SEARCH · Search PubMed

Results for “Oregon”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources

PubMed2003

Oregon's transition to a managed care model for Medicaid-funded substance abuse treatment: steamrolling the glass menagerie.

The approval of a Health Care Financing Administration (now called Centers for Medicare and Medicaid Services) 1115 Medicaid waiver in Oregon allowed the state to design and implement an expanded publicly funded health care system, the Oregon Health Plan (OHP). Integral to OHP is the administration of physical and behavioral health services, including outpatient substance abuse treatment, through contracted managed care organizations. The two overarching changes to the outpatient substance abuse treatment system were expanded Medicaid eligibility and new operating procedures for the outpatient substance abuse treatment system. The authors used grounded theory to examine the effects of this transition on the treatment system, with an emphasis on the experiences of treatment providers.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2005

Genetic structure of the tick Ornithodoros coriaceus (Acari: Argasidae) in California, Nevada, and Oregon.

The argasid tick Ornithodoros coriaceus (Koch) is the only confirmed vector of epizootic bovine abortion (EBA) in the United States. The disease and its tick vector have historically been reported in the foothills of the Sierra Nevada Mountains and coast ranges of California. In the past two decades, the range of EBA has apparently expanded into southern Oregon and northern Nevada. Possible explanations for this expansion include 1) increased recognition and reporting of EBA in these regions; 2) widespread movement of tick-infested and EBA-infected hosts with subsequent colonization of these regions by infected ticks; and 3) widespread movement of the EBA agent, independent of tick movements, into extant tick populations in these new regions. The current study was performed to evaluate these hypotheses by examining patterns of variability in a 420-bp segment of the 16S mitochondrial rDNA gene sequence among 210 O. coriaceus individuals from 14 sites in California, Oregon, and Nevada. Sixty-three unique haplotypes were identified in the ticks tested, with 84% of the sequence variation attributable to among-population variation and 16% to within-population variation. A majority of the haplotypes were unique to their particular collection site, whereas only four collection sites shared haplotypes. Overall, very little evidence of gene flow among tick populations was detected, making it unlikely that widespread tick movement had introduced O. coriaceus and the EBA agent into new regions.

Abortion, Veterinary↗

PubMed1994

Just caring: Oregon, health care rationing, and informed democratic deliberation.

This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must learn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democratic deliberation. Part I of this essay notes that rationing is a ubiquitous feature of our health care system at present, but it is mostly hidden rationing, which is presumptively unjust. Part II argues that the need for health care rationing is inescapable. Although Oregon is flawed as a model of health rationing, it gives us worthy moral lessons for health reform at the national level, which I analyze and defend in Part III. The most significant of these lessons is the importance of rational democratic deliberation in articulating fair rationing protocols for a community. In Part IV I sketch the philosophic justification for this approach and respond to some important criticisms from Daniels.

Community Participation↗

PubMedDate not supplied

Releasing pre-adoption birth records: a survey of Oregon adoptees.

OBJECTIVE: In June 2000, Oregon implemented a citizen-initiated ballot measure that grants adult adoptees access to their birth records, which contain their birth parents' identifying information. Because other states are considering similar policy changes, the authors explored whether Oregon's new law is meeting the information needs of adoptees. METHODS: Birth records were abstracted for a 9% (221/2,529) random sample of adoptees who obtained their records from June 20, 2000, to July 20, 2000, to describe the population and the information they obtained. Telephone interviews documented their motivations, expectations, and whether they considered the birth record useful. RESULTS: The mean age of the adoptees was 41 years, 64% were female, and 97% were white. Virtually all received information about their birth mother; however, only one-third received information about their birth father. Of the 221 sampled, 123 (59%) participated in the telephone survey, 12 were ineligible, 84 could not be reached, and 2 refused. The most common motivations for requesting records were to find birth parents (29%) and to obtain medical information (29%). Twenty-nine percent received less information than they expected, with many expecting, but not receiving, birth father information. Thirty-three (47%) of the 70 adoptees who tried to find their birth mother were successful. The records were considered "very" useful by 52% of respondents, "somewhat" or "a little" useful by 42%, and "not at all" useful by 6%. CONCLUSIONS: The results indicate that many adoptees received less information than they expected, and many did not meet their goals of finding birth parents or obtaining medical information. Nonetheless, the majority considered their birth records useful and important.

Access to Information↗

PubMed1988

Blood selenium and glutathione peroxidase activity of populations in New Zealand, Oregon, and South Dakota.

The relationship of whole blood selenium (Se) to glutathione peroxidase (GPX) activity was examined for individuals in New Zealand, Oregon, and South Dakota who represented, respectively, populations with exposure to low, medium, and high amounts of Se. The mean (respective) blood Se levels were 60, 200, and 400 ng/ml. Intergroup differences in blood Se levels were highly significant (P less than 0.001). GPX assays were performed using two variations of an enzyme-coupled procedure to assess the equivalence of the two methods. Despite a fourfold difference in absolute activities measured by these methods, the GPX activities were highly correlated (r = .86) between procedures. Average blood GPX activity was significantly lower (P less than 0.001) for the New Zealand group compared with the other two groups, but there was no difference in GPX activities between the Oregon and South Dakota groups. Linear regression of GPX vs. Se values within each group indicated a significant correlation of these parameters only in the New Zealand group (r = .46, P less than 0.01). Comparison of these parameters for combined data from all three groups also showed a significant positive correlation (r = .60, P less than 0.001). A saturation model (In GPX = k1 + k2 (Se)-1)) fits the combined data better (r = .80, P less than 0.01) than does direct comparison of the two parameters. These results suggest that GPX activity is an appropriate indicator of human Se status only in populations with below normal exposure to Se, as activity of this enzyme is saturated at relatively low levels.

Glutathione Peroxidase↗

PubMed2001

Statutory and regulatory recognition for clinical nurse specialists in Oregon.

Clinical nurse specialists (CNSs) in Oregon initiated the process of achieving statutory and regulatory recognition several years ago. Throughout this process, specific phases of activity and events helped CNSs to identify what was required to achieve this goal. The resulting lessons learned are shared in this report. Statutory recognition of CNSs in Oregon occurred in 1999, and the administrative rules for CNS practice were published in 2001. These administrative rules delineate the CNS scope of practice and other aspects of CNS practice consistent with national standards.

Humans↗

PubMed1989

Risks of radioactive material transportation accidents in Oregon.

As a continuation of previous research on worst case transportation accidents involving radioactive material (Dodd and Humphries 1988a), and protective action guidance for radioactive material transportation accidents (Dodd and Humphries 1988b), this paper describes the risks from such accidents in Oregon. Radioactive material transportation risks are defined in terms of accident consequences multiplied by the accident probabilities and are expressed as latent cancer fatalities (LCFs). For each of 17 different shipment types, five dose contributions are summed and multiplied by the population density and accident probability. The five dose contributors considered are: inhalation, resuspension, cloudshine, groundshine and direct exposure. The variables over which each of these dose contributors are integrated include seven accident severity categories, three population density zones, five regions of the state, as well as many isopleth areas and radionuclides. Allowance is also made for the possible distribution of meteorological conditions in each area. The dose to the public, emergency responders, pedestrians and personnel in other traffic are all considered. It is concluded that the current level of risk is 1.2 X 10(-5) latent cancer fatalities per year in Oregon. This is equivalent to one LCF every 83,000 y. This compares to 1.2 non-radiological fatalities associated from the same shipments.

Accidents↗

PubMed1997

An effective methodology for surveying a Medicaid population: the 1996 Oregon Health Plan client satisfaction survey.

There are many barriers to measuring client satisfaction for a Medicaid population. This vulnerable group is poor, often undereducated, and highly mobile, making both telephone surveys and mail-return surveys difficult to administer successfully. The Oregon Health Plan (OHP), a Medicaid managed care delivery system, has developed a client satisfaction survey and approach that yielded a 63% response rate. Readability, satisfaction indicators reflective of a Medicaid population, and survey administration are all identified as essential to an adequate response rate. The data from the 1996 Oregon Health Plan Client Satisfaction Survey are being used in the OHP's analysis and evaluation program and its ongoing quality improvement process.

Chronic Disease↗

PubMed1996

The ethical dilemmas of the Oregon health plan.

Escalating health care costs place our country at an economic disadvantage in the world marketplace. Currently, a mixture of rationing methods in the health care system limits access to control costs. Federal and state moneys fund the state Medicaid programs. States on limited budgets often tighten eligibility to far below the poverty level; those with benefits get unlimited care and those without get none. The state of Oregon has a different idea: Medicaid covers everyone below the poverty level but limits services to those with the "best cost-to-benefit ratio." Many people consider the distribution and finance of health care an ethical issue. The Oregon plan raises some ethical concerns and several arguments. The federal government waived Title XIX of the Social Security Act to allow implementation of the plan. Many providers believe universal access is important; however, the drive to see more patients may limit visit time.

Decision Making, Organizational↗

PubMed2002

Finding the courage to lead: the Oregon experience.

A severe nursing shortage has the profession in crisis. The national picture is paralleled in Oregon. The Oregon Nursing Leadership Council (ONLC), through intense dialogue, developed a comprehensive statewide plan to resolve the shortage. From the perspective of group relations and leadership theories, this article describes the issues and events that contributed to the remarkable journey that culminated in this plan. Motivated by our concern for the public welfare and the survival of our profession, individual ONLC members surrendered their own narrow organizational goals to achieve a more effective collective outcome.

Forecasting↗

PubMed2002

Public health surveillance approaches in Oregon's Medicaid population.

The development of methods for public health surveillance in Medicaid populations is an important goal for public health practice. In Oregon, we developed approaches to case finding using claims and self-reported data obtained from the Medicaid beneficiary population. Disease rosters, derived from claims data, form the basis for analyses pertaining to particular health conditions. Self-reported information obtained through a telephone survey forms the basis for analyses pertaining to behavioral risk factors, disease history, and other information not available in claims data. We also describe some projects in which we plan to use combined claims and survey data. We describe our experiences with using these techniques and provide examples from projects in progress or planned. Our initial experiences suggest that these approaches enhance our ability to conduct public health surveillance in Oregon's Medicaid population.

Feasibility Studies↗

PubMed2002

Tracking Oregon Medicaid patients' enrollment and health utilization patterns.

The Oregon Medicaid program consists of various sub-programs with different eligibility requirements and multiple health care delivery systems. Administrative events, such as the loss of Medicaid eligibility or a change in health plan enrollment, can cause disruptions in the continuity of medical care and may contribute to missed opportunities to provide appropriate medical services, including preventive care. Thus, in order to improve public health surveillance and describe the health care utilization patterns of Oregon's Medicaid beneficiaries, a standardized approach was developed to track the enrollment status of Medicaid patients for extended periods of time.

Continuity of Patient Care↗

PubMed1998

The effects of nursing case management on the utilization of prenatal care by Mexican-Americans in rural Oregon.

This quasi-experimental, retrospective study used birth certificate and medical record data to evaluate the effectiveness of the Rural Oregon Minority Prenatal Program (ROMPP) in improving patterns of prenatal care utilization by rural-dwelling, low-income, Mexican-American women at risk of poor pregnancy outcomes. The ROMPP intervention provided nursing case management services and peer outreach to pregnant Mexican-American women in a rural Oregon community. The intervention group had more prenatal visits in months 2, 3, 4, 5, 6, and 7 than the comparison group (P < 0.05). The intervention group had a similar number of emergency room (ER) visits, but had more respiratory diagnoses and fewer urinary tract infections. ROMPP women had more inpatient admissions and longer lengths of stay. No differences were found in the initiation of prenatal care or the total number of prenatal care visits, nor in the timing of screening serum glucose tests. The intervention should be expanded to address the persistent attitudinal, financial, transportation and language barriers to adequate prenatal care. Nurses should increase their cultural competency and sharpen their clinical focus on advocacy, marketing, facilitation of relationships between community groups, and community organizing.

Adolescent↗

PubMed1986

Impact of Medicare diagnosis-related groups (DRGs) on nursing homes in the Portland, Oregon metropolitan area.

To evaluate the impact of the Medicare Prospective Payment System (PPS) on nursing homes, resident census and staffing data from 78 Portland, Oregon nursing homes were compiled from annual reports filed with the state. Between fiscal years (FYs) 1983 and 1984, (before and after initiation of the Medicare PPS), there was no significant change in the total number of patient-days, but there was a 20.5% increase in the total number of deaths and a significant increase in average facility adjusted death rates (P = .004). Between the previous FYs 1982 and 1983, the total number of deaths had risen only 8.3%, and the average facility adjusted death rate had no significant change. Since initiation of diagnosis-related groups (DRGs), these nursing homes also made sizeable increases in their adjusted full-time registered nurse employment rate, and reported fewer patients reimbursed by Medicare. These same nursing homes were surveyed in spring, 1985 to determine the impact of Medicare DRGs in more qualitative terms. Of the 51 nursing homes (66%) responding, more than half reported increased severity of illness, shorter length of stay, increased prevalence of clinical problems, and increased use of medical supplies. In addition, more than half of the respondents reported increased frequency of requests for Friday and weekend admissions, admission of patients too sick for the facility, and physician phone consultation. These findings indicate that Portland, Oregon nursing homes experienced increased patient severity of illness, explained at least in part by earlier hospital discharge, following DRGs.

Diagnosis-Related Groups↗

PubMed2004

Use of the Physician Orders for Life-Sustaining Treatment program in Oregon nursing facilities: beyond resuscitation status.

OBJECTIVES: Program was designed to communicate resident/surrogate treatment preferences in the form of medical orders. To assess statewide nursing facility use of the Physician Orders for Life-Sustaining Treatment (POLST) and to identify the patterns of orders documented on residents' POLST forms. DESIGN: Telephone survey; on-site POLST form review. SETTING: Oregon nursing facilities. PARTICIPANTS: One hundred forty-six nursing facilities in the telephone survey; 356 nursing facility residents aged 65 and older at seven nursing facilities in the POLST form review. MEASUREMENTS: A telephone survey; onsite POLST form reviews. RESULTS: In the telephone survey, 71% of facilities reported using the POLST program for at least half of their residents. In the POLST form review, do-not-resuscitate (DNR) orders were present on 88% of POLST forms. On forms indicating DNR, 77% reflected preferences for more than the lowest level of treatment in at least one other category. On POLST forms indicating orders to resuscitate, 47% reflected preferences for less than the highest level of treatment in at least one other category. The oldest old (> or = 85, n=167) were more likely than the young old (65-74, n=48) to have orders to limit resuscitation, medical treatment, and artificial nutrition and hydration. CONCLUSION: The POLST program is widely used in Oregon nursing facilities. A majority of individuals with DNR orders requested some other form of life-extending treatment, and advanced age was associated with orders to limit treatments.

Advance Care Planning↗

PubMed2004

The Physician Orders for Life-Sustaining Treatment program: Oregon emergency medical technicians' practical experiences and attitudes.

OBJECTIVES: To evaluate emergency medical technicians' (EMTs) experiences with the Physician Orders for Life-Sustaining Treatment (POLST) program and learn about attitudes regarding its effectiveness. DESIGN: Anonymous survey mailed to a stratified random sample. SETTING: Tri-County Portland, Oregon, area. PARTICIPANTS: A total of 572 Oregon EMT respondents (out of 1,048 surveys) were included in the analysis. MEASUREMENTS: Survey questions about experiences with the POLST form and opinions about POLST. RESULTS: Respondents were mostly male (76%) and paramedics (66%). Most respondents (73%) had treated a patient with a POLST, and 74% reported receiving education about POLST. EMTs reported that POLST, when present, changed treatment in 45% of cases. Seventy-five percent of the respondents agreed that the POLST form provides clear instructions about patient preferences, and 93% agreed that the POLST form is useful in determining which treatments to provide when the patient is in cardiopulmonary arrest. Fewer (63%) agreed that the form is useful in determining treatments when the patient has a pulse and is breathing. CONCLUSION: Most respondents have experience with the POLST program. EMTs find the POLST form useful and often use it to change treatment decisions for patients.

Advance Care Planning↗

PubMedDate not supplied

Oregon trauma system: change in initial admission site and post- admission transfer of injured patients.

OBJECTIVE: Associate statewide trauma system development with a change in the percentage of injured patients initially hospitalized at Levels I and II categorized trauma hospitals and a change in the length of stay (LOS) prior to arrival at a Level I or II hospital (PRE-LOS) and total LOS (T-LOS) for post-admission transfer patients. METHODS: A retrospective analysis was performed using a hospital discharge database of 235,395 discharges with codes for acute injury managed at 74 acute care hospitals in Oregon State from 1983 to 1991. Primary outcome measures were admission site and transfer patient PRE-LOS and T-LOS. Predicator variables included category of initial hospital admission site, injury severity scale (ISS) score, head injury, age, and status of trauma system (pre-system, 1983 to 1987; transitional, 1988 to 1989; and post-system, 1991 to 1992). RESULTS: There was a significant increase in the percentage of initial admissions to hospitals with Level I and II categorization (17.6%, 26.2%, and 27.6% for the three periods of development, respectively; p < 0.00001). The percentage of patients with ISS scores greater than 15 admitted initially to Level I or II hospitals increased from 33.4% to 52.6% and 57.3%; p < 0.00001). Only 1,059 0.57%) of 185,321 patients initially admitted to Level III, Level IV, or noncategorized hospitals were transferred to a Level I or II hospital. Mean PRE-LOS for 1.059 transferred patients showed a significant decrease with system development (2.3, 1.9, and 1.8 days, respectively; p < 0.02). When adjusted for age, ISS score, and head injury effects, mean T-LOS was significantly reduced for the transitional and post-system periods (p < 0.05). CONCLUSIONS: In Oregon, development of a statewide trauma system was associated with increased initial admissions to Level I and II trauma hospitals. For those patients transferred to higher levels of care post- admission, hospital LOSs were decreased with trauma system development.

Adolescent↗

PubMed1994

Using the youth risk behavior survey to estimate prevalence of sexual abuse among Oregon high school students.

To estimate the extent of childhood sexual abuse, questions were added to the 1993 Oregon Youth Risk Behavior Survey of students in grades 9-12. Twenty-five high schools throughout Oregon participated in the survey. Among the 2,332 students who answered sexual abuse questions, 20.9% had ever been sexually abused; females (33.1%) were much more likely to have ever been abused than were males (8.1%). Females (10.3%) also were more likely than males (3.4%) to have been sexually abused within the past year. High school students sexually abused in the past year engaged in many high risk health behaviors such as weapon carrying, substance abuse, seriously considering suicide in the past year, and sexual activity when compared with students who had never been sexually abused. Further educational efforts with teachers, health care providers, parents, and child care providers, as well as development and use of school curricula, are needed to reduce sexual abuse.

Adolescent↗