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PubMed1998

The demand for post-acute and chronic care in nursing homes.

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.

Aged↗
PubMed1996

[Home care service: a need for AIDS patients. Epidemiological and economical data].

The Authors present epidemiological and economic data, to demonstrate that in Bologna and in Emilia Romagna region the home care service is an important instrument to treat AIDS patients and in particular those who have psychological and social problems as the drug abusers. There are human, social, sanitary and economic reasons to realize an integrate home care assistance according to the law 135/1990. The serious epidemiological situation of Emilia Romagna strongly induces to apply the guidelines for the home care service in the city where they haven't been realized and to extend the program where it's inadequate.

English Abstract↗
PubMed2005

Economic evaluation of cardiac rehabilitation: a systematic review.

BACKGROUND: Economic evaluation is an important tool in the evaluation of competing healthcare interventions. Little is known about the economic benefits of different cardiac rehabilitation program delivery models. DESIGN: The goal of this study was to review and evaluate the methodological quality of published economic evaluations of cardiac rehabilitation services. METHODS: Electronic databases were searched for English language evaluations (trials, modeling studies) of the economic impact of cardiac rehabilitation. A review of study characteristics and methodological quality was completed using standardized tools. All costs are adjusted to 2004 US dollars. RESULTS: Fifteen economic evaluations were identified which met eligibility criteria but which displayed wide variation in the use of comparators, evaluation type, perspective and design. Evidence to support the cost-effectiveness of supervised cardiac rehabilitation in myocardial infarction and heart failure patients was identified. The range of cost per life year gained was estimated as from 2193 dollars to 28,193 dollars and from - 668 dollars to 16,118 dollars per quality adjusted life year gained. The level of evidence supporting the economic value of home-based cardiac rehabilitation interventions is limited to partial economic analyses. CONCLUSIONS: Evidence to support the cost-effectiveness of supervised cardiac rehabilitation compared with usual care in myocardial infarction and heart failure was identified. Further trials are required to support the cost-effectiveness of cardiac rehabilitation in cardiac patients who have under gone revascularization. The literature evaluating home-based and alternative delivery models of cardiac rehabilitation was insufficient to draw conclusions about their relative cost-effectiveness. The overall quality of published economic evaluations of cardiac rehabilitation is poor and further well-designed trials are required.

Cost-Benefit Analysis↗
PubMed2006

Multiple measures of socioeconomic circumstances and common mental disorders.

While serious mental disorders typically show socioeconomic differences similar to physical illness-that is, that lower positions imply poorer health-differences for common mental disorders have been inconsistent. We aim to clarify the associations and pathways between measures of socioeconomic circumstances and common mental disorders by simultaneously analysing several past and present socioeconomic measures. The data were derived from middle-aged women and men employed by the City of Helsinki. Cross-sectional surveys were conducted in 2000-2002 among employees who, during each year, reached 40, 45, 50, 55 or 60 years of age. The pooled data include 8970 respondents (80% women; response rate 67%). Common mental disorders were measured by GHQ-12 and the SF-36 mental component summary. Seven socioeconomic measures were included: parental education, childhood economic difficulties, own education, occupational class, household income, home ownership, and current economic difficulties. Logistic regression analysis was used to examine associations between the socioeconomic circumstances and common mental disorders. Past and present economic difficulties were strongly associated with common mental disorders, whereas conventional past and present socioeconomic status measures showed weak or slightly reverse associations. Adjusting for age and gradually for each socioeconomic measure did not affect the main findings, which were very similar for women and men, as well as for both measures of common mental disorders. While the associations of conventional socioeconomic status measures with common mental disorders were weak and inconsistent, our results highlight the importance of past and present economic difficulties to these disorders.

Adult↗
PubMed2005

Associations of socio-economic position and disability among older women in Britain and Jyväskylä, Finland.

The aim was to compare the pattern of associations in measures of socio-economic position and disability among British and Finnish older women. In Britain data from the British Women's Heart and Health Study was used. Women from 23 towns took part in a nurse-assessed medical examination and postal questionnaire (n = 4286). In Finland, data from the Evergreen study was used. Eight hundred and four women from the city of Jyväskylä were interviewed at home. Socio-economic position was measured according to social class in childhood, education, use of a car, home ownership and previous occupation. Disability measures included questions on difficulties in washing/dressing and climbing stairs. Logistic regression analyses were conducted to examine the relationship between disability and socio-economic position. In the age-adjusted analysis of both samples increasing disability in washing/dressing and climbing stairs was associated with at least one of the measures of deprivation. The relationship between socio-economic position and disability was more distinct in the British than Finnish women. Despite adjustment for a range of confounders, the relationship between socio-economic position and disability was not much attenuated, particularly in the British women. The associations in the measures of socio-economic position and disability showed a slightly different pattern between the British and Finnish women.

Age Factors↗
PubMed1998

Evaluation of cost of home therapy for patients with terminal diseases.

Palliative care and palliative medicine embrace the philosophy and the body of knowledge regarding the correct treatment of patients with terminal disease. Palliative treatments can be delivered intramurally (eg, in a hospice or palliative care unit) or at home (home care hospice). The optimal delivery pattern consists of the co-utilization of both care settings, to allow patients who need palliative, supportive, and terminal care to benefit from each setting. In obtaining the available resources, health service costs in Western countries have lately become exorbitant. Home care hospice is a system capable of defeating the challenge on two fronts: to meet the patients' needs and to fulfill this task through economically advantageous practices. Home care hospice is undoubtedly more cost-effective than conventional or generic home care, conventional care (hospitalization), and inpatient hospice care. Its advantage is more evident in the last 3 months of life, due to shorter hospitalization and nonutilization of high-technology interventions and high-cost drugs. The development of a range of palliative care programs integrating primary territorial care and specialized palliative services can constitute the ideal synthesis to respond to patients' needs in a threefold manner: firstly, the patient's right to qualified palliative and terminal care; secondly, the requirements of health services, and lastly, cost containment through a correct and tailored use of available resources.

Cost-Benefit Analysis↗
PubMed1982

Outcome of cataract surgery. IV. Socio-economic aspects.

This outcome assessment study is based on data collected prospectively in a group of 123 consecutive cataract patients. Cataract surgery to vast majority of patients means prevention of blindness, better vision, better visual functioning and better quality of life. Due to cataract surgery the occupational status is maintained in many patients, and a majority of the retired patients are able to continue a normal life in their own homes. Thus the economic benefit to the community are savings of disablement pensions and of geriatric nursing home accommodation. In this study we found that these savings by far exceeded the costs of cataract surgery. Capacity for cataract surgery ought to be sufficient everywhere.

Aged↗
PubMed1996

SCI recidivism and nursing home placement: an interdisciplinary approach.

Satisfactory placement of spinal cord injury (SCI) patients in community nursing homes presents a challenge for interdisciplinary team members and caregivers. Problems of recidivism exist. There is limited information about the presenting signs/symptoms of these patients in nursing homes or the economic impact of their frequent reentries into hospitals. To identify factors related to recidivism, nurses at the James A. Haley Veterans Hospital analyzed the demographic and clinical characteristics of readmissions from nursing homes to SCI units for two years. Analysis of risk factors aided in the identification of situations that predisposed patients to recidivism and served as a basis for program development. A Community Nursing Home Enrichment Program (CNHEP) was designed utilizing the interdisciplinary team. The CNHEP consisted of pre- and post-placement interventions designed to 1) prepare the veteran for a change in life style, 2) decrease frequency of rehospitalization and 3) improve placement outcomes.

Community Health Nursing↗
PubMed2005

Socioeconomic position and self-rated health: the contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources.

OBJECTIVES: We examined socioeconomic inequalities in self-rated health by analyzing indicators of childhood socioeconomic circumstances, adult socioeconomic position, and current material resources. METHODS: We collected data on middle-aged adults employed by the City of Helsinki (n=8970; 67% response rate). Associations between 7 socioeconomic indicators and health self-ratings of less than "good" were examined with sequential logistic regression models. RESULTS: After adjustment for age, each socioeconomic indicator was inversely associated with self-rated health. Childhood economic difficulties, but not parental education, were associated with health independently of all other socioeconomic indicators. The associations of respondents' own education and occupational class with health remained when adjusted for other socioeconomic indicators. Home ownership and economic difficulties, but not household income, were the material indicators associated with health after full adjustment. CONCLUSIONS: Own education and occupational class showed consistent associations with health, but the association with income disappeared after adjustment for other socioeconomic indicators. The effect of parental education on health was mediated by the respondent's own education. Both childhood and adulthood economic difficulties showed clear associations with health and with conventional socioeconomic indicators.

Adult↗
PubMedDate not supplied

Applying a nine cell financial analysis model to home health care.

A nine-cell financial analysis model is used to evaluate the effectiveness of strategies on the economic performance of a home health care agency. Strategies associated with the drivers of economic performance are discussed: volume, unit price, unit costs of resources applied, and quantity of resources applied.

Commerce↗
PubMed1991

Review on risk factors of cervical cancer.

This article reviews risk factors of cervical cancer which have been studied in the following aspects: (1) sociodemographic factors including educational level, urbanizational level, socioeconomic status, race and marriage; (2) sexual activity including age at first marriage, age at first coitus, multiple marriage, multiple sexual partners, broken marriage, unstable sex relationship, syphilis/gonorrhea history, coital frequency, multiple pregnancies and age at menarche; (3) factors related to husband including circumcision, sperm, smegma, previous wife with cervical cancer and occupations entailed mobility of husband and periods away from home; (4) psychosocial factors including stressful emotional status, deprived economic background and discontent home situation; (5) virus including herpes simplex type 2 and papilloma virus; (6) other factors including smoking, barrier and oral contraceptives.

Female↗
PubMedDate not supplied

A cost-utility analysis of the home parenteral nutrition program at Toronto General Hospital: 1970-1982.

We performed an economic evaluation of a home parenteral nutrition (HPN) program by measuring the incremental costs and health outcomes for a cohort of 73 patients treated at our institution from November 1970 to July 1982. Over a 12-year time frame, we estimate that HPN resulted in a net savings in health care cost of $19,232 per patient and an increase in survival, adjusted for quality of life, of 3.3 years, compared with the alternative of treating these patients in hospital with intermittent nutritional support when needed. This result was sensitive to assumptions made about the cost of the alternative treatment strategy. When these assumptions were most unfavorable to the HPN program, we estimated that HPN resulted in incremental costs of $48,180 over 12 years, $14,600 per quality-adjusted life-year gained. We conclude that the cost-utility of HPN compares favorably with other health care programs, when HPN is used to treat patients with gut failure secondary to conditions such as Crohn's disease or acute volvulus. Since only one patient with active malignancy was enrolled in our HPN program, these results should not be extrapolated to patients with active malignancy.

Actuarial Analysis↗