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PubMed1986

An evaluation of a program to regulate rural hospital costs: the Finger Lakes Hospital Experimental Payment program.

In 1981 eight small- and medium-sized hospitals in a rural area of New York State began voluntary participation in the Finger Lakes Hospital Experimental Payment (FLHEP) program. An annual maximum reimbursement formula was set for each hospital, which offered financial incentives to contain the growth in expenditures without penalty in subsequent years. In this analysis of the first three years of the program, we found that the growth in revenues and expenses in study group hospitals was reduced and chronic deficits were eliminated. The FLHEP model may have wider potential for ensuring solvency while controlling expenditures of hospitals in other rural areas of the United States.

Cost Control↗

PubMed1988

Persistence of reduction in blood pressure and mortality of participants in the Hypertension Detection and Follow-up Program. Hypertension Detection and Follow-up Program Cooperative Group.

The Hypertension Detection and Follow-up Program (HDFP) previously described a significant reduction in five-year, all-cause mortality in its intensively treated stepped care (SC) group relative to its referred care (RC) control group. At the time this finding was described, a proportion of the SC cohort had been treated for periods as long as 6.7 years, but comparable RC and SC mortality data beyond five years were not available. These data, which are described herein, indicate that the 6.7-year life-table mortality rates were 95.1/1000 participants for SC vs 116.3/1000 participants for RC, a larger mortality difference than was observed at five years. This favorable finding for SC extended to all major subgroups, including white women and those aged 30 to 49 years at trial entry. Six months after the close of the treatment trial, a two-year posttrial surveillance study, which extended mortality follow-up to 8.3 years, was conducted. The posttrial use of antihypertensive medication declined in SC and increased in RC participants so that by the end of the posttrial period, there was little difference in the percentages of SC and RC participants taking medication. Control of blood pressure, indicated by mean diastolic blood pressure and by percent of participants with a pressure of 90 mm Hg or less, was slightly better for SC than for RC participants (SC group, 86.5 mm Hg and 68% controlled; RC group, 87.8 mm Hg and 62% controlled). The absolute mortality advantage found at 6.7 years persisted and increased throughout the posttrial period of follow-up despite discontinuation of the formal SC therapy program. It is postulated that regression of hypertensive end-organ changes brought about by the more effective SC treatment caused this favorable outcome.

Adult↗

PubMed1987

Educational level and 5-year all-cause mortality in the Hypertension Detection and Follow-up Program. Hypertension Detection and Follow-up Program Cooperative Group.

Excess mortality in persons of lower socioeconomic status is a finding confirmed in many population studies. Among the nearly 11,000 hypertensive trial participants in the population-based Hypertension Detection and Follow-up Program, lower educational level (an indicator of low socioeconomic status) was associated with a 5-year death rate significantly above that found in those with higher education. This report examines whether this excess was observed uniformly within both treatment groups--stepped care and referred care--or whether the more vigorous antihypertensive program of stepped care was able to reduce the mortality gradient associated with education. In addition, impact on mortality of degree of blood pressure control during the trial was assessed within stepped and referred care groups, taking account also of educational level. Finally, the benefit of stepped care compared with referred care (control group) in reducing mortality was analyzed, controlling for education. Referred care participants with less than a high school education had a 5-year death rate twice as high as those with more than a high school education, whereas no such gradient of mortality was seen in the stepped care group. Level of blood pressure control throughout the trial was better in the stepped than in the referred care group and was significantly (inversely) associated with mortality in the stepped care group, regardless of educational level. In the referred care group as well, the better the control of elevated blood pressure (again, regardless of educational level), the lower the mortality, although this inverse association did not quite reach statistical significance in the referred care group.(ABSTRACT TRUNCATED AT 250 WORDS)

Educational Status↗

PubMedDate not supplied

A wellness program model for family practice residency programs.

For some time health promotion and disease prevention have been expected tenets of medical practices with the public. However, the medical profession has only recently emphasized prevention and wellness promotion as required curricula for study at the undergraduate and graduate levels. Family physicians have been at the forefront in accepting this additional responsibility, but actual implementation of such practices has been difficult for the individual physician. To address this needed transitional step from public demand to practice, a wellness program for residents, faculty, staff, and patients was designed for the Family Practice Residency Program at Cheyenne.

Family Practice↗

PubMed1986

[Program and effectiveness of psychologically-oriented preparation for childbirth. 1. Behavior therapeutic program for childbirth preparation].

A program of preparation for childbirth tested at present by the author is demonstrated, and some results of an investigation about anxieties for labour are pointed out. The program of preparation for childbirth is oriented on behavioural and learning-theoretical principles and contains the following elements: information on pregnancy and labour, functions and effects of pains in labour and the influence of anxiety to muscle tension, vasoconstriction and pain as well as a good knowledge of hospital; relaxation training, breathing exercises and anxiety management techniques as well as self-control strategies.

Adaptation, Psychological↗

PubMed1979

Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group.

The Hypertension Detection and Follow-up Program (HDFP), in a community-based, randomized controlled trial involving 10,940 persons with high blood pressure (BP), compared the effects on five-year mortality of a systematic antihypertensive treatment program (Stepped Care [SC]) and referral to community medical therapy (Referred Care [RC]). Participants, recruited by population-based screening of 158,906 people aged 30 to 69 years in 14 communities througout the United States, were randomly assigned to SC or RC groups within each center and by entry diastolic blood pressure (DBP) (90 to 104, 105 to 114, and 115 + mm Hg). Over the five years of the study, more than two thirds of the SC participants continued to receive medication, and more than 50% achieved BP levels within the normotensive range, at or below the HDFP goal for DBP. Controls of BP was consistently better for the SC than for the RC group. Five-year mortality from all causes was 17% lower for the SC group compared to the RC group (6.4 vs 7.7 per 100, P less than .01) and 20% lower for the SC subgroup with entry DBP of 90 to 104 mm Hg compared to the corresponding RC subgroup (5.9 vs 7.4 per 100, P less than .01). These findings of the HDFP indicate that the systematic effective management of hypertension has a great potential for reducing mortality for the large numbers of people with high BP in the population, including those with "mild" hypertension.

Adult↗

PubMedDate not supplied

Evaluation of a community program for the control of cardiovascular risk factors: the CHAD program in Jerusalem.

A community-focused program for the control of cardiovascular risk factors, the CHAD program, was instituted in a family practice in western Jerusalem in 1971. Its effectiveness was evaluated by comparing the changes detected by surveys conducted in 1970 and 1975 with those observed in an adjacent control neighborhood. Hypertension decreased in prevalence by 33%, hypercholesterolemia by 31%, cigarette smoking by 23% (among men), and overweight by 13%. Allowing for the reductions observed in the control population, the net percent reductions in prevalence were 20% for hypertension, 15% for hypercholesterolemia, 11% for cigarette smoking (men) and 13% for overweight. The net reductions in hypertension, smoking and overweight were statistically significant. The net reductions in mean systolic and diastolic pressures and weight were also significant. The results suggest that intervention centered in primary health care can have an appreciable effect on cardiovascular risk factors in the population.

Adult↗

PubMed1994

Family medicine residency programs. Evaluating the need for different third-year programs.

We asked hospital chief executive officers (CEOs) and District Health Council executive directors (DHCs) to compare third-year family medicine residency programs and judge which are more needed in their communities. Care for the elderly and emergency medicine ranked highest among CEOs, while DHCs ranked care for the elderly and mental health highest. Academic family medicine and northern programs ranked lowest for both groups.

Attitude of Health Personnel↗

PubMed1993

Expression of tyrosinase gene in transgenic mice: programmed versus non-programmed expression.

The transgenic experiment is a useful tool for the study of cell type-specific expression of genes during embryogenesis. We constructed a minigene, mg-Tyrs-J, by fusing a tyrosinase cDNA, Tyrs-J, with the 5' upstream region of genomic deoxyribonucleic acid (DNA) clone, G3L, and microinjected this minigene into fertilized eggs from albino BALB/c mice. It was expected that a melanin pigment would be produced and deposited in the melanosomes of melanocytes of BALB/c mice if the mg-Tyrs-J was expressed in a cell type-specific manner. In the transgenic mice, melanin pigments were observed only in melanocytes and in hair shafts of hair follicles, and in the choroid and pigmented epithelium of the eyes. However, Southern blot analysis of the genomic DNA of the transgenic mice showed that the transgene was present in all tissues examined. These results apparently indicate that the introduced transgene is integrated into a chromosome(s) and distributed among somatic cells, whereas the gene is expressed exclusively in melanocytes, i.e., the transgene is expressed in a cell type-specific manner. Some founder mice were crossed with BALB/c albino mice to establish transgenic lines. Each line and subline shows inherited characteristic phenotypes; in particular, offsprings from two founders exhibited a patched phenotype. The possible mechanism of this interesting expression of these transgenes is discussed in comparison with the results of other investigators who observed both programmed and non-programmed expression of the tyrosinase gene in transgenic mice.

Animals↗

PubMed1993

Implications of the systolic hypertension in the elderly program. The Systolic Hypertension in the Elderly Program Cooperative Research Group.

Several imperatives drive the need to establish the merit of treating isolated systolic hypertension in the elderly. These include its higher prevalence with age, the associated excess cardiovascular risks, and the rapid aging of the population. The Systolic Hypertension in the Elderly Program demonstrated a significant reduction in stroke incidence (fatal and nonfatal) (36%, equivalent to preventing 30 strokes per 1,000 participants per 5 years). A 27% reduction in coronary heart disease incidence and a 32% reduction in all major cardiovascular events were also achieved (equivalent to the prevention of 16 and 55 events per 1,000 participants per 5 years, respectively). These results were associated with a treatment regimen in which the primary agent was low-dose chlorthalidone. The benefits accrued to all subgroups identified based on baseline age, race and sex, blood pressure, serum cholesterol levels, and electrocardiographic abnormalities. The reduction in coronary disease is consistent with predictions based on prospective epidemiological studies and is concordant with other recent intervention trials. It is a reasonable inference from the Systolic Hypertension in the Elderly Program findings that middle-aged as well as older people with isolated systolic hypertension, and people with less severe degrees of this condition, particularly when other risk factors are present, would benefit from such therapy. Another reasonable implication of the trial relates to the matter of preferred drug treatment regimens for diastolic hypertension, in middle-aged as well as older people.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMedDate not supplied

[Comparison between age-dependent (Wald alpha program) and age-independent (Ulm index) analysis program for prenatal detection of Down's syndrome with serum markers].

An age-dependent analytic program (Alpha-Software from Wald) was compared to an age-independent Index (Ulm-Index) in order to determine effectivity of detection in prenatal screening for Down's Syndrome in 7060 pregnant women. The rate of accuracy was similar in both analytic programs (6 from 7), but, the rate of false-positive results was twice as high using the Ulm-Index (14.7 versus 7.7%). The higher rate of amniocentesis necessary using the age-independent Ulm-Index apparently does not justify this method for prenatal screening of Down's Syndrome.

Adolescent↗

PubMed2000

[Development and results of a screening program for COPD in primary care. The PADOC Project(Program for the Increase in the Diagnosis of COPD in Primary Care].

Several studies have shown that up to 75% of patients with chronic obstructive pulmonary disease (COPD) remain undiagnosed. Early diagnosis of such individuals will allow appropriate preventive and therapeutic measures to be prescribed. The PADOC project aimed to determine the efficacy of a COPD screening program for Spanish primary care settings. The participating primary care physicians were required to administer a spirometric test (forced expiratory volume) to all individuals who had not previously been given a diagnosis of COPD, who visited the clinic for any reason over a period of three months and who met the following enrollment criteria: a) age over 35 years and b) smoker of more than 10 cigarettes per day or ex-smoker of more than 10 packs per year. Individuals meeting the criteria for suspicion of COPD (FEV1 < 90% of predicted and FEV1/FVC < 70%) were referred to a pneumologist for confirmation of the diagnosis. One hundred ninety-four primary care physicians participated, administering 3,209 valid spirometric tests. The physicians identified 723 likely cases of COPD (22.5%). Pneumologists examined 278 patients (38.4% of the likely cases) and the final diagnosis was COPD in 153 of the 278 (55%) and asthma in 28 (10%). Therefore, 4.3% of all patients given spirometric tests received a diagnosis of COPD and 0.8% received a diagnosis of asthma. Agreement between spirometric measurements taken by the primary care physicians and those taken by pneumologists was low for FVC and FVC (%) (intra-class correlation coefficient ICC = 0.38 and 0.45, respectively) but good for FEV1 and FEV1 (%) (ICC = 0.78 and 0.67, respectively). We conclude that primary care screening for COPD is possible and would allow us to detect up to 22% of possible cases. Patient flow from one level of clinical care to another should be improved, given that most of the possible cases detected (61.6%) were not seen by the referral pneumologist. Agreement between spirometric measurements taken by primary care physicians and pneumologists was low for FVC but good for FEV1.

Adult↗

PubMed1998

A mental health program report card: a multidimensional approach to performance monitoring in public sector programs.

This report presents a comprehensive, multi-dimensional mental health program performance monitoring system that has recently been implemented in the Department of Veterans Affairs. Principles underlying the development of the system are reviewed and 68 specific monitors are described addressing four major performance domains: access, inpatient care, outpatient care, and economic performance. Simple methods are presented for identifying outliers, for generating summary performance scores across series' of related monitors, and for adjusting results for differences in patient characteristics across locales. Although still technically imperfect, and therefore requiring continuous improvement, monitoring systems such as the one presented can be useful tools guiding and improving service delivery and mental health system performance, and providing a medium of accountability to consumers and other stakeholders.

Community Mental Health Centers↗

PubMed2000

Peer promotion programs and social networks in Ghana: methods for monitoring and evaluating AIDS prevention and reproductive health programs among adolescents and young adults.

This article summarizes the observations and lessons learned regarding the application of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) prevention and reproductive health evaluation methodologies in the context of adolescent and young adult populations and discusses the use of peer network evaluation to understand the dynamics of peer promotion. To examine the interpersonal communication process of peer education, this study tested a new approach using multiple semistructured interviews and network analysis to collect data on 106 peer educators and 526 of their contacts. These evaluation activities were conducted at three sites in Ghana during April 1998, in both periurban and rural locations in both in-school and out-of-school settings. By evaluating the social networks of peer educators it was possible to gain a better understanding of the process of peer education in terms of (a) defining the composition of peer contacts, (b) identifying the social norms that play a critical role in youth decision making, and (c) observing the range of messages and services transmitted during peer education. The objective of this paper is to disseminate the experience of the Center for Education and Development of Population Activities (CEDPA) and Focus on Young Adult's cooperative development of evaluation methodologies for peer promotion and to highlight utilization of these methodologies in a case study in Ghana. The results will be discussed in terms of their possible implications for program managers, researchers, and international agencies.

Acquired Immunodeficiency Syndrome↗

PubMed1989

The role of parents and older peers in school-based cardiovascular prevention programs: implications for program development.

This article describes a set of studies which compare the effectiveness of innovative interventions led by older peers and which included a parent component with teacher-led interventions for nutrition, blood pressure, and smoking prevention. Information about the agreement between parents' and children's (grades six through eight) perception of the children's health behavior and family interaction was also found, by surveying parents and children in 1051 households. Both teacher-led and older peer-led interventions were successful in increasing behavioral capabilities for nutrition and blood pressure, measured one year after the interventions. Results of the parent-child survey showed reasonable agreement between parents and children for reports of the child's exercise, dieting, and fast food consumption, but poorer agreement for smoking and perceptions of family interaction. Results are discussed in relation to the planning of future programs designed to address the importance of peer and parental role models.

Adolescent↗

PubMed1995

Medicaid program; rescission of the guidelines for documenting Medicaid recipient access to immunizations under the Vaccines for Children (VFC) Program--HCFA. Notice.

This notice rescinds the guidelines that we published in the Federal Register on October 3, 1994, that required States to document equal access to immunizations for Medicaid children if States elected to use lower vaccine administration fees than the maximum charges that were published and applicable under the Vaccines for Children program. These guidelines are rescinded in response to public comments on the October 3, 1994 notice. States indicated that there were numerous problems regarding the collection of useable data.

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

PubMed1996

Using clinical data in program design: a family support program for families with preterm infants.

HMOs can use clinical data culled from computerized medical records and provider and patient interviews to examine the impact of premature infant births on the family. The results can help guide health plans in developing a clinical intervention program to address the physical and emotional consequences of low birthweight babies. The Harvard Pilgrim Health Care experience describes the data collection process administrators are taking to design such a clinical intervention.

Case Management↗

PubMed1997

Program activity in the second year of the Rural Telemedicine Grant Program Part 2.

Part 1, in our last issue, detailed the activity levels, number and types of consults, and transmission costs of the 13 telemedicine networks funded in 1994 by the Office of Rural Health Policy's Rural Telemedicine Grant Program. This concluding section presents the authors' conclusions drawn from the objective data in Part 1.

California↗