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PubMed1995

A comparison of the investment in hospital-based obstetrical ultrasound in Wales and Washington state.

The purpose of this study was to examine differences in the way Britain and the United States invest in and deploy a new medical technology. We used structured interviews to obtain information on the technical sophistication and approximate replacement value of all hospital-based obstetrical ultrasound machines in every maternity hospital in Washington state and Wales. The supply of hospital-based ultrasound machines--approximately two machines per 1,000 births--was similar in both countries. Wales had fewer advanced ultrasound machines than Washington state, and they were based exclusively in high-volume district general hospitals; there were no obstetric ultrasound machines in the private sector. In Washington state, the majority of advanced machines were in small and medium-sized hospitals, and many private offices had ultrasound machines. The approximate replacement value of hospital-based machines was three times as high per birth in Washington state as in Wales. In the case of obstetrical ultrasound, centralization of facilities, a relatively small private sector, and global budgeting lead to lower expenditures per patient within the National Health Service without compromising access to care.

Birth Rate↗
PubMed2003

Prehospital DNR orders: what do physicians in Washington know?

OBJECTIVES: To assess whether physicians know of Washington State's prehospital do-not-resuscitate (DNR) policy, 6 years after its implementation. DESIGN: Cross-sectional survey. SETTING: Washington State, April 2001. PARTICIPANTS: Four hundred seventy-one practicing physicians. MEASUREMENTS: Multivariate logistic regression was used to determine relationships between physician and practice characteristics with knowledge of policies governing advance care planning. RESULTS: Among respondents, 60% did not know that Washington State requires an emergency medical service (EMS)-specific DNR order authored by a physician. Seventy-nine percent did not know that patient-authored advance directives apply only in hospitals and medical offices. CONCLUSION: The findings in this study suggest that most physicians in Washington State lack knowledge about the documentation needed for EMS personnel to forgo pre-hospital attempts at cardiopulmonary resuscitation. Further study is needed to determine whether physician education or legislative change is necessary.

Cross-Sectional Studies↗
PubMed1998

Employees exposed to lead in Washington state nonconstruction workplaces: a starting point for hazard surveillance.

A survey of selected Washington state employers was carried out to (1) determine the number of employees working in lead-using businesses, (2) characterize processes and tasks where exposures occur, and (3) determine the number of employers familiar with the lead standard, lead health effects, and how exposures can be controlled. A total of 1822 nonconstruction employers likely to use lead were identified using Washington State Department of Labor and Industries files, telephone directories, Washington State Department of Ecology files, air sampling results from state workplace inspections, and the state's Adult Blood Lead Registry. A total of 89.5% of employers returned the mail questionnaire. Of 789 employers responding that they engaged in lead-using tasks, 45% stated they were aware there was an Occupational Safety and Health Administration standard for lead, 21% had done air sampling for lead, 17% had done blood-lead screening, and 76% reported some type of industrial hygiene measures to control exposures. The most commonly reported lead-using activities included soldering; auto repair; scrap metal handling; sanding; cutting or welding surfaces coated with leaded materials; painting with leaded paints; and radiator repair. A total of 18,970 nonconstruction workers (and 9416 construction workers) were estimated to be lead-exposed in Washington in 1995. Identification of potentially exposed workers through hazard surveillance and characterization of workplace knowledge and practices (through survey and the registry) has allowed the Department of Labor and Industries to target resources toward industries most in need of exposure reduction efforts.

Adult↗
PubMed2004

The effect of mandating complementary and alternative medicine services on insurance benefits in Washington State.

OBJECTIVES: Washington was the first state to require insurance companies to cover all categories of licensed providers. The purpose of this paper was to examine the effect of Washington's law on coverage decisions of major health plans. DESIGN: The study uses literature and document review as well as key informant interviews. SETTINGS/LOCATION: The study focuses on legislation and other legal activity in the state of Washington. The key informant interviews are focused on the decisions of three major health plans. RESULTS: Although the law had a major effect on complementary and alternative medicine (CAM) coverage in Washington, the impact on the use of CAM services and expenditures has been bounded by changing market forces. CONCLUSIONS: CAM providers face scientific tests of measurable efficacy and market tests of consumer value. In this economic environment, CAM stakeholders will have to work hard to maintain their political gains.

Complementary Therapies↗
PubMed2001

Improving the quality of workers' compensation health care delivery: the Washington State Occupational Health Services Project.

This article has summarized research and policy activities undertaken in Washington State over the past several years to identify the key problems that result in poor quality and excessive disability among injured workers, and the types of system and delivery changes that could best address these problems in order to improve the quality of occupational health care provided through the workers' compensation system. Our investigations have consistently pointed to the lack of coordination and integration of occupational health services as having major adverse effects on quality and health outcomes for workers' compensation. The Managed Care Pilot Project, a delivery system intervention, focused on making changes in how care is organized and delivered to injured workers. That project demonstrated robust improvements in disability reduction; however, worker satisfaction suffered. Our current quality improvement initiative, developed through the Occupational Health Services Project, synthesizes what was learned from the MCP and other pilot studies to make delivery system improvements. This initiative seeks to develop provider incentives and clinical management processes that will improve outcomes and reduce the burden of disability on injured workers. Fundamental to this approach are simultaneously preserving workers' right to choose their own physician and maintaining flexibility in the provision of individualized care based on clinical need and progress. The OHS project then will be a "real world" test to determine if aligning provider incentives and giving physicians the tools they need to optimize occupational health delivery can demonstrate sustainable reduction in disability and improvements in patient and employer satisfaction. Critical to the success of this initiative will be our ability to: (1) enhance the occupational health care management skills and expertise of physicians who treat injured workers by establishing community-based Centers of Occupational Health and Education; (2) design feasible methods of monitoring patient outcomes and satisfaction with the centers and with the providers working with them in order to assess their effectiveness and value; (3) establish incentives for improved outcomes and worker and employer satisfaction through formal agreements with the centers and providers; and (4) develop quality indicators for the three targeted conditions (low back sprain, carpal tunnel syndrome, and fractures) that serve as the basis for both quality improvement processes and performance-based contracting. What lessons or insights does our experience offer thus far? The primary lesson is the importance of making effective partnerships and collaborations. Our policy and research activities have benefited significantly from the positive relationship the DLI established with the practice community through the Washington State Medical and Chiropractic Associations and from the DLI's close association with the Healthcare Subcommittee of the Workers' Compensation Advisory Committee. This committee is established by state regulation and serves as a forum for dialogue between the committee and the employer and labor communities. Our experience thus underscores the importance of establishing broad-based support for delivery system innovations. Our research activities have also benefited from the close collaboration between DLI program staff and UW health services researchers. The DLI staff brought important program and policy experience, along with an appreciation of the context and environment within which the research, policy, and R&D activities were conducted. The UW research team brought scientific rigor and methodological expertise to the design and implementation of the research and policy activities. In Washington State, the DLI represents a "single payer" for the purposes of workers' compensation. As discussed earlier, Washington State, along with five other states, has a state-fund system that requires all employers that are not self-insured to purchase workers' compensation insurance through the state fund. No matter what one feels about the merits or drawbacks of a single-payer system of health care financing, the fact is that such a system creates important opportunities for policy initiatives and for research and evaluation. Our ability to access population-based data on injured workers and to develop policy initiatives through innovation and pilot testing to assess whether proposed changes are really improvements has been critical. Understanding what works within the constraints and complexities of the system on a small scale is critical in order to bring forth policy and processes that will be of value systemwide. Finally, we note that general medical care faces many of the same quality-related problems and challenges as occupational health care. Medical care for chronic diseases, such as diabetes, is often fragmented and uncoordinated. (ABSTRACT TRUNCATED)

Case Management↗
PubMed2005

A cross-national comparison of school drug policies in Washington State, United States, and Victoria, Australia.

Using mail survey data collected from primary and secondary school administrators in Washington State, United States, and in Victoria, Australia, this study compared aspects of the school drug policy environment in the 2 states. Documented substance-use policies were prevalent in Washington and Victoria but less prevalent.in primary schools, especially in Victoria. Victorian school policy-setting processes were significantly more likely to involve teachers, parents, and students than processes in Washington schools. Consistent with expectations based on their respective national drug policy frameworks, school drug policies in Washington schools were more oriented toward total abstinence and more frequently enforced with harsh punishment (such as expulsion or calling law enforcement), whereas policies in Victorian schools were more reflective of harm-minimization principles. Within both states, however, schools more regularly used harsh punishment and remediation consequences for alcohol and illicit-drug violations compared to tobacco policy violations, which were treated more leniently.

Adolescent↗
PubMed2005

The need to legislate the health-care industry in the state of Washington to protect health-care workers from back injury.

There is an epidemic of health-care worker back injury in the State of Washington. Voluntary programs are not keeping pace with the increasing back injury rates to health-care workers. Adding all the health-care industry SIC codes, hospitals, nursing homes, home health and residential care puts health-care as the leading industry in the State of Washington for back injury. Licensed practical nurses, nurses aides, and registered nurses account for the majority of all claims in the health-care industry. Self-insured hospitals led the state for lost time compensable back injuries between 1993 and 2001, and combined Washington State Fund and self-insured health-care hospitals and nursing homes led all other industries for compensable soft-tissue disorders of the neck, back, and upper extremities. Legislation is needed to protect this group of workers in this type of industry. A bill will be re-introduced in the 2006 session that calls for hospitals to implement back injury prevention programs through either the Zero-Lift model, with nursing staff use of lift equipment, or the Lift-Team model, with a specially trained team using lift equipment, or a combination of the two, for all shifts. The State of Washington should provide funding, through savings created by back injury prevention programs, for small rural health-care institutions to assist them in compliance with the legislation.

Back Injuries↗
PubMedDate not supplied

Nitrate distributions and source identification in the Abbotsford-Sumas Aquifer, northwestern Washington State.

The Abbotsford-Sumas Aquifer is a shallow, predominantly unconfined aquifer that spans regions in southwestern British Columbia, Canada and northwestern Washington, USA. The aquifer is prone to nitrate contamination because of extensive regional agricultural practices. A 22-month ground water nitrate assessment was performed in a 10-km2 study area adjacent to the international boundary in northwestern Washington to examine nitrate concentrations and nitrogen isotope ratios to characterize local source contributions from up-gradient sources in Canada. Nitrate concentrations in excess of 10 mg nitrate as nitrogen per liter (mg N L(-1)) were observed in ground water from most of the 26 domestic wells sampled in the study area, and in a creek that dissects the study area. The nitrate distribution was characteristic of nonpoint agricultural sources and consistent with the historical documentation of agriculturally related nitrate contamination in many parts of the aquifer. Hydrogeologic information, nitrogen isotope values, and statistical analyses indicated a nitrate concentration stratification in the study area. The highest concentrations (> 20 mg N L(-1)) occurred in shallow regions of the aquifer and were linked to local agricultural practices in northwestern Washington. Nitrate concentrations in excess of 10 mg N L(-1) deeper in the aquifer (> 10 m) were related to agricultural sources in Canada. The identification of two possible sources of ground water nitrate in northwestern Washington adds to the difficulty in assessing and implementing local nutrient management plans for protecting drinking water in the region.

Agriculture↗
PubMedDate not supplied

Childhood lead poisoning in Washington state: A statewide survey.

Although childhood lead poisoning is an important health issue in the United States, it is not distributed evenly across the country. To estimate the prevalence of childhood lead poisoning in Washington State, the authors conducted a birth certificate follow-back survey of 1- to 2-year-old children. Interviewers visited participating families at their homes to conduct blood lead tests with a portable testing device. The estimated prevalence of lead poisoning for all 1- to 2-year-old children in the state was 0.9% (95% confidence interval [CI]: 0.3-2.7); for Hispanic children in central Washington, it was 3.7% (95% CI: 1.3-10.2), and their risk of lead poisoning was significantly higher than that of all other children in the state (relative risk [RR] = 5.8, 95% CI: 1.3-24.9). Lead poisoning prevalence in Washington State children is lower than the US average and is highest among Hispanic children in central Washington.

Child, Preschool↗
PubMedDate not supplied

Abortion services in rural Washington State, 1983-1984 to 1993-1994: availability and outcomes.

CONTEXT: Fewer rural health providers offer abortion services than a decade ago. It is unknown how the reduction in service availability has affected women's pregnancy outcomes, the extent to which they must travel to obtain an abortion or whether abortions are delayed as a result. METHODS: Population, birth and fetal death data, as well as pregnancy termination reports, obtained from Washington State were used to calculate abortion rates and ratios and birthrates for Washington residents in 1983-1984 and in 1993-1994. Residence of abortion patients was classified by county only, and location of providers was recorded as large urban county, small urban county, large rural county or small rural county. Distances that women traveled to obtain an abortion were calculated. Chi-square tests were used to compare urban and rural rates and ratios within time periods, and to compare changes that occurred between time periods. RESULTS: Birthrates and abortion rates decreased for both rural and urban Washington women between 1983-1984 and 1993-1994, but the magnitude of the decrease was greater for rural women. The rural abortion rate fell 27%, from 14.9 abortions per 1,000 women to 10.9 per 1,000, while the urban rate dropped 17%, from 21.8 to 18.2 per 1,000. The decline in the abortion rate was larger for adolescents than it was for other age-groups. In rural areas, the abortion rate decreased from 16.5 per 1,000 adolescents aged 10-19 in 1983-1984 to 10.8 per 1,000 in 1993-1994, while it declined from 23.3 per 1,000 to 16.9 per 1,000 in urban areas. From the earlier to the later time period, rural women traveled on average 12 miles farther each way to obtain an abortion, and the proportion who obtained the procedure in a rural county decreased from 25% to 3%. In the earlier time period, 62% of rural women traveled 50 miles or more to obtain an abortion, compared with 73% in 1993-1994. From 1983-1984 to 1993-1994, the proportion of rural women who traveled out of state for an abortion increased from 8% to 14%. The proportion of rural women terminating their pregnancy after the first trimester increased from 8% in 1983-1984 to 15% in 1993-1994. CONCLUSION: Rural Washington women are traveling farther and more often to urban and out-of-state locations for abortion services, and are obtaining their abortions at a later gestational age, which is associated with a decade-long decline in the number of abortion providers.

Abortion, Legal↗
PubMed1996

Improving American Indian Cancer Data in the Washington State Cancer Registry using linkages with the Indian Health Service and Tribal Records.

BACKGROUND: Previous reports have suggested that American Indians are sometimes classified as other races on cancer registries. Also, cancer registries typically do not include data on tribal affiliation. This study determined the extent of racial misclassification of American Indians in the Washington State Cancer Registry (WSCR) and obtained tribal-specific cancer data for Washington State. METHODS: A computer file including persons registered for services with the Portland Area Indian Health Service (IHS) or who were enrolled members of 19 tribes in Washington, Oregon, and Idaho (n = 127,375) was linked with WSCR records of incident cases for 1992 and 1993 (n = 49,420). Linkage was conducted with probabilistic methods using the AutoMatch software package. RESULTS: Of 180 persons recorded as American Indian in the WSCR, 130 (72.2%) were identified in the IHS/tribal roll file. Of 259 American Indians included in the IHS/tribal file who were identified in the WSCR, 130 (50.2%) were classified as American Indian. The estimated age-adjusted cancer incidence among American Indians in Washington State increased from 153.5 per 100,000 population before record linkage to 267.5 per 100,000 after linkage. Of the 259 persons who were linked to the WSCR, 17 were not registered with IHS and appeared solely in the tribal rolls. Only two tribes had more than five identified cancer cases during the 2-year study period. CONCLUSIONS: The number of IHS-enrolled American Indians or tribal members included in the WSCR would be underestimated by one third in the absence of record linkages, and the estimated cancer incidence of 43.6% would be lower before linkage. It is feasible to obtain tribal-specific cancer rates by linking tribal rolls to cancer registries, although the small number of cases in most tribes is a significant limitation. Further efforts to improve racial classification of American Indians in cancer registries should be undertaken.

Data Collection↗
PubMed1996

A follow-up study of childhood nasopharyngeal radium irradiation in Washington County, Maryland.

In 1978 an epidemiologic study exploring the health consequences of nasopharyngeal radium irradiation among individuals treated for adenoid enlargement in Washington County, Maryland, found an excess risk of brain tumors and a deficit of female breast cancers. The study population included all persons first seen at the Washington County Clinic for the Prevention of Deafness in Children from 1940 to January 1, 1960. We will continue the follow-up of irradiated and nonirradiated patients to (1) assess the risk of brain tumors and other neoplasms of the head and neck developing during a 40-year period, (2) assess hormone-related disorders resulting from irradiation of the pituitary gland, and (3) compare cancer incidence and mortality rates among exposed and nonexposed groups. Of the 2135 persons eligible for this study, 93.5% have been traced, and 90% have replied to a mailed questionnaire that elicits information on demographic characteristics, reproductive and medical history, infertility, and other sources of radiation exposure. Information on cancer incidence and mortality is being obtained from the Washington County Cancer Registry and death certificate files from Washington County and the Social Security Administration. Statistical methods to be used in the data analysis include standardized mortality ratios, standardized cancer incidence ratios, and Kaplan-Meier survival analysis.

Brain Neoplasms↗
PubMed1992

Barnes Hospital and the Washington University Medical Center.

The author documents the development of the Medical School at Washington University since 1891, when the St. Louis Medical College was first included as part of the University. In 1909, Robert Brookings, President of the Corporation of Washington University, acquired a large endowment and moved the clinical and hospital facilities to a new location, enabled by the estate of Robert Barnes. Harvey Cushing was offered the chair of surgery but eventually decided in favor of Harvard University in 1910. Dr. Ernest Sachs was recruited to Washington University by Dr. Fred Murphy, and in 1919 became the first ever Professor of Neurological Surgery. The history of neurosurgery and those who served it at the Washington University Medical Center and Barnes Hospital is recounted.

History, 19th Century↗
PubMed2004

Mental illness hospitalizations of youth in Washington State.

OBJECTIVE: To determine if mental health hospitalizations have increased among youth. DESIGN: A retrospective cross-sectional time trend study. The Washington State Comprehensive Hospital Abstract Reporting System data set was used to examine hospitalizations among youth (aged 5-19 years) from January 1, 1990, through December 31, 1999. The yearly rates of youth hospitalized for mental illness were calculated, as were the proportions of hospitalizations due to mental illness. Chi(2) tests of trend were computed to assess for significant change over time. Additional analyses examined trends in hospital days due to mental illness and repeated hospitalizations and compared mental illness with other major causes of child and adolescent hospitalization. RESULTS: The rate of school-aged children (aged 5-14 years) hospitalized for mental illness increased by 22% during the 1990s (P =.004). The proportion of hospitalizations due to mental illness in school-aged children increased from 7.8% in 1990 to 12.8% in 1999 (P<.001). Among adolescents (aged 15-19 years), no significant change occurred in the rate of mental illness hospitalizations, but the proportion of hospitalizations due to mental illness increased from 14.5% in 1990 to 21.5% in 1999 (P<.001). Although injuries were the leading cause of hospitalizations among youth in 1990, mental illness has since surpassed injuries as a cause for hospitalization. Mental illness accounted for one third of all hospital days for youth in 1999. CONCLUSIONS: Mental illness hospitalizations account for an increasing proportion of admissions and hospital days among children and adolescents in Washington State. During the past decade, mental illness has surpassed injury as a leading cause of hospitalization for Washington youth.

Adolescent↗
PubMed1990

Trends in teenage smoking during pregnancy. Washington State: 1984 through 1988.

Smoking rates in the United States have decreased since 1963, but this trend is less apparent in adolescents, especially girls. Using data on birth certificates from 1984 through 1988, we analyzed smoking trends during pregnancy in teenagers in Washington State. There was a small but significant increase in the overall smoking prevalence during pregnancy between 1984 (32%) and 1988 (37%). Smoking rates varied by mother's age, race and ethnicity, marital status, and prenatal care. Whites had the highest smoking prevalence, and native Americans showed the largest increase in smoking prevalence over time. In the 5 years studied, unmarried pregnant teenagers had a smoking prevalence of 42.8%, compared with a rate of 31.7% in married teenagers. Compared with other studies of smoking rates in nonpregnant teenagers, pregnant teenagers in Washington State had a much higher smoking prevalence than their nonpregnant peers, and the differences between these two groups did not appear to diminish over time. This study suggests that there is little movement toward meeting the 1990 Health Objectives for the Nation regarding smoking in Washington State teenagers who become pregnant.

Adolescent↗
PubMed1995

Prevalence of corporal punishment among students in Washington State schools.

OBJECTIVES: To determine the prevalence of corporal punishment in Washington State and the factors associated with its use in Washington elementary and secondary schools. DESIGN: Cross-sectional mail survey performed during the summer of 1992. SETTING: All elementary and secondary schools in the state of Washington. RESULTS: One thousand eighteen schools (47%) responded to the survey, of which 80% were publicly funded and 63% were located in urban areas. The study sample closely resembled the profile of all schools in the state. Almost 11% of participating schools permitted corporal punishment at the time of the survey and 3.2% reported its actual use during the 1991-1992 school year, resulting in an estimated prevalence of 7.2 incidents per 1000 students per year. Sixteen percent of corporal punishment actions occurred in schools not permitting its use. Ninety percent of public schools relied on district policy regarding corporal punishment. School characteristics associated with the use of corporal punishment included rural location (crude odds ratio, 2.2; 95% confidence interval, 1.5 to 3.4), enrollment of less than 500 students (crude odds ratio, 1.7; 95% confidence interval, 1.1 to 2.7), and kindergarten to eighth-grade or kindergarten to 12th-grade enrollment (crude odds ratio, 2.5; 95% confidence interval, 1.6 to 3.9). CONCLUSIONS: The lack of a statewide ban on school corporal punishment at the time of this survey was associated with the continued use of corporal punishment against children in districts that continued to permit it. School policies against corporal punishment were associated with much lower prevalence. Continued efforts are needed to enact and enforce laws in the remaining states that have not yet banned corporal punishment.

Adolescent↗
PubMed2003

Work-related falls among union carpenters in Washington State before and after the Vertical Fall Arrest Standard.

BACKGROUND: Washington State enacted a change in their fall standard for the construction industry in 1991, preceding the Safety Standard for Fall Protection in the Construction Industry promulgated by Federal OSHA in 1994. METHODS: We evaluated changes in the rate of falls from elevations and measures of severity among a large cohort of union carpenters after the fall standard change in Washington State, taking into account the temporal trends in their overall injury rates. RESULTS: There was a significant decrease in the rate of falls from height after the standard went into effect, even after adjusting for the overall decrease in work-related injuries among this cohort. Much of the decrease was immediate, likely representing the publicity surrounding fatal falls and subsequent promulgation of the standard. The greatest decrease was seen between 3 and 3(1/2) years after the standard went into effect. There was a significant reduction in mean paid lost days per event after the standard change and there was a significant reduction in mean cost per fall when adjusting for age and the temporal trend for costs among non-fall injuries. CONCLUSIONS: Through the use of observational methods we have demonstrated significant effects of the Washington State Vertical Fall Arrest Standard among carpenters in the absence of a control or comparison group. Without controlling for the temporal trend in overall injury rates, the rate of decline in falls appeared significantly greater, but the more pronounced, but delayed, decline was not seen. The analyses demonstrate potential error in failing to account for temporal patterns or assuming that a decline after an intervention is related to the intervention.

Accidental Falls↗
PubMed1980

Prenatal genetic diagnosis and elective abortion in women over 35: utilization and relative impact on the birth prevalence of Down syndrome in Washington State.

We have examined the relative contributions of a population-based antenatal detection program and unrestricted elective abortion used by women 35 years old and over in Washington State and King County for 1976--1977 to the declining birth prevalence of Down syndrome (DS). The amniocentesis/live birth (LB) ratio for women 35 years old and over was 20.5/100 LBs for King County and 11.7/100 LBs for Washington State in 1977. For the state in 1976, abortion ratios/1,000 LBs were 571 for women 35 to 39 years old and 1,096 for women 40 years old and over. Based on the total Washington State data, elective abortion has a greater impact on averting DS births than does the antenatal detection program. The impact of elective abortion appears to be related to its disproportionate use by women 35 years old and over compared to their contribution to the population of of LBs.

Abortion, Legal↗