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Biomedical subjects

C Hoover

Publications and source records attributed to C Hoover.

16 recordsLinked to original sources
PubMed1997

Competition, ownership, and access to hospital services. Evidence from psychiatric hospitals.

OBJECTIVES: This article examines the impact of increasing competition among hospitals on access to inpatient services and preexisting differences in access between nonprofit and for-profit facilities. It tests theoretical propositions that suggest that nonprofit and for-profit hospitals will respond in different ways and to differing degrees to changing competitive pressures. METHODS: Drawing data from a 1987-88 national survey of psychiatric hospitals, the authors measured access in terms of the availability of different types of services and the provision of uncompensated care. The impact of hospital ownership, competition as well as the interaction of ownership and competition was assessed through a set of regression models, controlling for other characteristics of the hospital markets and local service system. RESULTS: Nonprofit psychiatric hospitals provide greater access than their for-profit counterparts under conditions of limited competition. Increased competition reduces the ownership-related differences in uncompensated care, but increases the differences for marginally profitable services. The market share of for-profit hospitals had an independent negative effect on access, holding constant the intensity of competition. CONCLUSIONS: The interaction of ownership and competition explains some seemingly inconsistent finding in the literature and points to the complexity of relying on ownership-based policies to protect access in an increasingly competitive health-care system.

Diagnosis-Related Groups↗
PubMed1997

The determinants of dumping: a national study of economically motivated transfers involving mental health care.

OBJECTIVE: To examine the prevalence and determinants of economically motivated transfers (aka "dumping") from hospitals treating mental illness. DATA SOURCES: A composite data set constructed from three national random-sampled surveys conducted in 1988 and 1989: (1) of hospitals providing mental health care, (2) of community mental health centers, and (3) of psychiatrists. STUDY DESIGN: The study uses reports from administrators of community mental health centers (CMHCs) to assess the extent of patient dumping by hospitals. To assess the determinants of dumping, reported perceptions of dumping are regressed on variables describing the catchment area in terms of the proportion of for-profit hospitals, intensity of competition among hospitals, extent of utilization review, and capacity of the local treatment system, as well as competition among community mental health centers. To assess if dumping is motivated by factors distinct from those affecting other aspects of access, comparable regressions are estimated with ease of hospital admission as the dependent variables. PRINCIPAL FINDINGS: Economically motivated transfers of psychiatric patients were widespread in 1988: according to the reports of CMHC administrators, 64.7 percent of all hospitals providing inpatient mental health care engaged in transfers of this sort. The extent of dumping was higher in catchment areas with more competition among hospitals, more proprietary hospitals, and less inpatient capacity in the public sector. Dumping appeared to be more sensitive to capacity in the public sector but less sensitive to involvement by for-profit hospitals than were other measures of access to care. CONCLUSIONS: Economically motivated transfers of patients with mental illness were widespread in 1988 and likely have increased since that time, affecting the viability of the community mental health care system.

Adolescent↗
PubMed1996

Molecular cloning and disease association of hepatitis G virus: a transfusion-transmissible agent.

An RNA virus, designated hepatitis G virus (HGV), was identified from the plasma of a patient with chronic hepatitis. Extension from an immunoreactive complementary DNA clone yielded the entire genome (9392 nucleotides) encoding a polyprotein of 2873 amino acids. The virus is closely related to GB virus C (GBV-C) and distantly related to hepatitis C virus, GBV-A, and GBV-B. HGV was associated with acute and chronic hepatitis. Persistent viremia was detected for up to 9 years in patients with hepatitis. The virus is transfusion-transmissible. It has a global distribution and is present within the volunteer blood donor population in the United States.

Acute Disease↗
PubMed1995

Redesigning a skills mix in the ICU.

A group of unit-based personnel set about to redesign work in the intensive care unit. Their strategy acknowledged the fiscal reality of the hospital's situation, while maintaining a proactive and positive approach. The implementation process of such a program--establishing a skills mix, redesigning a patient care delivery system and capitalizing on the RNs' career ladder is described.

Career Mobility↗
PubMed1991

A national study of psychiatric hospital care.

BACKGROUND: The delivery system for psychiatric inpatient services in the United States has changed dramatically over the past 30 years, undergoing a marked privatization. METHOD: To assess the effect of changes in ownership and types of inpatient settings on the structure of the mental health services system, the authors surveyed a national sample of nonfederal mental health facilities in 1988. RESULTS: Comparing their data to those of earlier surveys, they found that a decline in the number of patients per staff occurred in most settings over the last decade, suggesting that this aspect of quality of care may have improved. They observed important ownership-related differences in 1988 in diagnostic mix (e.g., more schizophrenia treated in public facilities than in private ones) and in payer source (e.g., more third-party revenues in public facilities than occurred in the past). CONCLUSIONS: There was a significant interaction between ownership form and type of facility, suggesting that the type of inpatient setting, ownership, and the relation between the two should be considered in assessing the impact of privatization on the accessibility of health care available for the mentally ill. The authors found that the increase in private psychiatric hospitals has widened the availability and choice of treatment facilities for those with private funding sources (especially children and adolescents) but has not had a similar effect in increasing sources of care for the seriously mentally ill dependent upon public financing.

Adolescent↗
PubMed1990

A highly sensitive, nonradioactive DNA labeling and detection system.

A highly sensitive method for detecting specific nucleotide sequences was recently developed. The method uses digoxigenin-labeled nucleic acid probes for hybridization to immobilized target nucleic acids. Probes can be labeled by the random-primed method, nick translation, oligonucleotide tailing, cDNA synthesis, photodigoxigenin or SP6/T7/T3 polymerase-mediated transcription. Hybrids are detected by an enzyme-linked immunoassay using an anti-digoxigenin antibody conjugate. Visualization of the bound antibody is accomplished by an enzymatic color reaction, enzymatic chemiluminescent reaction or immunofluorescence, depending on the antibody conjugate and enzymatic substrate used. Here we report the successful application of this technology in the detection of specific cloned DNA in colony and plaque hybridizations, specific detection of a single mRNA species in Northern blots and single-copy gene detection in genomic Southern blots.

Bacteriophage lambda↗
PubMed1983

Parents of patients with obsessive-compulsive disorder.

Family histories obtained from 27 patients with obsessive-compulsive disorder failed to find a single parent with the disorder. To augment the family history data the Leyton Obsessional Inventory was completed by a subset of 10 patients and by their 20 parents. Although as a group parents showed lower Leyton Obsessional Inventory symptom scores than their obsessional offspring, 3 parents who had not been identified by family history were distinguished by high symptom scores in the absence of significant resistance or interference.

Adolescent↗
PubMed1980

Comparison of dietary habits and dental health of subjects with hereditary fructose intolerance and control subjects.

Persons with HFI follow a lifelong, self-imposed, sucrose-restricted diet in which foods containing sucrose are consumed infrequently. Our subjects with HFI had a total sucrose intake that was approximately 5% that of control subjects and had a caries score (DMFS) that was less than 10% that of control subjects. No significant differences were found in the oral hygiene status (plaque or oral hygiene indexes) of the two groups. Foods containing starch, in the absence of sucrose, are not articularly inducive to caries. The daily intake of sucrose of the control group was less than expected. Consumption of sucrose is, therefore, less than estimates calculated by per capita sucrose disappearance. We consider that caries is initiated when the sucrose content of the diet and the frequency of ingestion exceed a low limit.

Carbohydrate Metabolism, Inborn Errors↗
PubMed1980

[Severe cardiopathies of childhood. Diagnosis, early treatment and remote sequelae].

Long term follow-up data on 43 infants with life threatening cardiovascular anomalies treated at the University of Kansas Medical Center are presented. Our long term survival for the group has been 63% and palliative or corrective surgery was necessary in 67% of the cases. The importance of early diagnosis and the role played by surgery in the management of this group of cardiac anomalies have been emphasized.

Age Factors↗
PubMedDate not supplied

Suicidal and nonsuicidal coping methods of adolescents.

The authors investigated the coping methods used by adolescents hospitalized for suicidal behaviors and adolescents hospitalized for nonsuicidal behaviors. The authors' purpose was to determine if a significant difference between the two groups existed. The findings suggested that adolescents with suicidal thoughts and behaviors use affective-oriented coping methods to a more significant degree than they use problem-solving strategies. The nonsuicidal group was found to use both affective and problem-oriented coping methods.

Adaptation, Psychological↗
PubMedDate not supplied

Accuracy of perceiving blood glucose in IDDM.

Type I (insulin-dependent) diabetic individuals and health professionals often assume that the symptoms of extremely low or high blood glucose (BG) levels can be recognized and, consequently, appropriate treatment decisions can be based on symptom perception. Because no research has documented the validity of these assumptions, this study tested the ability to perceive BG concentration. Nineteen type I adults, experienced in self-monitoring of BG (SMBG), estimated their BG 40-54 times just before measurement of actual BG. This procedure was repeated under two conditions: (1) in the hospital (hospital condition) while connected to an insulin/glucose infusion system that artificially manipulated BG, leaving subjects only symptomatic, or internal, cues and (2) in the natural environment (home condition), where both internal and external cues, e.g., food and insulin consumption, were available. Estimates significantly correlated with actual BG for 7 of 16 subjects in the hospital condition and for 18 of 19 subjects in the home condition. Believed ability to estimate BG did not predict documented ability in either condition. An evaluation of the treatment significance of estimation errors showed that the majority of errors were relatively benign. The most common error affecting clinical outcome was estimated euglycemia when actual BG was hypoglycemic or hyperglycemic.

Adult↗