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PubMedDate not supplied

Trends in medical care cost--revisited.

Market forces have had a greater influence on the health care sector than anticipated. The increased use of managed care, particularly HMOs, has been largely responsible for a sharp deceleration in the rise of medical care costs. After recording double-digit growth for much of the post-Medicare/Medicaid period, national health expenditures rose just 5.1 percent and 5.5 percent in 1994 and 1995, respectively. The medical care Consumer Price Index (CPI) rose 3.5 percent in 1996-just 0.5 percent above the overall CPI. The delivery and financing of health care continues to evolve within a framework of cost constraints. As such, mergers, acquisitions and provider alliance groups will remain an integral part of the health industry landscape. However, cost savings are likely to become more difficult to achieve, especially if the "quality of care" issue becomes more pronounced. National health expenditures, which surpassed the $1 trillion mark in 1996, are projected to rise to $1.4 trillion by the year 2000--representing a 7.2 percent growth rate from 1995. In any event, demographics and technological advances suggest that the health sector will demand a rising share of economic resources. The ratio of health care expenditures to gross domestic product is forecast to rise from 13.6 percent in 1995 to 15 percent by the year 2000.

Economic Competition↗
PubMed2005

[The introduction of the electronic health card in Germany].

From 2006 onwards all members of the health insurance system in Germany will be issued an electronic health card which will replace the current health insurance card. The new health card will be technically upgraded to also include patient-related health data or provide access to such data in addition to its administrative functions. Therefore, it is evident that the health card be fitted with a microprocessor that permits authentication (electronic identity check), encryption and the electronic digital signature, thus ensuring maximum data safety and security. For easy identification of the insured person, the electronic health card will bear a photograph of the card holder.

Computer Communication Networks↗
PubMed2005

Association between physical and cognitive function in healthy elderly: the health, aging and body composition study.

Performance measures of physical function (gait speed, chair stands, standing balance) and cognitive function [Teng-modified Mini-Mental Status Exam (3MS) and digit symbol substitution test (DSST)] were assessed at baseline in 3,075 participants in the Health, Aging and Body Composition Study. Each physical function measure was examined for the strength and magnitude of association with cognitive function. All physical function measures were associated with both the 3MS and DSST scores (p < 0.001), and in multivariate analysis each relationship was independent of demographic characteristics, weight, physical activity and comorbid health conditions of participants. The association of motor performance was consistently greater for the DSST than the 3MS and, among the motor tests, gait speed retained a significant association with both cognitive measures independent of demographic, weight, physical activity and comorbid health conditions. In this large cohort of high-functioning older adults, the correlation between physical and cognitive function was not entirely explained by demographics. Longitudinal studies are needed to determine the direction of causality in this relationship.

Aged↗
PubMed1993

Access to medical care among the elderly in rural northeastern Ohio.

BACKGROUND: Conventional wisdom holds that the elderly living in rural areas suffer poor health and have limited access to health care compared with their urban peers. The relation between poor health and limited access, however, has yet to be adequately defined. METHODS: We conducted a telephone survey of 1000 elderly persons living in four rural northeastern Ohio counties using a proportional random-digit dialing method. RESULTS: Many rural elderly respondents appeared to suffer poor health and have limited access to medical care. However, a detailed analysis revealed that poor health and limited access were more perceptual than actual. CONCLUSIONS: Elderly persons living independently in rural northeast Ohio have much better health and access to care than suggested by the literature.

Aged↗
PubMed2006

Predictors of frequent emergency department utilization in Southeastern Pennsylvania.

STUDY OBJECTIVE: We sought to determine socioeconomic and demographic factors that predict frequent emergency department (ED) use among asthmatics in Southeastern Pennsylvania. DESIGN: Retrospective cohort study using the 2004 Philadelphia Health Management Corporation's Southeastern Pennsylvania Household Health Survey. SETTING AND PARTICIPANTS: Health behaviors were surveyed using telephone interviews (random-digit dialing) in Bucks, Montgomery, Delaware, Philadelphia, and Chester counties. Response rate was 30%. RESULTS: Of 13,342 respondents, 1,799 (13%) stated that they had asthma. The mean reported visits in 12 months were as follows: clinic--1.2 (SD 2.7); doctor's office--4.7 (SD 5.6); ED--0.8; (SD 1.8); overnight hospitalizations--0.4 (SD 0.9). Most (91%) reported that a primary care doctor was their principal source of care, whereas 2% reported the ED as their principal source of care. Frequent ED use (>or=3 visits/12 months) was reported in 180 (10%). Frequent ED use was associated with race, education, diabetes, mental illness, smoking at home, and language barriers (p < 0.001) as well as indicators of severity of illness (clinic visits, office visits, prescription for asthma medication, p < 0.001). Using multivariable logistic regression, predictors of frequent ED use were: prescription for asthma meds (OR 2.3, 95%CI 1.4-3.7), having Medicaid or Medical Assistance (OR 1.7, 95%CI 1.1-2.6), having a high school education or less (OR 1.5, 95%CI 1.0-2.3), number of clinic visits (OR 1.1, 95% CI 1.1-1.1), office visits (OR 1.1, 95%CI 1.1-1.1), number of children living in the house (OR 1.2, 95% CI 1.0-1.3), and living in Philadelphia (OR 2.0, 95% CI 1.3-3.1). CONCLUSIONS: Frequent ED use is associated with demographic factors, geographic factors, and markers of severity of illness. While care guidelines recommend prompt referral to a primary care physician to prevent ED visits, given the level of primary care use in this population, frequent primary care attendance alone may not prevent asthma-related ED visits.

Adolescent↗
PubMed2004

The transition from an analog to a digital echocardiography laboratory: the Mayo experience.

Our echocardiography laboratory has completed the transition from an analog to a digital imaging laboratory. The process involved a thorough analysis of the practice and design of a complete digital solution. After an effective implementation of a robust reporting solution, the transition to digital imaging ensued. The implementation plan for digital imaging enabled the transition to be made without adversely affecting the practice, which has an average daily examination load of more than 200 patients. Full-load testing simulations were required on high-end image processing review workstations, high-speed local area network connections to each imaging suite, and new clustered imaging servers. We had to test the ability of approximately 100 ultrasound machines with 3 idiosyncratic ultrasound platforms to allow digital image transfer to the new imaging servers over the local area network. Our sonographer, allied health, and physician staff of more than 250 persons had to be trained to adapt to important changes that the digital echocardiographic image acquisition and review platform would have on their specific roles in the laboratory. The efficiency of the implementation, reporting, and imaging resulted in improved staff resource allocation. The lessons learned may benefit laboratories with a similar interest in making the transition to a digital imaging laboratory with minimal effect on patient scheduling and staff satisfaction. The effect of the transition to a completely digital laboratory on operating expenses, imaging, and reviewing systems and the impact on the clinical practice of echocardiography at our institution are presented, with emphasis on the particular aspects of transitioning to digital imaging.

Cardiology↗
PubMed1998

Morphologic operations used to distinguish between two patient populations differing in periodontal health.

OBJECTIVES: This study was conducted to determine whether morphologic operation procedures applied to digitized, non-standardized, clinical radiographs of mandibular alveolar bone could be used to distinguish between a population of patients diagnosed with periodontitis and a population of patients either diagnosed with gingivitis or having healthy gingivae. STUDY DESIGN: Two groups, one consisting of 29 patients who either had healthy gingivae or had been diagnosed with gingivitis and the other consisting of 32 patients who had been diagnosed with periodontitis, were compared. Pre-existing clinical radiographs were digitized, and for each patient three to six regions of interest were placed on an image of the mandibular posterior region of the interdental bone. The regions of interest were processed under two morphologic-operations protocols, and a mean density (referred to as an MO number) was calculated for each patient. With paired t-tests, the resulting MO numbers for the two groups were compared. RESULTS: The two populations were statistically different (p < 0.05). CONCLUSION: The results of this study indicate that morphologic operations have the potential to differentiate between patient groups differing in periodontal health.

Adult↗
PubMed2003

The relationship of race to women's use of health information resources.

OBJECTIVE: The purpose of this study was to examine, among the general public, the independent effect of race on women's use of health information resources. STUDY DESIGN: A population-based random-digit dialing survey of adult women, aged 18 to 64 years, was conducted between October 1999 and January 2000. Subjects included 509 women (341 white women, 135 black women, and 33 women of other races). The response rate was 66%. The main outcome variable was the use of health information resources (print health or news media, broadcast media, computer resources [Internet], health organizations, organized health events). Logistic regression was used to determine the independent effect of race/ethnicity on the use of different information resources, with an adjustment for age, income, education, and marital status. RESULTS: After the adjustment for socioeconomic factors, black women had <50% odds of using print news media (odds ratio, 0.5; 95% CI, 0.4-0.8), <60% odds of using computer-based resources (odds ratio, 0.4; 95% CI, 0.2-0.6), and <70% odds of using health policy organizations (odds ratio, 0.3; 95% CI, 0.2-0.7), compared with white women. CONCLUSION: There is a large racial disparity in women's use of health information resources. Traditional sources that are used to provide patient information may not be effective in certain populations.

Adult↗
PubMed2000

Epidemiological data sources in Estonia: a survey of registries and databases.

BACKGROUND: Central and Eastern European countries offer opportunities for studying the health effects of historical and present exposures, as well as the transition to a market economy. A prerequisite for research is the availability of good-quality information. This study was undertaken to describe sources of individual data that are available for epidemiological research in Estonia. Particular attention was paid to the methods of operation of health registries. METHODS: Information was collected during site visits, interviews with registry personnel and from published reports. For health registries, information was specifically requested on data collection, scope of recorded data, quality control, electronic linkage capability and use of data in research. RESULTS: The authors describe 35 data sources containing individual information on vital status, mortality, morbidity, natality and women's health, health and health care, and occupation. The most important health registries are the cancer registry, with data from 1968, and the medical birth registry, with data from 1992. Computerised cause-of-death information is available from 1983. Electronic linkage can be done with most of the data sources, the main matching variable being the eleven-digit personal identification number. Factors potentially affecting data-quality in health registries are undefined legal basis, scarcity of funding and staff, poor acknowledgement of problems, and rare scientific use of registry DISCUSSION: Various data sources are available for epidemiological research in Estonia. Thus far, collected data have largely been an under-used scientific resource. In health registries, more attention should be paid to quality control and continuous involvement of researchers.

Birth Certificates↗
PubMed2005

What is eHealth (4): a scoping exercise to map the field.

BACKGROUND: Lack of consensus on the meaning of eHealth has led to uncertainty among academics, policymakers, providers and consumers. This project was commissioned in light of the rising profile of eHealth on the international policy agenda and the emerging UK National Programme for Information Technology (now called Connecting for Health) and related developments in the UK National Health Service. OBJECTIVES: To map the emergence and scope of eHealth as a topic and to identify its place within the wider health informatics field, as part of a larger review of research and expert analysis pertaining to current evidence, best practice and future trends. METHODS: Multiple databases of scientific abstracts were explored in a nonsystematic fashion to assess the presence of eHealth or conceptually related terms within their taxonomies, to identify journals in which articles explicitly referring to eHealth are contained and the topics covered, and to identify published definitions of the concept. The databases were Medline (PubMed), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Science Citation Index (SCI), the Social Science Citation Index (SSCI), the Cochrane Database (including Dare, Central, NHS Economic Evaluation Database [NHS EED], Health Technology Assessment [HTA] database, NHS EED bibliographic) and ISTP (now known as ISI proceedings). We used the search query, "Ehealth OR e-health OR e*health". The timeframe searched was 1997-2003, although some analyses contain data emerging subsequent to this period. This was supplemented by iterative searches of Web-based sources, such as commercial and policy reports, research commissioning programmes and electronic news pages. Definitions extracted from both searches were thematically analyzed and compared in order to assess conceptual heterogeneity. RESULTS: The term eHealth only came into use in the year 2000, but has since become widely prevalent. The scope of the topic was not immediately discernable from that of the wider health informatics field, for which over 320000 publications are listed in Medline alone, and it is not explicitly represented within the existing Medical Subject Headings (MeSH) taxonomy. Applying eHealth as narrative search term to multiple databases yielded 387 relevant articles, distributed across 154 different journals, most commonly related to information technology and telemedicine, but extending to such areas as law. Most eHealth articles are represented on Medline. Definitions of eHealth vary with respect to the functions, stakeholders, contexts and theoretical issues targeted. Most encompass a broad range of medical informatics applications either specified (eg, decision support, consumer health information) or presented in more general terms (eg, to manage, arrange or deliver health care). However the majority emphasize the communicative functions of eHealth and specify the use of networked digital technologies, primarily the Internet, thus differentiating eHealth from the field of medical informatics. While some definitions explicitly target health professionals or patients, most encompass applications for all stakeholder groups. The nature of the scientific and broader literature pertaining to eHealth closely reflects these conceptualizations. CONCLUSIONS: We surmise that the field -- as it stands today -- may be characterized by the global definitions suggested by Eysenbach and Eng.

Delivery of Health Care↗
PubMed2001

The readability of pediatric patient education materials on the World Wide Web.

BACKGROUND: Literacy is a national and international problem. Studies have shown the readability of adult and pediatric patient education materials to be too high for average adults. Materials should be written at the 8th-grade level or lower. OBJECTIVE: To determine the general readability of pediatric patient education materials designed for adults on the World Wide Web (WWW). MATERIALS AND METHODS: GeneralPediatrics.com (http://www.generalpediatrics.com) is a digital library serving the medical information needs of pediatric health care providers, patients, and families. Documents from 100 different authoritative Web sites designed for laypersons were evaluated using a built-in computer software readability formula (Flesch Reading Ease and Flesch-Kincaid reading levels) and hand calculation methods (Fry Formula and SMOG methods). Analysis of variance and paired t tests determined significance. RESULTS: Eighty-nine documents constituted the final sample; they covered a wide spectrum of pediatric topics. The overall Flesch Reading Ease score was 57.0. The overall mean Fry Formula was 12.0 (12th grade, 0 months of schooling) and SMOG was 12.2. The overall Flesch-Kincaid grade level was significantly lower (P<.0001), at a mean of 7.1, when compared with the other 2 methods. All author and institution groups had an average reading level above 10.6 by the Fry Formula and SMOG methods. CONCLUSIONS: Pediatric patient education materials on the WWW are not written at an appropriate reading level for the average adult. We propose that a practical reading level and how it was determined be included on all patient education materials on the WWW for general guidance in material selection. We discuss suggestions for improved readability of patient education materials.

Adult↗
PubMed1986

[Experiences with early diagnosis of colon and rectum carcinomas in West Germany--epidemiological viewpoint].

In the framework of a nationwide screening for cancer in the Federal Republic of Germany, the digital rectal examination has been paid for by legal health insurance since 1974 and the fecal occult blood test since 1977. In view of the cost involved, attempts at an evaluation ought to be made despite the lack of necessary documentation for direct linkage of participation with outcome. Two national registries show rising incidence already beginning at age 40 for both tumour sites, whereas since 1977 the mortality rates in the whole Republic for rectal cancer began to decline. A similar effect became apparent for colon cancer mortality in 1979 for both sexes. The discrepancy between low participation rates in the age groups with the most substantial decline of mortality makes it hard to reason that it was a direct effect of the screening, especially in the light of a theoretical estimation of no effect on overall mortality considering the sensitivity of the screening test, in-depth follow-up examination, lethality with and without screening and a predictive value of the test of five percent. It appears, therefore, imperative to improve the evaluation, if necessary by case-referent studies.

Adult↗
PubMed1999

Aspects of computer security: a primer.

As health care organizations continue on the path toward total digital operations, a topic often raised but not clearly understood is that of computer security. The reason for this is simply the vastness of the topic. Computers and networks are complex, and each service offered is a potential security hole. This article describes for the lay person the fundamental points of computer operation, how these can be points attacked, and how these attacks can be foiled--or at least detected. In addition, a taxonomy that should aid system administrators to evaluate and strengthen their systems is described.

Computer Communication Networks↗
PubMed2006

[The task of the HNO specialist by Hearing Aid fitting. Part 1: indications, special diagnostic tests, prescription].

The first part of the article deals with the indication of fitting, which mainly is given when the communication is impaired, not only in dialogue with one person, but also in conversation with several persons and in noisy surrounding. Yet, the healthy insurances cover only the expenses if the guidelines on relief-aid are considered, which are exactly listed in this article. Bevor starting the fitting of an Hearing Aid, special diagnostic tests are necessary, such as pure tone audiogram, speech audiogram including dB(opt), freefield measurement in noise, and several retrocochlear tests, as well as tinnitus determination and masking with narrow-band and broad-band noise. Most important is the correct filling in the form "Ohrenärztliche Verordnung einer Hörhilfe", including the necessity of renewal. In addition, it is necessary to accentuate the need of trying out several Hearing Aids and to let the patient know that digital Hearing Aids will not be covered by the health insurance.

Germany↗
PubMed2006

Systemic vasculitis revealing a benign tumor: a paraneoplastic syndrome?

Systemic vasculitis is a rare event in the course of malignant tumors and has not been described in association with benign tumors. We report a case of renal oncocytoma in a patient who presented with digital necrosis, arthralgia, myalgia, and a decline in general health. The symptoms resolved fully after tumor excision, supporting a diagnosis of paraneoplastic syndrome.

Adenoma, Oxyphilic↗
PubMed2002

Improved electrocardiographic detection of left ventricular hypertrophy.

We studied the echocardiographic measurements and the digital electrocardiograms (ECGs) of 3378 participants in the Cardiovascular Health Study and divided the subjects into a Learning Set of 1678 subjects and a demographically matched Test Set of 1700 subjects. We defined left ventricular hypertrophy (LVH) as values of the echocardiographic left ventricular mass index (LVMI) >116 g/m(2) in men or >104 g/m(2) in women. We performed univariate linear regression separately on the male and female subjects in the Learning Set to find all the ECG parameters that correlated significantly with LVMI. We then applied multivariate linear regression (MLR) to these parameters to identify the 4 variables for each sex that discriminated best between the subjects with and without LVH. We then applied the resultant sex-specific linear regressions to the subjects in the Test Set. We found that the diagnostic performances for LVH of the new MLR equations were superior to those of three commercial computerized ECG diagnostic algorithms in both men and women. We also found that for the new MLR and for all three commercial algorithms, the diagnostic sensitivities at matched specificities were superior in the men compared to those in the women. We conclude that the new MLR equation identifies patients with echocardiographically determined LVH more reliably than do 3 commercial computerized diagnostic algorithms and that the sensitivities of each of these modalities is greater in men than it is in women.

Echocardiography↗
PubMedDate not supplied

Quality of life in rheumatoid arthritis.

Assessment of health-related quality of life (HRQoL) is relevant for the patients and is important in both clinical research and daily clinical practice. Generic and disease-specific instruments for assessment of HRQoL are reviewed. Changes in HRQoL provide important information on randomized controlled clinical trials as well as on observational studies. The floor effect is a limitation of many of the scales, especially in patients with less severe disease. Feasibility and low test-retest reproducibility limit the use of many of the instruments in clinical practice, especially when they are used for individual treatment decisions. Electronic transferral of data from patients to the health professionals by, for example, internet or a personal digital assistant (PDA), opens up new opportunities for frequent patient reports and improved access to the data.

Arthritis, Rheumatoid↗
PubMed2002

Using personal digital assistants to access drug information.

The use of personal digital assistants (PDAs) to access drug information in a health system is described. Given the widespread use of PDAs at an 872-bed university health system, an opportunity existed to provide current drug information to physicians via these devices. As part of the health system's intranet, extensive online content had been made available through a browser; extension to PDAs was a natural next step. There were two primary requirements: the ability to synchronize information with the database server when a PDA was used and the development of content and applications by using existing staff. Mobile enterprise software was chosen that supports multiple PDA platforms, is easy to use, and does not require programming skills. The software works through customized "channels," or collections of information from a content provider. The customized channel service works over the Internet. Two channels of content were created, an ambulatory care channel and an inpatient care channel. The ambulatory care channel contains a list of preferred ambulatory care agents, poison control information, the locations of outpatient pharmacies, drug information, and safety tips for prescribing. The inpatient channel contains the inpatient formulary, current news and events, information on currrent drug shortages and recalls, pharmacy contact information, and medication safety tips. When a user synchronizes his or her PDA, the software contacts the department's intranet servers and processes the request. The data are compressed and downloaded to the user's PDA. A university health system successfully used PDAs to access drug and other information.

Clinical Pharmacy Information Systems↗