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PubMed1990

An econometric model of an episode of mental health care for patients with mild conditions: implications for caregiver substitution.

This article presents a model of the number of hours of mental health care, the concurrent improvement in the patient's condition, the probability the patient will receive medications, and the reasons for treatment termination. The variables related to these aspects of mental health care are analyzed separately for patients of psychiatrists, psychologists, and social workers. Estimates of the average length of treatment, the average price and income elasticities, and the average cost of treatment are obtained from the model. The major conclusions from this study are that psychiatrists do not have a benefit-cost advantage in the treatment of relatively mild conditions, and that consumer responsiveness to variations in price appear to be largely confined to the decision to seek treatment. These and other findings provide a basis for making tentative recommendations about personnel substitution and reimbursement policies in mental health.

Cost-Benefit Analysis↗
PubMed1991

A disaggregation model of a flexible nurse scheduling support system.

A nurse scheduling support system is developed in which the demand profile and nurses' preferences are input to an expert-like capability designed to formulate linear and/or goal programming representations of the problem. Solutions of the alternative optimization models of this decision support system are then evaluated. An assignment model for disaggregating the optimum work patterns of individual nurses based on their desires and compatibilities is discussed in detail. A brief overview of one of the scheduling models and its extension is also presented along with discussion of the various uses of the assignment model.

Hospitals, Urban↗
PubMed1992

High-risk clients and mental health care management.

A framework characterizing high-risk psychiatric patients by their probability of hospitalization and lengthy stay is introduced. Risk curves are then developed for each patient showing the potential impact of mental health case management on patient risk. Preliminary empirical analysis reveals that although most patients benefit from the case management intervention, some 30% of the client population may face an increase in risk of hospitalization and lengthy stay.

Adult↗
PubMed1989

Statistical methods for the analysis of longitudinal data from school-based smoking prevention studies.

The features which make longitudinal data obtained from school-based smoking prevention studies well-suited for efficient analysis by survival analysis methods are discussed. Survival analysis methods, in particular relative risk regression models, are described and illustrated through an example involving data from the Waterloo Smoking Prevention Project--Study 1. Indications of some of the possible applications for these techniques in the evaluation of interventions to prevent smoking and the study of the smoking onset process are provided.

Adolescent↗
PubMed1988

The demand for episodes of mental health services.

Observational studies of demand for mental health services showed much greater use by those with more generous insurance, but this difference may have been due to adverse selection, rather than in response to price. This paper avoids the adverse selection problem by using data from a randomized trial, the RAND Health Insurance Experiment (HIE). Participating families were randomly assigned to insurance plans that either provided free care or were a mixture of first dollar coinsurance and free care after a cap on out-of-pocket spending was reached. We estimate that separate effects of coinsurance and the cap on the demand for episodes of outpatient mental health services. We find that outpatient mental health use is more responsive to price than is outpatient medical use, but not as responsive as most observational studies have indicated. Those with no insurance coverage would spend about one-quarter as much on mental health care as they would with free care. Coinsurance reduces the number of episodes of treatment, but has only a small effect on the duration and intensity of use within episodes. Users appear to anticipate exceeding the cap, and spend at more than the free rate after they do so.

Data Collection↗
PubMed1988

Competition among hospitals.

The traditional view of hospital competition has posited that hospitals compete primarily along 'quality' dimensions, in the form of fancy equipment to attract admitting physicians and pleasant surroundings to entice patients. Price competition among hospitals is thought to be non-existent. This paper estimates the effects of various hospital market characteristics on hospital prices and expenses in an attempt to determine the form of hospital competition. The results suggest that both price and quality competition are greater in markets that are less concentrated, although the net effect of the two on prices is insignificant. It appears, therefore, that, despite important distortions, hospital markets are not immune to standard competitive forces.

Catchment Area, Health↗
PubMed1992

Persistence in the use of pharmaceuticals by the elderly. Evidence from annual claims.

An analysis of four-and-a-half years of claims data from the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program shows a pronounced degree of persistence in annual prescription drug expense by individual enrollees from year to year, particularly among the heaviest users. There is evidence of eventual regression to the mean, but it takes a substantial length of time--far longer than observed for other types of health care used by the elderly. The study findings raise questions about the insurability of drug expenses in non-group Medigap policies.

Aged↗
PubMed1994

A new test for supplier-inducement and application to the Canadian market for dental care.

The hypothesis that dentists do not induce demand for their services is tested using reduced form estimates of the price elasticity of demand. If demand is autonomous, shifts in supply for whatever reason should generate equivalent estimates provided access costs change proportionately with shifts in supply. If demand inducement is present demand can appear to be very elastic, or very inelastic, depending on what is causing the shift in supply. Each of three applications of this test, conducted in the context of jointly estimated fee and quantity equations using annual Canadian data for 1956-1989, rejects the no inducement hypothesis.

Canada↗
PubMed1991

Recent trends in expenditures on physicians' services in Canada.

Analysis of Canada's restraints on the growth in volume of physicians' services can help shape the framework and direction of policy development in other countries. This paper analyzes trends in recent expenditures on physicians' services in Canada from 1982 to 1987. Growth in payments to physicians who were paid fee-for-service is broken down into three component parts in Canada nationwide and in four provinces: Ontario, Quebec, Nova Scotia and British Columbia. The three component parts are: (1) growth in the number of services billed; (2) physician service prices; and (3) the mixture of high- and low-priced services billed. Expenditure increases are disaggregated according to some major categories of medical services, both per physician and per capita. Increases in growth in physician payments were explained mainly by increases in prices, while some evidence of an increase in higher priced services per physician was found. The varying payment restraint policies across Canadian provinces were manifested in different patterns with respect to components of payment change. Higher rates of payment and volume growth were found for diagnostic/therapeutic and office medical services than for surgeries, although a few contrary patterns across provinces occurred. Interprovincial utilization growth, both per physician and per capita, was variable. This suggests that Canada's regionally administered system is neither uniform nor monolithic.

Canada↗
PubMed1995

Learning needs of hospitalized veteran patients: developing a tool for practice.

The purpose of the study was to develop a practical tool for easy administration by staff to identify Veteran patients' perceived learning needs. Initial development of the tool was based upon a comprehensive literature review, an expert panel review using a modified Delphi Method, and pilot testing of select patients. Two study phases each involved 200 patient interviews from the Department of Veterans Affairs Medical Center in Buffalo, New York. The first phase showed that the tool, the 'Perceived Health Education Needs Scale' had strong internal consistency. Exploratory factor analysis suggested one dominant factor of health. Similar results showing strong internal consistency and one dominant factor were found during a second phase. Veteran patients placed importance on a wide range of educational learning needs, independent of their immediate health concerns.

Adult↗
PubMed2006

Analysis of ambulance transports and diversions among US emergency departments.

STUDY OBJECTIVE: We describe emergency department (ED) visits in which the patient arrived by ambulance and estimate the frequency of and reasons for ambulance diversion. Using information on volume of transports and probabilities of being in diversion status, we estimate the number of patients for whom ED care was delayed because of diversion practices. METHODS: Data from the 2003 ED component of the National Hospital Ambulatory Medical Care Survey, an annual sample survey of visits to US hospital EDs, were used for the analysis. Data were provided by 405 participating EDs on 40,253 visits. Data from supplemental questionnaires to the hospital staff were used to describe volume and frequency of ambulance diversions. RESULTS: In 2003, patients arrived by ambulance for 16.2 million ED visits (14.2%). About 31 ambulances arrived at a US ED every minute. Of ambulance-related visits, 39% were made by seniors, 68% were triaged as emergent or urgent, and 37% resulted in hospital-admission. About 45% of EDs reported diverting ambulances at some point during the previous year. Among EDs that had any diversion, approximately 3% of operating time was spent in diversion status. In 2003, an estimated 501,000 ambulances were diverted, ie, 1 ambulance diversion per minute. Large EDs represent 12% of all EDs, 35% of all ambulance arrivals, 18% of all EDs that went on diversion, 47% of all hours spent in diversion status, and 70% of all ambulances diverted to another ED. CONCLUSION: Description of current use of ED ambulance transports and likelihood of diversions should help policymakers plan for demographic changes in the population during the next 15 years.

Adolescent↗
PubMed2006

Penile length alterations following penile prosthesis surgery.

OBJECTIVE: Determine the impact of penile prosthetic surgery on penile length. METHODS: Stretched flaccid penile length was measured in men undergoing first-time penile implant surgery. Measurements were done before implantation and at 1 and 6 mo postoperatively. Patients were evaluated by the International Index of Erectile Function (IIEF) preoperatively and the IIEF and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) at 6 mo postoperatively. Patients also provided subjective assessment of penile changes at 6 mo postoperatively. Preoperative and postoperative IIEF and EDITS scores were compared as were the patients who complained of penile length loss with those who did not. RESULTS: Of the 56 patients, 50% were diabetic and 28.5% had previous radical prostatectomy; 78% of the implants were three-piece (Alpha-1, Mentor) and 22% were two-piece (Ambicor, American Medical Service). There were no statistically significant differences in penile length after the surgery compared to preoperative measurements. Forty of 56 patients (72%) reported a decrease in penile length, 10 of 50 (19%) reported no change, and 6 of 56 (9%) had a slight increase. Subjective penile length loss was more common in patients who had undergone radical prostatectomy before prosthesis implantation (32%). No statistical difference in EF domain scores occurred between patients who complained of penile length loss and those who did not; however, men complaining of length loss had lower IIEF satisfaction domain and EDITS scores. CONCLUSION: Penile prostheses do not have a negative impact on measured stretched flaccid penile length. Treatment satisfaction scores do not depend on subjective penile length loss.

Humans↗
PubMed2004

Patterns of intra-cluster correlation from primary care research to inform study design and analysis.

OBJECTIVE: To provide information concerning the magnitude of the intraclass correlation coefficient (ICC) for cluster-based studies set in primary care. STUDY DESIGN AND SETTING: Reanalysis of data from 31 cluster-based studies in primary care to estimate intraclass correlation coefficients from random effects models using maximum likelihood estimation. RESULTS: ICCs were estimated for 1,039 variables. The median ICC was 0.010 (interquartile range [IQR] 0 to 0.032, range 0 to 0.840). After adjusting for individual- and cluster-level characteristics, the median ICC was 0.005 (IQR 0 to 0.021). A given measure showed widely varying ICC estimates in different datasets. In six datasets, the ICCs for SF-36 physical functioning scale ranged from 0.001 to 0.055 and for SF-36 general health from 0 to 0.072. In four datasets, the ICC for systolic blood pressure ranged from 0 to 0.052 and for diastolic blood pressure from 0 to 0.108. CONCLUSION: The precise magnitude of between-cluster variation for a given measure can rarely be estimated in advance. Studies should be designed with reference to the overall distribution of ICCs and with attention to features that increase efficiency.

Cluster Analysis↗
PubMedDate not supplied

Developing and refining interventions in persons with health disparities: the use of qualitative description.

Eliminating health disparities by the year 2010 has become a clear priority for nursing and health sciences research. To date, much of the research has relied on traditional analytic methods to identify the disparities and develop clinical interventions. However, health disparities are typically embedded in complex, cultural and contextual issues. Interventions to improve access, quality and care among vulnerable populations need to be developed with these factors in mind. This article illustrates the benefits of using Qualitative Description as one method for assessing, developing and refining interventions with vulnerable populations. Qualitative Description study results have tremendous potential to translate directly to pressing health care situations and provide clear information about ways to improve care.

Attitude to Health↗
PubMed2006

Trends in colon cancer screening procedures in the US Medicare and Tricare populations: 1999-2001.

BACKGROUND: This study examined trends in the numbers of double contrast barium enemas, flexible sigmoidoscopies, and colonoscopies and trends in the choices of colorectal cancer screening service providers. METHODS: Descriptive statistics were used to examine Medicare and Tricare data for the years 1999 to 2001. RESULTS: The total volume of procedures increased 5% and 14%, respectively, in Tricare and Medicare. Tricare and Medicare, respectively, saw 32% and 33% reductions in barium enemas and 28% and 41% reductions in flexible sigmoidoscopies. Colonoscopies increased by 45% and 34% in Tricare and Medicare, respectively. Gastroenterologists provided the majority of colonoscopies for both groups each year. CONCLUSIONS: The volume of colonoscopies increased from 1999 to 2001 for both groups while the volumes of barium enemas and flexible sigmoidoscopies decreased. Gastroenterologists appear to be the preferred providers of colonoscopies.

Aged↗
PubMed1998

The muscular load on the lower back and shoulders due to lifting at different lifting heights and frequencies.

The aim of the study was to investigate the muscular load on the lower back and shoulders and the circulatory load on employees at a post center during repetitive lifting of mail transport boxes. A mock-up was designed in the laboratory, a total of nine combinations of lifting height and frequency were studied. Surface EMG was recorded bisymmetrically from m. erector spinae (L3-level) and m. trapezius. The circulatory load was evaluated by measuring the heart rate. The results show a trade off between the low back and shoulders. The maximum load on the low back occurred at the low lifting height (363 and 54.4 cm) whereas the maximum load on the shoulders occurred at the high lifting height (144.9 and 163.0 cm).

Adult↗
PubMed2000

[Prospective study of patients who leave the emergency department before being seen by the physician].

BACKGROUND: To define epidemiological characteristics, the main reasons, and outcome of patients who leave the emergency department (ED) without being seen by a physician. PATIENTS AND METHODS: We performed a prospective survey of patients who left the ED before medical visit over a period of 26 consecutive weeks. For every non-visited patient (NV), the next visited patient (V) was included as a control. Clinical and epidemiological data, reasons to leave ED and outcome were obtained from clinical records and personal telephone interview. RESULTS: Out of a total of 21,022 patients who were attended in the ED, 383 (1.8%) were NV. To be under 50-year-old, to come the ED alone, to be previously visited by a community physician, and to previous expect short waiting times for ED visit were associated with higher risk for being NV (p < 0.01, p < 0.01, p < 0.05 and p < 0.0001, respectively). The main reasons noted to leave the ED were: feeling better (35%), feeling too sick to wait longer (30%) and being too angry to wait (25%). Only 46% of the NV looked for medical care in the 72 following hours and 6.5% of them needing to be further to hospital. NV-patients considered as suffering a serious pathology at ED arrival, and those being visited by a community physician previously to go to ED were found to be at increased risk to be subsequently admitted (p = 0.01 and p = 0.001, respectively). CONCLUSIONS: Patients who leave ED department before being seen by a doctor are usually young, literate, have not previously visited their community physician, and consulted for minor complaints. The main reason to leave is their own impression of suffering a minor disease, and less than 50% visit another physician after their leaving, being the rate of hospital admission low. We should be particularly cautious with those patients referred by a community doctor and those identified as to have a seriously affected health status at their arrival at the hospital, since they are at increased risk to be admitted.

Age Factors↗