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PubMed2002

Older Latinos, pets, and health.

The majority of thefindings regarding pet ownership, interaction, and the human-animal bond have involved only Caucasians or have included other ethnic group members only incidentally. The extent to which older adultsfrom other ethnic groups may benefitfrom pet ownership and interaction is unclear. If the benefits of human-animal interaction are to be used effectively in promoting health and preventing illness, it is necessary to identify the "boundaries" of effectiveness for this interaction across various populations. The present study is an initial effort at describing one ethnic minority group, Latino pet owners, the extent of their relationships with their pet, and the extent to which these relationships may be beneficial in facilitating health. Twenty-four Latinos over age 50 were studied and are described in terms of their demographic characteristics, relationships with their pets, health, and exercise practices. The findings suggest that the participants were very devoted to their pets, had been involved with pets since childhood, and viewed themselves as healthy.

Aging↗

PubMed1992

Hospital variations in adverse patient outcomes.

Careful review of the literature suggests that the conceptual problem in analyzing hospitals' quality of care is the difficulty of identifying problem domains of hospital care. An appropriate measurement model using multiple indicators of hospital quality problems is developed and evaluated. Adverse patient outcomes reflecting the quality problems are compiled from a peer review organization's generic screen indicators for 85 acute care hospitals. Predictor variables of adverse outcomes include bed size, number of high-technology services offered, case mix, severity of patients treated, ownership, case mix, severity of patients treated, ownership, net profit, market share, efficiency, teaching status, and metropolitan size. The findings show that hospital characteristics exert limited effects on adverse outcomes. Efficiency and average length of stay are the only statistically significant factors that explain the variation in adverse outcomes.

Hospital Mortality↗

PubMed1995

An analysis of the adoption of managerial innovation: cost accounting systems in hospitals.

The adoption of new medical technologies has received significant attention in the hospital industry, in part, because of its observed relation to hospital cost increases. However, few comprehensive studies exist regarding the adoption of non-medical technologies in the hospital setting. This paper develops and tests a model of the adoption of a managerial innovation, new to the hospital industry, that of cost accounting systems based upon standard costs. The conceptual model hypothesizes that four organizational context factors (size, complexity, ownership and slack resources) and two environmental factors (payor mix and interorganizational dependency) influence hospital adoption of cost accounting systems. Based on responses to a mail survey of hospitals in the Chicago area and AHA annual survey information for 1986, a sample of 92 hospitals was analyzed. Greater hospital size, complexity, slack resources, and interorganizational dependency all were associated with adoption. Payor mix had no significant influence and the hospital ownership variables had a mixed influence. The logistic regression model was significant overall and explained over 15% of the variance in the adoption decision.

Accounting↗

PubMed2006

Safety-net activities and hospital contracting with managed care organizations.

This article studies factors of safety-net hospitals that affect contracting with managed-care organizations. Web-based data were used to identify the hospital networks of managed-care plans in 71 metropolitan statistical areas. We collected lists of hospitals from a national sample of managed-care plans. After combining these data with hospital, managed-care, and area characteristics, multivariate logistic regressions with random effects were estimated to determine hospital characteristics that influence the probability of a contract between the plan and hospital. Hospital characteristics included size, ownership, whether it was part of a system, teaching status, and safety-net activities. Managed-care plan characteristics included type of plan and ownership. Certain safety-net hospital measures and a cluster of related hospital characteristics are associated with a lower probability of contract. Hospitals accounting for a disproportionate share of safety-net activities are less likely to belong to managed-care networks, which may place them at a competitive disadvantage.

Contracts↗

PubMed2000

Cost containment of pharmaceutical use in Iceland: the impact of liberalization and user charges.

OBJECTIVES: Iceland was the first Nordic country to liberalise its drug distribution system, in March 1996. Subsequent regulation in January 1997 increased patients' share of drug costs. The objectives of this study were to test the assumptions that liberalizing community pharmacy ownership would lower reimbursement costs for the state's Social Security Institute and that increasing patient charges would reduce use and, therefore, lower the cost to the Institute. METHODS: Based on the assumptions, we built and tested two models using interrupted time series designs that contrast the monthly reimbursement costs before and after the legislation and regulation took effect. A control variable (the number of office visits to general practitioners) was tested to assess other events in the health care arena. Monthly data on these variables were provided by the Icelandic State Social Security Institute for January 1993 to August 1998 for reimbursement costs and to December 1998 for office visits to general practitioners. RESULTS: Reimbursement costs have risen steadily throughout the period under study. The interrupted time series analysis did not show a substantial effect from the legislative change in March 1996 or from the regulatory intervention in January 1997. CONCLUSIONS: The main argument used for liberalizing community pharmacy ownership in Iceland was built on false assumptions regarding the effect on drug reimbursement costs to the state. It will be necessary to find more promising interventions to halt the rapidly increasing cost of drugs.

Cost Control↗

PubMed2003

Sleeping arrangements and mosquito net use among under-fives: results from the Uganda Demographic and Health Survey.

BACKGROUND: The Roll Back Malaria Initiative has identified the under-fives as one of the high risk groups for malaria, and one of the strategies to fight malaria in this group is increasing mosquito net use. This implies that there must be selective targeting at the household level such that the children are protected. However, the Roll Back Malaria preferences must be reconciled with those at the household level to take into account household level preferences. METHODS: This paper is based on the 2000-2001 Uganda Demographic and Health Survey data in which information on mosquito net ownership and use was collected. The patterns of household mosquito net ownership and use for children under five years of age were examined using both bi-variate and multivariate analysis. RESULTS: The preferences at the household level seem to be different; children use mosquito nets primarily because they happen to share a bed with their parents. A child who shares a bed with the mother is 21 times more likely to use a mosquito net than his/her counterpart. CONCLUSION: Increasing mosquito net coverage such that 60% (the target for the RBM) of households have at least one mosquito net will not necessarily protect the under-fives. Either the coverage will have to be expanded or appropriate targeting strategies designed.

Journal Article↗

PubMed2001

Defining populations: a key step in identifying spatial and temporal scales.

The scale at which ecological risk assessors frame their analyses can be driven by a number of considerations. In many cases, the selection of the scale is among the most important decisions within the 'problem-formulation' phase of the ecological risk characterization. The scale of a risk characterization is often defined based on ownership boundaries, ecological, or habitat boundaries and/or physical and hydrogeological boundaries (e.g., watersheds). With increasing value being placed on consideration of spatial scales in risk characterization, the need to define a scale that balances analytical and ecological realities is imperative. Defining the spatial scale based on the scale of a population offers the risk assessor the opportunity to improve the ecological relevance of the risk characterization. Arriving at a single operational definition of a population would be difficult and not appropriate because of the variability in sites, issues, and management goals; however, we can begin to review operational definitions and establish analytical frameworks by which to select the appropriate, site-specific scale within the problem-formulation phase. Defining a scale based on a combination of ecological and site ownership considerations and the inclusion of habitat quality in the assessment of scale can improve the power and relevance of the problem formulation and risk characterization. In this analysis, we assess methods for incorporating spatial considerations into risk analyses, beginning with developing an understanding of the context of a site within the larger landscape. Clearly defining the scale of an assessment including the operational definition of populations is an important step in the problem formulation. Within a site or landscape, the scale may be refined further based on the percentage of the land within the scale of the analysis that provides habitat for a given species.

Animals↗

PubMed2005

Barriers to success for an evidence-based guideline for chronic obstructive pulmonary disease.

OBJECTIVES: To evaluate 1) barriers to clinical guideline use and 2) the relationship between guideline use and inpatient outcomes in chronic obstructive pulmonary disease (COPD). METHODS: 1) Four focus groups of specific health professions (n = 30), from three metropolitan hospitals, and interview of 99 medical officers (MOs), linked to 349 admissions, both guided by behavioural modelling theory; 2) association between guideline use and patient outcomes (length of hospital stay > or = 14 days, and readmission within 28 or 90 days) was evaluated in a cohort of 405 COPD patients. RESULTS: 1) In focus groups, nurses and allied health professionals emphasized facilitation issues including paperwork duplication and time limitations as barriers, but considered improved patient care outcomes as the major guideline use determinant. There were similar findings in junior MOs (nonconsultants) by both focus group and interview, with the addition of a need for a sense of ownership. Senior MOs (consultants) greatly emphasized sense of ownership. Barriers to guideline use varied between types of units. Behavioural modelling explained 49% of the variation in intention to use the guideline for MOs. For nonconsultants, habit and intention were significantly associated with extent of guideline use. 2) Patient outcomes: guideline use was not associated with length of stay or readmission. CONCLUSIONS: 1) Guideline implementation should address issues relevant to different health professions, units and seniority of profession. 2) Guideline use was not associated with reductions in readmission or length of stay.

Adult↗

PubMed2003

Depression and poverty among African American women at risk for type 2 diabetes.

Poverty is associated with negative health outcomes, including depression. Little is known about the specific elements of poverty that contribute to depression, particularly among African American women at risk for type 2 diabetes. This study examined the relationships of economic and social resources to depression among African American women at high risk for the development of type 2 diabetes (N = 181) using the Conservation of Resources theory as a conceptual framework. Women were assessed at 3 time points in conjunction with a dietary change intervention. At baseline, 40% of women reported clinically significant depression, and 43.3% were below the poverty line. Depressed women reported fewer economic assets and greater economic distress than nondepressed peers. Multivariate logistic regression analyses indicated that nonwork status, lack of home ownership, low appraisal of one's economic situation, low self-esteem, and increased life events were significantly associated with depression at baseline. Longitudinal multivariate logistic regression models indicated that income, home ownership, future economic appraisal, life events, and self-esteem predicted depression trajectories at Time 3. These results speak to the multifaceted sources of stress in the lives of poor African American women. Interventions that address the economic and social factors associated with depression are needed.

Adult↗

PubMed1998

Stroke and intracranial venous thrombosis during pregnancy and puerperium.

OBJECTIVES: To determine nationally representative estimates of the incidence of stroke and intracranial venous thrombosis during pregnancy and the puerperium, and to identify potential risk factors for these conditions. METHODS: National Hospital Discharge Survey data were analyzed for the period 1979 to 1991. Nationally representative estimates of risk were calculated by age, race, presence of pregnancy-related hypertension, census region, hospital ownership, and number of hospital beds. Multivariate models were developed using logistic regression. RESULTS: There were an estimated 8,918 cases of stroke and 5,723 cases of intracranial venous thrombosis during pregnancy and the puerperium in the United States among 50,264,631 deliveries, giving risks of 17.7 cases of stroke and 11.4 cases of intracranial venous thrombosis per 100,000 deliveries. In the multivariate models, stroke was associated strongly with pregnancy-related hypertension, larger hospital size, and proprietary hospital ownership, and inversely associated with living in the South. Intracranial venous thrombosis was associated with maternal age. CONCLUSIONS: Stroke and intracranial venous thrombosis are relatively common complications of pregnancy and the puerperium. Collectively, rates for these conditions are about 50% greater for the entire period of pregnancy and the puerperium than for the immediate peripartum period.

Adolescent↗

PubMed2006

The impact of state community benefit laws on the community health orientation and health promotion services of hospitals.

This study examined the effect of state community benefit laws and guidelines on the community health orientation and the provision of hospital-based health promotion services in hospitals. The sample included all not-for-profit and investor-owned acute-care hospitals in the United States during the year 2000. Multiple regression procedures were used to test the effect of community benefit laws and type of ownership while controlling for organizational and environmental variables. The results of these procedures indicated that, on average, not-for-profit hospitals in the ten states with community benefit laws/guidelines reported significantly more community health orientation activities than did not-for-profit hospitals in the forty other states. The results of the multiple regression procedures also indicated that, on average, the investor-owned hospitals in the ten states with laws/guidelines reported significantly more community health orientation activities than did the investor-owned hospitals in the forty other states. The study found that community benefit laws had the effect of decreasing ownership-related differences in reported community health orientation activities. Further, Levene's test of equality of variance showed that the not-for-profit hospitals in community benefit states exhibited significantly lower variance in the community health orientation activities when compared with the not-for-profit hospitals in non-community benefit states. However, none of the statistical tests supported the hypotheses that community benefit laws compelled or induced hospitals to offer significantly more health promotion services. The study concluded that coercive measures such as community benefit laws were effective in compelling not-for-profit hospitals to report increased community orientation activities, and it also concluded that the mimetic pressures associated with these laws were effective in inducing investor-owned hospitals to report increased community orientation activities.

Community-Institutional Relations↗

PubMed1991

Multivariate analysis of family risk factors in predicting appointment attendance in a pediatric otology and communication clinic.

Parents of pediatric patients attending regional otologic medical clinics were given a questionnaire to document family risk factors predictive of poor appointment attendance, and to determine barriers which caused non-attendance of medical appointments. Family risk factors which affected clinic attendance were studied using univariate and multivariate analyses. Univariate analyses revealed all factors except patients' sex and family size to be correlated with attendance. However, multivariate analysis revealed that parental age (p less than 0.0153), ownership of car (p less than 0.0012), parental education (p less than 0.0048), and age of patient (p less than 0.0023) were major predictors of clinic attendance. Although ownership of a car was a major independent factor, it was highly correlated with parental age and parental education and only shown to be significant in the subset of patients not having access to public transportation. The identified parental factors which affect pediatric health care delivery underscores the importance of family centered case management in promoting the health care of children and casts doubt on the effectiveness of interventions which are solely centered on the patient or are designed to mitigate only one of these factors.

Adult↗

PubMedDate not supplied

Student pharmacist perspectives of rural pharmacy practice.

OBJECTIVE: To evaluate the level of interest of upper-level doctor of pharmacy students in rural pharmacy practice, rural pharmacy ownership, and a proposed rural pharmacy practice model. DESIGN: Cross-sectional study. SETTING: Minnesota, North Dakota, and South Dakota in October through December 2003. PARTICIPANTS: Third- and fourth-year professional student pharmacists at the University of Minnesota, North Dakota State University, and South Dakota State University. INTERVENTION: Self-administered questionnaire completed by study participants. MAIN OUTCOME MEASURES: Student interest in rural pharmacy practice and potential future directions for maintaining access to medications and the knowledge of pharmacists in rural communities. RESULTS: Of 177 respondents, 62.7% has given serious consideration to practice in rural communities with populations of 5,000 or fewer residents. Of these 111 students, 81% would be interested in the proposed practice model explained in the survey. Of the 108 total students expressing interest in the proposed rural pharmacy practice model, 63% had not previously given serious consideration to pursuing ownership (full or partnership) of a community pharmacy. CONCLUSION: Students from the schools that have traditionally supplied the majority of Minnesota rural pharmacists indicated an interest in practicing in rural areas as long as opportunities align with their personal and professional interests.

Community Pharmacy Services↗

PubMed1998

Analysis of expenditures and outcomes of residential alternatives for persons with developmental disabilities.

Expenditures, staffing, and outcomes were examined for 116 adults with severe or profound mental retardation who moved from state institutions in Minnesota to various community living settings and a comparison group of 71 persons who remained institutionalized. Outcome variables included community access, social activities, community inclusion, family relationships, and choice. Comparison of participants' personal characteristics revealed no differences between groups, but several differences emerged when the community sample was grouped by residence size or public versus private ownership. Where necessary, covariance analysis was used to adjust for these preexisting differences. Community residences were less costly and had more favorable staffing and uniformly better outcomes than did institutions. Few outcome differences were evident between community residents when compared by residence size or service ownership.

Adult↗

PubMedDate not supplied

Uncompensated care and hospital conversions in Florida.

Hospital conversions to for-profit ownership have prompted concern about continuing access to care for the poor or uninsured. This DataWatch presents an analysis of the rate of uncompensated care provided by Florida hospitals before and after converting to for-profit ownership. Uncompensated care declined greatly in the converting public hospitals, which had a significant commitment to uncompensated care before conversion. Among converting nonprofit hospitals, uncompensated care levels were low before conversion and did not change following conversion. The study suggests that policymakers should assess the risk entailed in a conversion by considering the hospital's historic mission and its current role in the community.

Florida↗

PubMedDate not supplied

Intolerable risk, irreparable harm: the legacy of physician-owned specialty hospitals.

Issues of physician ownership and referral could cause major shifts in the structure of medical care and make the financing of U.S. hospital services problematic. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 mandated research on this matter and applied an eighteen-month moratorium against self-referral to allow policymakers to consider the issue. Research findings thus far confirm that physicians' ownership and referral present conflicts of interest through medical and economic patient selection and potentially excessive utilization. The policy response must prevent these results and preserve fair competition among hospitals.

Conflict of Interest↗

PubMed1982

New dental graduates: mobility and choice of dental practice arrangement. Bureau of Economic and Behavioral Research.

The key to understanding changes in the distribution of dentists through time is organizing and understanding the location decisions of recent graduates and dentists leaving the armed forces and federal service. New graduates represented approximately 57% of the new practices located between 1976 and 1979, and dentists in institutional service represented 21% of all movers. The migration rate among private practicing dentists who remain in private practice is roughly one-third the rate among all dentists. Further, practitioners who do move do not move very far. The proportion of interstate moves among all private practitioners that moved was only 28%. Apparently, migration among private practicing dentists is a statistically negligible phenomenon, at least in the short run. In contrast, more than 5,000 people have graduated from dental school each year since 1976. Of these, the majority immediately enter private practice, with most of the remainder split between specialty education and some form of institutional practice. Within approximately five years, the transition of the graduation cohort is largely complete. In the three years studied, the number of dentists entering private practice from either dental school or institutional practice is roughly four times the number of private practicing dentists who relocated. Few dentists in private practice do not own or share in the ownership of the practice where they treat patients. Although a higher percentage of the younger, less experienced dentists are in salaried, commissioned, or associate positions compared with all dentists, the majority assumes ownership positions soon after leaving dental school.

Dentists↗

PubMed1988

A national comparison of public- and private-sector alcoholism treatment delivery system characteristics.

The primary purpose of this study was to investigate the question of the existence, nationally, of separate public- and private-sector alcoholism treatment delivery systems in regard to the economic status of clients served, types of care provided and treatment setting. The analysis was based on data from the 1982 National Federal Census Survey of Treatment units. Public- and private-sector profiles based on the aforementioned delivery system characteristics were constructed and compared. Each of the profiles was also compared to a hypothesized profile, based on perceptions drawn from the literature, of the characteristics of treatment delivery in the private sector, generally, or the private-for-profit sector, specifically. The results of the analysis support the conclusion that two separate systems of treatment delivery existed, nationally, during the study period. The distribution of the nation's alcoholism treatment units among the public and private ownership sectors and ownership trends were also investigated using data from national federal census surveys conducted in 1979, 1980, 1982 and 1984. The implications of the study findings for the future are discussed.

Alcoholism↗