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Deprivation payments to general practitioners: limitations of census data.

The census data from which deprivation payments have been calculated since June 1995 suffer from limitations including underenumeration; under counting of homeless people and refugees, and artefactual errors because of the way in which the 1991 census data were tabulated. These limitations reduced the fairness of the changes that many practices experienced in their deprivation payments. The validity of the current system of deprivation payments would be improved if these limitations were borne in mind when allocating payments to practices and if enumeration districts were used as the basis of payments rather than electoral wards.

Catchment Area, Health↗

Relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units, and alternative residential options: a cross sectional survey, one day census data, and staff interviews.

OBJECTIVES: To examine the relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units and to explore the range of alternative residential options. DESIGN: Cross sectional survey, combined with one day census data; ratings by and interviews with staff; examination of routine data sources. SETTINGS: Nationally representative sample of acute psychiatric units. SUBJECTS: 2236 patients who were inpatients on census day. MAIN OUTCOME MEASURES: Bed occupancy levels, judged need for continuing inpatient care, reasons preventing discharge, scores on the Health of the Nation outcome scales. RESULTS: Bed occupancy was related to social deprivation and total availability of acute beds (r = 0.66, 95% confidence interval 0.19 to 0.88, F = 8.72, df = 2.23; P = 0.002). However, 27% (603/2215) of current inpatients (61% (90/148) of those with stays of > 6 months) were judged not to need continuing admission. The major reasons preventing discharge were lack of suitable accommodation (37% (176/482) of patients in hospital < 6 months v 36% (31/86) of those in hospital > 6 months); inadequate domiciliary based community support (23% (113) v 9% (8)); and lack of long term rehabilitation places (21% (100) v 47% (40)). Scores on the Health of the Nation outcome scale were generally consistent with these staff judgments. CONCLUSIONS: The shortage of beds in acute psychiatric units is related to both social deprivation and the overall availability of acute beds. Patients currently inappropriately placed on acute admission wards should be relocated into more suitable accommodation, either in hospital or in the community. A range of provisions is required; simply providing more acute beds is not the answer.

Acute Disease↗

National census of availability of neonatal intensive care. British Association for Perinatal Medicine.

OBJECTIVE: To determine whether availability of neonatal intensive care cots is a problem in any or all parts of the United Kingdom. DESIGN: Three month census from 1 April to 30 June 1999 comprising simple data sheets on transfers out of tertiary units. SETTING: The 37 largest high risk perinatal centres in the United Kingdom. PARTICIPANTS: One obstetric specialist and one neonatal specialist in each centre. MAIN OUTCOME MEASURES: Suboptimal care resulting directly from pressure on service-that is, transfers out of tertiary units (either in utero or after delivery) because the unit was "full" and not because the hospital was incapable of providing the care needed. RESULTS: All units provided data. The number of intensive care cots in each unit was between five and 16. During the three months 309 transfers occurred (equivalent to 1236 per year), of which 264 were in utero and 45 postnatal. Sixty five in utero transfers involved multiple births, hence the census related to 382 babies (1528 per year). There was considerable regional variation. The reason for transfer in most cases was "lack of neonatal beds". CONCLUSIONS: Currently most major perinatal centres in the United Kingdom are regularly unable to meet in-house demand; this has implications for the service as a whole. The NHS has set no standards to help health authorities and primary care groups develop services relating to this specialty; such a step may well be an appropriate lever for change.

Bed Occupancy↗

Census of mental hospital patients and life expectancy of those unlikely to be discharged.

A census in a London mental hospital was performed so that the numbers of patients requiring permanent care for the next 20 to 40 years could be estimated. Of 1467 resident patients 20% had been admitted in the preceding five months and 15% in the year before that. Of the 65% who had been in hospital for over 17 months 1% (16 patients) had been in hospital for over 5o years. Altogether 257 (18%) patients would probably be discharged, 339 (23%) might possibly be discharged if there were adequate community facilities, but 871 (59%) were not likely to be discharged; 239 patients under the age of 65 who had been admitted between 1950 and 1973 were unlikely to be discharged. There were about 10 new younger long-stay patients from each year's admissions. Three conditions--schizophrenia, organic brain syndrome, and affective illness--affected 79% of the population. Fourteen per cent had been employed on admission and 28% were considered employable or possibly employable. Half of those who might be considered for discharge (296) would need a hostel. No rehabilitation was needed or possible for 40% of the patients; 299 (20%) patients were chairbound or bedridden and 400 (27%) were totally dependent on nursing and 587 (40%) partly dependent. Twenty months after the census 361 (25%) patients had left (59 had been readmitted), 284 (19%) had died, and 822 (56%) had remained as inpatients. The most realistic future prediction was that 210 (14%) of these patients would still be in the hospital in 20 years and 43 (3%) in 40 years. In the light of these findings and the scarceness of resources current Department of Health and Social Security plans for phasing out mental hospitals must be challenged.

Affective Symptoms↗

A national census of ambulance response times to emergency calls in Ireland.

BACKGROUND: Equity of access to appropriate pre-hospital emergency care is a core principle underlying an effective ambulance service. Care must be provided within a timeframe in which it is likely to be effective. A national census of response times to emergency and urgent calls in statutory ambulance services in Ireland was undertaken to assess current service provision. METHODS: A prospective census of response times to all emergency and urgent calls was carried out in the nine ambulance services in the country over a period of one week. The times for call receipt, activation, arrival at and departure from scene and arrival at hospital were analysed. Crew type, location of call and distance from ambulance base were detailed. The type of incident leading to the call was recorded but no further clinical information was gathered. Results-2426 emergency calls were received by the services during the week. Fourteen per cent took five minutes or longer to activate (range 5-33%). Thirty eight per cent of emergencies received a response within nine minutes (range 10-47%). Only 4.5% of emergency calls originating greater than five miles from an ambulance station were responded to within nine minutes (range 0-10%). Median patient care times for "on call" crews were three times longer than "on duty" crews. CONCLUSION: Without prioritized use of available resources, inappropriately delayed responses to critical incidents will continue. Recommendations are made to improve the effectiveness of emergency medical service utilisation.

Ambulances↗

Policies of the Office of Population Censuses and Surveys. Philosophy and constraints.

The Medical Division of the Office of Population Censuses and Surveys (OPCS) organizes and indexes general systems of records for medical research and administration. The main sources of records are the census, registrations of births and of deaths, hospital discharge records, registered cases of cancer and of congenital malformations, surveys by the Social Surveys Division, and samples of records in general practice. Results take the form of regularly published series of statistics and commentaries and of studies in depth, often by scientists in the National Health Service (NHS), and research institutions which are encouraged to use the systems for prospective and retrospective surveys. The surveys are facilitated by the central registry where a note of every death in the country is attached to the relevant record (and the causes of death are available). Recent developments include studies of records of general practitioners; the causes of deaths among immigrants in England and Wales; the fertility, migration, and mortality of a cohort of about 1 percent of the population. The publication policy of OPCS is described.

Confidentiality↗

Prediction of general practice workload from census based social deprivation scores.

STUDY OBJECTIVE: The aim was to compare the ability of census based social deprivation scores devised by Jarman, Carstairs, and Townsend to predict workload in general practice. DESIGN: This was a prospective study of 140,050 patients registered with general practices over one year from 1 July 1981 (Third National Morbidity Survey). Main outcome measures were workload score for each patient, defined as a weighted sum of consultations at the surgery and consultations elsewhere, excluding preventive procedures. SETTING: 25 general practices in England and Wales. MAIN RESULTS: In multivariate analyses the Jarman, Carstairs, and Townsend indices all predicted workload, but the Townsend index was the best predictor, with both housing tenure and car ownership being strong predictors of workload. The overcrowding and geographical mobility variables used in the Jarman index did not predict increased workload. The weighting assigned to children under five by the Jarman index underestimated the additional workload this group generated. CONCLUSIONS: For identifying social pressures on general practice workload the Jarman index is less valid than other census based scores because it fails to include car ownership and housing tenure. A more rational scheme for compensating general practitioners would directly weight the capitation fee for children aged under five years and allocate current deprivation payments according to the Townsend index or a similar score. This would redistribute resources from London to deprived areas in northern England.

Adolescent↗

Cancer in young people in the north of England, 1968-85: analysis by census wards.

OBJECTIVE: To determine whether the seeming excess of childhood leukaemia and lymphoma identified in Seascale, Cumbria, UK, remains unusual when put into a wider context. DESIGN: Analysis of cancer incidence by geographical area. SETTING: The north of England including the Northern and North Western Regional Health Authority regions and the Southport and South Sefton districts of the Mersey Regional Health Authority. SUBJECTS: Altogether 6686 cases of malignant disease in people under 25 years old. MEASUREMENTS AND MAIN RESULTS: Cases of cancer diagnosed before their 25th birthday between January 1968 and December 1985 identified from three regional cancer registries were allocated to a census ward on the basis of 'usual place of residence'. Population data were derived from the 1971 and 1981 censuses, and the cancer incidence was calculated for each ward. Of the 6686 cases, there were 1035 cases of acute lymphoblastic leukaemia and 361 of non-Hodgkins lymphoma. Wards were ranked by cancer incidence and Poisson probability, using different population bases. Seascale ward is the most highly ranked ward for acute lymphoblastic leukaemia for the time periods 1968-85 or 1968-76. It is not the most highly ranked for non-Hodgkins lymphoma. However, combining acute lymphoblastic leukaemia and non-Hodgkins lymphoma incidence gives an even more extreme position for Seascale. The most extreme Poisson probability for any of the analyses was that for brain tumours in the electoral ward of Ashton St Michael, Tameside (p = 0.000009). CONCLUSION: The incidence of acute lymphoblastic leukaemia and non-Hodgkins lymphoma in the Seascale ward remains high when put into a wider context. For other cancers there are wards with even more extreme Poisson probability values.

Adolescent↗

Census and consensus in bacterial ecosystems: the LuxR-LuxI family of quorum-sensing transcriptional regulators.

The importance of accurate demographic information is reflected in the United States Constitution, Article 1, which provides for a decennial census of this country's human population. Bacteria also conduct a census of their population and do so more frequently, more efficiently, and as far we know, with little if any of the political contentiousness caused by human demographers. Many examples have been found of particular bacterial genes, operons, or regulons that are expressed preferentially at high cell densities. Many of these are regulated by proteins related to the LuxR and LuxI proteins of Vibrio fischeri, and by a diffusible pheromone called an autoinducer. LuxR and LuxI and their cognate autoinducer (3-oxohexanoyl homoserine lactone, designated VAI-1) provide an important model to describe the functions of this family of proteins. LuxR is a VAI-1 receptor and a VAI-1-dependent transcriptional activator, and LuxI directs the synthesis of VAI-1. VAI-1 diffuses across the bacterial envelope, and intracellular concentrations of it are therefore strongly increased by nearby VAI-1-producing bacteria. Similar systems regulate pathogenesis factors in Pseudomonas aeruginosa and Erwinia spp., as well as T1 plasmid conjugal transfer in Agrobacterium tumefaciens, and many other genes in numerous genera of gram-negative bacteria. Genetic analyses of these systems have revealed a high degree of functional conservation, while also uncovering features that are unique to each.

4-Butyrolactone↗

[Risk profile: multivariate cluster analysis of urban small areas based on socioeconomic indicators - census tracts from the Greater Rio de Janeiro Metropolitan Area]

A method based on small area data analysis was developed to build a health risk classification for the Greater Rio de Janeiro Metropolitan Area. The approach uses 1991 census data and studies data pertaining to sanitation, ownership and type of housing, size and occupancy of the household, demography, schooling, and income. Principal component analysis applied over each dimension allowed for the choice of 15 variables, which summarized most of the observed variances. Additional analysis with these variables suggested that just six variables are sufficient for the construction of a classification using k-means method of multivariate cluster analysis. Five classes were obtained: (A) high income; (B) lower income; (C) poor; (D) low schooling and income; (E) low-level access to sanitation. The existing inequality in each of the geopolitical established areas was clearly identified. The proposed method allowed for the construction of compound indices to evaluate quality of life, based on widespread and easily obtained data (the census). Moreover, the method contributed to the detection of socioeconomic inequality, identifying, not only the larger poor regions but also the small excluded areas.

Journal Article↗

Using census and mortality data to target small areas for breast, colorectal, and cervical cancer screening.

OBJECTIVES: The goal of this study was to develop and validate quantitative models for estimating cancer incidence in small areas. METHODS: The outcome for each cancer site was the incidence of disease that had reached a late stage at the time of diagnosis. Two sets of predictors were used: (1) census-based demographic variables and (2) census-based demographic variables together with the cancer-specific mortality rate. RESULTS: The best models accounted for a substantial percentage of between area variability in late-stage rates for cancer of the breast (46%), cervix (61%), and colon/rectum (58%). A validation procedure indicated that correct identification of small areas with high rates of late-stage disease was two to three times more likely when model-based estimates were used than when areas were selected at random. CONCLUSIONS: Additional testing is needed to establish the generality of the geographic targeting methodology developed in this paper. However, there are strong indications that small-area estimation models will be useful in many regions where planners wish to target cancer screening programs on a geographic basis.

Breast Neoplasms↗

Basic characteristics of radiology groups in the United States: results of a 1991-1992 census.

OBJECTIVE: The American College of Radiology (ACR), the principal professional organization of United States radiologists, receives numerous requests for information on the characteristics of radiology groups. This report describes the basic characteristics of radiology groups in the United States. We defined radiology groups as any practice with two or more radiologists or radiation oncologists, including academic departments, units in multispecialty groups, and staff of government facilities. MATERIALS AND METHODS: To collect basic information on radiology groups, the ACR conducted a mail census of all identified radiology groups in the United States during late 1991 and early 1992. Follow-up was conducted by mail and telephone. To make the responses accurately representative of all radiology groups, we weighted the approximately 2000 responses to correspond to known control totals for the number of groups of each of seven size categories in each of the four census regions (Northeast, Midwest, South, and West). These control totals were obtained from the ACR's 1990 Manpower Survey, which showed a total of approximately 3200 radiology groups. RESULTS: Approximately one fourth of all groups have two radiologists, one fourth have three or four radiologists, one fourth have five to seven radiologists, and one fourth have eight or more radiologists. Academic groups were relatively large; almost 50% had 11 or more radiologists. Nonmetropolitan areas had very few large groups, and metropolitan center cities had relatively few small groups. Ninety-two percent of all groups practiced at hospitals, and 73% of all groups practiced at nonhospital offices or centers. The median number of practice sites for all groups was three, including both hospital and nonhospital sites. Eighty-eight percent of all groups provided diagnostic radiology services, 23% provided radiation oncology, 12% offered both, and 11% were oncology-only groups. Relatively many academic groups (25%) were oncology-only groups; very few radiology groups (2%) in multispecialty practices were oncology-only groups. The diagnostic radiology techniques available from the largest percentages of groups were general radiography (plain film), sonography, mammography, and CT. One eighth of academic groups that provided diagnostic services did not report providing mammography, compared with only a few percent of all groups in the United States that provided diagnostic services. CONCLUSION: Half of all groups have two to four radiologists, and this has not changed since at least 1986. A substantial percentage of groups that perform diagnostic radiology do not provide MR, interventional, or nuclear medicine services. This is particularly true of relatively small groups. These characteristics may become the source of some problems as managed care becomes more prominent and larger groups, offering a full range of services and practicing at several sites, are favored by managed care organizations that seek to contract with one group for all their radiology services.

Data Collection↗

The relationship between census-derived socio-economic variables and general practice consultation rates in three town centre practices.

BACKGROUND: The relationship between socio-economic factors and consultation rates is important in determining resource allocation to general practices. AIM: To determine the relationship between general practice surgery consultation rates and census-derived socio-economic variables for patients receiving the same primary and secondary care. METHOD: A retrospective analysis was taken of computerized records in three general practices in Mansfield, North Nottinghamshire, with 29,142 patients spread over 15 electoral wards (Jarman score range from -23 to +25.5). Linear regression analysis of surgery consultation rates at ward and enumeration district levels was performed against Jarman and Townsend deprivation scores and census socio-economic variables. RESULTS: Both the Townsend score (r2 = 59%) and the Jarman score (r2 = 39%) were associated with surgery consultation rates at ward level. The Townsend score had a stronger association than the Jarman score because all four of its component variables were individually associated with increased consultations compared with four out of eight Jarman components. CONCLUSIONS: Even in practices not eligible for deprivation payments there were appreciable differences in consultation rates between areas with different socio-economic characteristics. The results suggest that the variables used to determine deprivation payments should be reconsidered, and they support suggestions that payments should be introduced at a lower level of deprivation and administered on an enumeration district basis.

England↗

What sells? 1991 Menu Census.

The boneless chicken fillet, seasoned fries and broccoli pictured on our cover are an operator's dream: According to the operators surveyed for R&I's Menu Census, these items not only sell well enough to be on the menu--they're top good sellers. In this issue's Menu Census exclusive, "What Sells," we examine the major menu categories and identify, for both commercial and institutional operations, which menu items qualify for good-seller status. Compare your menu to our list of what sells--how do your offerings stack up? Bonus: Sidebars show most-menued items and top-scoring rookie entries.

Consumer Behavior↗

Declining average daily census. Part 2: Possible solutions.

Several possible solutions are available to hospitals experiencing a declining average daily census, including: Closure of some U.S. hospitals; Joint ventures between physicians and hospitals; Development of integrated and coordinated medical-fiscal-management information systems; Improvements in the hospital's short-term marketing strategy; Reduction of the facility's internal operation expenses; Vertical more than horizontal diversification to develop a multilevel (acute through home care) regional health care system with an alternative health care payment system that is a joint venture with the medical staff(s); Acquisition or management by a not-for-profit or investor-owned multihospital system (emphasis on horizontal versus vertical integration). Many reasons exist for an institution to choose the solution of developing a regional multilevel health care system rather than being part of a large, geographically scattered, multihospital system. Geographic proximity, lenders' preferences, service integration, management recruitment, and local remedies to a declining census all favor the regional system. More answers lie in emphasizing the basics of health care regionalization and focusing on vertical integration, including a prepayment plan, rather than stressing large multihospital systems with institutions in several states or selling out to the investor-owned groups.

Bed Occupancy↗

The curse of census variation.

Variations in daily census have been on ongoing problem for hospitals. An even greater, but virtually ignored, problem is that of yearly census variation. In this article, formulas for predicting the possible range in utilization over the life of the physical facility and methods of planning for those variations are discussed.

Appointments and Schedules↗

Socio-demographic characteristics of New Zealand smokers: results from the 1996 census.

AIMS: To examine the key socio-demographic characteristics of adult smokers in New Zealand based on 1996 census data. METHODS: Data were obtained from the 1996 Census of Populations and Dwellings on smoking status and key socio-demographic variables. Age standardised smoking prevalence rates were calculated. RESULTS: Of the New Zealand population aged 15 years and over, 23.7% reported that they were regular smokers. Maori have the highest smoking prevalence in New Zealand (40.5%) and the peak rate is 55% among young Maori women aged 25-29 years. Pacific Island people, particularly males, have higher smoking rates than Europeans, while among Asians, the rate for males is three to four times the rate for females. People with no qualifications, who are unemployed or earning less than $30,000 per year, and women with high parities also have relatively high smoking prevalence rates. CONCLUSION: The smoking rates of New Zealand population groups are highly heterogeneous and there is substantial scope for focusing tobacco control interventions on those groups with the highest prevalence.

Adolescent↗

A general method of correction for age misreporting in census populations.

The paper provides a general method for estimating age-reporting errors from two consecutive census populations along the lines suggested by Demeny and Shorter (1968). When the true age structures in the two censuses are the same, the general method and the Demeny-Shorter method give identical results. However, the latter method faces increasingly the problem of inconsistency of the results with the underlying sssumptions as the disparity between the age structures becomes more and more significant. The present method is more general in the sense that it always gives consitent results irrespective of the populations under consideration.

Adolescent↗