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PubMed2005

Unmet need for substance abuse treatment of adults in Massachusetts.

This article presents a methodology to estimate the size and cost of eliminating unmet need for substance abuse treatment services among adults who have clinically significant substance use disorders, and applies the approach to Massachusetts' information. Unmet treatment needs were derived using a statewide household telephone survey of 7,251 Massachusetts residents aged 19 and older conducted in 1996-1997, and an index of treatment mix and cost information from state and Medicaid financial data. The study estimates that 39,450 adult state residents (0.81% of the total sample) had a clinically significant past-year substance use disorder, but had not received treatment in the past year. Providing substance abuse treatment and outreach services to them would have required an additional cost of approximately 109 million dollars (17 dollars per capita), of which the state's payer of last resort, the Massachusetts Department of Public Health Bureau of Substance Abuse Services (BSAS), would need to fund 31 million dollars (5 dollars per capita). The share paid by BSAS (28%) would represent an increase of 42% over its current spending. This paper quantifies an important but sometimes overlooked objective of managed care: to improve access for substance abusers who need but do not seek treatment.

Adult↗
PubMed2005

Stakeholder perspectives on public managed behavioral care in Massachusetts.

The 2003 survey of Massachusetts behavioral health providers, as well as conference presentations by other key stakeholders, demonstrate continuing high ratings for the Massachusetts Behavioral Health Program. Key issues facing the program include improving integration, state funding cutbacks, movement into performance and outcomes measurement, and concerns about continuing stigma of mental illness. These issues are prevalent in other states that can benefit from the studies and perspectives of the Massachusetts experience.

Interviews as Topic↗
PubMed1993

Variation in hysterectomy rates across small geographic areas of Massachusetts.

OBJECTIVE: Our objective was to determine whether small-area variation in hysterectomy rates exists within Massachusetts and, if so, whether regions with persistently high or low rates can be identified. STUDY DESIGN: By examining data derived from standardized hospital discharge forms between 1982 and 1989, we compared hysterectomy rates among 172 small geographic areas within Massachusetts. The ratios of actual to expected number of hysterectomies for each area were also computed. Statistical significance of rate variation was established by a value of p < 0.01 (chi 3 test). RESULTS: The-hysterectomy rate per 1000 women varies fivefold across small-population areas of Massachusetts. Eight areas had persistently high and five had persistently low rates compared with the statewide average. CONCLUSION: Possible explanations for these rate variations include indigenous population factors, supply of health care resources, income, insurance coverage, methodological problems in data analysis, and variation in professional judgment with regard to the indication for hysterectomy. Only a combination of the study of local causes of high and low rates and the study of the clinical outcomes of different treatment decisions will allow physicians to develop an informed consensus on appropriate indications for surgery.

Female↗
PubMed2004

Effect of nurses' attitudes on hospital-based abortion procedures in Massachusetts.

Our study explored a largely unacknowledged obstacle to abortion access in Massachusetts: the unwillingness of nurses to staff abortion procedures. Evidence suggests that nurses tend to be more likely to oppose abortion than other medical professionals. However, the attitudes and practices of hospital-based nurses regarding abortion have not been thoroughly investigated. We collected qualitative information from physicians and nurse managers to understand how nurses' attitudes affect hospital-based abortion services in Massachusetts. We surveyed key respondents at all hospitals in Massachusetts where abortion services are available to any woman who requests them. Of the 20 individuals who responded (87%), 17 were physicians and 3 were nurse managers. We found that over half of physician respondents believed that the unavailability or unwillingness of nurses to staff abortions is a slight or moderate problem, and nearly a quarter of physician respondents characterized it as a large or very large problem. Thus, nurses' attitudes towards abortion and their unwillingness to assist with procedures may hinder patient access to abortion services.

Abortion, Legal↗
PubMed1998

The economic cost of infertility-related services: an examination of the Massachusetts infertility insurance mandate.

OBJECTIVE: To examine the costs and outcomes of infertility-related services in Massachusetts during a time of expanded use of assisted reproductive technology (ART). DESIGN: Cost data were obtained from the Massachusetts Department of Insurance Rate-Setting Commission and 9 large group insurance plans for the period 1986-1993. Utilization and success rates of ART were examined, and the cost per live delivery with the use of ART in 1993 was estimated. SETTING: The state of Massachusetts, in which access to infertility-related services has been mandated by law since 1989. PATIENT(S): The study population consisted of 8 large health maintenance organization plans and the Blue Cross/Blue Shield indemnity plan. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Per capita infertility-related expenditures, infertility-related expenditures as a percentage of total expenditures, live deliveries per initiated ART cycle, and cost per live delivery. RESULT(S): Expenditures for infertility services increased at a rate similar to or slower than inflation during the years 1988-1992. Increases were slowest in health maintenance organizations, probably as a result of provider arrangements. Infertility services accounted for 0.41% of total expenditures within the indemnity plan in 1993 (approximately $1.71 per contract-month). Examination of ART utilization showed no evidence of overutilization by patients with a low chance of success. The cost per live delivery with the use of ART in 1993 was $59,484. CONCLUSION(S): Mandated infertility coverage was associated with increased use of ART but not with excessive increases in consumer cost for infertility insurance coverage.

Adult↗
PubMed1994

Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.

We provide current, normative data on the prevalence of impotence, and its physiological and psychosocial correlates in a general population using results from the Massachusetts Male Aging Study. The Massachusetts Male Aging Study was a community based, random sample observational survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston, Massachusetts. Blood samples, physiological measures, socio-demographic variables, psychological indexes, and information on health status, medications, smoking and lifestyle were collected by trained interviewers in the subject's home. A self-administered sexual activity questionnaire was used to characterize erectile potency. The combined prevalence of minimal, moderate and complete impotence was 52%. The prevalence of complete impotence tripled from 5 to 15% between subject ages 40 and 70 years. Subject age was the variable most strongly associated with impotence. After adjustment for age, a higher probability of impotence was directly correlated with heart disease, hypertension, diabetes, associated medications, and indexes of anger and depression, and inversely correlated with serum dehydroepiandrosterone, high density lipoprotein cholesterol and an index of dominant personality. Cigarette smoking was associated with a greater probability of complete impotence in men with heart disease and hypertension. We conclude that impotence is a major health concern in light of the high prevalence, is strongly associated with age, has multiple determinants, including some risk factors for vascular disease, and may be due partly to modifiable para-aging phenomena.

Adult↗
PubMed1998

Comprehensive health data systems spanning the public-private divide: the Massachusetts experience.

As systems of health care delivery have evolved from claims-based fee-for-service to capitated or managed care, with its emphasis on cost-effectiveness, quality, and performance measurement, some states have begun to experiment with new ways to collect, organize, and share health information. In many cases, the drivers of these changes have been purchasers of health care, including large and small private employers and public agencies such as Medicaid. One of the results of these changes is the increased interest in the sharing of health information, between health plans and employers, and, in some instances, between private plans and public agencies such as public health. Massachusetts, which has one of the highest rates of managed care penetration in the United States, has brought together the various parties involved in the collection and utilization of health information, to craft agreements on standards and protocols that will allow the sharing of health data. While much of the activity involves business transactions between private sector health plans, the Department of Medical Assistance (Medicaid) has joined with its private sector purchasing partners in demanding cost-effective, high-quality care; it is these demands that have helped stimulate the need to reorganize previously proprietary health information systems. The activities of two public-private coalitions, the Massachusetts Healthcare Purchaser Group and the Massachusetts Health Data Consortium, have been critical in initiating and supporting the complex processes that have led to significant changes in state-based systems of health information.

Health Maintenance Organizations↗
PubMed2003

A null association between smoking during pregnancy and breast cancer using Massachusetts registry data (United States).

OBJECTIVE: An earlier investigation reported a five-fold increase in breast cancer risk among women who smoked during pregnancy. Using a similar design, we re-examined this hypothesis. METHODS: The source population comprised Massachusetts residents who gave birth between 1987 and 1999 with a birth record in the Massachusetts Vital Statistics Registry. Cases were diagnosed with breast cancer between 1988 and 2000 at ages 25-55 with a record in the Massachusetts Cancer Registry. Three controls were matched to each case on maternal age, year of giving birth, and birth facility. Information on smoking, the matched factors, and potential confounders were collected from the birth certificate. The data were analyzed using conditional logistic regression. RESULTS: After adjusting for potential confounders, women who smoked during pregnancy did not have an increased risk of breast cancer compared to women who did not smoke during pregnancy (relative risk = 1.0, 95% Confidence interval CI = 0.81-1.2). We observed no dose response relation between number of cigarettes smoked per day during pregnancy and breast cancer risk. There was no evidence that our results were biased by misclassification from women inaccurately reporting their smoking status. CONCLUSION: In contrast to the previous study, we did not observe an increased risk of breast cancer in women who smoked during pregnancy.

Adult↗
PubMedDate not supplied

Household hazardous waste in Massachusetts.

Household wastes, when disposed of improperly, are hazardous to health. This paper reports a random digit dial telephone survey of Massachusetts households concerning household hazardous waste (HHW) disposal with a 54% response. Of the automotive oil disposed of by 33% of survey households, 57% was deposited in the ground, sewer, or landfill. Annually by household oil disposal in Massachusetts is estimated to be 8.8 million quarts. Four percent of hazardous waste generated in Massachusetts is from households. Improper disposal makes it a major environmental contaminant. More households (41.5%) in smaller communities disposed of oil compared with 26% of households in larger communities. Paint and pesticides were disposed of by 10% of the households, but were dumped on the ground sewer or landfills more than 90% of the time.

Household Products↗
PubMed2003

Results of the Massachusetts methylene chloride end-users survey.

A survey of Massachusetts companies reporting use of methylene chloride between 1995 and 1999 was conducted to assess the status of industrial use of the chemical in 2000. Methylene chloride has had wide use in industry although it has been identified as potentially hazardous to exposed workers and the environment. New and tightened occupational and environmental regulations taking effect in the 1990s were hypothesized to have reduced use of the chemical in Massachusetts. Substitute technologies, especially aqueous cleaning, were expected to have replaced methylene chloride in many industries. Seventeen of the 21 Massachusetts manufacturing companies reporting use of over 10,000 lb/y of methylene chloride between 1995 and 1999 were surveyed by telephone regarding their experiences of methylene chloride use and elimination and/or replacement. Fifteen of the 17 companies had either eliminated (10) or reduced to below 10,000 lbs/yr (5) their use of methylene chloride at the time of the survey in 2000. Many of the surveyed companies moved to aqueous cleaning from methylene chloride degreasing operations. Environmental concerns were the most popular reason given for eliminating or reducing use of methylene chloride. Worker health and safety concerns, especially concern about compliance with the 1997 Occupational Safety and Health Administration methylene chloride standard, were also a motivation. In general, the companies associated many benefits and few problems with eliminating or reducing use of methylene chloride. Exposure reduction strategies based on toxics use reduction techniques appear to be feasible for many manufacturing companies. However, research should be conducted to assess the introduction of new hazards as a result of tightened regulations on methylene chloride.

Data Collection↗
PubMed1991

Cancer surveillance of Veterans in Massachusetts, USA, 1982-1988.

This surveillance study is a follow-up to previous findings of elevated soft tissue sarcoma mortality in Massachusetts Vietnam veterans compared to other veterans. The roster of veterans was compiled from Massachusetts residents who received a state bonus for military service in the period 1958-1973. This computerized list was linked to the central files of the Massachusetts Cancer Registry and cases diagnosed between 1982 and 1988 were identified. Odds ratios (ORs) for several cancer sites were computed; only that for soft tissue sarcoma incidence was significantly elevated in Vietnam veterans compared to other veterans (OR = 3.08; 95% confidence interval: (CI) 1.07-8.73). Kaposi's sarcoma cases who were also AIDS patients were excluded from the analysis. Non-Hodgkin's lymphoma was also investigated but was not significantly elevated in these surveillance data. Sources of bias are discussed and recommendations for continued surveillance and follow-up studies are made.

Adult↗
PubMedDate not supplied

A public health response to emerging technology: expansion of the Massachusetts newborn screening program.

The development of a new technology, called tandem mass spectrometry (tandem MS), has challenged governments worldwide to consider expanding universal newborn screening for rare metabolic disorders. In 1997 the Massachusetts Department of Public Health developed a public process to meet this challenge. After addressing significant medical, legal, ethical, and logistical issues raised by tandem MS, Massachusetts incorporated one new disorder into the mandatory newborn screen and developed an optional pilot program for 20 additional disorders. The Massachusetts experience has wide relevance for other nations and states. As screening protocols are contemplated for entire populations-for newborns and others- it will remain essential that the public participate in an open process of reviewing the justification for and logistics of screening.

Ethics, Medical↗
PubMed2006

Nurse staffing, nursing intensity, staff mix, and direct nursing care costs across Massachusetts hospitals.

OBJECTIVE: This study describes the distribution of patient-to-registered nurse (RN) ratios, RN intensity of care, total staff intensity of care, RN to total staff skill mix percent, and RN costs per patient day in 65 acute community hospitals and 9 academic medical centers in Massachusetts. METHODS: We conducted a retrospective secondary analysis of the Patients First database published by the Massachusetts Hospital Association for planned nurse staffing in 601 inpatient nursing units in the state for 2005 using a multivariate linear statistical model controlling for hospital type and unit type. Nursing unit types were identified as adult and pediatric medical/surgical, step down, critical care, neonatal level II, and neonatal level III/IV nurseries. RESULTS: Medical centers had significantly higher case-mix index (1.72 vs 1.20, P < .001), longer lengths of stay (5.18 vs 4.19, P < .001), more beds (574 vs 147, P < .001), discharges (31,597 vs 7,248, P < .001), and patient days (161,440 vs 31,020, P < .001) compared with to community hospitals. Medical centers had significantly lower patient-to-RN ratios (3.22 vs 4.64, P < .001), higher nursing intensity and total nursing staff intensity (9.62 vs 7.43/11.75 vs 9.87, both P < .001), higher percent of RN to all staff mix (79% vs 71%, P < .001), and higher RN costs per patient day ($385 vs $297, P < .001) compared with to community hospitals. There were significant differences in adult med/surg units between community hospitals and medical centers for patient-to-RN staffing ratios (5.25 vs 4.08), nursing intensity (5.1 vs 6.2 hours daily), skill mix (67% vs 73% RN), and RN costs per patient day ($203 vs $248, all P < .001). There were no significant differences between the adult step-down units. CONCLUSION: The significant differences between community hospitals and medical centers, unit type, as well as the high degree of variability in patient-to-RN ratios, nursing intensity, skill mix, and RN costs per patient day suggest that nursing resource expenditure at Massachusetts hospitals is complex and affected by case mix, unit size, and complexity of care.

Academic Medical Centers↗
PubMed1996

Medical surveillance for ethylene oxide exposure: practices and clinical findings in Massachusetts hospitals.

The medical surveillance requirements of the Occupational Safety and Health Administration's (OSHA) ethylene oxide (EtO) standard became effective in 1985. However, little is known about the nature of the response of EtO users to this regulatory requirement. In an effort to begin to understand this, we conducted a survey of EtO health and safety in Massachusetts hospitals (n = 92). We determined the cumulative incidence of provision of EtO medical surveillance, the characteristics of the surveillance interventions provided, and the clinical findings of EtO medical surveillance efforts in Massachusetts hospitals. From 1985 to 1993, medical surveillance for EtO exposure was provided one or more times in 62% of EtO-using hospitals. Sixty-five percent of EtO medical surveillance providers reported performance of all five medical surveillance procedures required by OSHA's EtO standard. Medical surveillance provider certification in occupational medicine or nursing, and a greater extent of coverage of written medical surveillance policies, were related to higher likelihoods of fulfillment of OSHA-required procedures. Twenty-seven percent of medical surveillance providers reported detection of EtO-related symptoms or conditions, ranging from mucous membrane irritation to peripheral neuropathy. These findings reveal wide-spread implementation of OSHA-mandated EtO medical surveillance, with concomitant incomplete fulfillment of OSHA-specified procedures. From the provider-based survey, we estimate that one or more workers at 19% of EtO-using Massachusetts hospitals have experienced EtO-related health effects.

Adult↗
PubMedDate not supplied

Who supports tobacco excise taxes? Factors associated with towns' and individuals' support in Massachusetts.

OBJECTIVES: The authors examined factors related to public support for cigarette taxes: smoking behavior, attitudes about other tobacco control policies, and sociodemographic factors. METHODS: The authors regressed referendum voting outcomes on sociodemographic characteristics of Massachusetts' 351 towns. Logistic regressions on the surveys of Massachusetts adults (N = 14,000+) showed support for hypothetical tax increases to be related to respondents' smoking status, support for other tobacco control policies, and sociodemographic characteristics. RESULTS: Average educational attainment, probably acting as a proxy for nonsmoking prevalence, strongly predicted town-level support for Massachusetts' 1992 cigarette tax referendum. Survey respondents' support for hypothetical further increases was strongest if tax proceeds were earmarked for tobacco control or health purposes and if the individual was a nonsmoker and favored other tobacco control policies. For an earmarked tax, support was stronger among younger persons, females, persons with higher education, racial/ethnic minorities, and smokers with children. CONCLUSIONS: The high nationwide proportion of nonsmokers means that tobacco tax proposals can obtain strong voter support, but only if tax revenues are clearly earmarked for tobacco control and similar uses. Individual- and town-level characteristics can identify likely concentrations of support. Because attitudes toward tobacco control are only partly linked to smoking status, education campaigns may make a difference.

Educational Status↗
PubMedDate not supplied

Therapeutic decisions for menopause: results of the DAMES project in central Massachusetts.

OBJECTIVE: To investigate the factors that influence therapeutic decisions at menopause, particularly those related to the burden of menopause symptoms, in a population of women living in Massachusetts, as part of the multisite DAMES (Decisions At Menopause Study). DESIGN: A survey using face-to-face interviews with a randomly selected sample of 293 women aged 45 to 55 who are members of the Fallon Community Health Plan in Central Massachusetts. The instrument combined closed- and open-ended questions and elicited information about a number of health topics, including the symptoms experienced by respondents over the preceding month and the decisions they made regarding therapies. RESULTS: Symptom reporting was found to be relatively high, with more than half of the sample reporting hot flashes, sleep disturbances, joint pains, and headaches in the month preceding the survey; one third to one half of the women reported palpitations, night sweats, fatigue, and numbness. The highest frequency of symptoms occurred during perimenopause. Nearly four fifths of the women consulted a healthcare provider, and one fifth used hormone therapy. More than half of the respondents said menopause is a difficult phase, and about half found decisionmaking about it to be difficult. CONCLUSIONS: This study documents a relatively heavy burden of symptoms in a relatively healthy population and provides an update on earlier studies in Massachusetts.

Adult↗
PubMed1994

Emergence of eastern encephalitis in Massachusetts.

The 20th century emergence in Massachusetts of zoonotic eastern encephalitis was interpreted in terms of recorded environmental change. The main mosquito vector of the infection, Cs. melanura, appears to have been scarce in eastern North America before the 1930s. Its relative scarcity resulted from destruction of the swamps that had been lumbered or drained for farming in the 18th and 19th centuries. When swamps matured once again early in the 1900s, the formation of subsurface pools of water beneath mature trees would have increased the availability of breeding sites for this mosquito. Transmission would have further been enhanced by the simultaneous proliferation of wetland-roosting robins and the extinction of such vagile birds as the passenger pigeon. Although numerous horses were maintained in Massachusetts at the time, no outbreaks of "equine sleeping sickness" came to public notice between the 1830s and the 1930s, when mature trees were scarce and the fauna was most disturbed. The severity of the first major outbreak in 1938 may have been potentiated by the absence of herd-immunity in a rapidly proliferating population of reservoir birds. These considerations suggest that recent landscape and faunal changes caused zoonotic EE to emerge in Massachusetts after waning for a century.

Animals↗
PubMed1985

What Massachusetts residents know about fluoridation.

The Massachusetts Department of Public Health conducted a comprehensive, statewide telephone health interview survey during 1980. Adult members of 1,091 households were interviewed. The purpose of this paper is to report the attitudes and knowledge of the Massachusetts residents surveyed regarding fluoridation, as well as the relation of their attitudes with demographic and socioeconomic variables, dental and other health behaviors, and outcome of fluoridation referenda. The majority, 60 percent, were in favor of community water fluoridation. As expected, groups that were most likely to favor fluoridation were parents, those who were better educated, and those with higher incomes. About three-fourths of those surveyed were correctly aware of the purpose of fluoridation. Public opinion about fluoridation, as measured by this survey, did not correspond with the outcome of fluoridation referenda held in 14 Massachusetts communities between 1980 and 1983, which showed that 61 percent of the voters were not in favor of fluoridation.

Adolescent↗