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PubMed1996

Hospital financing and neonatal intensive care.

OBJECTIVE: To investigate the relationship between hospital financing patterns and hospital resources for the care of babies born at low birthweight in New York City. DATA SOURCES AND STUDY SETTING: Data on neonatal care beds in New York City hospitals for 1991, obtained from the Greater New York Hospital Association, which were matched to 1991 hospital-specific birthweight and payment distributions from the New York State Department of Health. STUDY DESIGN: Statistical analyses were used to assess the relationship between insurance and beds across all hospitals and across hospitals classified by ownership and teaching status. PRINCIPAL FINDINGS: After adjusting for low birthweight and other measures of patient need and for hospital affiliation, the study finds that hospitals with more privately insured patients, especially those with more privately insured low-birthweight newborns, have statistically significantly more neonatal intensive care beds than do those with fewer such patients. This result persists within hospital affiliation categories. CONCLUSIONS: These results suggest that differences in the care received by privately insured, Medicaid insured, and uninsured low-birthweight babies may stem from differences in the resources available to the hospitals that treat these patients.

Catchment Area, Health↗
PubMed1997

Legal issues in health care administration: what is important to the administrator?

Many legal questions are presented to hospital administrators daily. To determine the relative importance of their concerns, a questionnaire covering 57 legal issues was submitted to the administrators of all 196 Louisiana hospitals. The survey indicated that every issue was considered important, but some issues were considered very important. Sometimes the level of concern was influenced by the characteristics of the hospital, for example, size and ownership.

Analysis of Variance↗
PubMed1997

Dynamics of dog and cat populations in a community.

OBJECTIVE: To describe dynamics of the pet dog and cat populations in a single community in terms of reproductive patterns and turnover. DESIGN: Cross-sectional, random-digit dial telephone survey. SAMPLE POPULATION: Information gathered from 1,272 households in St Joseph County, Ind that owned a dog or cat between Dec 1, 1993 and Nov 30, 1994 was compared with data on 9,571 dogs and cats received by the Humane Society of St Joseph County during the same period. RESULTS: Prevalence of pet ownership was lower than expected, compared with consumer panel surveys. Eight hundred forty-three of 1,335 (63.1%) dogs were neutered, compared with 816 of 1,023 (79.8%) cats. Cost was cited as a reason that 35 of 441 (7.9%) dogs and 34 of 132 (25.8%) cats were not neutered. Only 33 of 968 (3.4%) dog-owning households reported that their dog had had a litter during the past year, whereas 52 of 662 (7.9%) cat-owning households reported their cat had had a litter of kittens. Most cat litters were unplanned, whereas two thirds of dog litters were planned. Annual turnover in owned pets was 191 of 1,354 (14.1%) dogs and 194 of 1,056 (18.4%) cats. Pet owners underreported relinquishing pets to a shelter in the telephone survey. CLINICAL IMPLICATIONS: A combination of animal shelter- and human population-based data are needed to describe pet population dynamics in a community. Information about species-specific reproductive patterns is essential in designing population control programs.

Animal Welfare↗
PubMed1997

Trends toward a national health care marketplace.

In recent years, the health care industry has experienced considerable growth in organizations that are national in focus-organizations that operate in multiple markets not all clustered in one geographic region. This study summarizes information on trends in ownership of various types of health care organizations (i.e., HMOs, PPOs, hospitals, physician practices) for purposes of assessing the growth rate of national companies and the overall significance of this phenomenon. This is followed by a synthesis of factors that encourage or impede the growth of national managed care companies, the sector that has exhibited the most pronounced growth of national companies. We discuss likely future directions and the degree to which national companies may enjoy long-term competitive advantages.

Economic Competition↗
PubMed1997

The effect of chain membership on hospital costs.

OBJECTIVE: To compare the cost structures of hospitals in multihospital systems and independently owned hospitals. DATA SOURCES: The American Hospital Association's Annual Survey from 1990 for data on hospital costs and attributes. Area characteristics came from the Area Resource File, and the Medicare case-mix index came from the Health Care Financing Administration. Data on wages are from the Bureau of the Census' State and Metropolitan Area Data Book. The Guide to Hospital Performance from HCIA, Inc. provided data on quality of care. STUDY DESIGN: Separate cost functions were estimated for chain and independent hospitals. Hybrid translog cost functions included measures of outputs, input prices, and hospital and area characteristics. The estimation method accounted for the simultaneous determination of costs and chain membership, and for any nonrandom selection of hospitals into chains. Several economic cost measures were calculated to compare the cost structures of the two types of hospitals. DATA EXTRACTION METHODS: Data from all sources were merged at the hospital level to form the study sample. PRINCIPAL FINDINGS: Hospitals in multihospital systems were less costly than independently owned hospitals. Among independent hospitals, for-profits had the highest costs. There were no statistically significant differences in costs by ownership among chain members. Economies of scale were enjoyed in both types of hospitals only at high volumes of output, while economies of scope occurred at all volumes for chain hospitals, but only at low and medium volumes for independent hospitals. CONCLUSIONS: This study provides support for the idea that growth of the multihospital system sector can provide a market solution to the problem of constraining costs. It does not, however, support the property rights theory that proprietary hospitals are more efficient than nonprofit hospitals.

Cost Control↗
PubMed1998

The rights of the patient in art therapy.

Artistic activities are widely used in mental health care for both diagnostic and therapeutic purposes. The art produced in this process is often recognized as a valuable commodity in its own right, and this raises questions of ownership, self-determination, privacy, respect and psychic integrity.

Art Therapy↗
PubMed1998

Practice [made profitable].

Buy a medical practice, lose money: There's a cycle worth breaking. In fact, you don't have to accept red ink as the price of ownership. You do have to manage your practices differently. Here's how.

Accounts Payable and Receivable↗
PubMed2005

Participation in health impact assessment: objectives, methods and core values.

Health impact assessment (HIA) is a multidisciplinary aid to decision-making that assesses the impact of policy on public health and on health inequalities. Its purpose is to assist decision-makers to maximize health gains and to reduce inequalities. The 1999 Gothenburg Consensus Paper (GCP) provides researchers with a rationale for establishing community participation as a core value of HIA. According to the GCP, participation in HIA empowers people within the decision-making process and redresses the democratic deficit between government and society. Participation in HIA generates a sense that health and decision-making is community-owned, and the personal experiences of citizens become integral to the formulation of policy. However, the participatory and empowering dimensions of HIA may prove difficult to operationalize. In this review of the participation strategies adopted in key applications of HIA in the United Kingdom, we found that HIA's aim of influencing decision-making creates tension between its participatory and knowledge-gathering dimensions. Accordingly, researchers have decreased the participatory dimension of HIA by reducing the importance attached to the community's experience of empowerment, ownership and democracy, while enlarging its knowledge-gathering dimension by giving pre-eminence to "expert" and "research-generated" evidence. Recent applications of HIA offer a serviceable rationale for participation as a means of information gathering and it is no longer tenable to uphold HIA as a means of empowering communities and advancing the aims of participatory democracy.

Community Health Planning↗
PubMed2006

[Guidelines for management of animal bites].

Bites caused by pets or free living animal, including the so called exotic ones are a common cause of medical care request, although its real dimension has not been well defined in the local setting. This paper reviews the epidemiology of the topic placing emphasis in the initial approach and recommendations for the management of dog and cat bites. Due to increasing ownership or contact with other animals, management of bites from hamsters, mice, ferrets, rabbits, prairie dogs, monkeys, bats, lizards and bird bites is also discussed.

Animals↗
PubMed1995

Tracking the changes in physician practice settings.

OBJECTIVE: To describe the relationships among types of practice settings and physician characteristics and to document changes in these relationships over time. DESIGN: Two national telephone surveys of randomly selected young physicians were conducted in 1987 and 1991. The 1991 survey included reinterviews of 1987 respondents, providing both cohort and repeated cross-sectional data. PARTICIPANTS: The 1987 survey included data on 5312 physicians who had between 2 and 6 years of practice experience and were under age 41 years. The 1991 survey included data on 5002 physicians under age 45 years and in practice between 2 and 10 years, including 2151 reinterviews of 1987 respondents. MAIN OUTCOME MEASURES: Practice settings were classified as traditional, government, group, or managed, based on ownership, practice type, group size, and managed care contracts. RESULTS: Physician sex, race/ethnicity, specialty, and type of medical school were related to the type of practice setting. Young physicians were less likely to practice in traditional settings in 1991 than in 1987 and were more likely to practice in organized practice settings, especially in managed practices. CONCLUSION: Between 1987 and 1991, there was a significant shift away from traditional physician practice settings toward organized practice settings.

Adult↗
PubMed2002

Cat-associated zoonoses.

Cats co-occupy one third of all residences in the United States. As common household pets, they serve as sources of joy and companionship for their owners. However, feline ownership also comes with its own inherent risks, as cats can transmit an array of diseases to their owners, ranging from trivial to fatal ailments. By understanding the pathogenesis of cat-associated diseases, owners and their pets can live together with little risk of disease transmission. This article reviews cat-related diseases, with an emphasis on their prevention and management.

Animals↗
PubMed2003

Lower physician estimate of underlying asthma severity leads to undertreatment.

BACKGROUND: Asthma undertreatment has been linked to poor outcomes. National guidelines recommend that physicians classify asthma severity based on pretreatment symptoms and titrate care as the disease changes in the individual patient. This study evaluated the extent to which the physician estimate of underlying severity affects a patient's asthma care. METHODS: Data used were collected from a cohort of adults with asthma enrolled in managed care. Eligible patients were adults enrolled in managed care with medical encounters coded for asthma. Physicians were eligible if they were main asthma providers. The patient survey covered demographics, symptoms, asthma treatment, and self-management knowledge. Physicians were asked to assess the underlying severity of their patients' asthma. RESULTS: There were 4005 patients with asthma with physician estimates of underlying severity. Of the patients, 70.1% were female (mean age, 44.8 years) and 83.5% were white. Most patients' current asthma symptoms were moderate (39.4%) and severe (50.1%). Most physician estimates of underlying severity were mild (44.6%) and moderate (44.5%). Among those patients reporting moderate symptoms, daily inhaled corticosteroid use was reported in 35.2% when physician estimates were mild, 53.0% when moderate, and 68.1% when severe (P =.001). Rates of peak flowmeter ownership, allergy testing, and self-management knowledge tracked similarly with physician estimates of underlying severity. CONCLUSIONS: Physician estimates of underlying asthma severity appear to determine asthma care. For patients with inadequate symptom control, lower physician estimates of underlying severity were associated with care that is less consistent with national guidelines. To improve the quality of asthma care, physicians need to update treatment based on their patients' current symptoms and adapt care accordingly.

Adult↗
PubMed2004

African American patients' perspectives on medical decision making.

BACKGROUND: The medical literature offers little information about how older African Americans view the medical decision-making process. We sought to describe the perspectives of older African American patients in a primary care clinic as they consider a medical decision. METHODS: We interviewed 25 African American patients older than 50 years who had discussed flexible sigmoidoscopy with their primary care provider. Interviews were analyzed using qualitative methods. RESULTS: Patients listed concerns about cancer and health, risks and benefits, their own understanding of the test, and the recommendation of the provider as the most important factors in their decision. Most patients wanted information about medical tests and procedures to increase their understanding and to provide reassurance rather than to guide decision making. Most patients explained that they wanted the provider to make medical decisions because of his or her training and experience. Despite this, many expressed a sense of ownership or control over one's own body. Patients thought trust was built by a health care provider's honesty, patience, kindness, interest, and continuity of care. CONCLUSIONS: Although traditional models of informed consent have emphasized providing patients with information to guide autonomous decision making, patients may want this information for other reasons. Fully informing patients about their medical condition increases understanding and provides reassurance. Because many of these patients want their provider to participate in making medical decisions, he or she should not only provide information but should also provide guidance to the patient.

Black or African American↗
PubMed1983

Household pets among veterans with multiple sclerosis and age-matched controls. Pilot survey.

A pilot study was carried out among 22 Vietnam-era male US veterans with multiple sclerosis (MS) and 55 age- and sex-matched controls for prior exposure to dogs, cats, and animals with a distemperlike illness. No difference in dog ownership, or sick animals, and subsequent human illness was found in the group with MS or the control group. However, the distribution of dogs by indoor-outdoor status, as reported by patients with MS or controls, showed significant variation by tier of residence. Indoor dogs were more common in northern than southern latitudes, and this may be an important finding in light of the variation in the risk of MS with latitude.

Adult↗
PubMed1998

Partial status epilepticus associated with asomatognosia and alien hand-like behaviors [corrected].

BACKGROUND: Paroxysmal alien hand syndrome (AHS) has been reported in association with ictal phenomena, but simultaneous electroencephalographic verification has not been made. OBSERVATION: A 61-year-old woman with a right hemisphere glioblastoma multiforme developed movements of the left hand that she claimed were not under her control, and she denied ownership of the affected limb. Simultaneous electroencephalograms documented continuous spikes in the right frontotemporal region. Intravenous diazepam therapy (2.5 mg) reversed both the abnormal movements and the spike activity on the electroencephalograms. CONCLUSIONS: Our case demonstrates that partial seizures can produce AHS along with asomatognosia. This variety of AHS appears to be different, both etiologically and phenomenologically, from other forms of AHS.

Aged↗
PubMed1995

Epidemiology of xerophthalmia in Nepal. A pattern of household poverty, childhood illness, and mortality. The Sarlahi Study Group.

A case-control study of xerophthalmia (120 cases, two with corneal disease; 3377 children without xerophthalmia, 12 to 60 months of age) was conducted in the rural plains of Nepal. Relative household wealth (ownership of animals and goods, house quality) and social standing (parental education, nondaily laboring, more affluent castes) were inversely related to risk of xerophthalmia. Mothers of cases were more likely to have had children die than mothers of controls (odds ratio, 1.85; 95% confidence interval, 1.22 to 2.78); case households were more likely to have had a young child die in the past year (odds ratio, 2.85; 95% confidence interval, 1.43 to 5.67). Children with xerophthalmia were more wasted and stunted than controls, although these associations largely disappeared after adjusting for socioeconomic influences. Frequency of breast-feeding was highly protective against xerophthalmia in a dose-response manner (odds ratio, 0.32 for 1 to 10 times a day, 0.12 for > 10 times a day) after adjusting for age and other factors. The risk of xerophthalmia rose directly with reported duration of dysentery in the previous week (odds ratio, 2.13 and 5.81 for durations of 1 to 6 days and > or = 7 days, respectively, vs none). Mild xerophthalmia is reflective of a lower, local standard of living within which child health, nutrition, and survival are compromised.

Case-Control Studies↗
PubMed1989

Barriers to bicycle helmet use among children. Results of focus groups with fourth, fifth, and sixth graders.

As a preliminary step in the development of a school-based educational intervention to promote bicycle helmet use among children, focus group encounters were conducted with fourth, fifth, and sixth graders at three elementary schools in the Boston, Mass, area. Analysis of transcripts of encounter tape recordings indicated that (1) the prevalence of helmet ownership and use was low, (2) children were concerned that helmet use would invite derision from their peers, and (3) children tended to respect other children who wore helmets. We concluded that focus groups can be useful in conceptualizing health education interventions and suggest that school-based peer-led bicycle helmet programs may be effective in developing normative change toward helmet use among elementary schoolchildren.

Adolescent↗
PubMed1996

Disparities in clinical laboratory performance for blood lead analysis.

OBJECTIVE: To evaluate the validity of blood lead analysis for clinical specimens. DESIGN: We submitted blood lead samples with a known lead concentration, in a blinded fashion, as clinical specimens to 18 laboratories. These laboratories were surveyed for the following characteristics that were hypothesized to be related to assay validity: laboratory ownership (state vs private), participation in the Centers for Disease Control Blood Lead Proficiency Program, assay method, and price. Each laboratory received 6 specimens with an actual blood lead (ABPb) concentration of 0.43 mumol/L (9 micrograms/dL) and 3 additional specimens--each with an ABPb concentration of 0.33, 0.89, and 1.59 mumol/L (6.9, 18.4, and 32.9 micrograms/dL, respectively). OUTCOME MEASURES: Misclassification error rates for reporting an elevation ( > or = 0.48 mumol/L [ > or = 10 micrograms/dL) in the blood lead concentration, the within-laboratory mean and coefficient of variation (CV) (for multiple specimens with an ABPb concentration of 0.43 mumol/L [9 micrograms/dL]), and the adjusted odds of a reported blood lead concentration differing from those of an ABPb concentration by more than 0.14 mumol/L (3 micrograms/dL). RESULTS: Blood lead results were obtained for 157 of 162 submissions. One laboratory reported all blood lead specimens as "below 0.48 mumol/L (10 micrograms/dL)." Two (11%) of 18 specimens with an ABPb concentration of 0.89 mumol/L (18.4 micrograms/dL) and 1 (6%) of 17 with an ABPb concentration of 1.59 mumol/L (32.9 micrograms/dL) were classified as below 0.48 mumol/L (10 micrograms/dL); 2 (11%) of 18 with an ABPb concentration of 0.33 mumol/L (6.9 micrograms/dL) and 44 (42%) of 104 with an ABPb concentration of 0.43 mumol/L (9 micrograms/dL) were classified as 0.48 mumol/L or greater ( > or = 10 micrograms/dL). For specimens with an ABPb concentration of 0.43 mumol/L (9 micrograms/dL), the within-laboratory mean ranged from 0.23 to 0.52 mumol/L (4.8-10.7 micrograms/dL); the CV ranged from 3% to 37%. Laboratories that used anodic stripping voltammetry were 6.3 (95% confidence interval, 1.4-28.6) times more likely to report a specimen that differed from the ABPb concentration by more than 0.14 mumol/L (3 micrograms/dL) than those that used atomic absorption methods. No other laboratory characteristic predicted discordance between the reported blood lead and ABPb concentrations. CONCLUSIONS: This study documents wide variation in the validity of the blood lead measurement among clinical laboratories. While the performance of some laboratories far exceeded the criteria of the Centers for Disease Control Blood Lead Proficiency Program, others made large errors that could have resulted in the false-negative misclassification of children with significant lead exposure. Given these differences, the purchasers of laboratory services may require access to laboratory proficiency data to make rational choices among clinical laboratories. Further study of laboratory performance on clinical specimens is required to determine if order-of-magnitude errors occur with sufficient frequency to warrant routine submission of blinded quality control specimens by proficiency programs and to determine the cause of the poor performance of laboratories that used the anodic stripping voltammetry methodology.

Clinical Laboratory Techniques↗