Biomedical subjects
M Romans
Publications and source records attributed to M Romans.
Delivering breast and cervical cancer screening services to underserved women: Part I. Literature review and telephone survey.
Although breast and cervical cancer screening procedures have been shown to reduce morbidity and mortality, many women are not using these services. These women are likely to be older, of ethnic or racial minority, of low socioeconomic status, less educated, underinsured, or living in rural locations. Many breast and cervical cancer screening programs employ strategies to increase use. In order to identify and assess those strategies, we reviewed the literature and completed a telephone survey, altogether assessing 61 programs. Our study identified several strategies and found that not all strategies work for all women. Management systems directed to both patients and providers consistently are effective for most underserved women. Community-based outreach and integration of preventive services at the primary health care (PHC) site are effective strategies for both African American and Hispanic women. Use of mass media has been successful when targeted toward Hispanic women, but not when targeted toward African American women. Mobile units and integration of preventive services at PHC sites are effective strategies for elderly women. In many cases, a combination of strategies may be effective. Programs should employ strategies best suited to their target populations.
Delivering breast and cervical cancer screening services to underserved women: Part II. Implications for policy.
Many breast and cervical cancer screening (BCCS) programs for underserved women employ strategies to increase the use of preventive services. In Phase I of a two-phase study, strategies were identified and assessed. In Phase II, we further assess strategies previously identified and comment on policy implications. Site visits were conducted at BCCS programs that had used one successful strategy identified during Phase I, provided services to underserved women, and were located in different geographic regions. The federally funded National Breast and Cervical Cancer Early Detection Programs (NBCCEDP) were also considered for site visits. Interviews were completed and available data were reviewed. A descriptive and qualitative analysis was completed. Programs visited were found to be increasing the use of BCCS services for the defined target populations. Some programs focused on outreach and recruitment. Other programs focused on clinical preventive services with little emphasis on outreach and recruitment. Management information systems were used by most programs. We found that there continues to be a large number of women not receiving BCCS services. Some programs have had to limit outreach and recruitment because the clinical preventive services offered are at capacity. Programs need to have a balanced approach to providing services from the outset. Existing programs may need to establish partnerships to provide comprehensive BCCS services to underserved women. Because the unmet need (women who have not received BCCS services) exceeds available clinical preventive services, it is a challenge to know how to best use available resources.
Gender and patient satisfaction in managed care plans: analysis of the 1999 HEDIS/CAHPS 2.0H Adult Survey.
This paper investigates gender differences in satisfaction, and in the variables associated with satisfaction, using the Consumer Assessment of Health Plans Study (CAHPS) adult questionnaire administered by the National Committee for Quality Assurance (NCQA) as part of HEDIS 1999. Data represent 97,873 men and women enrolled in 206 commercial managed care plans nationwide. Mean plan-level gender differences in satisfaction measures are small, with no consistent pattern of one gender being more satisfied than the other. Controlling for health plan, member, utilization, and selected HEDIS performance indicators, health plan characteristics account for the largest proportion of variance explained in satisfaction. Not-for-profit status and lower turnover of primary care providers are stronger determinants of women's than men's satisfaction. We conclude that it can be useful to analyze CAHPS scores by gender to identify areas for quality improvement in women's health care.
Impact of managed care on obstetrician-gynecologists' practice: the providers' perspective.
The American College of Obstetricians and Gynecologists' 1998 Socioeconomic Survey of Fellows included questions, developed in collaboration with the Jacobs Institute of Women's Health, to assess the impact of managed care on respondents' practices and patients. Participation in managed care is extensive among obstetricians and gynecologists (ob/gyns), especially in commercial managed care plans. The greatest areas of dissatisfaction for physicians were administrative workload, external review of clinical decisions, and promptness of payment. More research is needed to determine the impact of administrative burdens, restrictions on access to ob/gyns, and denial of coverage on women's receipt of timely and appropriate services.
Mineralization patterns of dentin of human teeth.
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