HOSP,MONTREAL,PQ H3G 1A4,CANADA. RP VISTNES, JP (reprint author), AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. RI Ho, Vivian/A-2827-2008 NR 11 TC 18 Z9 18 U1 0 U2 2 PU AMER ECON ASSN PI NASHVILLE PA 2014 BROADWAY SUITE 305, NASHVILLE, TN 37203 SN 0002-8282 J9 AM ECON REV JI Am. Econ. Rev. PD MAY PY 1995 VL 85 IS 2 BP 117 EP 121 PG 5 WC Economics SC Business & Economics GA RB651 UT WOS:A1995RB65100025 PM 10160522 ER PT J AU HSIA, DC FLEISHMAN, JA EAST, JA HELLINGER, FJ AF HSIA, DC FLEISHMAN, JA EAST, JA HELLINGER, FJ TI PEDIATRIC HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - RECENT-EVIDENCE ON THE UTILIZATION AND COSTS OF HEALTH-SERVICES SO ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE LA English DT Article ID UNITED-STATES; HIV-INFECTION; AIDS; CHILDREN; CARE; EPIDEMIOLOGY AB Objective: To measure the utilization and costs of pediatric human immunodeficiency virus (HIV)-related health care services. Design: Cohort survey. Setting: Eight outpatient departments serving large numbers of HIV-infected children in five standard metropolitan areas with high prevalence of HIV-infected children. Patients: One hundred forty-one HIV-seropositive children older than 15 months of age or children whose clinical conditions meet the definition of acquired immune-deficiency syndrome (AIDS) at any age who visited the selected providers during the second quarter of 1991. Interventions: None. Main Outcome Measures: Quarterly interview survey (via adult proxies) of health care services utilization during each preceding 3-month period, repeated six times between March 1991 and August 1992. Charge data were abstracted from inpatient, outpatient, home health care, and pharmacy bills. Results: Children with AIDS averaged 1.4 hospitalizations, 16 inpatient days, two emergency department visits, 18 ambulatory care visits, 15 professional home health care visits, and one dental visit per year, generating an estimated $37 928 in annual charges. The HIV-infected children used fewer services, with annual charges of $9382. Conclusions: We found lower utilization than reported in prior research on pediatric HIV and similar unit costs after inflation adjustment. Increasing experience in clinical management and expanded ambulatory care may have contributed to reductions in inpatient services utilization and total costs since the mid-1980s. C1 GEORGE WASHINGTON UNIV, SCH MED, WASHINGTON, DC USA. RP HSIA, DC (reprint author), US DEPT HHS, AGCY HLTH CARE POLICY & RES, EOC 502, 2101 E JEFFERSON ST, ROCKVILLE, MD 20852 USA. NR 41 TC 37 Z9 37 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60654-0946 USA SN 1072-4710 EI 1538-3628 J9 ARCH PEDIAT ADOL MED JI Arch. Pediatr. Adolesc. Med. PD MAY PY 1995 VL 149 IS 5 BP 489 EP 496 PG 8 WC Pediatrics SC Pediatrics GA QW848 UT WOS:A1995QW84800002 PM 7735400 ER PT J AU WEINICK, RM AF WEINICK, RM TI SHARING A HOME - THE EXPERIENCES OF AMERICAN WOMEN AND THEIR PARENTS OVER THE 20TH-CENTURY SO DEMOGRAPHY LA English DT Article; Proceedings Paper CT 1994 Annual Meeting of the Population-Association-of-America CY MAY 04-07, 1994 CL MIAMI BEACH, FL SP Populat Assoc Amer ID YOUNG-ADULTS; INTERGENERATIONAL EXCHANGES; FAMILY-STRUCTURE; LEAVING HOME; AGE; SEMIAUTONOMY; CORESIDENCE; MARRIAGE; MIDDLE AB Trends and determinants of daughter-parent coresidence over the twentieth century are examined by using the 1987-1988 National Survey of Families and Households. Young women from more recent birth cohorts leave their parents' home for the first time at earlier ages, but are more likely to make return trips home than those born earlier. Thus cohorts show remarkable consistency in the proportion of life lived in the parental home. For the 1900-1929 birth cohorts, daughters' lifetime probability that a parent will move in with them is approximately 15%; younger cohorts show similar age-specific probabilities to date. Explanations for these trends are considered. RP WEINICK, RM (reprint author), AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 50 TC 14 Z9 14 U1 0 U2 1 PU POPULATION ASSN AMER PI WASHINGTON PA 1722 N ST NW, WASHINGTON, DC 20036 SN 0070-3370 J9 DEMOGRAPHY JI Demography PD MAY PY 1995 VL 32 IS 2 BP 281 EP 297 DI 10.2307/2061745 PG 17 WC Demography SC Demography GA RD185 UT WOS:A1995RD18500009 PM 7664965 ER PT J AU BROOKS, JM KIRKING, DM AF BROOKS, JM KIRKING, DM TI EFFECT OF PRODUCTION ENVIRONMENT ON LABOR DEMAND IN VETERANS-AFFAIRS-MEDICAL-CENTER PHARMACIES SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Article DE DEPARTMENT OF VETERANS AFFAIRS; MANPOWER; PERSONNEL, PHARMACY; PHARMACEUTICAL SERVICES; PHARMACISTS, HOSPITAL; PHARMACY, INSTITUTIONAL, HOSPITAL; TIME STUDIES; WORKLOAD AB The relationship between pharmacy production environment and labor-time requirements was estimated by using data from Veterans Affairs medical center (VAMC) pharmacies. Economic theory was used to derive equations for estimating labor-time requirements for pharmacy services that take into account differences in production environment (factors that cannot be controlled by the pharmacy manager within a given observation period, such as pharmacy service mix and distance to patient care wards). The equations were estimated by using information obtained from the Department of Veterans Affairs (VA) and from a mail survey of VAMC pharmacy chiefs. The resulting estimates of labor-time requirements were compared with pharmacy labor-time requirements produced by the VA in 1989. Labor-time requirements varied dramatically with production environment, and the labor-time requirements calculated in this study generally exceeded those used by the VA. Accurate forecasts of required pharmacist and technician labor time must take into account the production environment within each pharmacy. C1 UNIV MICHIGAN,DEPT ECON,ANN ARBOR,MI 48109. UNIV MICHIGAN,COLL PHARM,ANN ARBOR,MI 48109. UNIV MICHIGAN,SCH PUBL HLTH,ANN ARBOR,MI 48109. RP BROOKS, JM (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR GEN HLTH SERV INTRAMURAL RES,DIV PROVIDER STUDIES,ROCKVILLE,MD 20852, USA. NR 10 TC 0 Z9 0 U1 0 U2 0 PU AMER SOC HEALTH-SYSTEM PHARMACISTS PI BETHESDA PA 7272 WISCONSIN AVE, BETHESDA, MD 20814 SN 1079-2082 J9 AM J HEALTH-SYST PH JI Am. J. Health-Syst. Pharm. PD APR PY 1995 VL 52 IS 8 BP 812 EP 822 PG 11 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA QZ855 UT WOS:A1995QZ85500005 PM 7634116 ER PT J AU DOR, A WATSON, H AF DOR, A WATSON, H TI THE HOSPITAL-PHYSICIAN INTERACTION IN US HOSPITALS - EVOLVING PAYMENT SCHEMES AND THEIR INCENTIVES SO EUROPEAN ECONOMIC REVIEW LA English DT Article; Proceedings Paper CT 9th Annual Congress of the European-Economic-Association CY SEP 03-05, 1994 CL MAASTRICHT, NETHERLANDS SP European Econ Assoc DE HOSPITALS; PHYSICIANS; BUNDLING; NASH-BARGAINING ID ORGANIZATION; BOARDS AB Unlike the case in several European countries, where physicians are salaried employees of the hospital, in the U.S. physicians are independent agents who are granted admitting privileges by their affiliated hospitals. Hospitals and physicians bill separately for their components of inpatient care, and patients or insurers compensate them separately. This has raised questions about the degree of efficiency and cooperation between the agents. In the first part of this paper we review previous models that examined this interaction under cost-based and prospective reimbursement. In the second part, we consider an experimental mechanism ('price-bundling') in which payers allow a single payment for an episode of care, leaving the physician and the hospital to negotiate over how the fee should be split. Modelling this as a Nash bargaining game, we cast doubt on the notion that price bundling can ensure cooperation and efficiency from the perspective of the players, and suggest other incentives that may have led hospitals to participate in the experiment. C1 GEORGE WASHINGTON UNIV,DEPT ECON,WASHINGTON,DC 20052. US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR INTRAMURAL RES,ROCKVILLE,MD 20852. NR 7 TC 13 Z9 13 U1 0 U2 2 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0014-2921 J9 EUR ECON REV JI Eur. Econ. Rev. PD APR PY 1995 VL 39 IS 3-4 BP 795 EP 802 DI 10.1016/0014-2921(94)00087-G PG 8 WC Economics SC Business & Economics GA RA079 UT WOS:A1995RA07900044 ER PT J AU SCHULMAN, KA RUBENSTEIN, LE CHESLEY, FD EISENBERG, JM AF SCHULMAN, KA RUBENSTEIN, LE CHESLEY, FD EISENBERG, JM TI THE ROLES OF RACE AND SOCIOECONOMIC-FACTORS IN HEALTH-SERVICES RESEARCH SO HEALTH SERVICES RESEARCH LA English DT Article DE RACE; HEALTH SERVICES RESEARCH; ACCESS; OUTCOMES ID CORONARY HEART-DISEASE; LOW-BIRTH-WEIGHT; RACIAL-DIFFERENCES; RISK-FACTORS; PERINATAL-MORTALITY; BLACK POPULATIONS; VISUAL IMPAIRMENT; ARTERY DISEASE; BLOOD-PRESSURE; MEDICAL-CARE AB For decades data have been collected comparing health care in racial and ethnic groups. The use of such groups in health services research assumes that standard, reliable, and valid definitions of race and ethnicity exist and that these definitions are used consistently. In fact, race is a term often used, but ill defined. It can incorporate biological, social, and cultural characteristics of patients and can refer to both genetic and behavioral traits. Various investigators have reported differences between racial and ethnic groups in health status, disease manifestation and outcome, resource utilization, and health care access, often specifying neither a definition of race nor the measurement they used to classify their study populations. The role of race as an explanatory variable in health services research requires greater scrutiny than many researchers currently provide. Many studies use race as a proxy for other socioeconomic factors not collected in the research effort. This article explores the ambiguities about race as an explanatory variable that render such research difficult to interpret. We suggest that health services researchers focus on nonracial socioeconomic characteristics that might be both more informative and more useful in guiding policy formation. C1 GEORGETOWN UNIV,MED CTR,DEPT MED,DIV GEN INTERNAL MED,CLIN ECON RES UNIT,WASHINGTON,DC. AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD. NR 56 TC 54 Z9 55 U1 0 U2 3 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 1995 VL 30 IS 1 BP 179 EP 195 PN 2 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA RB542 UT WOS:A1995RB54200004 PM 7721591 ER PT J AU CUNNINGHAM, PJ SHORT, PF FEINLEIB, SE AF CUNNINGHAM, PJ SHORT, PF FEINLEIB, SE TI ESTIMATING NURSING-HOME EPISODES FROM A SAMPLE OF DISCHARGES - THE IMPORTANCE OF ADJUSTING FOR PRIOR AND SUBSEQUENT STAYS SO MEDICAL CARE LA English DT Note ID POLICIES; CARE RP CUNNINGHAM, PJ (reprint author), AGCY HLTH CARE POLICY & RES,CTR INTRAMURAL RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 9 TC 8 Z9 8 U1 0 U2 0 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQUARE, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD APR PY 1995 VL 33 IS 4 BP 432 EP 440 DI 10.1097/00005650-199504000-00010 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA QU123 UT WOS:A1995QU12300010 PM 7731284 ER PT J AU BENJAMIN, KL PERFETTO, EM GREENE, RJ AF BENJAMIN, KL PERFETTO, EM GREENE, RJ TI PUBLIC-POLICY AND THE APPLICATION OF OUTCOMES ASSESSMENTS - PARADIGMS VERSUS POLITICS SO MEDICAL CARE LA English DT Article; Proceedings Paper CT Conference on Measuring the Effects of Medical Treatment CY APR 21-22, 1994 CL MINNEAPOLIS, MN SP AGCY HLTH CARE POLICY & RES ID ALZHEIMERS-DISEASE; TACRINE RP BENJAMIN, KL (reprint author), AGCY HLTH CARE POLICY & RES,CTR MED EFFECTIVENESS RES,2101 E JEFFERSON ST,SUITE 605,ROCKVILLE,MD 20852, USA. NR 25 TC 6 Z9 6 U1 1 U2 2 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQUARE, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD APR PY 1995 VL 33 IS 4 SU S BP AS299 EP AS306 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA QU755 UT WOS:A1995QU75500036 ER PT J AU SCHWARTZ, HA AF SCHWARTZ, HA TI DATA LINKAGE SO STATISTICS IN MEDICINE LA English DT Editorial Material RP SCHWARTZ, HA (reprint author), AGCY HLTH CARE POLICY & RES,OFF SCI & DATA DEV,2101 E JEFFERSON ST,SUITE 604,ROCKVILLE,MD 20852, USA. NR 6 TC 2 Z9 2 U1 0 U2 1 PU JOHN WILEY & SONS LTD PI W SUSSEX PA BAFFINS LANE CHICHESTER, W SUSSEX, ENGLAND PO19 1UD SN 0277-6715 J9 STAT MED JI Stat. Med. PD MAR 15 PY 1995 VL 14 IS 5-7 BP 687 EP 689 DI 10.1002/sim.4780140525 PG 3 WC Mathematical & Computational Biology; Public, Environmental & Occupational Health; Medical Informatics; Medicine, Research & Experimental; Statistics & Probability SC Mathematical & Computational Biology; Public, Environmental & Occupational Health; Medical Informatics; Research & Experimental Medicine; Mathematics GA QP760 UT WOS:A1995QP76000021 PM 7792458 ER PT J AU Fanning, TR Turner, BJ Cosler, LE OetjenGerdes, L Markson, LE McKee, L Gallagher, P Chiarella, J Fleishman, J Fahs, M AF Fanning, TR Turner, BJ Cosler, LE OetjenGerdes, L Markson, LE McKee, L Gallagher, P Chiarella, J Fleishman, J Fahs, M TI The quality of Medicaid data for HIV/AIDS research: Examination of a statewide data base SO AIDS & PUBLIC POLICY JOURNAL LA English DT Article ID NATIONAL-DEATH-INDEX; ACQUIRED-IMMUNODEFICIENCY-SYNDROME; PEPTIC-ULCER DISEASE; CASE-MANAGEMENT; VITAL STATUS; DRUG-USE; AIDS; ACCURACY; ASCERTAINMENT; PROGRAM C1 JEFFERSON MED COLL,DEPT GEN MED,PHILADELPHIA,PA. JEFFERSON MED COLL,DEPT MED,BIOSTAT SECT,PHILADELPHIA,PA. AGCY HLTH CARE POLICY & RES,DEPT HLTH & HUMAN SERV,ROCKVILLE,MD. MT SINAI MED CTR,DIV HLTH ECON,NEW YORK,NY 10029. RP Fanning, TR (reprint author), NEW YORK STATE DEPT SOCIAL SERV,DIV HLTH & LONG TERM CARE,ALBANY,NY, USA. NR 32 TC 32 Z9 32 U1 0 U2 0 PU UNIV PUBL GROUP, INC PI FREDERICK PA 12 SOUTH MARKET ST, STE 301, FREDERICK, MD 21701 J9 AIDS PUBLIC POLICY J JI Aids Public Policy J. PD SPR PY 1995 VL 10 IS 1 BP 39 EP 47 PG 9 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA TU576 UT WOS:A1995TU57600005 ER PT J AU Allen, SM Mor, V Fleishman, JA Piette, JD AF Allen, SM Mor, V Fleishman, JA Piette, JD TI The organizational transformation of advocacy: Growth and development of AIDS community-based organizations SO AIDS & PUBLIC POLICY JOURNAL LA English DT Article C1 AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD. VET ADM MED CTR,CTR HLTH CARE EVALUAT,PALO ALTO,CA 94304. STANFORD MED CTR,PALO ALTO,CA. RP Allen, SM (reprint author), BROWN UNIV,CTR GERONTOL & HLTH CARE RES,PROVIDENCE,RI 02912, USA. NR 28 TC 5 Z9 5 U1 1 U2 1 PU UNIV PUBL GROUP, INC PI FREDERICK PA 12 SOUTH MARKET ST, STE 301, FREDERICK, MD 21701 J9 AIDS PUBLIC POLICY J JI Aids Public Policy J. PD SPR PY 1995 VL 10 IS 1 BP 48 EP 59 PG 12 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA TU576 UT WOS:A1995TU57600006 ER PT J AU HUGHES, D SIMPSON, L AF HUGHES, D SIMPSON, L TI THE ROLE OF SOCIAL-CHANGE IN PREVENTING LOW-BIRTH-WEIGHT SO FUTURE OF CHILDREN LA English DT Review ID INFANT-MORTALITY; PRENATAL-CARE; UNITED-STATES; CHILD HEALTH; RISK-FACTORS; PREGNANCY OUTCOMES; WOMEN; PROGRAMS; MEDICAID; BLACKS AB The authors of this article examine the relationship between social factors and low birth weight and the ways in which disparities in socioeconomic status have been addressed over time. The evidence regarding the effectiveness of various efforts to influence birth weight by mitigating the consequences of disadvantage are also assessed. Low socioeconomic status has been shown to influence low birth weight through its various correlates. Historically and today, most programs and policies directed at low birth weight prevention attempt to address the individual health consequences of economic and social disadvantage. By and large, these efforts have produced mixed results. Efforts to affect low birth weight by addressing the underlying causes of social and economic disadvantage have been similarly inconclusive, reflecting the paucity of research on the subject, as well as the historical and ongoing failure to make the research link between health and social policy. The authors argue that reducing persistent disparities in low birth weight requires several steps, including embracing a broader definition of health which incorporates social dimensions, recasting the focus of research and interventions from pregnancy outcomes and infant health exclusively to include the notion of women's health more globally, expanding the research agenda to unravel the paradox of socioeconomic factors and health, and pursuing a dedicated, national commitment to assuring adequate support to individuals and families, including both adequate income and health care. C1 US DOE,AGCY HLTH CARE POLICY & RES,WASHINGTON,DC 20585. RP HUGHES, D (reprint author), UNIV CALIF SAN FRANCISCO,INST HLTH POLICY STUDIES,SAN FRANCISCO,CA 94143, USA. NR 101 TC 43 Z9 44 U1 1 U2 5 PU CENTER FUTURE CHILDREN, DAVID LUCILE PACKARD FOUNDATION PI LOS ALTOS PA 300 SECOND ST, STE 102, LOS ALTOS, CA 94022 SN 1054-8289 J9 FUTURE CHILD JI Future Child. PD SPR PY 1995 VL 5 IS 1 BP 87 EP 102 DI 10.2307/1602509 PG 16 WC Family Studies; Health Policy & Services; Social Sciences, Interdisciplinary SC Family Studies; Health Care Sciences & Services; Social Sciences - Other Topics GA RP312 UT WOS:A1995RP31200007 PM 7633870 ER PT J AU COHEN, JW CUNNINGHAM, PJ AF COHEN, JW CUNNINGHAM, PJ TI MEDICAID PHYSICIAN FEE LEVELS AND CHILDRENS ACCESS TO CARE SO HEALTH AFFAIRS LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Public-Health-Association CY OCT 25, 1993 CL SAN FRANCISCO, CA SP AMER PUBLIC HLTH ASSOC AB This study examines the effects of physician fees on children's use of preventive and illness related ambulatory physician services under the Medicaid program. Using data from the 1987 National Medical Expenditure Survey (NMES), we examine the effects of Medicaid fee generosity on physician service use and overall ambulatory physician spending. The results indicate that more generous fees are associated with a greater likelihood of having a doctor's office as a usual source of care and a higher number of preventive visits at office based sites of care. Having a doctor's office as a usual source of care is associated with lower overall ambulatory physician expenditures. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR GEN HLTH SERV INTRAMURAL RES,ROCKVILLE,MD 20852. RP COHEN, JW (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,DIV MED EXPENDITURE STUDIES,ROCKVILLE,MD 20852, USA. NR 22 TC 50 Z9 50 U1 0 U2 0 PU PROJECT HOPE-HEALTH AFFAIRS PI SYRACUSE PA PO BOX 8015, SYRACUSE, NY 13217 SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SPR PY 1995 VL 14 IS 1 BP 255 EP 262 DI 10.1377/hlthaff.14.1.255 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA QW298 UT WOS:A1995QW29800029 PM 7657211 ER PT J AU COLBY, DC RICE, T BERNSTEIN, J NELSON, L AF COLBY, DC RICE, T BERNSTEIN, J NELSON, L TI BALANCE BILLING UNDER MEDICARE - PROTECTING BENEFICIARIES AND PRESERVING PHYSICIAN PARTICIPATION SO JOURNAL OF HEALTH POLITICS POLICY AND LAW LA English DT Article ID ASSIGNMENT; ACCEPTANCE AB Medicare's experience with balance billing provides valuable lessons for policy making for national or state health care reform. Medicare developed several policies to encourage physicians to become participating providers who accept Medicare-allowed charges as payment in full. Only nonparticipating physicians are permitted to bill for additional amounts beyond that paid by Medicare, and there are limits on the amount of balance billing per claim. As shown by the analysis of claims presented in this article, Medicare has successfully provided financial protection to beneficiaries. In 1986, more than 60 percent of expenditures for physician services were on assigned claims for which there could be no balance billing; by 1990, 80 percent of expenditures were on assigned claims. Balance billing decreased by about 30 percent during the same period. Although these policies have been successful in reducing total expenditures for balance billing, they may not provide financial protection to the most economically vulnerable beneficiaries. Using survey and claims data, we found that the poor have lower balance billing expenditures for services provided by primary care physicians, but that there is no relationship between poverty status and balance billing expenditures for services of nonprimary care physicians. In addition, most low-income beneficiaries are liable for balance bills. Under health care reform, adoption of Medicare's incentive-based approach with mandatory assignment for the poor would allow for some choice based on price and would provide financial protection for all consumers. C1 UNIV CALIF LOS ANGELES,SCH PUBL HLTH,LOS ANGELES,CA 90024. AGCY HLTH CARE POLICY & RES,OFF PROGRAM DEV,WASHINGTON,DC. MATH POLICY RES INC,PRINCETON,NJ. RP COLBY, DC (reprint author), PHYSICIAN PAYMENT REVIEW COMMISS,WASHINGTON,DC, USA. NR 19 TC 3 Z9 3 U1 0 U2 0 PU DUKE UNIV PRESS PI DURHAM PA BOX 90660, DURHAM, NC 27708-0660 SN 0361-6878 J9 J HEALTH POLIT POLIC JI J. Health Polit. Policy Law PD SPR PY 1995 VL 20 IS 1 BP 49 EP 74 DI 10.1215/03616878-20-1-49 PG 26 WC Health Care Sciences & Services; Health Policy & Services; Medicine, Legal; Social Issues; Social Sciences, Biomedical SC Health Care Sciences & Services; Legal Medicine; Social Issues; Biomedical Social Sciences GA QG349 UT WOS:A1995QG34900004 PM 7738321 ER PT J AU PEZZIN, LE AF PEZZIN, LE TI EARNINGS PROSPECTS, MATCHING EFFECTS, AND THE DECISION TO TERMINATE A CRIMINAL CAREER SO JOURNAL OF QUANTITATIVE CRIMINOLOGY LA English DT Article DE CRIME DESISTANCE; RATIONAL CHOICE; LIFE-CYCLE MODELS; MATCHING EFFECTS; VALUE OF A CRIMINAL CAREER ID CRIME; MODELS; AGE; PARTICIPATION; EXPLANATION; SEARCH AB This study represents an effort to investigate the age pattern of criminal involvement from an economist's perspective. It presents a dynamic stochastic model of sequential search and match evaluation which is used to explain the reasons for, and the timing of, the decision to terminate a criminal career. The behavioral implications derived from the theoretical model are tested using individual National Longitudinal Survey of Youth data. Estimation results strongly support the prediction of a negative relation between the option value of retaining a criminal career and desistance decisions. More specifically, the effects of current and future expected criminal earnings are shown to be negative, substantial, and statistically significant in determining desistance probabilities. Retiring behavior is also significantly responsive to variables measuring personal costs of punishment and the availability and attractiveness of a legal income-generating activity in ways consistent with theoretical expectations. RP PEZZIN, LE (reprint author), AGCY HLTH CARE POLICY & RES,CTR INTRAMURAL RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 37 TC 23 Z9 23 U1 2 U2 4 PU PLENUM PUBL CORP PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 SN 0748-4518 J9 J QUANT CRIMINOL JI J. Quant. Criminol. PD MAR PY 1995 VL 11 IS 1 BP 29 EP 50 DI 10.1007/BF02221299 PG 22 WC Criminology & Penology SC Criminology & Penology GA QW141 UT WOS:A1995QW14100003 ER PT J AU SPILLMAN, BC KEMPER, P AF SPILLMAN, BC KEMPER, P TI LIFETIME PATTERNS OF PAYMENT FOR NURSING-HOME CARE SO MEDICAL CARE LA English DT Article; Proceedings Paper CT 43rd Annual Meeting of the Gerontological-Society-of-America CY NOV, 1990 CL BOSTON, MA SP Gerontol Soc Amer DE NURSING HOME; LONG-TERM CARE; MEDICAID SPEND-DOWN; ASSET SPEND-DOWN; FINANCING NURSING HOME CARE ID MEDICAID ELIGIBILITY; SPEND-DOWN AB Although much is known about who pays the annual aggregate nursing home bill, relatively little is known about payment-source patterns of individuals during their lifetimes. In this article, lifetime payment-source patterns are analyzed for elderly nursing home users, particularly the extent to which they spend down assets to become eligible for Medicaid. During their lifetimes, 44% of persons who use nursing homes after 65 years of age start and end as private payers, 27% start and end as recipients of Medicaid benefits, and 14% spend DOWN assets to become eligible for Medicaid benefits. Although still a relatively small proportion, the asset spend-down estimate based on lifetime data is 2.5 times previous national estimates based on data for single nursing home stays. The projected risk of spending down assets in nursing homes for all persons who turn 65 years of age in 1995, including users and nonusers of nursing homes, is slightly more than 6%. Equally or more important for policy is that 17% of ail persons who turn 65 yeats of age can expect to end up using a nursing home and receiving Medicaid reimbursement. Of those, more than 3 in 5 will have entered the nursing home already eligible for Medicaid benefits. RP SPILLMAN, BC (reprint author), AGCY HLTH CARE POLICY & RES,CTR INTRAMURAL RES,DIV LONG TERM CARE STUDIES,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 30 TC 14 Z9 14 U1 0 U2 1 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQUARE, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 1995 VL 33 IS 3 BP 280 EP 296 DI 10.1097/00005650-199503000-00007 PG 17 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA QK263 UT WOS:A1995QK26300007 PM 7861830 ER PT J AU MURTAUGH, CM FREIMAN, MP AF MURTAUGH, CM FREIMAN, MP TI NURSING-HOME RESIDENTS AT RISK OF HOSPITALIZATION AND THE CHARACTERISTICS OF THEIR HOSPITAL STAYS SO GERONTOLOGIST LA English DT Article DE LONG-TERM CARE; HOSPITAL TRANSFER; PREVENTION PROGRAMS ID INFLUENZA-A H3N2; CARE; OUTBREAK; VACCINE AB Little national data have been available to guide the design of programs aimed at reducing the hospitalization of nursing home residents. This article uses the 1987 National Medical Expenditure Survey to identify elderly nursing home residents with an elevated risk of hospitalization and the reasons for and outcomes of residents' hospital stays. Study findings include an elevated risk of hospitalization for residents with one of several different primary diagnoses and a rise in risk as ADL dependence increases. An infection was the main medical reason for roughly 27% of hospital stays. The results suggest possible target groups for two types of programs aimed at reducing hospitalization. RP MURTAUGH, CM (reprint author), US DEPT HHS,CTR INTRAMURAL RES,AGCY HLTH CARE POLICY & RES,SUITE 500,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 27 TC 65 Z9 65 U1 0 U2 1 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD FEB PY 1995 VL 35 IS 1 BP 35 EP 43 PG 9 WC Gerontology SC Geriatrics & Gerontology GA QG438 UT WOS:A1995QG43800005 PM 7890201 ER PT J AU CUNNINGHAM, PJ CIRNELIUS, LJ AF CUNNINGHAM, PJ CIRNELIUS, LJ TI ACCESS TO AMBULATORY CARE FOR AMERICAN-INDIANS AND ALASKA NATIVES - THE RELATIVE IMPORTANCE OF PERSONAL ANC COMMUNITY RESOURCES SO SOCIAL SCIENCE & MEDICINE LA English DT Article DE AMBULATORY CARE; UTILIZATION; ACCESS; AMERICAN INDIANS ID HEALTH-CARE AB The debate on health care reform in the United States has been greatly influenced by various national studies showing a strong relationship between lack of public or private health care coverage and inadequate access to health services. There is also much concern about deficiencies in the availability and delivery of services to certain population groups-especially for those living in the most remote and sparsely populated areas of the country. However, national studies have generally not demonstrated that the use of health services is strongly associated with urban/rural residence or the supply of medical providers. In this study, we show that national studies can obscure the problems of certain population groups including American Indians and Alaska Natives. Using data from the 1987 National Medical Expenditure Survey, the findings show that the availability of medical providers as well as place of residence were strongly associated with the use of health care by American Indians and Alaska Natives. Although American Indians and Alaska Natives included in this study were eligible to receive health care free of charge from the Indian Health Service (IHS), financial factors were also significantly associated with use due to the use of services other than those provided or sponsored by IHS. Also, the results show that while geographic and supply factors have only modest effects on the average travel time to medical providers for the U.S. population as a whole, travel times are dramatically longer for American Indians and Alaska Natives living in rural areas and where there are few medical providers. In addition, there appear to be fewer hospitalizations in areas where there are IHS outpatient services. We conclude by discussing the need for health care reform to take into account the diversity of a large country such as the U.S., and the special needs of population groups that are usually not adequately represented in national studies. C1 UNIV MARYLAND,BALTIMORE,MD 21201. RP CUNNINGHAM, PJ (reprint author), AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 26 TC 34 Z9 34 U1 0 U2 3 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD, ENGLAND OX5 1GB SN 0277-9536 J9 SOC SCI MED JI Soc. Sci. Med. PD FEB PY 1995 VL 40 IS 3 BP 393 EP 407 DI 10.1016/0277-9536(94)E0072-Z PG 15 WC Public, Environmental & Occupational Health; Social Sciences, Biomedical SC Public, Environmental & Occupational Health; Biomedical Social Sciences GA QB505 UT WOS:A1995QB50500012 PM 7899951 ER PT J AU CLANCY, CM BRODY, H AF CLANCY, CM BRODY, H TI MANAGED CARE - JEKYLL OR HYDE SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID DOCTORS C1 MICHIGAN STATE UNIV,DEPT FAMILY PRACTICE,E LANSING,MI 48824. RP CLANCY, CM (reprint author), AGCY HLTH CARE POLICY & RES,DIV PRIMARY CARE,EOC 502,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 16 TC 80 Z9 80 U1 0 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 25 PY 1995 VL 273 IS 4 BP 338 EP 339 DI 10.1001/jama.273.4.338 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA QC057 UT WOS:A1995QC05700036 PM 7815664 ER PT S AU Fitzmaurice, JM AF Fitzmaurice, JM BE Laires, MF Ladeira, MJ Christensen, JP TI Information society challenges in the USA SO HEALTH IN THE NEW COMMUNICATIONS AGE: HEALTH CARE TELEMATICS FOR THE 21ST CENTURY SE STUDIES IN HEALTH TECHNOLOGY AND INFORMATICS LA English DT Proceedings Paper CT Conference on Health in the New Communications Age - Health Care Telematics for the 21st-Century CY DEC 06-10, 1994 CL LISBON, PORTUGAL C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,OFF SCI & DATA DEV,WASHINGTON,DC. RP Fitzmaurice, JM (reprint author), 2101 E JEFFERSON ST 601,ROCKVILLE,MD, USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU I O S PRESS PI AMSTERDAM PA VAN DIEMENSTRAAT 94, 1013 CN AMSTERDAM, NETHERLANDS SN 0926-9630 BN 90-5199-224-6 J9 ST HEAL T PY 1995 VL 24 BP 34 EP 37 PG 4 WC Computer Science, Information Systems SC Computer Science GA BE31S UT WOS:A1995BE31S00006 ER PT S AU Fitzmaurice, JM AF Fitzmaurice, JM BE Laires, MF Ladeira, MJ Christensen, JP TI The American perspective for the future SO HEALTH IN THE NEW COMMUNICATIONS AGE: HEALTH CARE TELEMATICS FOR THE 21ST CENTURY SE STUDIES IN HEALTH TECHNOLOGY AND INFORMATICS LA English DT Proceedings Paper CT Conference on Health in the New Communications Age - Health Care Telematics for the 21st-Century CY DEC 06-10, 1994 CL LISBON, PORTUGAL C1 US GOVT,DEPT HLTH & HUMAN SERV,AGCY HLTH CARE POLICY & RES,OFF SCI & DATA DEV,WASHINGTON,DC. RP Fitzmaurice, JM (reprint author), 2101 E JEFFERSON ST 601,ROCKVILLE,MD, USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU I O S PRESS PI AMSTERDAM PA VAN DIEMENSTRAAT 94, 1013 CN AMSTERDAM, NETHERLANDS SN 0926-9630 BN 90-5199-224-6 J9 ST HEAL T PY 1995 VL 24 BP 646 EP 650 PG 5 WC Computer Science, Information Systems SC Computer Science GA BE31S UT WOS:A1995BE31S00097 ER PT J AU MOR, V BRANCO, K FLEISHMAN, J HAWES, C PHILLIPS, C MORRIS, J FRIES, B AF MOR, V BRANCO, K FLEISHMAN, J HAWES, C PHILLIPS, C MORRIS, J FRIES, B TI THE STRUCTURE OF SOCIAL ENGAGEMENT AMONG NURSING-HOME RESIDENTS SO JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES LA English DT Article ID MEASUREMENT INVARIANCE; HEALTH; SCALE AB This research tests the reliability and construct validity of social engagement, a new quality of life measure embedded in the federally mandated Resident Assessment Instrument (RAI) for the nursing home population. The sample consisted of 1,848 residents from 268 homes in 10 states with data collected by trained research nurses. Three resident groups were formed based on residents' cognitive and ADL functioning. Social engagement was significantly related to average time spent in activities across ad three groups. We hypothesized a four-factor model with social engagement distinct from mood problems, conflicted relationships, and behavior problems. LISREL confirmatory factor analysis found the data to be consistent with this hypothesis (Fit Index > .98). Intercorrelations between factors showed that for high-functioning residents, engagement was negatively related to conflict bat was positively related to conflict among the most impaired. The validity of the social engagement measure and its stability across types of residents suggest its potential utility as a marker of nursing home quality. C1 STONEHILL COLL,DEPT SOCIOL,N EASTON,MA. AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD. RES TRIANGLE INST,RES TRIANGLE PK,NC. HEBREW REHABIL CTR AGED,INST RES & TRAINING,BOSTON,MA. UNIV MICHIGAN,CTR GERONTOL,ANN ARBOR,MI 48109. RP MOR, V (reprint author), BROWN UNIV,CTR GERONTOL & HLTH CARE RES,BOX G-B213,PROVIDENCE,RI 02912, USA. FU AHRQ HHS [HS00011] NR 53 TC 109 Z9 109 U1 0 U2 4 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 SN 1079-5014 J9 J GERONTOL B-PSYCHOL JI J. Gerontol. Ser. B-Psychol. Sci. Soc. Sci. PD JAN PY 1995 VL 50 IS 1 BP P1 EP P8 PG 8 WC Geriatrics & Gerontology; Gerontology; Psychology; Psychology, Multidisciplinary SC Geriatrics & Gerontology; Psychology GA QK432 UT WOS:A1995QK43200001 PM 7757818 ER PT J AU KRAKAUER, H BAILEY, RC COOPER, H YU, WK SKELLAN, KJ KATTAKKUZHY, G AF KRAKAUER, H BAILEY, RC COOPER, H YU, WK SKELLAN, KJ KATTAKKUZHY, G TI THE SYSTEMATIC ASSESSMENT OF VARIATIONS IN MEDICAL PRACTICES AND THEIR OUTCOMES SO PUBLIC HEALTH REPORTS LA English DT Article ID PROSPECTIVE-PAYMENT SYSTEM; CARE; BENEFICIARIES; POPULATION; MORTALITY; QUALITY AB The Health Care Financing Administration of the Department of Health and Human Services has carried out for several years the systematic assessment of variations over time and among geographic locales in patterns of care and patterns of outcomes experienced by Medicare beneficiaries. This routine monitoring focuses principally on hospitalizations and their outcomes (death and readmission) and is based on the Medicare enrollment file and the claims file for inpatient care. The period 1985-88 has been marked by declining adjusted post-admission risks for mortality (down 4 percent) and readmission (down 6 percent) for Medicare beneficiaries. The downward trend in mortality risks is most evident following hospitalizations for acute myocardial infarction (down 8 percent) and stroke (down 12 percent). Hospital admission and population mortality rates, adjusted for differences in demographic and socioeconomic characteristics of the populations, vary substantially among areas as large as States and Metropolitan Statistical Areas, as do risk-adjusted post admission probabilities of death among those areas and among hospitals. Thus, if overall admission and mortality rates in the upper three quartiles of Metropolitan Statistical Areas were brought down to the average of the lowest quartile, there would be 20 percent fewer admissions and 12 percent fewer deaths within 180 days of admission for hospitalized patients. Although favorable trends in the effectiveness of the hospital care received by Medicare beneficiaries appear discernible, the existence of substantial variations suggests that further improvement may be possible. C1 US HLTH CARE FINANCING ADM,HLTH STAND & QUAL BUR,BALTIMORE,MD. US HLTH CARE FINANCING ADM,DIV PROGRAM ASSESSMENT & INFORMAT,BALTIMORE,MD. US HLTH CARE FINANCING ADM,OFF ACTUARY,BALTIMORE,MD. US PHS,AGCY HLTH CARE POLICY & RES,OFF FORUM,ROCKVILLE,MD. RP KRAKAUER, H (reprint author), USUHS,SCH MED,DEPT PREVENT MED & BIOMETR,4301 JONES BRIDGE RD,BETHESDA,MD 20814, USA. NR 20 TC 9 Z9 9 U1 0 U2 0 PU US GOVERNMENT PRINTING OFFICE PI WASHINGTON PA SUPT OF DOCUMENTS, WASHINGTON, DC 20402-9325 SN 0033-3549 J9 PUBLIC HEALTH REP JI Public Health Rep. PD JAN-FEB PY 1995 VL 110 IS 1 BP 2 EP 12 PG 11 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA QG127 UT WOS:A1995QG12700002 PM 7838939 ER PT B AU Fitzmaurice, JM AF Fitzmaurice, JM BE Grundfest, WS TI Developing and sharing medical effectiveness information SO ROLE OF TECHNOLOGY IN THE COST OF HEALTH CARE: PROVIDING THE SOLUTIONS: HEALTH CARE TECHNOLOGY POLICY II SE PROCEEDINGS OF THE SOCIETY OF PHOTO-OPTICAL INSTRUMENTATION ENGINEERS (SPIE) LA English DT Proceedings Paper CT Conference on Health Care Technology Policy II - the Role of Technology in the Cost of Health Care: Providing the Solutions CY MAY 10-12, 1995 CL ARLINGTON, VA SP Soc Photo Opt Instrumentat Engineers, Whitaker Fdn, NIST, Adv Technol Programs, Cedars Sinai Medallions Charitable Fund, Hamamatsu Corp, Mayo Clin, IEEE, Engn Med & Biol Soc C1 AGCY HLTH CARE POLICY & RES,CTR INFORMAT TECHNOL,DEPT HLTH & HUMAN SERV,ROCKVILLE,MD 20852. NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPIE - INT SOC OPTICAL ENGINEERING PI BELLINGHAM PA PO BOX 10, BELLINGHAM, WA 98227-0010 BN 0-8194-1856-0 J9 P SOC PHOTO-OPT INS PY 1995 VL 2499 BP 34 EP 43 PG 10 WC Computer Science, Information Systems; Optics SC Computer Science; Optics GA BE37N UT WOS:A1995BE37N00005 ER PT J AU Cornelius, LJ Altman, BM AF Cornelius, LJ Altman, BM TI Have we succeeded in reducing barriers to medical care for African and Hispanic Americans with disabilities? SO SOCIAL WORK IN HEALTH CARE LA English DT Article ID HEALTH-CARE; ACCESS; BLACK; EQUITY AB There has been considerable progress in reducing barriers to care for African and Hispanics Americans. Yet current research indicates that overall African and Hispanic Americans are disproportionately encountering barriers to care. Unfortunately very little is known regarding the status of African and Hispanic Americans with disabilities. The purpose of this paper is to assess by using data from the 1987 National Medical Expenditure Survey (NMES), the degree of disability for African, Hispanic and Native Americans and the extent to which it is correlated with the use of services. The findings report that as in the case of other African and Hispanic Americans, African and Hispanic Americans with disabilities disproportionately encounter barriers to care. They are more likely than whites to lack insurance, a regular provider and less likely to see a doctor during the year. The implications of these findings for the care of persons with disabilities are discussed. C1 US DEPT HHS,AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD 20852. RP Cornelius, LJ (reprint author), UNIV MARYLAND,SCH SOCIAL WORK,525 W REDWOOD ST,BALTIMORE,MD 21201, USA. NR 33 TC 7 Z9 7 U1 0 U2 1 PU HAWORTH PRESS INC PI BINGHAMTON PA 10 ALICE ST, BINGHAMTON, NY 13904-1580 SN 0098-1389 J9 SOC WORK HEALTH CARE JI Soc. Work Health Care PY 1995 VL 22 IS 2 BP 1 EP 17 PG 17 WC Social Work SC Social Work GA UB871 UT WOS:A1995UB87100002 PM 8658316 ER PT J AU ANDREW, E ANIS, A CHALMERS, T CHO, M CLARKE, M FELSON, D GOTZSCHE, P GREENE, R JADAD, A JONAS, W KLASSEN, T KNIPSCHILD, P LAUPACIS, A MEINERT, CL MOHER, D NICHOL, G OXMAN, A PENMAN, MF POCOCK, S REISCH, J SACKETT, D SCHULZ, K SNIDER, J TUGWELL, P TYSON, J VARIN, F WALOP, W WALSH, S WELLS, G AF ANDREW, E ANIS, A CHALMERS, T CHO, M CLARKE, M FELSON, D GOTZSCHE, P GREENE, R JADAD, A JONAS, W KLASSEN, T KNIPSCHILD, P LAUPACIS, A MEINERT, CL MOHER, D NICHOL, G OXMAN, A PENMAN, MF POCOCK, S REISCH, J SACKETT, D SCHULZ, K SNIDER, J TUGWELL, P TYSON, J VARIN, F WALOP, W WALSH, S WELLS, G TI A PROPOSAL FOR STRUCTURED REPORTING OF RANDOMIZED CONTROLLED TRIALS SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID DOUBLE-BLIND TRIALS; CLINICAL-TRIALS; MEDICAL JOURNALS; BIAS; METHODOLOGY; GUIDELINES; ARTHRITIS; AUTHORS C1 OTTAWA CIVIC HOSP,LOEB MED RES INST,CLIN EPIDEMIOL UNIT,WRITING COMM,OTTAWA K1Y 4E9,ON,CANADA. NYCOMED IMAGING,OSLO,NORWAY. NEW ENGLAND MED CTR HLTH SERV RES & STUDY DESIGN,BOSTON,MA. UNIV CALIF SAN FRANCISCO,INST HLTH POLICY STUDIES,SAN FRANCISCO,CA 94143. RADCLIFFE INFIRM,CLIN TRIAL SERV UNIT,OXFORD OX2 6HE,ENGLAND. BOSTON UNIV,SCH MED,WRITING COMM,BOSTON,MA 02118. NORD COCHRANE CTR,WRITING COMM,COPENHAGEN,DENMARK. AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD. OXFORD REG PAIN RELIEF UNIT,OXFORD,ENGLAND. WALTER REED ARMY INST RES,WASHINGTON,DC. CHILDRENS HOSP EASTERN ONTARIO,DIV EMERGENCY MED,OTTAWA K1H 8L1,ON,CANADA. RYKSUNIV LIMBURG,VAKGOEP EPIDEMIOL,LIMBURG,NETHERLANDS. JOHNS HOPKINS UNIV,DEPT EPIDEMIOL,BALTIMORE,MD. BRIGHAM & WOMENS HOSP,CLIN EPIDEMIOL UNIT,BOSTON,MA 02115. NATL INST PUBL HLTH,DEPT HLTH SERV,OSLO,NORWAY. OTTAWA GEN HOSP,MULTIPLE SCLEROSIS CLIN,OTTAWA K1H 8L6,ON,CANADA. UNIV LONDON,LONDON SCH HYG & TROP MED,MED STAT UNIT,WRITING COMM,LONDON,ENGLAND. UNIV TEXAS,HLTH SCI CTR,DEPT PEDIAT & MED COMP SCI,DALLAS,TX 75235. UNIV OXFORD,NUFFIELD DEPT CLIN MED,WRITING COMM,OXFORD,ENGLAND. CTR DIS CONTROL & PREVENT,NATL CTR PREVENT SERV,DIV STD HIV PREVENT,ATLANTA,GA 30341. UNIV OTTAWA,DEPT EPIDEMIOL & COMMUNITY MED,OTTAWA,ON,CANADA. UNIV OTTAWA,DEPT MED,WRITING COMM,OTTAWA,ON,CANADA. UNIV TEXAS,SW MED CTR,DEPT PEDIAT,DALLAS,TX. UNIV MONTREAL,FAC PHARM,MONTREAL H3C 3J7,PQ,CANADA. HLTH & WELF CANADA,DRUGS DIRECTORIE,DIV BIOMETR,OTTAWA,ON,CANADA. OTTAWA CIVIC HOSP,DEPT MED,OTTAWA K1Y 4E9,ON,CANADA. OI Moher , David /0000-0003-2434-4206; Tugwell, Peter/0000-0001-5062-0556 NR 66 TC 142 Z9 144 U1 0 U2 4 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD DEC 28 PY 1994 VL 272 IS 24 BP 1926 EP 1931 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA PX927 UT WOS:A1994PX92700038 ER PT J AU FLEISHMAN, JA HSIA, DC HELLINGER, FJ AF FLEISHMAN, JA HSIA, DC HELLINGER, FJ TI CORRELATES OF MEDICAL-SERVICE UTILIZATION AMONG PEOPLE WITH HIV-INFECTION SO HEALTH SERVICES RESEARCH LA English DT Article DE HIV INFECTION; AIDS; SERVICE UTILIZATION; HEALTH INSURANCE; HEALTH STATUS ID INTRAVENOUS-DRUG-USERS; HEALTH SURVEY SF-36; CARE COSTS; AIDS; INSURANCE; VALIDITY; MODEL; RACE AB Objective. To examine factors affecting the use of inpatient, outpatient, and emergency room services by people with HIV infection. Data Sources and Study Setting. Study participants are adults with HIV infection receiving services at major providers of medical care in ten U.S. cities. Six interviews were conducted over an 18-month period (March 1991 to September 1992). Data Collection Methods. Data on service utilization, personal background characteristics, insurance status, and functional status are based on self-report. Disease stage is based on medical record data. Study Design. This is an observational study using a panel survey design. Linear and Poisson regression analyses were conducted to determine the effects of need, enabling, and predisposing factors on the dependent variables of ambulatory visits, emergency room visits, inpatient admissions, and average length of inpatient slay. Analyses use 1,449 respondents who completed the second and third interviews. Independent variables were measured as of the second interview, while dependent variables were measured in the third and fourth interview periods. Principal Findings. Service utilization was higher among respondents with AIDS than among those at earlier stages of HIV infection. Functional limitations, experienced pain, and negative mood each were associated with increased service use, over and above disease stage. Black respondents reported more hospital admissions and longer lengths of inpatient stays than white respondents. Lack of insurance was related to reduced service use. The effects of disease stage and functional limitations were reduced among people with public, compared to private, insurance. Conclusions. While disease stage affects use of medical care, the experience of adverse HIV-related conditions, such as pain or functional limitations, has an additional effect on service use. Persistent racial differences in utilization remain to be explained. Lack of insurance impedes use directly and also modifies the effects of disease stage and functioning. RP FLEISHMAN, JA (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR GENERAL HLTH SERV EXTRAMURAL RES,ROCKVILLE,MD 20852, USA. NR 34 TC 85 Z9 85 U1 2 U2 5 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 1994 VL 29 IS 5 BP 527 EP 548 PG 22 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA PX776 UT WOS:A1994PX77600003 PM 8002348 ER PT J AU HELLINGER, FJ FLEISHMAN, JA HSIA, DC AF HELLINGER, FJ FLEISHMAN, JA HSIA, DC TI AIDS TREATMENT COSTS DURING THE LAST MONTHS OF LIFE - EVIDENCE FROM THE ACSUS SO HEALTH SERVICES RESEARCH LA English DT Article DE HIV; AIDS; SURVIVOR AND DECEDENT COSTS ID MEDICAL-CARE COSTS; HIV-INFECTION; MICHIGAN AB Objective. The volume and cost of services consumed by persons with AIDS (PWAs) during their last months of life are examined in this study. Data Sources. This study utilizes data from the AIDS Costs and Service Utilization Survey (ACSUS). The ACSUS is the most comprehensive survey of medical services that are consumed by persons with HIV. Study Design. This study is restricted to persons with AIDS who survived the fifth time period (an approximately three-month period in the early spring and summer of 1992). The types and costs of services consumed during the fifth time period by PWAs who did survive (609) and who did not survive (79) the sixth time period are compared. Data Collection. The ACSUS consists of six interviews over an 18-month period from Spring 1991 to Fall 1992. Principal Findings. Decedents were hospitalized more than four times as many days and experienced more than four times the number of home health visits as survivors. Both the average length of stay (19.3 days for decedents and 10.3 for survivors) and the frequency of hospitalization during the fifth time period (.70 for decedents and .28 for survivors) were higher for decedents than survivors. The levels of outpatient care (including emergency room care) and of prescription drug use were similar for decedents and survivors. Conclusions. This study shows that the cost of treating decedents is more than three times the cost of treating survivors. RP HELLINGER, FJ (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CGHSER,DIV COST & FINANCING,SUITE 502,ROCKVILLE,MD 20852, USA. NR 16 TC 40 Z9 40 U1 0 U2 0 PU HEALTH ADMINISTRATION PRESS PI MELROSE PARK PA C/O FOUNDATION AMER COLL HEALTHCARE EXECUTIVES 1951 CORNELL AVE, MELROSE PARK, IL 60160 SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 1994 VL 29 IS 5 BP 569 EP 581 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA PX776 UT WOS:A1994PX77600005 PM 8002350 ER PT J AU HSIA, DC AF HSIA, DC TI BENEFITS DETERMINATION UNDER HEALTH-CARE REFORM - WHO SHOULD DECIDE COVERAGE POLICY SO JOURNAL OF LEGAL MEDICINE LA English DT Article ID TECHNOLOGY-ASSESSMENT; MEDICAL TECHNOLOGY; THERAPY; REIMBURSEMENT; ERISA; COURT RP HSIA, DC (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 51 TC 1 Z9 1 U1 0 U2 0 PU TAYLOR & FRANCIS PI BRISTOL PA 1900 FROST ROAD, SUITE 101, BRISTOL, PA 19007-1598 SN 0194-7648 J9 J LEGAL MED JI J. Legal Med. PD DEC PY 1994 VL 15 IS 4 BP 533 EP 556 PG 24 WC Law; Social Sciences, Biomedical SC Government & Law; Biomedical Social Sciences GA PX485 UT WOS:A1994PX48500002 PM 7852830 ER PT J AU RESCHOVSKY, JD STONE, SE AF RESCHOVSKY, JD STONE, SE TI MARKET INCENTIVES TO ENCOURAGE HOUSEHOLD WASTE RECYCLING - PAYING FOR WHAT YOU THROW AWAY SO JOURNAL OF POLICY ANALYSIS AND MANAGEMENT LA English DT Article ID STRATEGIES AB This article investigates the use of market incentives to encourage household waste recycling by pricing waste-disposal services according to the quantity of waste generated. We use a natural experiment from an upstate New York county to examine how quantity-based pricing of waste disposal affects reported household recycling behavior, when used by itself or in conjunction with curbside pickup of recyclables or mandatory recycling laws. Curbside pickup was found to have the greatest effect on reported recycling behavior, although higher waste-disposal prices might alter these conclusions. Other concerns about quantity-based pricing of solid waste-distributional effects, public acceptance, and adverse incentives-are also examined. C1 FUTURES GRP INC,GLASTONBURY,CT. RP RESCHOVSKY, JD (reprint author), US DEPT COMMERCE,AGCY HLTH CARE POLICY & RES,CTR GEN HLTH,SERV INTRAMURAL RES,WASHINGTON,DC 20230, USA. NR 25 TC 67 Z9 68 U1 1 U2 15 PU JOHN WILEY & SONS INC PI NEW YORK PA 605 THIRD AVE, NEW YORK, NY 10158-0012 SN 0276-8739 J9 J POLICY ANAL MANAG JI J. Policy Anal. Manage. PD WIN PY 1994 VL 13 IS 1 BP 120 EP 139 DI 10.2307/3325093 PG 20 WC Economics; Public Administration SC Business & Economics; Public Administration GA MM935 UT WOS:A1994MM93500006 ER PT J AU BRODY, H AF BRODY, H TI QUALITY AND HEALTH-CARE REFORM SO JOURNAL OF FAMILY PRACTICE LA English DT Article C1 AGCY HLTH CARE POLICY & RES,CTR GEN HLTH SERV EXTRAMURAL RES,DIV PRIMARY CARE,ROCKVILLE,MD. NR 0 TC 1 Z9 1 U1 0 U2 0 PU APPLETON & LANGE PI E NORWALK PA 25 VAN ZANT ST, E NORWALK, CT 06855 SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD NOV PY 1994 VL 39 IS 5 BP 423 EP 426 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA PR005 UT WOS:A1994PR00500001 PM 7964534 ER PT J AU MCCORMICK, KA LANG, N ZIEISTORFF, R MILHOLLAND, K SABA, V JACOX, A AF MCCORMICK, KA LANG, N ZIEISTORFF, R MILHOLLAND, K SABA, V JACOX, A TI TOWARD STANDARD CLASSIFICATION SCHEMES FOR NURSING LANGUAGE - RECOMMENDATIONS OF THE AMERICAN-NURSES-ASSOCIATION STEERING-COMMITTEE-ON-DATABASES-TO-SUPPORT-CLINICAL-NURSING-PRACTICE SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article AB The American Nurses Association (ANA) Cabinet on Nursing Practice mandated the formation of the Steering Committee on Databases to Support Clinical Nursing Practice. The Committee has established the process and the criteria by which to review and recommend nursing classification schemes based on the ANA Nursing Process Standards and elements contained in the Nursing Minimum Data Set (NMDS) for inclusion of nursing data elements in national databases. Four classification schemes have been recognized by the Committee for use in national databases. These classification schemes have been forwarded to the National Library of Medicine (NLM) for inclusion in the Unified Medical Language System (UMLS) and to the International Council of Nurses for the development of a proposed International Classification of Nursing Practice. C1 AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD. UNIV PENN,PHILADELPHIA,PA 19104. MASSACHUSETTS GEN HOSP,BOSTON,MA 02114. GEORGETOWN UNIV,WASHINGTON,DC. JOHNS HOPKINS UNIV,BALTIMORE,MD. RP MCCORMICK, KA (reprint author), AMER NURSES ASSOC INC,600 MARYLAND AVE,SW,SUITE 100 W,WASHINGTON,DC 20024, USA. NR 34 TC 44 Z9 45 U1 0 U2 1 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD NOV-DEC PY 1994 VL 1 IS 6 BP 421 EP 427 PG 7 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Information Science & Library Science; Medical Informatics SC Computer Science; Information Science & Library Science; Medical Informatics GA QE642 UT WOS:A1994QE64200001 PM 7850567 ER PT J AU GAUS, CR AF GAUS, CR TI IMPROVING THE QUALITY OF HEALTH-CARE THROUGH RESEARCH - THE CHALLENGES AHEAD SO ACADEMIC MEDICINE LA English DT Editorial Material RP GAUS, CR (reprint author), AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD, USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 SN 1040-2446 J9 ACAD MED JI Acad. Med. PD OCT PY 1994 VL 69 IS 10 BP 814 EP 815 DI 10.1097/00001888-199410000-00004 PG 2 WC Education, Scientific Disciplines; Health Care Sciences & Services SC Education & Educational Research; Health Care Sciences & Services GA PM143 UT WOS:A1994PM14300006 PM 7916792 ER PT J AU GREENE, RJ MAKLAN, CW AF GREENE, RJ MAKLAN, CW TI RESEARCH INTO OUTCOMES AND EFFECTIVENESS SO BRITISH MEDICAL JOURNAL LA English DT Letter RP GREENE, RJ (reprint author), AGCY HLTH CARE POLICY & RES,CTR MED EFFECTIVENESS RES,2101 E JEFFERSON ST,605,ROCKVILLE,MD 20852, USA. NR 2 TC 1 Z9 1 U1 0 U2 0 PU BRITISH MED JOURNAL PUBL GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON, ENGLAND WC1H 9JR SN 0959-8138 J9 BRIT MED J JI Br. Med. J. PD OCT 1 PY 1994 VL 309 IS 6958 BP 879 EP 880 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA PK501 UT WOS:A1994PK50100073 PM 7950641 ER PT J AU SPECTOR, WD KEMPER, P AF SPECTOR, WD KEMPER, P TI DISABILITY AND COGNITIVE IMPAIRMENT CRITERIA - TARGETING THOSE WHO NEED THE MOST HOME CARE SO GERONTOLOGIST LA English DT Article DE CHANNELING DATA; LONG-TERM CARE; PUBLIC POLICY; HOME CARE; ELIGIBILITY CRITERIA; TARGETING GOAL ID LONG-TERM CARE; COMMUNITY; DEMENTIA; FUTURE AB Proposed federal long-term care reforms include eligibility criteria based on disability and cognitive impairment. This article illustrates the process of evaluating alternative eligibility criteria based on one possible targeting goal - serving those who need the most care. Channeling data are used to construct a measure of total care needs which is used to evaluate success at meeting the targeting goal. Results indicate the difficulty of establishing eligibility cutoffs that are equitable and meet the targeting goal. RP SPECTOR, WD (reprint author), US DEPT HHS,AGCY HLTH CARE POLICY & RES,CTR INTRAMURAL RES,DIV LONG TERM CARE STUDIES,ROCKVILLE,MD 20852, USA. NR 25 TC 25 Z9 25 U1 1 U2 1 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 1994 VL 34 IS 5 BP 640 EP 651 PG 12 WC Gerontology SC Geriatrics & Gerontology GA PX801 UT WOS:A1994PX80100015 PM 7959132 ER PT J AU MONHEIT, AC COOPER, PF AF MONHEIT, AC COOPER, PF TI HEALTH-INSURANCE AND JOB MOBILITY - THEORY AND EVIDENCE SO INDUSTRIAL & LABOR RELATIONS REVIEW LA English DT Article ID FRINGE BENEFITS AB It is widely hypothesized that health insurance deters job mobility because of imperfections in the labor and health insurance markets. This paper describes the nature of the welfare loss attributable to such ''job-lock'' and reviews several studies that empirically test the job-lock hypothesis. The authors find that estimates of the magnitude and importance of job-lock vary. Studies that support the job-lock hypothesis typically report a 20% to 40% reduction in mobility rates, depending on worker marital status and gender. Their own estimates suggest that although job-lock is present in the labor market, the proportion of workers affected and the magnitude of the welfare loss are less than generally supposed. RP MONHEIT, AC (reprint author), AGCY HLTH CARE POLICY & RES,CTR GEN HLTH SERV INTRAMURAL RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 20 TC 24 Z9 24 U1 1 U2 5 PU INDUSTRIAL LABOR RELAT REV PI ITHACA PA CORNELL UNIV, ITHACA, NY 14851-0952 SN 0019-7939 J9 IND LABOR RELAT REV JI Ind. Labor Relat. Rev. PD OCT PY 1994 VL 48 IS 1 BP 68 EP 85 DI 10.2307/2524627 PG 18 WC Industrial Relations & Labor SC Business & Economics GA PM500 UT WOS:A1994PM50000005 ER PT J AU DOR, A AF DOR, A TI NONMINIMUM COST-FUNCTIONS AND THE STOCHASTIC FRONTIER - ON APPLICATIONS TO HEALTH-CARE PROVIDERS SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE STOCHASTIC FRONTIER; COST FUNCTIONS RP DOR, A (reprint author), AGCY HLTH CARE POLICY & RES,2101 E JEFFERSON ST,SUITE 500,ROCKVILLE,MD 20852, USA. NR 8 TC 21 Z9 22 U1 0 U2 1 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD OCT PY 1994 VL 13 IS 3 BP 329 EP 334 DI 10.1016/0167-6296(94)90032-9 PG 6 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA PQ493 UT WOS:A1994PQ49300006 PM 10138859 ER PT J AU ROBINSON, CA EVANS, WB MAHANES, JA SEPE, SJ AF ROBINSON, CA EVANS, WB MAHANES, JA SEPE, SJ TI PROGRESS ON THE CHILDHOOD IMMUNIZATION INITIATIVE SO PUBLIC HEALTH REPORTS LA English DT Article AB President Clinton submitted the Comprehensive Childhood Immunization Initiative Act to Congress in April 1993. The objective of the legislation is to protect all children in the United States by their second birthday against nine vaccine-preventable infectious diseases. As originally introduced in the Congress the initiative called for (a) Federal purchase and distribution of recommended childhood vaccines for all children, (b) improving the public health capacity to deliver vaccine, (c) establishing a State-based national immunization information and tracking system, and (d) expanding immunization education and mobilization efforts directed to health care providers and parents. The authors review the progress and current status of the initiative, updating a previous progress report. The President's legislative proposal, modified by Congress, was enacted August 10, 1993. Several key provisions of the original legislation, deferred by Congress, may be incorporated in subsequent legislation or implemented through existing authorities. Therefore, the evolving framework for the initiative derives not from a single legislative mandate, but expands current immunization program activities and adds important new and complementary activities. As mentioned in the original title of the legislation, this is a ''comprehensive'' effort to address the problem of under-immunization in U.S. preschool children. C1 CTR DIS CONTROL & PREVENT,ATLANTA,GA. US HLTHCARE FINANCING ADM,WASHINGTON,DC. US PHS,AGCY HLTH CARE POLICY RES,WASHINGTON,DC. RP ROBINSON, CA (reprint author), NATL VACCINE PROGRAM OFF,ROCKWALL II BLDG,SUITE 1075,5600 FISHERS LANE,ROCKVILLE,MD 20857, USA. NR 6 TC 9 Z9 9 U1 0 U2 2 PU US GOVERNMENT PRINTING OFFICE PI WASHINGTON PA SUPT OF DOCUMENTS, WASHINGTON, DC 20402-9325 SN 0033-3549 J9 PUBLIC HEALTH REP JI Public Health Rep. PD SEP-OCT PY 1994 VL 109 IS 5 BP 594 EP 600 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA PN152 UT WOS:A1994PN15200002 PM 7938378 ER PT J AU FOWLER, FJ CLEARY, PD MAGAZINER, J PATRICK, DL BENJAMIN, KL AF FOWLER, FJ CLEARY, PD MAGAZINER, J PATRICK, DL BENJAMIN, KL TI METHODOLOGICAL ISSUES IN MEASURING PATIENT-REPORTED OUTCOMES - THE AGENDA OF THE WORK GROUP ON OUTCOMES ASSESSMENT SO MEDICAL CARE LA English DT Article ID SICKNESS IMPACT PROFILE; CHRONIC-DISEASE; HEALTH; QUALITY; TRIAL; LIFE AB The primary goal of the Inter-PORT work group on Outcomes Assessment is to foster methodological knowledge about the implications of various measure and design decisions for studies of the outcomes of treatment. A number of key methodological issues currently are unresolved and are in need of further study. These include: 1) the best questions to ask to assess how patients are affected by their treatments; 2) the comparative advantages of various study designs, including prospective cohorts, retrospective studies, and randomized clinical trials; 3) the way data collection decisions, such as mode of data collection and use of proxy respondents, affect study results; and 4) the best way to assess the significance of observed effects from patient, provider, and public policy perspectives. Studies conducted by the Patients Outcomes Research Teams (PORTs) are using diverse designs, measures, and data collection procedures. They provide a unique opportunity to further knowledge about methods of obtaining information about treatment outcomes. Through meetings, conferences, and publications, the Inter-PORT work group on Outcomes Assessment is trying to stimulate analyses aimed at methodological issues summarized in this paper and to ensure that new knowledge about methods is disseminated to a wide audience. C1 UNIV WASHINGTON,SCH PUBL HLTH & COMMUNITY MED,SOCIAL & BEHAV SCI PROGRAM,SEATTLE,WA 98195. AGCY HLTH CARE POLICY & RES,CTR MED EFFECTIVENESS RES,ROCKVILLE,MD. HARVARD UNIV,SCH MED,DEPT HLTH CARE POLICY,BOSTON,MA 02115. HARVARD UNIV,SCH MED,DEPT SOCIAL MED,BOSTON,MA 02115. HARVARD UNIV,SCH PUBL HLTH,DEPT HLTH & SOCIAL BEHAV,BOSTON,MA 02115. UNIV MARYLAND,SCH MED,DEPT EPIDEMIOL & PREVENT MED,BALTIMORE,MD 21201. RP FOWLER, FJ (reprint author), UNIV MASSACHUSETTS,CTR SURVEY RES,100 MORRISSEY BLVD,BOSTON,MA 02125, USA. NR 39 TC 22 Z9 22 U1 1 U2 2 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 1994 VL 32 IS 7 SU S BP JS65 EP JS76 PG 12 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA NW560 UT WOS:A1994NW56000006 PM 8028414 ER PT J AU GOLDBERG, HI CUMMINGS, MA STEINBERG, EP RICCI, EM SHANNON, T SOUMERAI, SB MITTMAN, BS EISENBERG, J HECK, DA KAPLAN, S KENZORA, JE VARGUS, AM MULLEY, AG RIMER, BK AF GOLDBERG, HI CUMMINGS, MA STEINBERG, EP RICCI, EM SHANNON, T SOUMERAI, SB MITTMAN, BS EISENBERG, J HECK, DA KAPLAN, S KENZORA, JE VARGUS, AM MULLEY, AG RIMER, BK TI DELIBERATIONS ON THE DISSEMINATION OF PORT PRODUCTS - TRANSLATING RESEARCH FINDINGS INTO IMPROVED PATIENT OUTCOMES SO MEDICAL CARE LA English DT Article; Proceedings Paper CT 8th Annual Meeting of the Association-for-Health-Services-Research CY JUN 30, 1991 CL SAN DIEGO, CA SP ASSOC HLTH SERV RES AB This report outlines the activities undertaken by the Inter-PORT Dissemination work group during its first 2 years of operation. The work group's initial purpose was to assist the individual PORTs in developing their plans for both disseminating research findings and evaluating the effectiveness of these strategies. However, it became quickly apparent that in a discipline little more than a decade old, a commonly understood vocabulary had yet to be adopted. Even the term ''dissemination'' held different meaning for different constituencies. Consequently, the work group has tried to encourage the development of both a definitional framework and a set of common data elements of importance to all dissemination programs. The work group has analogously attempted to agree on minimum standards of methodologic rigor as a starting point for coordination of evaluations across PORTs. To help determine the potential for further coordination, a matrix of each individual PORT's target audiences, intervention strategies, and evaluation designs has been constructed. Much remains to be learned before we can know with any certainty how best to translate research findings into useful behavior change and improved patient outcomes. Our goal is that the efforts of the work group will serve to catalyze this process. C1 UNIV WASHINGTON,SEATTLE,WA 98195. UNIV MARYLAND,BALTIMORE,MD 21201. UNIV MINNESOTA,MINNEAPOLIS,MN 55455. UNIV PITTSBURGH,PITTSBURGH,PA 15260. JOHNS HOPKINS UNIV,BALTIMORE,MD 21218. HARVARD UNIV,SCH MED,BOSTON,MA 02115. RAND CORP,SANTA MONICA,CA 90406. GEORGETOWN UNIV,WASHINGTON,DC 20057. INDIANA UNIV,MED CTR,BLOOMINGTON,IN 47401. MASSACHUSETTS GEN HOSP,BOSTON,MA 02114. DUKE UNIV,DURHAM,NC 27706. AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD. NR 5 TC 10 Z9 10 U1 0 U2 2 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 1994 VL 32 IS 7 SU S BP JS90 EP JS110 DI 10.1097/00005650-199407001-00008 PG 21 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA NW560 UT WOS:A1994NW56000008 PM 8028416 ER PT J AU LAVE, JR PASHOS, CL ANDERSON, GF BRAILER, D BUBOLZ, T CONRAD, D FREUND, DA FOX, SH KEELER, E LIPSCOMB, J LUFT, HS PROVENZANO, G AF LAVE, JR PASHOS, CL ANDERSON, GF BRAILER, D BUBOLZ, T CONRAD, D FREUND, DA FOX, SH KEELER, E LIPSCOMB, J LUFT, HS PROVENZANO, G TI COSTING MEDICAL-CARE - USING MEDICARE ADMINISTRATIVE DATA SO MEDICAL CARE LA English DT Article AB This paper describes how the PORTS are using data from the Medicare administrative records systems to study the medical care costs of specific conditions. The general strengths and weaknesses of the Medicare databases for studying cost related issues are discussed, and the relevant data elements are examined in detail. Changes in the nature of the data collected over time are noted. Information is provided on how the PORTS are using these data to estimate the cost to Medicare of treating Medicare beneficiaries with specific conditions and the social (opportunity) cost of treating these patients. Furthermore, information is provided on how data from the Medicare administrative records system can be used to determine the cost of services for patients who have been identified through other large databases (i.e., state hospital discharge tapes) or who have been enrolled in prospective cohort studies. C1 HARVARD UNIV,SCH MED,BOSTON,MA 02115. UNIV PENN,PHILADELPHIA,PA 19104. DARTMOUTH COLL,HITCHCOCK MED CTR,DARTMOUTH MED SCH,HANOVER,NH 03756. UNIV WASHINGTON,SEATTLE,WA 98195. INDIANA UNIV,INDIANAPOLIS,IN 46204. AGCY HLTH CARE POLICY & RES,ROCKVILLE,MD. DUKE UNIV,DURHAM,NC 27706. UNIV SAN FRANCISCO,SAN FRANCISCO,CA 94117. UNIV MARYLAND,BALTIMORE,MD 21201. RP LAVE, JR (reprint author), UNIV PITTSBURGH,GRAD SCH PUBL HLTH,PITTSBURGH,PA 15261, USA. NR 7 TC 91 Z9 91 U1 0 U2 2 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 1994 VL 32 IS 7 SU S BP JS77 EP JS89 PG 13 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA NW560 UT WOS:A1994NW56000007 PM 8028415 ER PT J AU MAKLAN, CW GREENE, R CUMMINGS, MA AF MAKLAN, CW GREENE, R CUMMINGS, MA TI METHODOLOGICAL CHALLENGES AND INNOVATIONS IN PATIENT OUTCOMES RESEARCH SO MEDICAL CARE LA English DT Article AB Between 1989 and 1992, the Agency for Health Care Policy and Research (AHCPR) awarded funding to 14 special projects known as Patient Outcomes Research Teams (PORTs). These large, complex projects form the centerpiece of the first generation of research under the Medical Treatment Effectiveness Program. In carrying out their individual 5-year research plans, and through collaborative work of six Inter-PORT Work Groups, PORTs have contributed to methodological advances related to their specific clinical focus and to outcomes research in general. Each of the PORTs has followed a standard research model, involving the application of: systematic literature review, measurement of outcomes, analysis of cost and claims data, decision analysis, and strategies for disseminating findings. This article reports what has been learned by individual PORTS, and by AHCPR, regarding the usefulness of each of these methodologies, both for the ongoing projects and for the next generation of effectiveness research. Examples from individual PORTs and work groups illustrate some of the methodological gains that have been made in effectiveness research and provide a glimpse of the work that remains to be done. RP MAKLAN, CW (reprint author), AGCY HLTH CARE POLICY & RES,CMER,SUITE 605,2101 E JEFFERSON ST,ROCKVILLE,MD 20852, USA. NR 15 TC 30 Z9 31 U1 0 U2 1 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 1994 VL 32 IS 7 SU S BP JS13 EP JS21 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA NW560 UT WOS:A1994NW56000002 PM 8028410 ER PT J AU POWE, NR TURNER, JA MAKLAN, CW ERSEK, M AF POWE, NR TURNER, JA MAKLAN, CW ERSEK, M TI ALTERNATIVE METHODS FOR FORMAL LITERATURE-REVIEW AND METAANALYSIS IN AHCPR PATIENT OUTCOMES RESEARCH TEAMS SO MEDICAL CARE LA English DT Article; Proceedings Paper CT 119th Annual Meeting of the American-Public-Health-Association CY NOV 11, 1991 CL ATLANTA, GA SP AMER PUBLIC HLTH ASSOC ID MYOCARDIAL-INFARCTION; CLINICAL-TRIALS; METAANALYSIS; QUALITY; SURGERY AB Formal literature review and synthesis is an important component of Patient Outcomes Research Teams (PORTs) and the development of clinical practice guidelines supported by the Agency for Health Care Policy and Research (AHCPR). Investigators face unresolved methodological issues and practical problems in carrying out this work because the use of such systematic reviews is relatively new in medicine. In addition, standard metaanalytic methods may not readily be applied to the literature pertinent to most PORTs. Representatives of the InterPORT Work Group on Literature Review and Meta-Analysis exchanged information to identify and assess their respective approaches to these challenges. All 12 PORTs used systematic approaches to identifying relevant studies and to gather and analyze data abstracted from these studies. Most PORTs had undertaken or made plans for several separate reviews, which focused on a specific question about the outcomes of therapeutic health care services or procedures, diagnosis, prevention or prognosis. The descriptive information provided by PORTs reveals substantial commonalities in their methods for searching literature and organizing bibliographic databases. However, there was considerable variation in other aspects of reviews, such as selection/exclusion criteria, the use of blinding, and the techniques used to assess the quality of studies. Alternative approaches to literature review and synthesis warrant further examination because they have implications for research and health policy both in terms of the substantive conclusions and efficiency of reviews. C1 JOHNS HOPKINS MED INST,WELCH CTR PREVENT EPIDEMIOL & CLIN RES,DEPT MANAGEMENT,BALTIMORE,MD 21205. JOHNS HOPKINS MED MED INST,PROGRAM MED TECHNOL & PRACTICE ASSESSMENT,BALTIMORE,MD 21205. UNIV WASHINGTON,DEPT PSYCHIAT,SEATTLE,WA 98195. UNIV WASHINGTON,DEPT BEHAV SCI,SEATTLE,WA 98195. UNIV WASHINGTON,DEPT REHABIL,SEATTLE,WA 98195. AGCY HLTH CARE POLICY & RES,CTR MED EFFECTIVENESS RES,ROCKVILLE,MD. SEATTLE UNIV,SCH NURSING,SEATTLE,WA. RP POWE, NR (reprint author), JOHNS HOPKINS MED INST,WELCH CTR PREVENT EPIDEMIOL & CLIN RES,DEPT MED & HLTH POLICY,BALTIMORE,MD 21205, USA. NR 38 TC 16 Z9 16 U1 1 U2 3 PU LIPPINCOTT-RAVEN PUBL PI PHILADELPHIA PA 227 EAST WASHINGTON SQ, PHILADELPHIA, PA 19106 SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 1994 VL 32 IS 7 SU S BP JS22 EP JS37 PG 16 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA NW560 UT WOS:A1994NW56000003 PM 8028411 ER EF