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Biomedical subjects

J C Kleinman

Publications and source records attributed to J C Kleinman.

At least 73 records · Page 4Linked to original sources
PubMed1983

Travel for ambulatory medical care.

This article describes travel patterns for ambulatory care based on the 1978 National Health Interview Survey. The county where a physician visit occurs has been compared with the county of patient's residence. Nearly 20 per cent of physician visits occur outside the county of residence, with substantial variation according to metropolitan status and proximity to an SMSA. Visits by nonmetropolitan residents are twice as likely to occur in another county as visits by metropolitan residents. The proportion of visits that occur outside the county of residence increases with decreasing population density, both among metropolitan and nonmetropolitan areas. Travel patterns for the usual source of care are similar to those for primary care physician visits. The results are used to estimate adjusted physician-population ratios by allocating physicians to each county type in proportion to their use by residents. These adjusted ratios exhibit substantially less variation than the unadjusted ratios.

Adolescent↗
PubMed1983

Changing practice in the surgical treatment of breast cancer. The national perspective.

This study documents changes in surgical treatment of breast cancer using data from the National Hospital Discharge Survey. All discharge records for women aged 25 years and older who received a mastectomy and had a diagnosis of breast cancer were selected for analysis. The proportion of such women discharged who received a radical mastectomy declined precipitously from 49% in 1972-1974 to 14% in 1978-1980. The proportion of women discharged who received modified radical mastectomies increased concomitantly from 29% in 1972-1974 to 64% in 1979-1980. Further, these changes in surgical practice were observed in all regions of the United States and for both small and large hospitals. The average length of hospital stay for discharged women treated surgically for breast cancer declined from 11.8 to 10.3 days between 1972-1974 and 1978-1980. About one third of this decline can be attributed to the shift toward less extensive operations.

Adult↗
PubMed1983

The relationship between hip fracture and water fluoridation: an analysis of national data.

Data from the 1973-1977 National Health Interview Surveys were used to determine whether water fluoridation prevents hip fractures related to osteoporosis. No protective effect was found for fluoride levels of 0.7 ppm, the level recommended for the prevention of dental caries. There are some indications that higher concentrations of fluoride might have a protective effect for groups with a high incidence of osteoporosis. However, no determination of the actual levels needed or the possible adverse effects of high water fluoride levels could be made.

Adult↗
PubMed1982

Indirect standardization of neonatal mortality for birth weight.

Recent advances in perinatal medicine, together with the proliferation of regionalized perinatal networks, have increased the need for monitoring of trends and variations in birth weight-specific perinatal mortality rates. Since the United states has no national system of linked birth and death records, the only available method for comparing weight-specific mortality among geographic areas or medical care facilities in through indirect standardization of mortality for birth weight. This paper investigates the characteristics of the Standardized Mortality Ratio (SMR) obtained by indirect standardization using 1974-77 neonatal mortality and birth weight data for 202 geographic areas across the United States. The results show that the SMR is not sensitive to the choice of standard rates even when the area's birth weight-specific mortality rates are not a constant multiple of standard rates. A method for estimating the standard error of the SMR without knowledge of the weight-specific rates is presented and shown to be nearly unbiased. There is also a substantial amount of variation among geographic areas in both neonatal mortality rates, SMRs, and birth weight distributions. Thus, despite certain limitations, the SMR provides a useful summary measure for monitoring trends and variations among geographic areas or medical care facilities in birth outcome.

Birth Weight↗
PubMed1981

Differences among hospitals as a source of excess neonatal mortality: the District of Columbia, 1970-1978.

Between 1970 and 1978 the neonatal mortality rate for black infants in the District of Columbia remained essentially constant while the national rate declined steadily. This report examines adjusted hospital-specific neonatal mortality rates in order to determine the extent to which the District's lack of improvement can be explained by excess mortality in a few hospitals. The indirect method of adjustment utilizing standardized morality ratios (SMRs) is used to control for the effect of the birth weight distribution on hospital-specific neonatal mortality rates. A generalized least squares approach is used to model the changes in the SMRs over time. No change was found in the SMRs for any hospital between 1970-72 and 1973-75, and four hospitals experienced no change in the 1973-75 to 1976-78 period (although one of these hospitals had very low SMRs initially). The remaining four hospitals experienced a 37% decline in their SMR's during the second interval (1973-75 to 1976-78). If the three hospitals that had high initial rates and showed no change in mortality rates from 1973-75 to 1976-78 had experienced the 37% decline, the District's SMR in 1976-78 would have been reduced by 20%.

Black or African American↗
PubMed1981

Use of ambulatory medical care by the poor: another look at equity.

Access to health services by the poor and other disadvantaged groups has improved considerably over the past 15 years. These circumstances have led some to question whether the poor now have equal access to health care. This article presents recent evidence from the 1976-78 National Health Interview Surveys (NHIS) comparing utilization among age, race, and income groups. Without adjustment for health status, the poor have more physician visits than those with higher incomes. After adjusting for age and health status, however, these differences are reversed. Depending on which measure is used, the poor have between 7 per cent and 44 per cent fewer visits than those with income above twice the poverty level. Furthermore, the age- and health-adjusted data show blacks have significantly fewer visits than their white counterparts. In addition, there are large differences among race and income groups in the characteristics of the ambulatory care obtained. Blacks and the poor are much more likely to use hospital clinics and less likely to use private physician offices or telephone consultations. The poor also receive less preventive care. It would appear from the present evidence that still further progress is required to achieve the goal of equity in the distribution of medical care services.

Adolescent↗
PubMed1981

Who is being screened for cervical cancer?

Data from the 1973 National Health Interview Survey, a probability sample of the United States population, are used to examine the relationship between Pap testing and four socioeconomic variables. It was found that women at highest risk of cervical cancer are least likely to have had Pap tests. The proportion of women who report never having had a Pap test is greater among Blacks, the poor, the elderly and nonmetropolitan residents. In particular, poor Black women in nonmetropolitan areas have extremely high proportions reporting no Pap test. However, high risk women are only slightly less likely to have visited a doctor in the two years preceding interview. These results suggest that improvement in Pap test coverage among high risk women could be attained by encouraging the use of the Pap test in regular ambulatory medical care.

Adult↗
PubMed1980

National health data for policy and planning.

The role of the National Center for Health Statistics (NCHS) in providing data for health policy and planning at the national and local level is discussed. Four specific examples are considered. First, data from the Hospital Discharge Survey are used to identify surgical procedures with large increases between 1965 and 1976: 30 percent rise in the incidence of hysterectomy, 169 percent increase in cesarean section, 100 percent increase in lens extraction, and 35 percent increase in orthopedic surgery. The extent to which such increases represent unnecessary utilization and their impact on costs are discussed. Second, the combination of data from two sources (Health Interview Survey and Health and Nutrition Examination Survey) is illustrated by considering selected policy issues related to hypertension. Next, the problem of designating medically underserved areas is discussed in relation to the difficulties in implementing federal policies at the local level without local data. The potential for national data systems to provide guidance for these policies is also considered. The final example discusses the use of vital statistics to provide small area data for local health planning. In conclusion several areas are considered which need development in order to maximize the use of data for policy and planning: research on measurement of health status, with particular emphasis on how health policy can affect health status; research on appropriate levels of health resources and services; development of shared data systems to reduce cost and respondent burden; and training, especially at the undergraduate level and in interdisciplinary graduate programs.

Data Collection↗
PubMed1979

"Positive programming": the use of data in planning for the rural health initiative.

A data-driven approach to allocating federal resources for primary care systems in rural areas is presented. This approach was developed and implemented by the Public Health Service (PHS) when it undertook its Rural Health Initiative Program. Nationally available small-area data were used to identify "priority counties" and PHS regional office staffs were asked to take an active role in developing rural health system projects in these counties. This approach was adopted to avoid the problem of the many communities eligible for and in need of funds that do not get them because they lack the organization and knowledgeable personnel required to develop a project grant application. The paper defines and discusses the "positive programming" approach (believed to be the first attempt to allocate federal health service delivery resources actively on the basis of small-area data), discusses the present shortcomings of the approach (including data limitations), and presents the results of implementing the approach. In the first year, 23% of the priority counties and 13% of the nonpriority counties were served, while in the second year 39% of the priority counties and 17% of the nonpriority counties were served. The substantial increase in the percentage of priority counties served reflects the effectiveness of the positive programming effort.

Community Health Services↗
PubMed1979

The effects of changes in smoking habits on coronary heart disease mortality.

Coronary heart disease (CHD) mortality declined by about 20 per cent between 1965 and 1976. During the same period there were substantial decreases in the proportion of adults who smoked based on data from the National Health Interview Survey (HIS). This study examines the extent to which changes in smoking can account for the decrease in CHD mortality for men and women aged 35-64 years. By applying US smoking levels (estimated from HIS) to data from four epidemiologic studies on the relative risk of CHD death by amount smoked, we obtain estimates of the portion of the decline in CHD mortality attributable to changes in smoking. Smoking changes among women were not generally consistent with declines in CHD mortality. For men, the estimated impact of smoking on CHD mortality varied considerably depending upon which study was used to estimate the relative risk by amount smoked.

Adult↗