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Biomedical subjects

J E Rohrer

Publications and source records attributed to J E Rohrer.

At least 37 records · Page 2Linked to original sources
PubMed1998

Capacity of rural community mental health centers to treat serious mental illness.

This study evaluates the capacity of rural community mental health center staff to treat persons with serious mental illness (SMI). A 20-item survey was mailed to 720 providers in 34 community mental health centers (CMHCs) in Iowa. Responses were received from 285/680 persons in 32/34 centers. The confidence and interest in receiving additional training in tasks necessary for the care of persons with SMI was assessed for staff members of various disciplines and both confidence and training interest was found to vary by discipline. Recommendations to enhance CMHC capacity to treat persons with SMI are discussed.

Community Health Centers↗
PubMed1998

The impact of case management on utilization of community support services in a rural state.

The authors report on a study testing the hypothesis that persons with serious mental illness (SMI) would report more utilization of community support services if they had a case manager. Individuals with SMI were asked to complete a survey reporting their use of 10 community support services and case management. Having a case manager was not associated with increased utilization of any support service or case management by persons with serious mental illness in this rural state.

Adult↗
PubMed1998

Variation in tertiary prevention and health service utilization among the elderly: the role of urban-rural residence and supplemental insurance.

OBJECTIVES: Tertiary prevention seeks to reduce chronic disease progression and illness-related dysfunction. Using the Aday-Andersen model, we evaluated the impact of predisposing, need, and enabling factors on tertiary prevention, hypothesizing that urban-rural geographic differences in delivery would be detected. METHODS: A population-based telephone survey was conducted evaluating six common chronic indicator conditions: arthritis (n = 488), hypertension (n = 414), cardiac disease (n = 185), diabetes mellitus (n = 125), peptic ulcer disease (n = 125), and chronic obstructive pulmonary disease (n = 103). Subjects were 787 (70% women) home-dwelling elderly (age > 65 years) who had one or more of the indicator conditions and who resided in Iowa's 12 most rural and 10 most urban counties. Tertiary prevention measures included counseling for and/or treatment with: influenza and pneumococcal vaccination, smoking cessation, dietary modifications, exercise, drug side effects, chronic disease rehabilitation, aspirin/estrogen for cardiac disease, and foot/eye care for diabetes. Tertiary prevention scores were calculated to compare preventive services across disease categories and to examine relations, in particular, with enabling factors. RESULTS: Education beyond high school, alcohol use, cigarette smoking, and medical specialist use were all significantly greater among urban residents, whereas home services use was greater among rural residents. Respondents with either health maintenance organization or fee-for-service supplemental coverage had higher tertiary prevention scores than respondents without supplemental coverage. After adjustment for the significant effects of the number of diseases, higher income, and place of residence, rural respondents having health maintenance organization supplemental coverage had higher (better) tertiary prevention scores than other respondents. CONCLUSIONS: In this community-based study of elderly, enrollment in an health maintenance organization plan, as opposed to a fee-for-service supplement to Medicare, increased tertiary prevention quality for rural but not for urban residents. This study emphasizes that additional research is needed to evaluate the importance of specific types of insurance coverage for preventive services among the elderly.

Aged↗
PubMed1998

Oversight of managed care for behavioral health services.

Contract specifications for behavioral health services can be used to ensure that services are accessible, efficient, and effective. Staff-per-population ratios and service utilization rates derived from the health services research literature, are proposed as a practical set of performance indicators. Structural, process, and outcome indicators are included. Examples include therapist full-time equivalents per 1000 cases (structural), number of crisis calls per 1000 enrollees (process), and number of emergency department visits per 1000 (outcome). The need for occasional clinical audits and further research in other areas is discussed.

Behavioral Medicine↗
PubMed1998

Physician visits in a farming-dependent county.

Physician visits in a farming-dependent county in the upper-Midwest were studied using a mail questionnaire. A 16 percent random sample of households yielded 426 surveys (60 percent response rate). The dependent variable was the natural log (plus one) of the number of times the respondent had seen a physician in the prior 12 months. Predisposing, enabling, and medical need variables were tested as potential predictors of medical care usage. Self-rated health status proved to be an important predictor, as was a history of hospitalization and being married. However, health insurance coverage and family income were not associated with increased physician visits. Implications for modifying the conceptual model employed to analyze medical care utilization in similar populations are discussed.

Adult↗
PubMed1998

County funding of mental health services in a rural state.

Relationships between funding for mental illness in Iowa counties and county wealth, political activism, need for public services, rural culture, and policy makers' attitudes were examined. Counties with fewer people, lower proportions of persons with college education, higher proportions of rural and elderly residents, higher rates of poverty, and a higher proportion of income from farms spent less money on mental health services. Regression analysis indicated that the size of the county population and the proportion of persons receiving Medicaid funds explained 96 percent of the variation between county budgets.

Community Mental Health Services↗
PubMed1997

Assessing public health performance in Iowa's counties.

Local health agencies in Iowa were surveyed to assess the performance of public health practices in their communities. Responses were received from 97 percent of counties. Less than 50 percent of counties were performing half of the indicators of the Assessment function. Policy Development functions also were frequently not performed. Performance was best in the Assurance function, with 86 percent of counties reporting that they inform and educate the public. However, the other three types of Assurance practices (Manage, Implement, and Evaluate) were performed less frequently. Comparison of the performance of Iowa's rural counties reveals a profile nearly identical to that reported elsewhere for a group of six other states.

Benchmarking↗
PubMed1997

Regionalization of tertiary care: impact of safe cardiovascular volumes in Iowa.

The outcomes of cardiovascular care for individual patients are known to be better when treatment is provided in hospitals where the volume of such care is greater. We examined the impact of establishing safe volume thresholds on hospitals now performing such procedures in the state of Iowa by analysing the relationship between various volume thresholds and the number of hospitals that would continue to provide the service if the thresholds were enforced. Four procedures performed in hospitals in Iowa in 1990 were studied: coronary artery bypass graft surgery, vascular surgery, cardiac valve surgery, and cardiac catheterization. The analysis was conducted assuming current per capita procedure rates and repeated assuming reduced procedure rates. The study finds that the 12 hospitals now performing coronary artery bypass graft surgery in Iowa could be reduced to two, providers of vascular surgery could be reduced to as low as four from the current 33, the 10 providers of cardiac valve surgery might be reduced to one, and catheterization could be provided at two rather than 22 hospitals.

Cardiac Catheterization↗
PubMed1997

Monitoring health care system performance in Iowa.

Monitoring the performance of the health care delivery system is a public health function that becomes more important as organized delivery systems begin to take control over larger portions of the medical care market. The study reported here illustrates how standard medical care epidemiology can be applied to analysis of health care system performance to aid governmental efforts to monitor new developments in the medical care market. In order to evaluate the efficiency of hospital care delivered in Iowa, age- and sex-adjusted population admission rates for five common procedures were generated for all 99 counties. The five common procedures were defined as follows: hernia, tonsillectomy, cesarean section, hysterectomy, and cholecystectomy. In addition, variations in 11 ambulatory care-sensitive condition rates were analyzed. Residents of at least 15 counties were at significantly greater than average risk of receiving each of the common procedures (chi 2 test, P < 0.05). Counties that had a high rate for one procedure tended to have a high rate for at least one other procedure. Several counties had more than twice the mean rate. Even a 10% reduction, when added across all five common procedures. amounts to well over 2,000 hospitalizations avoided. It is assumed that reductions would be concentrated in high-rate counties. If a 50% reduction could be achieved in only part of the ambulatory care-sensitive procedures, more than 10,000 hospital admissions could be avoided.

Data Collection↗
PubMed1997

Medical care reform: lessons from around the world.

Once again the United States is in a ferment of health policy reform. Proposals abound but sage observers remark that national health insurance has been "just around the corner" more than once in the last forty years. This time may be different, however. Proposals from all across the ideological spectrum are converging on the notion of "managed care" which is perhaps best known in its guise as a health maintenance organization (HMO). Other forms of managed care exist but they have neither the history nor the incentives found in traditional HMOs. The discussion on national health insurance (NHI) proposals has focused on financing issues to the virtual exclusion of public health concerns. In this article, the author addresses rural health and public hospitals in the United States; two problems that have been with us for a long time. Then articles examining the Canadian and English medical care systems are reviewed, illustrating some of the weaknesses of these approaches to national medical care. Research studies relating to Europe and the developing nations are next. Once again, these are intended to highlight public health problems found in differing medical care systems. Finally, the author examines utopian views of the United States medical care system of the future: the reform proposal offered by the National Association for Public Health Policy, the experimental policy in Washington State, and a vision of a planned system. The review is intended to draw together the lessons offered by public health policy research in other countries and the United States and apply them to the issue at hand: reforming the United States medical care system.

Canada↗
PubMed1996

Effect of centralized intake on outcomes of substance abuse treatment.

OBJECTIVE: State governments are exploring the potential of various forms of case management to control the costs of substance abuse treatment programs. This report describes an experimental program in one Iowa county in which clients are assessed and referred elsewhere if treatment is needed. Outcomes of clients in that county are compared with those of clients served elsewhere in the state. METHODS: All claims submitted by provider agencies to the Iowa Department of Public Health for substance abuse treatment of eligible clients in 1994 were analyzed to test the effect of the experimental intake-and-referral program on clients' utilization of outpatient treatment, rate of treatment completion, and rate of abstention at discharge from treatment. RESULTS: In the county with the experimental program, 27 percent of clients recommended for treatment actually attended, compared with 48 percent in other counties. Clients who used the experimental program were also less likely to complete treatment. These differences persisted after adjusting for baseline differences in client characteristics. CONCLUSIONS: Lower utilization arising from failure to attend recommended treatment may reduce treatment costs but is not the intended outcome of the intake-and-referral program. Failure to complete treatment also is an adverse outcome. Outcomes of various types of case management programs should be carefully evaluated before statewide implementation is considered.

Adult↗
PubMed1996

Health objectives and health system reform in Iowa: complementary approaches to health planning.

Current proposals for health system reform, such as that developed by the Iowa Leadership Consortium on Health care (ILC), call for the creation of agencies responsible for setting rates, monitoring quality and efficiency, and regulating capital investment. These can be described as health planning activities. However, it is planning of a very different nature than that conducted by community groups seeking to achieve the objectives of Healthy People 2000. Yet, despite their apparent differences, modern regulatory planning in the form proposed by the ILC and grass roots planning have at least the following in common: -Both seek to improve the efficiency of the health system in addressing health problems; -Both use population health status data as a basis for planning; -Both derive from a health planning tradition that focuses on restructuring the health care delivery system; -Both assume the legitimacy of the health care reform objectives relating to medical care; -Both may respond to community input regarding the nature of proposed reforms; and -Both may be criticized by radicals for railure to address the root, socioeconomic causes of disease.

Health Care Reform↗
PubMed1995

Munificent environments, management control, and the cost of rural hospital care.

Rural hospitals have been threatened by declining revenues. Control over costs will be necessary to help these hospitals survive. Investigation of the determinants of hospital costs in Iowa reveals that costs are primarily caused by environmental factors, rather than variables over which managers have control. Furthermore, efforts by policy makers to improve hospital efficiency by stimulating competition among hospitals may have been ineffective, since the level of competition was not found to be associated with hospital production costs.

Catchment Area, Health↗
PubMed1995

Regulation of accountable health plans in rural areas.

Monitoring newly emerging "accountable health plans" is a public health responsibility related to Certificate-of-Need regulation. AHPs should use locally-based primary care providers, assure access to high quality affordable care to rural communities, contract with essential community providers, be governed by local boards of health, and report information necessary to evaluate their performance. Performance should be measured epidemiologically, using population-based rates such as infant mortality, incidence of late-stage breast and cervical cancer, and avoidable hospitalizations. Supplemental indicators include travel time to care, primary care personnel per capita, volume in volume-sensitive procedures, EMS response time, and client satisfaction.

Certificate of Need↗