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PubMed1983

Changes of the mean birth weight in frequency tables with various number of classes--by prefecture, health center and city-town-village.

When the mean birth weights (MBW) calculated from frequency tables are compared with each other, the methods for grouping data into class intervals should be taken into consideration. We integrated the lower and/or upper classes of the frequency tables belonging to the type used in the Vital Statistics of Japan with 500 g intervals and 10 classes (less than or equal to 999, 1000-1499,..., 4500-4999, 5000 less than or equal to) into neighboring classes, and observed the differences between both MBW and the standard deviations (SD) calculated from the original standard frequency tables (o method) and those from the above modified ones (a,..., h method) at three community levels, namely, prefectural, health center (HC) and city-town-village level. At the prefectural level, MBW changed from -2 to 3 g through all the modified methods and SD changed most at -5 g in a,..., d method. At the HC level, MBW changed from -3 to -6 g and SD changed most at -8 g in a,..., d method. At the city-town-village level, MBW and SD did not change in over 50% of the communities, but the degrees of change were large in some communities where MBW or SD changed. The changes were larger in the case of integrating the lowest class into a class of less than or equal to 1499 g than that of integrating the highest class into a class of 4500 less than or equal to. Also they were larger in the case of integrating the lower two classes into a class of less than or equal to 1999 g than that of integrating the upper two classes into a class of 4000 g less than or equal to. We concluded that 1) MBW from the frequency tables where the lower classes were integrated should be carefully dealt with, especially at the small community level, but 2) the differences of population means between any method were not statistically significant and 3) if MBW from different frequency tables are compared with each other, reasonable differences of MBW depending on the methods of grouping and the size of the number of live births should be taken into account.

Birth Weight↗
PubMedDate not supplied

Making youth tobacco control programs more ecological: organizational and professional profiles.

PURPOSE: To identify the organizational and professional correlates of the integration of the ecological approach in Canadian public health organizations' tobacco control programs for youth. DESIGN: Cross-sectional survey. SETTING: Canadian public health organizations. SUBJECTS: One hundred and ten tobacco control programs implemented in 90 organizations. The response rate for the organizations was 87%. MEASURES: Descriptions of programs were obtained by telephone interviews. An analytical procedure was applied to the program data to identify intervention settings, targets and strategies for each program. Using this information, a summary score of the integration of the ecological approach was estimated for each program. Organizational and professional variables were assessed by self-administered questionnaires to managers and professionals involved in these programs. RESULTS: The level of integration of the ecological approach in programs was related to organizational (frequency of contacts and collaborations with external partners, team composition) and extraorganizational factors (size of the city in which the public health unit is located). Cognitive attributes of the practitioners (knowledge and beliefs) also emerged as significant predictors. Finally, positive associations were observed between practitioners' personal characteristics (educational achievement, working status in health promotion [full vs. part-time], previous experience, gender, and disciplinary/professional background) and cognitive predictors. CONCLUSIONS: Organizational environment and staff preparation play a critical role in the adoption of the ecological approach in tobacco control programs.

Access to Information↗
PubMed1996

"Inaccuracy' in death certification--where are we now?

BACKGROUND: This review aims to document and analyse aspects of death certification that are relevant to public health. METHODS: A literature review on death certification primarily used the computerized Index Medicus (1981 to mid-1995), and concentrated on completing death certificates, accuracy, standards, education and procedural requirements. Further sentinel publications pre-dating this were identified from the main literature base. RESULTS: The uses of mortality data, historical and procedural context for recording death, the philosophy of Underlying Cause of Death and its relationship to the truth, the extent and impact of "inaccuracy', the certificate and the certifier, and possible ways forward are discussed. It is argued that the question "How inaccurate are cause of death data?' is harder to answer than the literature suggests. Deriving a useful estimate is difficult because of inter-study differences in (1) definition, measurement (how and by whom?) and practical importance of error, and standards used; (2) focus (e.g. death certificate or mortality data), observing everyday practice or simulation exercises, diagnostic and/or semantic issues. CONCLUSION: The traditional perspective on improving the quality of death certification has not worked. There is a need for reorientated thinking rather than just urging more education. Evidence-based educational interventions are needed. The flaws in the theoretical framework of cause of death and the routine nature of death certification are unavoidable, but require consideration. Certifiers need practical feedback mechanisms, integral to continuing quality assurance at all levels and fostering an understanding of the construction of mortality data. Continued development should be a core public health medicine role.

Cause of Death↗
PubMed2003

Emergency medical services in rural areas: the supporting role of state EMS agencies.

CONTEXT: EMS is an integral part of health care and is especially important in less densely populated areas. What is known about EMS in rural areas is limited because of fragmentation in the system and rudimentary data collection efforts. PURPOSE: The goal of this study is to identify important issues faced by rural EMS systems and describe the support of rural EMS providers by state EMS agencies. METHODS: A telephone survey of state EMS directors (response rate 95.7%) asked questions regarding issues in medical direction, programs, and initiatives by state EMS agencies that target rural and volunteer EMS providers, integration initiatives, and anticipated effects of the new Medicare fee schedule. FINDINGS: Medical direction in rural EMS was identified as a major issue for a majority of states. Integration in EMS is seen as a possible solution but does not occur very commonly. The survey found substantial variation in the state approach to EMS issues. Less than a third of the states in the study have a statewide EMS plan. State EMS agencies address rural EMS provider needs in a limited manner. EMS state agencies focus on regulation and funding of EMS providers, with only approximately a third providing technical assistance to EMS providers. CONCLUSIONS: The range in approaches to EMS issues at the state level will need to be taken into account in formulating national EMS policy. The limited provision of technical assistance leaves a void that may be addressed by other agencies and organizations in some states. In the absence of major federal funding initiatives, the development of EMS has become a state and local issue. A new national initiative may help address EMS issues and stimulate the development of EMS as a system beyond its current fragmented state.

Ambulances↗
PubMedDate not supplied

Impact of the integrated Radio Communication Project in Nepal, 1994-1997.

The Radio Communication Project (RCP) in Nepal is an ongoing, theory-based, multimedia reproductive health campaign which began in 1995. It consists of two entertainment-education radio serials (a soap opera for the general public and a dramatized distance education serial for health workers), additional radio spot advertisements and promotions, and complementary print materials. This paper examines impact data from a variety of sources, including a pre- and postpanel survey of currently married women (N = 1905), three waves of clinic-based observations of client-provider interactions (N = 240 per wave) and client exit interviews (N = 240 per wave), and 2 years of clinic service statistics, in order to draw inferences about the separate and combined effects of the RCP components. The study found increased health worker interpersonal interaction skills, improved quality of client-provider interactions, increased client self-efficacy in dealing with health workers, improved client attitudes toward health services and toward the practice of family planning, increased adoption of family planning, and increased family planning service utilization, all attributable to the RCP. The panel data allowed statistical control of the influence of predisposing factors before the campaign on postcampaign ideation and behavior. The effect of the RCP on contraceptive behavior was largely indirect through its influence on ideation. Implications for the design of integrated, multimedia, entertainment-education campaigns and integrated evaluation designs are discussed.

Female↗
PubMed1987

Integrating hospice and home health services: analysis of strategic factors.

Two types of strategic factors promote the development of hospice-home health care alliances. Enabling factors include favorable reimbursement policies, acceptance of innovative and noninstitutional modes of health care delivery, and existing supportive infrastructures. Factors supporting alliances include similar types of patient needs, potential for sharing provider and administrative staff, joint referral networks, and common cost containment methodologies. A study of a multi-institutional arrangement between a hospice and a home health care program provided data on patient demographics, staff utilization, and programmatic costs. An analysis of these data showed surprising similarities between the programs. These findings support the continued efforts for service consolidation and integration.

Home Care Services↗
PubMed2004

Modeling, the essential step to consolidate and integrate a national NMDS.

How to develop a nursing minimum data set (NMDS) as a part of a nursing information system, which is itself a part of a health information system, this is the challenge presented in this paper and realized in Switzerland through the NURSING data project. The development of the CH-NMDS is not just a selection of data but a real conceptual work consisting in making the link between the information system and the terminology system and this for any level of aggregation. The building of a conceptual coherence between the collection of the data, their storage and their utilization for decision making was made by using the object modeling language, not for programming aims but statistical purposes. For example, the nursing phenomena and the nursing interventions are considered as classification concepts as well as sets of data.

Data Collection↗
PubMed1983

Quality assurance and program evaluation.

Some common forces have led to increased attention to quality assurance and program evaluation in the United States. However, these two types of public accountability have developed relatively independently, resulting in somewhat different but related approaches to examining health care. The similarities and differences between quality-of-case assurance and program evaluation are discussed as related to their definitions and approaches to data collection and utilization. Pressures to integrate quality assurance and program evaluation and evidence of a convergence in the two types of assessment activities are also presented. The article concludes with a discussion of the future role of the states and localities in assuming responsibility for these two types of accountability.

Evaluation Studies as Topic↗
PubMed2004

[Resources of information in the field of bioethics in Italy: survey of the present state and perspectives].

The research project "Collection and dissemination of bioethical information through an integrated electronic system", started in 2001 by the Istituto Superiore di Sanità (ISS), had among its objectives, the realization of an integrated system for data collection and exchange of documents related to bioethics. The system should act as a reference tool for those research activities impacting on citizens' health and welfare. This paper aims at presenting some initiatives, developed in the project framework, in order to establish an Italian documentation network, among which: a) exchange of ISS publications with Italian institutions active in this field; b) survey through a questionnaire aimed at assessing Italian informative resources, state-of-the-art and holdings of documentation centres and ethical committees; c) Italian Internet resources analysis. The results of the survey, together with the analysis of web sites, show that at present in Italy there are many interesting initiatives for collecting and spreading of documentation in the bioethical fields, but there is an urgent need for an integration of such resources. Ethical committees generally speaking need a larger availability of documents, while there are good potentialities for the establishment of an electronic network for document retrieval and delivery.

Academies and Institutes↗
PubMed2001

Differences in antimicrobial susceptibility among hospitals in an integrated health system.

We evaluated the differences in antimicrobial susceptibility among hospitals in three different integrated healthcare systems. Each system provided antibiogram-susceptibility reports from representative hospitals. Reports were analyzed for statistically significant differences between hospitals in a given system for nine important organisms. We found numerous significant interhospital differences in antimicrobial-susceptibility patterns within health systems. For this reason, the practice of combining antibiotic-susceptibility data into a systemwide antibiogram should be discouraged.

Delivery of Health Care, Integrated↗
PubMedDate not supplied

Kaiser Permanente's evaluation and management of biotech drugs: assessing, measuring, and affecting use.

Two decades into the age of high-cost biotechnology medications, health care organizations are challenged to provide safe, effective treatment while managing costs. In a market lacking generic biotech drugs, health care organizations have few opportunities to negotiate reduced pricing; other strategies must be devised to manage use. Kaiser Permanente leverages its integrated health care delivery system to deploy management tools for costly therapies: evidence analysis, usage measurements, and multidisciplinary planning. Evidence-based medicine and realization of value provided by new therapies will depend on data capture and outcomes measurement, tools that are crucial to Kaiser Permanente's management of biotechnologies and effective use of members' financial resources.

Biotechnology↗
PubMed1995

Integrated clinical database in a health maintenance organization.

This paper describes the development and implementation of the first phase of a comprehensive clinical information system in the Kaiser Permanente Northwest Region. This system integrates information from disparate departmental systems into a single clinical database. By using periodic batch downloads of patient data from departmental systems into the clinical database, rather than requiring real-time updates, we have been able to implement this system with relative ease and speed. It contains patient demographics, lab, outpatient pharmacy, radiology, pathology, dictated consults, admission histories and physicals, discharge summaries, and other dictated reports for over 380,000 Health Plan Members. The system is fast, intuitive, reliable, and user-friendly. In March 1994, there were approximately 1,600 active users. These individuals accounted for approximately 410,000 transactions in the month, with an average daily transaction volume of 11,450. Quantifiable cost-savings, in terms of decreased chart pulls and decreased phone calls for information, have offset the cost of development and implementation to some extent. Less quantifiable improvements in the quality of care and the associated cost-savings may eclipse the quantifiable benefits. This system lays the foundation for our clinical information system efforts.

Health Maintenance Organizations↗
PubMed2003

Integrating syndromic surveillance data across multiple locations: effects on outbreak detection performance.

Syndromic surveillance systems are being deployed widely to monitor for signals of covert bioterrorist attacks. Regional systems are being established through the integration of local surveillance data across multiple facilities. We studied how different methods of data integration affect outbreak detection performance. We used a simulation relying on a semi-synthetic dataset, introducing simulated outbreaks of different sizes into historical visit data from two hospitals. In one simulation, we introduced the synthetic outbreak evenly into both hospital datasets (aggregate model). In the second, the outbreak was introduced into only one or the other of the hospital datasets (local model). We found that the aggregate model had a higher sensitivity for detecting outbreaks that were evenly distributed between the hospitals. However, for outbreaks that were localized to one facility, maintaining individual models for each location proved to be better. Given the complementary benefits offered by both approaches, the results suggest building a hybrid system that includes both individual models for each location, and an aggregate model that combines all the data. We also discuss options for multi-level signal integration hierarchies.

Bioterrorism↗
PubMed1976

A model for program evaluation in a unitized setting.

The unitized psychiatric hospital poses unique problems for the design of successful program evaluation systems. Using the model of program evaluation in operation at the Harlem Valley Psychiatric Center in New York, the authors describe what they have found to be essential components of a successful evaluation system, including methods of data input, processing, and feedback. Also discussed are the roles of key personnel and the utilization of data by clinical and administrative staff. The reasons for success of the system are discussed, as well as the potential role of program evaluation in integrating services, training, and administration of the facility.

Aftercare↗
PubMed2007

Resource utilization and expenditures for overweight and obese children.

OBJECTIVES: To compare health care utilization and expenditures for healthy-weight patients, overweight patients, and patients with diagnosed and undiagnosed obesity and to examine factors associated with a diagnosis of obesity. DESIGN: Retrospective study using claims data from a large pediatric integrated delivery system. SETTING: An urban academic children's hospital. PARTICIPANTS: Children aged 5 to 18 years who presented to a primary care clinic for well-child care visits during the calendar years 2002 and 2003 and who were followed up for 12 months. MAIN OUTCOME MEASURES: Diagnosis of obesity, primary care visits, emergency department visits, laboratory use, and health care charges. RESULTS: Of 8404 patients, 57.9% were 10 years or older, 61.2% were African American, and 72.9% were insured by Medicaid. According to the criteria of body mass index (calculated as weight in kilograms divided by the square of height in meters), 17.8% were overweight and 21.9% were obese. Of the obese children, 42.9% had a diagnosis of obesity. Increased laboratory use was found in both children with diagnosed obesity (odds ratio [OR], 5.49; 95% confidence interval [CI], 4.65-6.48) and children with undiagnosed obesity (OR, 2.32; 95% CI, 1.97-2.74), relative to the healthy-weight group. Health care expenditures were significantly higher for children with diagnosed obesity (adjusted mean difference, $172; 95% CI, $138-$206) vs the healthy-weight group. Factors associated with the diagnosis of obesity were age 10 years and older (OR, 2.7; 95% CI, 2.0-3.4), female sex (OR, 1.5; 95% CI, 1.2-1.8), and having Medicaid (OR, 1.6; 95% CI, 1.1-2.3). CONCLUSIONS: Increased health care utilization and charges reported in obese adults are also present in obese children. Most children with obesity had not been diagnosed as having obesity in this administrative data set.

Adolescent↗
PubMedDate not supplied

Integrating behavior and intention regarding mammography by respondents in the 1990 National Health Interview Survey of Health Promotion and Disease Prevention.

Achieving and maintaining high rates of screening mammography are major public health priorities. This report examines data from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention on the utilization of mammography among women ages 40-75. Results show that progress is being made in some areas--57.7 percent of women "ever had" a mammogram; 50.3 percent, in previous 2 years. However, those not having repeated regular screening appear to be a sizable proportion. Only 28.6 percent of women ages 40-75 had been both screened on the recommended age-specific schedule and expressed an intention to continue screening; another 29.2 percent indicated no intention to have a mammogram in the near future. Income, clinical breast examination, and Pap (Papanicolaou's) test, having no regular source of care, region of the country and residential variables, smoking status, not exercising, not knowing how to do breast self-examination, and race were among the variables having the strongest associations with mammography status. Several groups in the population therefore remain at risk of not receiving regular screening. The combination of mammography status to date and future intention to have the examination provides an important perspective on efforts to reach public health screening objectives and appears to provide a strategy for targeting interventions.

Adult↗