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PubMed2005

[Instruments for patient-reported outcomes and predictors in German-speaking rehabilitation research--current developments within the "Rehabilitation Sciences" research funding programme].

In 1998, the German Federal Ministry of Education and Research (BMBF) and the German pension insurance scheme established a funding programme for research in rehabilitation. This initiative led to the establishment of eight regional research networks in which numerous research projects were sponsored for eight years (1998-2005). Within the framework of this funding programme, various self-assessment instruments were developed, adapted or improved in order to measure patient-reported outcomes and predictors. In sum, the analyses meet high psychometric standards. In this paper, a comprehensive review is given in five important assessment fields of rehabilitation research in Germany: Health-related quality of life (generic, disease-specific, children and adolescents, preference-based), evaluation of specific therapy and education programmes, motivation, screening for vocational problems and screening for comorbid mental disorders. The instruments are critically discussed, and perspectives for further research are pointed out.

Biomedical Research↗
PubMed1996

Physician-sponsored networks. Will physicians take back medicine?

Until about the late 1980s, American physicians and their allies, hospitals and the health care manufacturing industries, dominated all facets of the health system--the clinical, the economic, and the political. The bulk of these providers' revenue flowed to them from a highly fragmented insurance system whose governing principle was to provide each insured patient free choice of doctor and hospital. Two distinct, concurrent shifts threaten to erode the medical profession's traditional dominance. The first is a rapid, general shift of control from the supply side of the health sector to its demand side. The second is a shift away from government control, over which organized medicine held much sway in the past, toward private regulators--the executives of the managed care industry. Is the trend towards greater dependence of practicing physicians on non-physician executives inevitable, or can physicians retain--and, in part, regain--their hitherto autonomous position in the health system?

Community Networks↗
PubMed1997

For PSOs, it's ... ready, set, go!

With the signing of the federal balanced-budget act earlier this year, the long-awaited era of the provider-sponsored organization is here. The legislation contained a provision giving the green light for Medicare PSOs, an option sought for years by hospitals and other providers. If the rhetoric about PSOs is to be believed, the organizations are the next generation of managed-care plans, ones that are locally controlled and operated by providers, not remote insurance companies. To many in the industry, this idea has become the last best hope for provider-directed healthcare. The government is scheduled to issue the rules for PSO financial solvency and operation this spring so providers can begin forming their organizations. But before they can accomplish anything, PSOs must be sold to consumers and to regulators. In this issue, we examine the marketing and financing of a new breed of healthcare organization.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Educational posters to reduce antibiotic use.

INTRODUCTION: Antibiotic overuse promotes resistant strains of bacteria and puts patients at risk for adverse reactions. Given the use of educational posters in government-sponsored public health campaigns, this study examined the effectiveness of a waiting room poster in reducing excessive antibiotic use in clinical practice. METHODS: Investigators conducted a 1-month trial of an educational poster with historical controls using three private pediatric group practices in Westchester County, New York. Children between the ages of 6 months and 10 years at the time of a visit to diagnose and treat symptoms of respiratory illness were enrolled as subjects. Antibiotic prescriptions for children with respiratory illnesses seen during the poster month were compared with prescriptions written during three 1-month historical control periods. The proportion of visits that resulted in a prescription for an antibiotic served as the outcome measure. RESULTS: Overall, 326 of the 720 patients (45.2%) enrolled in the study were treated with an antibiotic. Multiple logistic regression analysis revealed no statistically significant difference in the proportion of visits resulting in an antibiotic prescription among the 4 study months (P = .79), indicating that the educational poster had no effect on antibiotic use. DISCUSSION: Public education in the form of a waiting room poster was not sufficient to decrease antibiotic prescriptions. This finding has implications for current large-scale programs and for health care providers as they continue to attempt to educate patients on the appropriate use of antibiotics.

Anti-Bacterial Agents↗
PubMed2003

Caribbean Public Health Laboratory Surveillance Project: a Department of Defense-sponsored humanitarian mission.

This report describes a Department of Defense humanitarian assistance project to develop and build a regional computer-assisted laboratory-based electronic disease surveillance system in the Caribbean basin. From 1997 through 2000, the project donated 146 computer systems and trained more than 250 personnel from 14 ministries of health to operate this system. This humanitarian mission provided the region with a sustainable and locally maintained and operated surveillance system having a broad and long-term impact on public health. It has improved data gathering, analysis, and reporting at the local, national, and regional level. Benefits to the region include the dissemination through the Internet of increasingly timely and accurate information on the incidence and prevalence of endemic, epidemic, and newly emerging diseases. This serves the Caribbean residents, travelers, and U.S. national interests. The project is a model for cooperative Department of Defense capacity building and training programs in support of partner countries and international public health agencies.

Altruism↗
PubMed2002

Collaboration and importance of federally sponsored Superfund research programs.

Numerous studies have shown that the release of hazardous substances in the environment impact the environment and human health. Communities want to know if they have been exposed, if their health is affected, and how they can protect themselves. For environmental impacts the concerns include how best to clean up and manage the contamination, and protect the environment. The answers to these questions are complex and many times unknown. Three federal agencies conduct Superfund-related research to answer a wide range of questions from identifying contaminants of concern and health risks to determining effective cleanup and prevention strategies. This article discusses the research programs for the Agency for Toxic Substances and Disease Registry, U.S. Environmental Protection Agency (Office of Research and Development), and National Institute of Environmental Health Sciences (Superfund Basic Research Program). The three agencies collaborate on their research programs and research agenda setting activities. This introduction to Superfund-related research provides a foundation and context for the scientific articles in this special edition of the journal. Because of the magnitude of environmental and human health concerns, there is a critical need for additional research to address many challenging questions involving exposures, biological responses, and environmental technologies.

Environmental Pollution↗
PubMed1980

Protection of human subjects--Department of Energy. Proposed rule.

Executive Order 12044 sets forth a program of regulatory reform to be followed by all executive departments. One element of that program is periodic review of existing regulations. The Department of Energy is committed to review all of its existing regulations within five years, on schedule set forth in the Federal Register for May 8, 1980, 45 FR 30448. As part of that commitment, the Department has reexmained the regulations contained in 10 CFR Part 745. These regulations deal with the protection of human subjects in research activities supported by the Department. In this notice, we are proposing regulations that will supersede the existing requirements. These proposed regulations are intended substantially to duplicate the policies and procedures proposed by the Department of Health and Human Services on August 14, 1979 (44 FR 47688). The primary responsibility for adequate review and approval to protect human subjects of research activities sponsored by the Department of Energy is placed on the institution that receives, or is accountable to the Department, for the funds awarded.

Ethics Committees, Research↗
PubMed1992

People's Community Clinic: collaboration in the Third World.

A West African government undertook to improve primary health care (PHC) training of mid-level health workers. In partnership with a neighboring squatter settlement, the premiere local training institution created a community-sponsored clinic, providing low-cost, PHC services, and a birthing center, as well as student experiences. Their collaboration in mobilization, research, planning and operations are described. Their success should encourage other educational and training institutions to consider a similar approach.

Africa, Western↗
PubMedDate not supplied

Study tour examines health care systems in Germany, Holland--Part I: A comparison of three health care systems.

In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and onsite visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. Beginning in this issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. This first report compares the health care delivery systems of the United States, Germany, and Holland. In subsequent reports, the German and Dutch health care systems will be described in greater detail and the ability of the United States to adopt European health care systems will be assessed.

Delivery of Health Care↗
PubMed2003

Innovative surveillance methods for rapid detection of disease outbreaks and bioterrorism: results of an interagency workshop on health indicator surveillance.

A system designed to rapidly identify an infectious disease outbreak or bioterrorism attack and provide important demographic and geographic information is lacking in most health departments nationwide. The Department of Defense Global Emerging Infections System sponsored a meeting and workshop in May 2000 in which participants discussed prototype systems and developed recommendations for new surveillance systems. The authors provide a summary of the group's findings, including expectations and recommendations for new surveillance systems. The consensus of the group was that a nationally led effort in developing health indicator surveillance methods is needed to promote effective, innovative systems.

Bioterrorism↗
PubMed2002

Pharmaceutical company sponsored disease management programs: an alternative for tax-exempt MCOs and hospitals.

On April 25, 2002, the Internal Revenue Service finalized the proposed Corporate Sponsorship regulations. The changes made in the final regulations pertain to the proposed $79 ceiling on disregarded benefits, the 2 percent threshold for disregarded benefits, the scope of disregarded benefits, Web site hyperlinks, the inclusion of certain electronic publications in the definition of periodicals, the valuation date for substantial return benefits, and the scope of use or acknowledgement. The proposed regulations were discussed in the Winter 2002 issue of Managed Care Quarterly in an article titled the same as this one. This article is based on the final IRS regulations and therefore supersedes the original article published in the Winter 2002 issue.

Disease Management↗
PubMed1977

Cooperative apartments: new programs in community mental health.

The potential of cooperative apartments as an alternative in residential care for former mental patients is only beginning to be explored. Existing programs demonstrate the viability of these apartments as a last stepping-stone to be used by patients as they move toward a completely independent way of life. In contrast to other residential arrangements, such as foster home care or halfway houses, cooperative apartments seem on balance to be less likely to induce patient dependence or to have an aura reminiscent of the hospital to patients. Moreover, they are relatively inexpensive, can be established without attracting untoward attention in the community, and permit their occupants to live more like other people and with comparatively little stigma. As indicated by the variety of sponsoring agencies described in this article, the impetus to establish cooperative apartments can come from many sources. Such diversity is currently necessary. Only through the evaluation of different models and their effectiveness will criteria be established for a national policy regarding residential care.

Community Mental Health Services↗
PubMed2001

Abbreviated report of the WHO Western Pacific Region Workshop on National Plans of Action for Nutrition: key elements for success, constraints and future plans.

A workshop on National Plans of Action for Nutrition: Constraints, Key Elements for Success, and Future Plans was convened and organized by the WHO Regional Office for the Western Pacific in collaboration with the Institute for Medical Research Malaysia and co-sponsored with FAO and UNICEF from 25-29 October 1999. It was attended by representatives of 25 countries in the region and resource persons, representatives from WHO and other international agencies. The objectives of the workshop were to review the progress of countries in developing, implementing and monitoring national plans of action for nutrition (NPANs) in the Western Pacific Region and to identify constraints and key elements of success in these efforts. Most of the countries have NPANs, either approved and implemented or awaiting official endorsement. The Plan formulation is usually multisectotal, involving several government ministries, non-governmental organizations, and international agencies. Often official adoption or endorsement of the Plan comes from the head of state and cabinet or the minister of health, one to six years from the start of its formulation. The NPAN has stimulated support for the development and implementation of nutrition projects and activities, with comparatively greater involvement of and more support from government ministries, UN agencies and non-governmental agencies compared to local communities, bilateral and private sectors and research and academic institutions. Monitoring and evaluation are important components of NPANs. They are, however, not given high priority and often not built into the plan. The role of an intersectoral coordinating body is considered crucial to a country's nutrition program. Most countries have an intersectoral structure or coordinating body to ensure the proper implementation, monitoring and evaluation of their NPANs. The workshop identified the constraints and key elements of success in each of the four stages of the NPAN process: development, operationalization, implementation, and monitoring and evaluation. Constraints to the NPAN process relate to the political and socioeconomic environment, resource scarcity, control and management processes, and factors related to sustainability. The group's review of NPAN identified successful NPANs as those based on recent, adequate and good quality information on the nutritional situation of the country, and on the selection of strategies, priorities and interventions that are relevant to the country and backed up by adequate resources. Continued high level political commitment, a multisectoral approach, and adequate participation of local communities are other key elements for success. The participants agreed on future actions and support needed from various sources for the further development, implementation, monitoring and evaluation of their NPANs. The recommendations for future actions were categorized into actions pertaining to countries with working NPAN, actions for countries without working NPAN and actions relevant to all countries. There was also a set of suggested actions at the regional level, such as holding of regular regional NPAN evaluation meetings, inclusion of NPAN on the agenda of regional fora by the regional organizations, and strengthening of regional nutrition networks.

Guideline Adherence↗
PubMed1999

Disclosing physician financial incentives.

Federal and state regulatory initiatives as well as court decisions increasingly require managed care organizations to disclose physician financial incentives and have raised the issue of disclosure by physicians themselves. These mandates are based on ethical and legal principles arising from the patient-physician relationship and the relationship between health plan sponsors and enrollees. Disclosing incentives also serves important policy objectives: it can inform enrollees' choice of plan, reinforce enrollees' capacity to understand and exercise other rights under managed care, and discourage use of compensation methods that might compromise patients' access to treatment. However, significant conceptual and practical questions remain about implementing a disclosure mandate. Unresolved issues include the timing, content, and scope of disclosure, the relationship of disclosure to patients' substantive rights, and the impact of disclosure on trust between patients and physicians. These uncertainties exemplify the challenges facing policymakers, plans, and physicians as they determine how best to inform patients about managed care.

Conflict of Interest↗
PubMed1991

Universal health insurance through incentives reform.

Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

Aged↗
PubMed2006

Quebec model for low vision rehabilitation.

The increase in longevity (and secondary morbidity) in the Quebec population adds social and financial pressure to society, as it does elsewhere in Canada and in many western countries. This article gives a brief history of the evolution of vision rehabilitation services in Quebec and describes how services are provided for people with low vision throughout the province. Although numerous groups, associations, centres, and resources are available to assist people with vision impairments, such as the Canadian National Institute for the Blind-Québec, the majority of visual rehabilitation services are provided by government-sponsored rehabilitation centres, namely the Centres régionaux de réadaptation en déficience physique that are located strategically throughout the province. Low vision clinical evaluations in these centres are shared by 36 optometrists throughout the province. Between 5 and 7 ophthalmologists are involved in low vision care, half in university-affiliated hospitals, primarily in Montreal. There may be delays of up to 6 months to be seen in a funded low vision clinic. Statistics obtained from la Régie de l'assurance maladie du Québec show that there are approximately 8,000 requests for low vision aids every year, and that 80% of clients retain at least some level of visual function. Services are covered by Medicare and low vision aids are provided at no cost, although ophthalmologists cannot prescribe low vision aids through the Medicare-funded system. We must ensure that the capacity of our system continues to provide adequately for clientele in the future.

Health Resources↗
PubMed2004

The National Survey of Children's Health: a new data resource.

CONTEXT: Federal and state maternal and child health programs are responsible for promoting and improving the health and well-being of children. To support achievement of this goal, the federal Maternal and Child Health Bureau (MCHB) in partnership with the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention has developed a new survey that will provide uniform national and state data on the health and well-being of children, as well as the characteristics of their families and neighborhoods. PURPOSE: The National Survey of Children's Health was designed to produce reliable and representative state- and national-level estimates for Healthy People 2010 national prevention objectives, for each state's Title V needs assessment, and for Title V program planning and evaluation. In addition, it will provide a new data resource for researchers, advocacy groups, and other interested parties. It is anticipated that this survey will be repeated periodically, making trend analysis possible. METHODS: This survey was conducted using the State and Local Area Integrated Telephone Survey (SLAITS) mechanism, which shares the random-digit-dial sampling frame of the National Immunization Survey (sponsored by the National Immunization Program and NCHS). Using the SLAITS platform, interviews on approximately 2000 children were conducted in each state and the District of Columbia. The parent or guardian most knowledgeable about the child completed a battery of questions on health and development, health insurance coverage, access to care, utilization of health care services, presence of a medical home, family functioning, parental health, and neighborhood characteristics. Data collection began in January 2003 and continued through April 2004. Summary reports and electronic data files will be available to the public by early 2005. CONCLUSION: This is the second state and national survey jointly completed by MCHB and NCHS. It is designed to complement the 2001 National Survey of Children with Special Health Care Needs by providing data on the health of the general child population.

Centers for Disease Control and Prevention, U.S.↗
PubMed2001

Public subsidies for employees' contributions to employer-sponsored insurance.

Proposals to provide or subsidize health insurance for low-income families must take account of the fact that many workers have access to employer-sponsored insurance (ESI), but decline it because of required employee premium contributions. This article considers a tax credit for the employee share of ESI in the context of a broader program of income-based health insurance tax credits. Helping uninsured workers pay for available ESI could be more cost-effective than subsidizing their coverage in the nongroup market. The credit would also be available to workers who were already covered, both for equity reasons and to reduce the incentives for employers to drop coverage or for workers to shift to subsidized individual plans. One key issue is how to prevent employers from reducing their current health plan contributions to take advantage of the new funding. Other design questions considered by the article include whether workers should be able to choose between ESI and nongroup coverage, whether minimum benefit standards should apply for employer plans, and how to achieve a fair balance in subsidies for group and nongroup coverage.

Cost-Benefit Analysis↗