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At least 1,135 records · Page 63Linked to original sources
PubMed1998

Creative payment strategy helps ensure a future for teaching hospitals.

The Colorado Medicaid Program in years past relied on disproportionate share hospital (DSH) payment programs to increase access to hospital care for Colorado citizens, ensure the future financial viability of key safety-net hospitals, and partially offset the state's cost of funding the Medicaid program. The options to finance Medicaid care using DSH payments, however, recently have been severely limited by legislative and regulatory changes. Between 1991 and 1997, a creative Medicaid refinancing strategy called the major teaching hospital (MTH) payment program enabled $131 million in net payments to be distributed to the two major teaching hospitals in Colorado to provide enhanced funding related to their teaching programs and to address the ever-expanding healthcare needs of their low-income patients. This new Medicaid payment mechanism brought the state $69.5 million in Federal funding that otherwise would not have been received.

Colorado↗
PubMed2003

Barriers to breast cancer screening for low-income Mexican and Dominican women in New York City.

The proportion of Mexican and Dominican women has increased rapidly in New York City and in other urban areas, and breast cancer screening rates continue to be lower for Latina women as a whole, but particularly for some nationality subgroups. The current analysis explored the reasons why Mexican and Dominican women from medically underserved communities in New York City do not seek breast cancer screening. Data were collected through interviews with 298 Mexican and Dominican women aged 40-88 years; the interviews included an open-ended question on the barriers women face in seeking screening. The three most commonly cited barriers were not taking care of oneself (descuido) (52.3%), lack of information (49.3%), and fear (44.6%). Women who had been screened cited fear, pain, or other personal barriers more often, but women who had never had a mammogram cited cost or other logistical barriers. Responses from Dominican and Mexican women were significantly different, with Mexican women more often citing shame or embarrassment and Dominican women more often citing fear. The dependent variable, barriers to screening, was grouped into major categories. When sociodemographic factors were controlled for, the effect of ethnicity disappeared. Multivariate logistic regression revealed that women with a source of health care were less likely to cite any logistical barriers, but significantly more likely to report only personal barriers (such as fear or descuido). The analysis indicated that personal barriers were very prevalent in the communities studied. It may not be sufficient merely to increase access to breast cancer screening services for low-income Latinas: even when women have a source of health care, personal barriers may prevent many women from seeking screening. Outreach programs need to be tailored to the target communities as there are significant differences among groups of Latinas. Targeted outreach programs must work in tandem with programs to increase access to ensure that both personal and logistical barriers to screening are addressed.

Adult↗
PubMed1999

Effects of enforcement of youth access laws on smoking prevalence.

Smoking is the primary preventable cause of death, and yet 3,000 adolescents become smokers each day. Most adult smokers begin this deadly habit when they are under the age of 18, which is the minimum legal age for the purchase of cigarettes. The majority of adolescent smokers are able to purchase cigarettes even though laws prohibit the sale of cigarettes to minors. In the late 1980s, Woodridge, IL, became one of the first towns in the nation to demonstrate a significant reduction in the ability of youth to purchase cigarettes. Almost 2 years after passage of this legislation, the percentage of regular smokers among 7th- and 8th-grade students had been reduced from 16 to 5%. Seven-year follow-up data in a sample of high school youths indicate that youths living in communities with regular enforcement had significantly less smoking than those living in communities without regular enforcement. In particular, rates of regular smoking were 8.1% in communities with regular enforcement versus 15.5% in communities without regular enforcement. It is possible that adolescents who had restricted access to tobacco products were less likely to become regular smokers. These findings have important public health implications, particularly in light of recent federal legislation mandating that all states develop programs to reduce access of youth to tobacco products.

Adolescent↗
PubMed2000

Lead abatement training for underserved populations: lessons learned.

An environmental-justice (equity) grant program was used to make accessible an existing lead-training program to minority persons and residents of low-income communities. The purpose of the program was to enhance the knowledge base within the communities concerning lead hazards and intervention strategies and expand possibilities for employment in the lead abatement industry. Barriers to attendance were anticipated and addressed, and included transportation, meals, license application fees, reminders of course date and location, and day care. The program was evaluated through measures of recruitment rates, pre- and post-testing scores, and change in perception of confidence at pre-test, post-test, and at four-month follow-up. Fee-paying registrants over the same time period were used as a comparison group. First day attendance rates for individuals recruited into the equity-grant was 59 percent, of these 94 percent completed all days. Equity and fee-paying groups had similar scores on the pre-test (p = .209), while mean scores on the final exam differed significantly (p < .001) between the groups and were 77 percent and 85 percent, respectively. After adjusting for demographic and course type attended, perceptions of self-efficacy (benefit) and outcome-effectiveness (confidence) increased significantly from pre- to post-tests for both groups and remained at post-course levels at four months follow-up. Lessons learned include: (1) Lead abatement and other related activities can be successfully taught through traditional training methods; (2) A necessary element for delivery of educational services to minority groups is forming workable ties with local community groups, but eligibility requirements must be maintained; (3) Once barriers to first-day attendance are overcome, the information necessary to perform specific work skills can be taught; (4) Positive changes in belief are not dependent on minority status, income, or education levels; (5) Training and education increased confidence in ability to perform learned skills, and belief that there will be a beneficial outcome when performed for themselves, their families, and communities; and, (6) A consensus regarding applicability of regulations must be achieved among federal, state, and local communities.

Adult↗
PubMed1999

An investigational new drug treatment program for patients with gemcitabine: results for over 3000 patients with pancreatic carcinoma.

BACKGROUND: An Investigational New Drug (IND) treatment program allows patients access to a drug that has shown activity against a serious or life-threatening disease prior to full Food and Drug Administration (FDA) review and approval. This treatment IND program, in which patients with locally advanced or metastatic pancreatic carcinoma were treated with gemcitabine, began in 1995. METHODS: Eligibility criteria were < or =1 prior chemotherapy regimen; a Karnofsky performance status (KPS) of > or =50; and adequate bone marrow, liver, and renal function. Gemcitabine was given at a dose of 1000 mg/m2 weekly x 7 followed by a week of rest, then weekly x 3 every 4 weeks thereafter. In this program, disease-related symptom improvement (DRSI) was defined retrospectively as 1) improvement in pain (on a 7-point scale) and/or analgesic class (e.g., morphine improving to codeine) and/or KPS (> or =20 points), or 2) stability of these three parameters with a 7% increase in weight from baseline. RESULTS: A total of 3023 patients enrolled. At baseline, 80% of them had Stage IV disease, and 84% had a baseline KPS > or = 70. The median age was 65 years, and 56% of the patients were male. The cumulative DRSI response rate after the fourth cycle was 18.4%. Of 982 patients with tumor response data, there were 14 with complete response and 104 with partial response, for an overall response rate of 12.0% (95% confidence interval [CI], 10.0-14.0%). For 2380 patients with survival data, the median survival was 4.8 months (95% CI, 4.5-5.1 months) and the 12-month survival was 15%. Gemcitabine was well tolerated; only 4.6% of discontinuations were due to adverse events. CONCLUSIONS: Notable disease-related symptom improvement and survival were seen with gemcitabine in this large, compassionate-use setting, and these findings were in agreement with those of earlier registration trials.

Aged↗
PubMed1998

The economic benefits of supported employment for persons with mental illness.

BACKGROUND: Policies and programs that emphasize employment for persons with mental illness are often promoted with the goals of improving economic self-sufficiency and reducing dependence on public welfare programs. At present, there is little empirical evidence about the actual effect of vocational interventions on economic self-sufficiency or on use of public benefits by persons with mental illness. STUDY AIMS: This study provides a preliminary look at how participating in supported employment, a form of vocational rehabilitation emphasizing ongoing support in competitive jobs, affects the amount that participants earn from work and the total amount of income they receive from all sources. Further, we examine the extent to which receiving public benefits affects the amount earned from private employment, taking into consideration other factors that might be associated with benefit status. METHODS: Data are from a randomized trial of supported employment interventions. This analysis followed 137 of those study participants with severe mental illness for 18 months after they enrolled in either of two supported employment programs. Income from various sources was estimated based on interviews with study participants upon study entry and at six-month intervals thereafter. Changes in income from work, government and other sources were analyzed using paired Wilcoxon matched-pairs signed-ranks tests and t-tests. Using ordinary least-squares regression, we analyzed the effect of benefit status on changes in earnings, taking into account diagnosis, work history, education, program type, site of program, psychiatric symptoms, global functioning and previous earnings. RESULTS: Estimated total income increased by an average of $134 (US) per month after enrolling in supported employment. More than three-quarters of this increase was from government sources, such as Social Security and educational grants. The increase in government income was largely due to participants applying for and getting cash benefits for the first time. Social Security payments for those receiving benefits before enrollment did not change significantly. A small group of persons (n = 22) who did not receive Social Security benefits before or after enrolment earned significantly more from competitive employment after enrolling than did those who received benefits. This finding persisted after taking into acount differences in work history, clinical and functional variables and education. LIMITATIONS: Because of the relatively small sample size and the lack of continuous measures of income these results should be considered preliminary. CONCLUSIONS: Supported employment, one of the more effective forms of vocational rehabilitation for persons with mental illness, did not reduce dependence on government support. Receiving government benefits was associated with lower earnings from work. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: These findings suggest that most persons in treatment for severe mental illness need continued public financial support even after enrolling in vocational rehabilitation programs. IMPLICATIONS FOR HEALTH POLICY FORMULATION: Undoubtedly increased labor force participation can benefit persons with mental illness in a number of ways. However, policy makers should be careful about justifying increased access to vocational programs on the basis of reduced spending for income support. Further, targeting such programs only to persons receiving income support may overlook the clients who can benefit most: those who are not currently receiving benefits. IMPLICATIONS FOR FURTHER RESEARCH: Policy makers need a better understanding of how vocational interventions and income support programs affect the income and well-being of persons with mental illness. Studies similar to this one should be repeated with larger, more diverse samples that will allow use of instrumental variables statistical techniques.

Journal Article↗
PubMed2003

Medicare and Medicaid programs; fire safety requirements for certain health care facilities. Final rule.

This final rule amends the fire safety standards for hospitals, long-term care facilities, intermediate care facilities for the mentally retarded, ambulatory surgery centers, hospices that provide inpatient services, religious nonmedical health care institutions, critical access hospitals, and Programs of All-Inclusive Care for the Elderly facilities. Further, this final rule adopts the 2000 edition of the Life Safety Code and eliminates references in our regulations to all earlier editions.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

Importance of solvent accessibility and contact surfaces in modeling side-chain conformations in proteins.

Contact surface area and chemical properties of atoms are used to concurrently predict conformations of multiple amino acid side chains on a fixed protein backbone. The combination of surface complementarity and solvent-accessible surface accounts for van der Waals forces and solvation free energy. The scoring function is particularly suitable for modeling partially buried side chains. Both iterative and stochastic searching approaches are used. Our programs (Sccomp-I and Sccomp-S), with relatively fast execution times, correctly predict chi1 angles for 92-93% of buried residues and 82-84% for all residues, with an RMSD of approximately 1.7 A for side chain heavy atoms. We find that the differential between the atomic solvation parameters and the contact surface parameters (including those between noncomplementary atoms) is positive; i.e., most protein atoms prefer surface contact with other protein atoms rather than with the solvent. This might correspond to the driving force for maximizing packing of the protein. The influence of the crystal packing, completeness of rotamer library and precise positioning of Cbeta atoms on the accuracy of side-chain prediction are examined. The Sccomp-S and Sccomp-I programs can be accessed through the Web (http://sgedg.weizmann.ac.il/sccomp.html) and are available for several platforms.

Algorithms↗
PubMed1999

Elder rehab: a student-supervised exercise program for Alzheimer's patients.

The physical and mental benefits of exercise are universally recognized, but seldom available to persons with early to moderate stage dementia. Difficulty in initiating and maintaining purposeful behavior, coupled with the inability to travel independently, preclude most community-dwelling dementia sufferers from accessing organized fitness programs. Overburdened caregivers typically lack the inclination and know how to structure and supervise systematic exercise sessions. The University of Arizona Elder Rehab program offers independent study credit to students who serve as rehab partners and fitness supervisors to noninstitutionalized persons with dementia. In addition to regular aerobics and weight training workouts, participants engage in supervised volunteer work and memory- and language-stimulation activities with their student partners. Multiple benefits accrue to all participants. The program is cost effective, easily replicated, and may also be suitable for frail and depressed elderly persons without dementia.

Academic Medical Centers↗
PubMed2005

Using half-normal probability plot and regression analysis to differentiate complex traits: differentiating disease response of multigenic resistance and susceptibility in tomatoes to multiple pathogen isolates.

The need for a new analytical approach was encountered in the course of characterizing newly developed tomato lines resistant to late blight. Late blight resistant tomato lines were created in independent breeding programs using the accession Solanum pimpinellifolium L. (formerly Lycopersicon pimpinellifolium (L.) Miller) L3708 as the source of the resistance. However, initial field observation suggested that the late blight resistance in the lines produced by two independent breeding programs differed. Possible causes included a partial transfer of the late blight resistance derived from S. pimpinellifolium L3708 or the possibility of race specificity of this resistance. A crucial issue was determining the most appropriate and robust analytical method to use with data from laboratory analyses of the responses of nine tomato lines against five P. infestans isolates. Prior analysis by standard ANOVA revealed significant differences across tomato lines but could not determine whether the disease responses in the CLN-R lines were different from those of the heterozygous F(1) hybrids, created by crossing susceptible tomatoes with the fixed CU-R lines. A different analytical method was needed. Therefore, sporangia numbers/leaflet and diseased area data were analyzed using a half-normal probability plot and regression analysis. The results of this analysis show its utility for genetic or pathology studies. Considering only populations of the uniform tomato lines, this method confirms the results obtained by using a standard ANOVA, but provides a clearer demonstration of the distributions of the individuals within the populations and how this distribution impacts variance and the difference among the populations. This method also allows a joint analysis of the uniform lines with an additional population that is less uniform, because it is segregating. Such an analysis would be invalid using a standard ANOVA. The results of this joint analysis determined that the additional population was divergent from the fixed CU-R lines, and, against some isolates, against the CLN-R lines as well. Half-normal probability plot analysis method would be applicable more broadly beyond analysis of disease resistance data. It could be useful for data from populations that are not normally distributed, for traits which are affected by epistatic gene action, and could be useful for selection of extremes.

Genotype↗
PubMedDate not supplied

Popular Medicaid programs do battle with state budget pressures: perspectives from twelve states.

Many are concerned that growth of state Medicaid and State Children's Health Insurance Program (SCHIP) spending, along with limited political clout among beneficiaries, make these programs extremely vulnerable in periods of serious state budget constraints. But observations based on Community Tracking Study site visits show that states have thus far largely avoided major cuts that would seriously harm beneficiaries' access, primarily because programs have more support among coalitions of public officials, health care providers, and local advocates than commonly assumed. However, the limits to this surprising level of support are exemplified by decisions in many states to shelve some planned future expansions indefinitely.

Budgets↗
PubMed2002

Overview of catheter-related infections with special emphasis on prevention based on educational programs.

Intra-vascular access is an unavoidable tool in sophisticated modern medical practice, and catheter-related infection remains a leading cause of nosocomial infections, particularly in intensive care units where it is associated with significant patient morbidity, mortality, and additional hospital costs. The incidence of catheter-related bloodstream infection ranges from 2 to 14 episodes per 1000 catheter-days. On average, microbiologically documented, device-related bloodstream infections complicate the use of a central venous line in three to five per 100 cases. But this represents only the visible part of the iceberg and most episodes of clinical sepsis are nowadays considered to be catheter-related. We briefly review the pathophysiology of these infections, highlighting the importance of the skin insertion site and the intravenous line hub as principal sources of colonization and infection. Principles of therapy are briefly addressed. A large proportion of these infections are preventable and this has been the objective of creating precise guidelines. It was recently suggested that the situation may evolve with the introduction of antibiotic/antiseptic-coated devices, whose impact on the epidemiology of antibiotic resistance remains to be determined. Recently, educational programs and/or a global preventive strategy based on the strict application of specific preventive measures and careful control of all factors associated with infection proved to be even more effective than coated devices in reducing rates of infection. Practical aspects regarding educational approaches will help clinicians to adapt and incorporate educational programs into clinical practice.

Catheterization↗
PubMed1987

Use of a microcomputer in a pediatric hospital.

The implementation and uses of a microcomputer in a 186-bed pediatric hospital are described. A Kaypro-10 portable microcomputer and an Epson Fx-80 printer were purchased in anticipation of increased workload generated by addition of beds to the hospital's neonatal intensive-care unit. Programs in C-BASIC language were developed for performing mathematical calculations, labeling of unit dose injections and oral liquids, and generating automatic-stop-order renewal notices. A master menu was designed to allow access to all programs. Work sheets to aid in the calculation of solution volumes required to deliver desired dosages of emergency drugs and for preparation of parenteral nutrient solutions are generated by the microcomputer, along with labels for these solutions. Other computer programs allow charging of floor stock items for i.v. admixtures, tracking of emergency-drug boxes, and generation of controlled-substances and anaphylaxis-dosing labels. A total of 510 hours was required to develop the microcomputer programs at a salary cost of $2600. Hospital pharmacies experiencing an expansion of patient services may be able to reduce the impact of the increased workload on manpower requirements by computerizing existing systems. Pharmacies with specialized needs can consider microcomputer implementation and inhouse software development as one alternative.

Arkansas↗
PubMed1999

A comparison study of access to health care under a Medicaid managed care program.

This article investigates the health care and insurance status of a low-income urban area in East Tennessee. The article reviews the background of TennCare, a compulsory Medicaid managed care program initiated in Tennessee in 1994. The study compared TennCare recipients with other insurance groups on key demographic and access variables. Possible explanations for how TennCare recipients rate their care also were examined. Qualitative analysis revealed accounts of long waiting periods, out-of-town specialist care, problems with obtaining pharmaceuticals, and general confusion about the new system. Implications of these findings for social work policy practitioners are discussed, and suggestions for alleviating the burden on patients are offered.

Adult↗
PubMedDate not supplied

Microcomputer based pharmacokinetic programs for calculating absorption rate.

A package of microcomputer based pharmacokinetic programs for evaluating in vivo absorption rate has been developed. The following programs are included in the package: TEXT FILE (program to create a data file which can be accessed by all pharmacokinetic programs), WN12GT (Wagner-Nelson method), LOO (modified Loo-Riegelman method), DECON (deconvolution method), and MODMOMT (method of statistical moments). All programs were tested with data obtained from standard texts or original articles. This package of programs designed to be interactive, flexible, and easily used by a novice. The modular design facilitates modification, upkeep and accommodation of new methods of calculation.

Absorption↗
PubMed1997

Homeless mentally ill clients' and providers' perceptions of service needs and clients' use of services.

OBJECTIVE: Clients' and providers' perceptions of clients' needs were compared in 18 community treatment programs participating in the Access to Community Care and Effective Services and Supports program of the Center for Mental Health Services, a national demonstration project on treatment of homeless persons with mental illness. The study sought to determine whether perceptions differed and whether assessed needs for services were related to service use. METHODS: A total of 1,482 clients contacted through community outreach who entered the case management phase of the program after an average of 32 days were given an evaluation interview at entry into the program. The clients and outreach workers identified clients' needs in seven core domains-mental health, general health, substance abuse, public financial support, housing assistance and support, dental care, and employment. Use of related services in the 60 days before the case management evaluation was determined. RESULTS: The greatest differences between clients' and providers' perceptions of service needs were in dental and medical services, which were more frequently identified as needs by clients, and in substance abuse and mental health services, which were more frequently identified by providers. Clients' and providers' assessments of need were significantly, but not strongly, correlated with each other, and both were correlated with use of mental health and substance abuse services. CONCLUSIONS: Mental health service providers are less likely than clients to identify needs for services other than mental health services. Service use, at least in the short run, is related to both clients' and providers' assessments of need.

Adult↗