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Biomedical subjects

S Crystal

Publications and source records attributed to S Crystal.

46 records · Page 3Linked to original sources
PubMed1992

New Jersey's Medicaid waiver for acquired immunodeficiency syndrome.

This article contains data from a study of New Jersey's home and community-based Medicaid waiver program for persons with symptomatic human immunodeficiency virus illness. Major findings include lower hospital costs and utilization for waiver participants compared with general Medicaid acquired immunodeficiency syndrome admissions in New Jersey. Average program expenditures were $2,400 per person per month. Based on study findings, it is evident that the waiver program is an important means of providing financial benefits and access to services and that comprehensive case management is a critical factor in assuring program quality.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Cumulative advantage, cumulative disadvantage, and inequality among elderly people.

It is often asserted that economic inequality narrows after age 65 when benefit programs replace labor markets as principal income sources. However, analysis of recent Census data suggests inequality is greatest among elderly people. The worst off one-fifth of the elderly (disproportionately unmarried women, minorities, and the physically impaired) receives 5.5% of the elderly's total resources, whereas the best off one-fifth receives 46%. Equalizing effects of Social Security are more than outweighed by private pensions, asset income, and other sources. Findings suggest a process of cumulative economic advantage and disadvantage throughout the life course.

Aged↗
PubMed1990

AIDS contact notification: initial program results in New Jersey.

As part of an 1988-89 evaluation of New Jersey's newly established HIV Notification Assistance Program (NAP), data were collected concerning number of HIV+ persons providing contact names; contact characteristics; reactions to NAP of HIV counselors, their clients, and of notified contacts; and program costs. There was initial resistance to the program both from HIV counselors and their clients. By mid-1989, acceptance of the program by referring HIV counselors had increased. The proportion of HIV+ clients who referred contacts was still low, but had increased to 10%. 160 contacts were notified: 72% sexual contacts and 28% needle sharing contacts, 59% male and 41% female, 58% black, 29% white, 13% Hispanic. 67% considered themselves at moderate or high risk for HIV; 31% stated that they had already been tested for HIV, with 7% having tested positive. Cost per notified contact was $2,260; cost per contact not previously tested HIV+ and unaware of risk was $3,014. Findings suggest that persuading counselors at HIV counseling and testing sites of the program's value is a key prerequisite for success, in situations where notification is carried out by a separate agency. Once the program has been in place for a time and has established credibility, the opportunity exists for initial resistance to be overcome.

AIDS Serodiagnosis↗
PubMed1989

Diagnostic patterns in hospital use by an urban homeless population.

Because patterns of disease and health care system usage by the homeless constitute a neglected area of research in the medical literature, we undertook a retrospective analysis of inpatient records on medically indigent adults, controlling for housing status, to add to the growing body of research in the area of homeless health care. Data on all 4,243 indigent patients admitted over 2 fiscal years (1985 and 1986) under the county medical services program of San Diego County, California, revealed 5.3% (226) to be homeless. The commonest major diagnostic category among the homeless discharges was "diseases and disorders of the skin, subcutaneous tissue, and breast," constituting 21.2% as compared with only 8.7% of the discharge diagnoses for housed indigent persons. Within this major diagnostic category, the predominant diagnosis-related group was cellulitis, accounting for 12.8% of diagnoses in the homeless and only 4.0% of discharge diagnoses in other medically indigent persons. A homeless housing status was also correlated with a higher percentage of discharges with the major diagnostic category of "substance use and substance-induced organic mental disorders" but was negatively correlated with that of "diseases and disorders of the circulatory system."

Delivery of Health Care↗
PubMedDate not supplied

Racial differences in end-of-life care for patients with AIDS.

This study examines the place of death for persons with AIDS, and the adequacy of the pain treatment that they received in their final months of life. Variations in the use of pain treatment during three months before death and place of death by patient's characteristics such as gender, race/ethnicity, mode of transmission, and geographical location are examined. We used merged AIDS surveillance data and paid Medicaid claims data for the period between 1991 and 1998 to examine the outcomes. Multivariate analysis was done using logistic regressions. Overall, approximately half of the sample received an outpatient prescription for analgesics during the last three months of life. A majority of the decedents (62 percent) died in a hospital. Significant differences in pain treatment and place of death existed between members of racial minority groups and Whites. Higher rates of pain treatment and lower likelihood of dying in a hospital were noted among beneficiaries enrolled in a statewide HIV/AIDS-specific home- and community-based Medicaid-waiver program. Despite financial eligibility, racial minorities, especially African-Americans, were disadvantaged in their access to healthcare services during their last months of life; some of these racial differences appear to be mediated by the use of the waiver program. There was some evidence that access to home care services and case-management mechanisms such as those built into the waiver program were an effective means of facilitating palliative care by increasing the use of pain medication and reducing the likelihood of dying in a hospital.

Acquired Immunodeficiency Syndrome↗