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Biomedical subjects

C Harrington

Publications and source records attributed to C Harrington.

At least 109 records · Page 6Linked to original sources
PubMed1991

Normal pelvic anatomy using transvaginal scanning.

The fine spatial and contrast resolution accorded by TVS provides us with the opportunity to see the uterus, ovary, and larger pelvic vessels with detail and accuracy. Other structures may also be visualized but not with the same finesse, regularity, or attention. Transvaginal color Doppler imaging and pulsed waveform analysis capabilities now provide us with the opportunity of distinguishing vascular and nonvascular structures, and gives us the ability to determine the normal and abnormal flow characteristics of pelvic viscera. Improvements in TVS technology will undoubtedly expand our future capabilities and applications.

Female↗
PubMed1990

Awareness and enrollment in the Social/HMO.

Marketing the Social/Health Maintenance Organization (S/HMO) relative to HMOs and fee-for-service health insurance is a complex undertaking. Awareness of the plans is relatively high among joiners and nonjoiners, as is awareness of the relative price and benefits of these competing options. Local market competition and out-of-pocket costs appear to be major factors in selection. Study subjects include a probability sample of S/HMO members in 1986 and probability samples of elderly Medicare beneficiaries who had enrolled in HMOs or were fee-for-service recipients within the demonstration communities.

Aged↗
PubMed1990

The delivery, regulation, and politics of home care: a California case study.

This study examined seven basic types of formal home care service providers in California, licensed and unlicensed, delivered by agencies and by individual providers. The primary differences were based on sources of payment, duration of care, supervision of personnel, and state regulation, rather than on statutory definitions of services offered and clients served. Many key officials and providers advocate regulatory reform by extending licensure to unlicensed agencies and providers. Competing special interest groups have not developed a consensus about regulation, leading to a political stalemate. Research has not determined differences in quality, access, and costs of licensed and unlicensed home care providers.

Aged↗
PubMed1990

Haemophilia, AIDS and lung epithelial permeability.

Lung 99mTc DTPA transfer was measured in HIV antibody-positive haemophiliacs (11 smokers, 26 nonsmokers, 5 patients with Pneumocystis carinii pneumonia (PCP]. Lung 99mTc DTPA transfer as a marker of lung epithelial permeability was measured as the half time of transfer (from airspace into blood). This half time was faster in smokers compared to nonsmokers and the transfer curve was monoexponential. In nonsmokers no difference was observed between asymptomatic HIV-positive haemophiliacs and normal subjects, with the exception of the lung bases. At the lung bases in HIV-positive haemophiliac nonsmokers the transfer was faster than in normal individuals, implying increased alveolar permeability. Pneumocystis carinii pneumonia resulted in a rapid transfer of 99mTc DTPA (mean T50 of 2 minutes) and the transfer curve was biphasic, confirming previous observations in homosexual HIV antibody-positive patients with PCP. These changes returned to a monoexponential profile by 6 weeks following successful treatment. The DTPA lung transfer study may enable clinicians to instigate therapy for PCP without the need for initial bronchoscopy and provide a noninvasive method for the reassessment of patients should further respiratory signs or symptoms develop. This method is considered to be highly cost-effective in that it obviates the use of factor VIII concentrates required to cover bronchoscopic procedures and, with its early application and ease of use as a follow-up investigation, permits the evaluation of patients on an outpatient basis, thus reducing hospital costs.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Certificate of need and nursing home bed capacity in states.

Rapid expenditure increases raise concern with nursing home utilization, of which bed stock is an important determinant. This focuses attention on state policies to limit bed stock, particularly certificate-of-need (CON). This paper reports a cross-sectional/time-series analysis of 1981-1984 changes in state nursing home beds per aged population as functions of CON factors and of other state policy and market factors. Nursing home CON appears to constrain expansion of bed stock, older CON programs having stronger effects. Bed stock changes are positively related to dollar amounts of state CON approvals per aged population--interpreted to reflect the stringency of state CON programs.

Aged↗
PubMed1990

State Medicaid ICF-MR utilization and expenditures in the 1980-1984 period.

State Medicaid ICF-MR expenditures have shown a dramatic increase during the 1980-1984 period. The ICF-MR bed capacity declined slightly relative to the total state population, whereas the number of ICF-MR Medicaid recipients increased somewhat during the period. Regression analysis showed a strong positive relation with higher ICF-MR utilization and expenditures. Higher Medicaid reimbursement rates and greater proportions of employees who were unionized were also associated with higher state expenditures. Some states may be using limits on ICF-MR bed supply and reimbursement rates to constrain their overall Medicaid ICF-MR program costs.

Health Expenditures↗
PubMed1990

Social Health Maintenance Organizations: assessing their initial experience.

The Social/Health Maintenance Organization (S/HMO) is a four-site national demonstration. This program combines Medicare Part A and B coverage, with various extended and chronic care benefits, into an integrated health plan. The provision of these services extends both the traditional roles of HMOs and that of long-term care community-service case management systems. During the initial 30 months of operation the four S/HMOs shared financial risk with the Health Care Financing Administration. This article reports on this developmental period. During this phase the S/HMOs had lower-than-expected enrollment levels due in part to market competition, underfunding of marketing efforts, the limited geographic area served, and an inability to differentiate the S/HMO product from that of other Medicare HMOs. The S/HMOs were allowed to conduct health screening of applicants prior to enrolling them. The number of nursing home-certifiable enrollees was controlled through this mechanism, but waiting lists were never very long. Persons joining S/HMOs and other Medicare HMOs during this period were generally aware of the alternatives available. S/HMO enrollees favored the more extensive benefits; HMO enrollees considerations of cost. The S/HMOs compare both newly formed HMOs and established HMOs. On the basis of administrator cost, it is more efficient to add chronic care benefits to an HMO than to add an HMO component to a community care provider. All plans had expenses greater than their revenues during the start-up period, but they were generally able to keep service expenditures within planned levels.

Aged↗
PubMed1989

Quality of care in licensed and unlicensed home care agencies: a California case study.

This descriptive study examines quality of care issues among licensed and unlicensed home care agencies in California. Data were collected from interviews with 56 key informants in state and federal agencies, representatives of provider associations, consumer groups, professional associations, licensed and unlicensed home care providers, referral agencies, and legislators. Primary and secondary data from state and federal sources were collected and analyzed. Many problems were found in the quality of services delivered by both licensed and unlicensed agencies. Most respondents were concerned about the potentially serious quality of care problems for consumers who received care from unlicensed agencies. However, the large number of providers and the diversity in provider types offering home care services make it difficult to monitor the quality of care being delivered in the home. The findings indicate that there are similar problems in the quality of services provided by licensed and unlicensed agencies. Licensure does not assure that the quality of services will be adequate. The development of stronger, more uniform standards for licensed and unlicensed agencies in California may provide greater safeguards against the potential for abuse.

California↗
PubMed1989

State Medicaid reimbursement for ICF-MR facilities in the 1978-1986 period.

Medicaid policies for Intermediate Care Facilities for the Mentally Retarded (ICF-MR) are important because of rapid expenditure growth. Our study of 1978-1986 state Medicaid ICF-MR reimbursement policies showed massive shifts from traditional retrospective reimbursement methods, paralleling changes in reimbursing skilled nursing facility and ICF care. Meanwhile, Medicaid per diem ICF-MR reimbursement rates increased about 67%. Regression analysis showed that personal income, population percentage in poverty, unionization, and percentage of ICF-MR beds in government facilities influenced rates positively, whereas prospective class and combination reimbursement methods negatively affected rates. Thus, within the context of economic factors, government involvement in care and the reimbursement methodology are policies found to affect rates.

Humans↗
PubMed1988

In situ hybridization analysis of osmotic stimulus-induced changes in ribosomal RNA in rat supraoptic nucleus.

A quantitative in situ hybridization analysis was used to investigate changes in levels of ribosomal RNA (rRNA) in neurons of the supraoptic nucleus (SON) of rats stimulated osmotically by giving 2% NaCl as drinking solution for 0 (control rats), 1, 4, and 14 days. The quantitation was autoradiographically accomplished by in situ hybridization with a nick-translated tritiated ribosomal DNA probe and with the use of computer-based image analysis system. The mean number of grains per neuron in the ventral SON was significantly increased: 1.8-fold for 1 day, 2.9-fold for 4 days, and 1.7-fold for 14 days of salt loading, whereas the mean number of grains per neuron in the dorsal SON was increased 1.3-fold for 1 day, 2.5-fold for 4 days, and 1.7-fold for 14 days. Kolmogorov-Smirnov analysis of frequency histograms of grains per neuron indicated that the amount of rRNA in neurons in the ventral and dorsal SON was significantly increased by osmotic stimulation. These increases were accompanied by increases in cell size. The subcellular location of hybridizable rRNA in magnocellular neurons was altered by osmotic stimulation. Following 1-14 days of salt-drinking, rRNAs appeared to be more unevenly distributed throughout the cytoplasm. These findings are consistent with the notion that hyperosmotic stimulation has a substantial effect on the expression of rRNA genes in neurons of both the ventral and dorsal SON.

Animals↗
PubMed1988

State Medicaid reimbursement for nursing homes, 1978-86.

State Medicaid reimbursement methods and rates are reported for the period 1978-86 for skilled nursing and intermediate care facilities. A cross-sectional time series regression analysis of Medicaid reimbursement rates on methods showed that States using prospective class reimbursement had significantly lower rates for the period 1982-86. States using prospective facility-specific reimbursement methods had lower rates than retrospective methods in 1983-84.

Data Collection↗
PubMed1988

Nursing home bed capacity in the States, 1978-86.

Trends in nursing home bed supply in the States show large variations in beds per population and a gradual decline in supply per aged population. A cross-sectional time-series regression analysis was used to examine some factors associated with nursing home bed supply. Variation was accounted for by economic factors, supply of alternative services, and climate. State Medicaid reimbursement rates had negative coefficients, with supply suggesting States may be increasing rates to improve access where supply is limited. Medicaid waiver policy was not found to be significant.

Data Collection↗
PubMed1988

Factors that contribute to Medicare HMO risk contract success.

In 1985, federal legislation was implemented that allowed HMOs to contract with the Health Care Financing Administration for Medicare enrollees on a risk basis. This change stimulated the development of risk contractors and a growth in HMO Medicare enrollees. This paper examines selected factors that contributed to large Medicare risk contract enrollment in four geographical locations: Los Angeles, Minneapolis-St. Paul, New York City, and Portland, Oregon. The primary types of factors examined were: HMO market conditions, HMO characteristics, and HMO marketing strategies and practices. The market competition varied substantially across the four areas. HMO plan age, total number of HMO enrollees, low premium, and the use of multimedia marketing strategies were positively associated with large Medicare risk contract enrollment.

Aged↗
PubMed1987

The impact of state Medicaid nursing home policies on utilization and expenditures.

State Medicaid programs must pay for a substantial proportion of overall nursing home costs--43% in 1984--and are likely to have to bear substantially more of these costs in the future. In an attempt to understand the extent to which state Medicaid policies and other factors influence nursing home utilization and expenditures, we undertook a cross-section time-series regression, using three sets of independent variables: state Medicaid policies, provider supply, and macrocontextual variables. We found that the state Medicaid nursing home reimbursement rate for intermediate care facilities was the strongest predictor of expenditures for all Medicaid recipients.

Aged↗