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Biomedical subjects

W Scanlon

Publications and source records attributed to W Scanlon.

14 recordsLinked to original sources
PubMed1997

The effect of a reduced energy diet and meal patterns on smoking and coffee drinking in women.

OBJECTIVE: We examined the effect of three feeding conditions on cigarette smoking and coffee drinking in four healthy women. We hypothesized that food deprivation and changes in meal patterns would increase rates of smoking and coffee drinking based on extensive animal literature documenting this effect. METHOD: The conditions were: normal three meals per day containing usual energy intake, one meal per day (dinner time) containing 50% of usual energy intake, and three meals per day containing 50% of usual energy intake. Each condition lasted 3 days. RESULTS: Neither reduction of energy intake nor alteration in the pattern of meals had any observable effect on number of cigarettes smoked, number of cups of coffee consumed, expired air carbon monoxide levels, or urges to smoke or drink coffee. DISCUSSION: This study adds to the growing body of literature suggesting that the food deprivation effect observed in animals does not apply readily to humans. Reasons for the absence of this effect are discussed.

Adult↗
PubMed1992

Helping oneself by helping others: evaluation of a service credit banking demonstration.

Between 1987 and 1990, the Robert Wood Johnson Foundation funded six service credit banking demonstration programs among the elderly in which participants delivered services in return for credits, entitling them to later service. This evaluation of the demonstrations found that these six sites successfully attracted elders for the delivery of household support services to a relatively old, frail population with potentially limited social networks. Evidence on the significance of the "credit" in attracting volunteers was mixed, but the programs have attracted new volunteers, and have not substituted for other volunteer activities. Program development has entailed considerable staff investment in volunteer support; programs are better understood as community membership organizations than as mechanical exchanges.

Aged↗
PubMed1991

Working group recommendations: measuring outcomes of care in geriatric evaluation and management units.

Issues related to measuring outcomes of care in geriatric evaluation and management (GEM) units were identified by the outcomes working group of the GEM evaluation conference. GEM units have as a major goal the improvement or maintenance of both physical and psychosocial function. Suggested outcome measures for physical health included survival, restricted activity days, general health perceptions, comprehensive physical function, and miscellaneous specific types of functioning. In the area of psycho-social function, the working group suggested measuring cognitive function, affect/life satisfaction, social function, and satisfaction with care. The patient's caregiver (eg, spouse or child) is often an important target of GEM care, and the group suggested measuring caregiver burden, life satisfaction, and assessment of patient behavior problems. While the primary goal of GEM units is to improve health status, their effects on the utilization and cost of health care are important to decisions about wide-spread implementation and funding. The group therefore suggested a comprehensive assessment of these outcomes. Among the large array of recommended outcomes, the most important were thought to be mortality, function, and cost.

Activities of Daily Living↗
PubMed1989

Case-mix payment for nursing home care: lessons from Maryland.

Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired directions without substantial negative consequences.

Activities of Daily Living↗
PubMed1986

Chronic mental patients in nursing homes: reexamining data from the National Nursing Home Survey.

A reanalysis of data from the 1977 National Nursing Home Survey, including data not available earlier, led to an estimate that 668,000 chronic mentally ill patients reside in nursing homes. Several subpopulations of nursing home residents were also identified and compared, which showed, for instance, that residents with only mental disorders were younger, were less likely to need the help of another person in daily activities, and were much less likely to be totally dependent than residents with only physical disorders. However, not surprisingly, mentally ill residents were more likely to have behavior problems and to have much longer stays. Residents diagnosed as senile, with or without a physical disorder, more closely resembled the purely physically ill than the purely mentally ill patients. The data illustrate the wide range of needs of mentally ill nursing home residents and reinforce the importance of assessing and improving the appropriateness of care offered.

Adaptation, Psychological↗
PubMed1982

Medicare's nursing-home benefit: variations in interpretation.

The use of skilled-nursing facilities by Medicare beneficiaries as measured in days of care per thousand elderly persons varies considerably from one state to another. To explore the possibility that this variation reflects differences in the administrative interpretation of rules governing coverage, we developed nine hypothetical cases and presented them by telephone to claims reviewers in fiscal intermediaries and professional standards review organizations. Cases were designed to illuminate the reviewers' use of discretion. We observed marked differences both in the reviewers' decisions to cover or not cover patients and in the reasoning behind their decisions. Three of the 18 reviewers decided to cover very few cases; almost half the reviewers decided to cover most of the cases, but not the same ones. In only two cases did the 18 reviewers approach consensus. This variation is a reflection of the complexity of Medicare's coverage rules and its decentralized administration. To reduce variation, we recommend more centralized review with oversight by Medicare's central office rather than by its 10 regional offices. This oversight should include the training of reviewers in a way that focuses on complex cases to improve the consistency of judgment.

Eligibility Determination↗
PubMed1980

Regulating the bed supply in nursing homes.

Federal and state regulation of capital expenditures has been advanced as a means both to ensure rational allocation of resources and to control costs. But evidence drawn from eight states suggests that limiting the supply of nursing home beds ("certificate of need"), without refining conflicting standards of eligibility, quality control, and reimbursement policies (Medicaid and "rate-setting"), effectively discriminates against persons most in need of medical care. Alternative strategies for achieving economy, equity, and efficiency are explored.

Certificate of Need↗
PubMed1979

Paying for physician services under Medicare and Medicaid.

Public systems for physician reimbursement aim to reconcile two disparate objectives: ensuring availability of services to the poor and aged; and keeping rates of cost increase within acceptable limits. Several interesting--and unorthodox--policy simulations of physician pricing behavior are investigated through econometric estimation. Current arrangement for paying physicians are fraught with difficulties. The objectives of Medicare and Medicaid are not well served.

Aged↗