SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
The Oregon Basic Health Services Act of 1989 seeks to establish universal access to basic medical care for all currently uninsured Oregon residents. To control the increasing cost of medical care, the Oregon plan will restrict funding according to a priority list of medical interventions. The basic level of medical care provided to residents with incomes below the federal poverty line will vary according to the funds made available by the Oregon legislature. A rationing plan such as Oregon's which potentially excludes medically necessary procedures from the basic level of health care may be just, for the right to publically-sponsored medical care is restricted by opposing rights of private property. However, the moral acceptability of the Oregon plan cannot be determined in the absence of knowing the level of resources to be provided. Finally, Oregon to date has failed to include the individuals being rationed in discussions as to how the scarce resources are to be distributed.
This paper presents for the first time the annual suicide incidence rates of residents from four Oregon state institutions for a 5-year (1983-1987) period of time. The suicide rate for inmate-patients of the Forensic Psychiatric Program (for the care and treatment of individuals who have been found guilty of serious crime and to be mentally ill) is 820/100,000. This represents a suicide rate 51 times higher than the rate for Marion County or the state of Oregon. This is also one of the highest annual suicide rates ever reported. The suicide rate for patients of the Oregon State Hospital is 289/100,000, which is similar to other reported suicide rates in hospitalized mentally ill populations. This rate is approximately 18 times higher than the rate for Marion County or the state of Oregon. The suicide rate for inmates of Oregon's four correctional institutions is approximately 29/100,000, which is similar to other reported rates for prisoners. This rate is approximately 1.8 times higher than the rate for Marion County or the state of Oregon. The suicide rate for residents of the Fairview Training Center (for care of the mentally retarded and developmentally disabled) is zero.
The Oregon Plan is an ambitious attempt to address the widespread problem in the United States of a growing number of individuals who are without private health insurance and are not eligible for federal assistance programs. Its aim is to provide universal access for all Oregonians, without increasing total health care expenditure, by restricting the cover of some treatments. It has aroused interest in Australia and elsewhere. The appeal of the Oregon Plan lies in its explicit approach to rationing, in community participation in setting priorities, and the use of a cost-effectiveness framework. This paper describes the beginnings and the development of the Oregon Plan, and compares the actual development of the Plan with the rhetoric. There is a gap between the rhetoric of the Plan and its reality. The Oregon plan should be considered in the context of the United States health care system. We compare the American problems with those facing the Australian health care system and conclude that the answer to the question of whether Oregon should be transported to Australia is no. Nevertheless there are elements of the rhetoric of the Plan which could be applied in rationing health care in Australia.
The state of Oregon has led the nation in creating legislation to guarantee universal access by establishing medical and funding priorities in a basic health care package. A preliminary prioritization project--known as the Oregon Medicaid Priority-Setting Project or the Golenski project--served as a "dry run" for Oregon's Basic Health Services Act passed in 1989. A list of 15 public policy principles developed from data gathered from citizen surveys was used as guide for participants in setting priorities. Oregon's pioneering attempt at creating a health care package using prioritization must be seen in the context of the state's particular democratic traditions.
The Oregon Health Services Commission recently completed work on its principal charge: creation of a prioritized list of health care services, ranging from the most important to the least important. Oregon's draft priority list was criticized because it seemed to favor minor treatments over lifesaving ones. This reaction reflects a fundamental and irreconcilable conflict between cost-effectiveness analysis and the powerful human proclivity to rescue endangered life: the "Rule of Rescue." Oregon's final priority list was generated without reference to costs and is, therefore, more intuitively sensible than the initial list. However, the utility of the final list is limited by its lack of specificity with regard to conditions and treatments. An alternative approach for setting health care priorities would circumvent the Rule of Rescue by carefully defining necessary indications for treatment. Such an approach might be applied to Oregon's final list in order to achieve better specificity.
OBJECTIVE: To provide an alternative to Oregon's treatment-specific approach to rationing, we propose a prioritization based on the local hospital resources invested in discretionary medical admissions. DESIGN: We used 1988 Oregon hospital discharge data to determine age- and sex-adjusted per-capita rates of inpatient days for discretionary medical admissions (for high-variation medical conditions) in each of 33 hospital service areas. Potential ceiling rates were defined based on prevailing utilization rates for discretionary medical admissions in each hospital service area. Savings were calculated under the assumption that resources allocated for inpatient treatment of these conditions in areas that exceed the ceiling rates were reduced accordingly. SETTING: Nonfederal, acute-care hospitals used by Oregon residents. STUDY POPULATION: Oregon residents. MAIN OUTCOME MEASURES: Savings were defined in terms of patient days, hospital beds, hospital charges, and average costs. RESULTS: Among the 16 largest hospital service areas, patient-day rates for discretionary medical admissions ranged from 188 to 335 patient days per thousand. Potential savings from applying different ceiling rates ranged from $0.4 million to $94.7 million per year. If the rate in the state capital (Salem) were used as the ceiling (218 days per thousand), then 238 beds could be closed in 20 hospital service areas, for an estimated cost savings of $47.3 million. CONCLUSIONS: Hospital resources invested in discretionary admissions in high-rate areas represent an important potential source of funds for reallocation to meet other defined health care needs. Setting limits based on units of health care supply (eg, beds, capital equipment, and physicians) should be considered as an option for resource reallocation within health care.
Monitoring of exposure to 1,6-hexamethylene (HDI) monomers and HDI polyisocyanates in Oregon was initiated in 1980 and covered primarily spray painting and related activities. A total of 562 air samples were collected from 60 workplaces during the years 1980-1990 and analyzed for HDI and HDI polyisocyanate content. Of the total, only a small fraction (6%) of the samples exceeded the state of Oregon permissible exposure limit (PEL) of 0.02 ppm for HDI monomer; however, a much higher number (42%) of the samples exceeded the Oregon PEL of 1 mg/m3 for HDI polyisocyanates. Spray finishing operations were divided into three categories: continuous industrial spraying, auto body repair shops, and intermittent spray operations of large objects. The highest exposures among all three categories for both HDI and HDI polyisocyanates were measured during spray finishing. The geometric mean for HDI in the industrial spray operations was 0.001 ppm and for HDI polyisocyanates was 3.78 mg/m3. Frequently, the peak exposures exceeded the Oregon PEL for polyisocyanates, reaching as high as 12.2 mg/m3. In auto body shops, the mean for HDI was 0.002 ppm and for HDI polyisocyanates was 1.60 mg/m3 with peak concentrations of 0.049 ppm for HDI and 18.4 mg/m3 for HDI polyisocyanates. In the third category of spray finishing of large objects, the geometric means for three subcategories ranged from 0.001 to 0.017 ppm for HDI with a peak concentration of 0.069 ppm. The geometric means for HDI polyisocyanates ranged from 2.09 to 15.9 mg/m3 with a peak of 29.5 mg/m3. In all the surveys, the ventilation facilities and personal protective equipment were evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)
I document 25 consecutive years (1963-1987) of unnatural deaths within the State of Oregon's mental and correctional institutions in Marion County. This study includes 93 unnatural deaths in the Oregon State Hospital, 18 in the Forensic Psychiatric Program, 52 in the Fairview Training Center, and 45 in the Corrections Department facilities. These institutional unnatural deaths are compared with the 2,618 unnatural deaths that occurred during this same period in Marion County (exclusive of these state facilities). Death rates are shown in five 5-year blocks of time to illustrate death trends. Accidents and suicides were the predominant types of unnatural death in the Oregon State Hospital; suicides predominated in the Forensic Psychiatric Program and the corrections facilities; and accidents predominated in the Fairview Training Center. Extremely high total unnatural death rates were found in the Oregon State Hospital (approximately 520/100,000 or 8.46 times that found in Marion County) and the Forensic Psychiatric Program (approximately 561/100,000 or 9.13 times that found in Marion County). The overall accident death rate for the Fairview Training Center was approximately 119/100,000 or 2.84 times that found in Marion County. The overall total unnatural death rate for the corrections facilities was approximately 75/100,000 or 1.23 times that found in Marion County. I compare these data with those of other investigators in the United States, Canada, and western Europe. The total unnatural death rate appears to represent a valid criterion of violent death within a community.
Routine inquiry legislation can significantly affect procurement of donor eye tissues. Oregon Revised Statute (ORS) 97.268 was the first legislation of this type passed in the United States. In the first 12 months under this legislation, the Oregon Lions Eye Bank obtained, 2,312 eyes, sustaining a 135% increase in donor eye procurement over the yearly average for 1984-1985. During the first 12 months of routine inquiry, 484 corneas suitable for penetrating keratoplasty were obtained versus an annual average of 291 corneas for 1984-1985. Tissues for other transplant purposes and for research have similarly become more available. Age of donor tissue appears to be increasing slightly due to the disproportionate increase of donor eyes from the 70-or-over population. The Oregon Donor Program, the public and professional education coalition of the transplant programs in the state of Oregon, has played an invaluable role in making this penalty-free law a success.
We wished to demonstrate evidence of the presence of California serogroup viruses in Oregon and to test for the presence of certain other arboviruses in large ungulates. Blood samples from black-tailed deer (Odocoileus hemionus columbianus), mule deer (O. hemionus hemionus), and Roosevelt elk (Cervus elaphus roosevelti) from nine counties in Oregon were tested by serum-dilution plaque reduction neutralization for antibody to California serogroup viruses, including snowshoe hare, California encephalitis, and Jamestown Canyon, as well as to Cache Valley (Bunyamwera serogroup) and Klamath, an ungrouped rhabdovirus. Of 132 samples tested, 60 (46%) were found to be seropositive at a dilution of greater than or equal to 1:10 for at least one of the five different arboviruses. Forty (30%) samples contained antibody to more than one arbovirus, and 15 samples (11%) contained antibody to all five. Of these 15, 14 were from 75 black-tailed deer sera collected in Lincoln County, Oregon. Seropositivity rates for black-tailed deer ranged from 23% to 35%, with all five arboviruses represented. Positive reactions for all five arboviruses were represented among mule deer sera at rates from 5% to 29%. Elk sera were found to be positive for four of the viruses (none for Klamath virus). Although Cache Valley and Klamath viruses have been reported from Oregon, these data represent the first evidence of a California serogroup virus in the state.
The state of Oregon has developed a unique method to set priorities for health services. The method is based on a cost-utility formula but also incorporates public attitudes and values. Using an explicit process, the Oregon Health Services Commission has completed the ranking of 714 condition-treatment pairs. The background, methods, and criticisms of the Oregon approach highlight key questions for managers and physicians in other health services when they allocate limited resources.
In 1989 and 1991, the Oregon legislature enacted a series of initiatives to extend health coverage to uninsured state residents. Among these initiatives is an act that seeks to extend a modified set of Medicaid benefits to state residents with family incomes below the federal poverty level. This act also reduces benefits the state is now required to provide to Medicaid-enrolled women of childbearing age and children. This Article explores the legal context in which the Oregon Medicaid experiment must be evaluated. It argues that by reducing the level of coverage to which tens of thousands of exceedingly poor, Medicaid-eligible women and children are entitled, the experiment falls outside the scope of valid research that the United States Department of Health and Human Services may either sanction or fund. The Article also discusses the implications of the Oregon experiment, if approved, for the future direction of the Medicaid program in particular, and for health care reform for the poor, generally.
Oregon Health Decisions is a citizen-based project intended to develop statewide awareness of severe bioethical dilemmas. The project has set in motion civic means for addressing and resolving problems in Oregon's health provision system associated with personal autonomy, equity of access, prevention of illness, and humane cost containment. The process of civic involvement with consequent results is described together with the implications for future health policy in Oregon and elsewhere.
The authors review the relationship that has evolved over the years between the Department of Psychiatry at Oregon Health Sciences University and Oregon's community and state mental health programs. They describe the compatibility that exists between the basic requirements of academic psychiatry departments and public mental health programs and demonstrate how these organizations have been able to fulfill one another's needs in Oregon. Specific examples of successful collaborations in the areas of education, administration, research, and service are presented to illustrate how relationships that have been designed to meet specific requirements of one organization can fulfill many requirements of both. Suggestions are provided for those organizations contemplating similar collaborative endeavors.
White muscle disease and other selenium deficiency syndromes, once extremely common in young calves and lambs in Oregon, especially in the areas of volcanic origin east of the Cascade mountain range, prompted extensive investigations in the Oregon Agricultural Experiment Station that resulted in the implementation of large-scale selenium supplementation programs. Although selenium deficiency in livestock is consequently now rare in Oregon, selenium-deficient soils and attendant selenium deficiency conditions have been reported near the Kesterson Wildlife Refuge in the Northern part of the San Joaquin Valley, California, where, paradoxically, selenium toxicity in wildfowl, nesting near evaporation ponds, occurred and attracted wide attention. This review cites studies which explain why there is no evidence of selenium toxicity in livestock, but some selenium deficiency on the east side of the San Joaquin Valley. They also show that there is no threat to the food supply owing to excessive selenium in this area and that the consumption of meat and milk from the herds would not exceed the safe range of selenium for humans.
STUDY OBJECTIVE: To examine current thrombolytic protocols in Oregon emergency departments with regard to variations in patient evaluation, inclusion and exclusion criteria, initiation of therapy, and available thrombolytic agents. DESIGN: Telephone survey of ED head nurses. SETTING: All acute-care hospital EDs in Oregon. TYPE OF PARTICIPANTS: Of 70 acute-care hospitals contacted, 67 (96%) were included: 61 (87%) have a written ED protocol for thrombolytic agent use. METHODS: Telephone survey of written thrombolytic protocols, with comparison of groups using Kruskal-Wallis test (P less than .05). MEASUREMENTS AND MAIN RESULTS: The primary modes of initiating thrombolytic therapy are at the emergency physician's discretion (32%). after private physician consultation (24%), through the use of an agreement developed by the emergency physicians in conjunction with cardiologists or internists (22%), or after cardiologist or internist consultation (22%). ECG interpretation before drug administration is most often performed by the emergency physician (41%), cardiologist or internist (28%), private physician (6%), or computer (10%). Both tissue plasminogen activator (tPA) and streptokinase are available at 50 hospitals (75%); tPA is used exclusively in ten (15%) and streptokinase in seven (10%) other hospitals. tPA and streptokinase are approved for ED use in 43 (72%) and 46 (81%), respectively, of the hospitals at which these agents are available. In these, the ED is the most frequent site of administration of tPA in only 28 (65%) and of streptokinase in 33 (72%) hospitals; tPA and streptokinase are kept in the ED in only 23 (53%) and 23 (50%) of these hospitals, respectively. There was a significant correlation between thrombolytic administration in the ED and the number of full-time emergency physicians and American Board of Emergency Medicine diplomates. CONCLUSION: Thrombolytic protocols are highly variable in Oregon EDs.
The authors conducted a retrospective hospital-based chart review of cases of hemolytic-uremic syndrome among children less than or equal to 18 years of age, hospitalized in Oregon during the four-year period from January 1979 to December 1982. Thirty children with hemolytic-uremic syndrome living in Oregon were hospitalized during this period, for an average annual incidence of 0.97 cases per 100,000 children. Seventy per cent of cases occurred in children under five years of age, for an incidence of 2.65 cases per 100,000 children. Twenty-seven (90%) of the 30 children were white, and 17 (57%) were female. Twenty-four (80%) had a diarrheal prodromal illness including 20 who had bloody diarrhea. Twelve children (40%) acutely required peritoneal dialysis, and two (7%) developed chronic renal failure. Three children died, for a case fatality ratio of 10%. Sixty per cent of the 30 cases occurred during the summer and early fall months. Geographic clustering was also evident. Hemolytic-uremic syndrome is a rare but endemic disease in Oregon and may occur in small clusters. Although descriptions of several large series of patients have been published, this study describes the first statewide population-based study of this syndrome.