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At least 217 records · Page 12Linked to original sources
PubMed1997

Medicaid AIDS waivers: seeking cost effective financing of AIDS care.

The epidemic of Acquired Immunodeficiency Syndrome (AIDS) emerged at a time of transition in American health care and health care policy. The waiver of traditional Medicaid limitations on home and community-based health care services for persons with AIDS has been utilized by several states attempting to demonstrate models of care where quality of life as well as financial concerns are addressed. The Medicaid AIDS Waiver programs in New Jersey and Florida note promising results in the cost-effectiveness of such programs when compared with traditional Medicaid. Variations in patient participation by geographic area and demographic characteristics indicate areas for future improvement in program accessibility.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The effectiveness of a remote access hotline service for the handling of night shift calls.

In order to justify dedicated staff for night calls, improve the quality of our handling of these calls, and qualify for certification by the AAPCC, we sought an alternative to hiring dedicated night staff. We offered our certified staff members the opportunity to fulfill part of their regular duties answering night calls from home. We set them up with a computer system, dedicated telephone line, texts and consultant information. They were able to access the Poison Center hotline computer via a remote access program. A significant increase took place in the number of documented calls to the Poison Center during the midnight to 8:00 am shift. Quality of documentation also improved significantly and level of service has been complemented by callers. The remote access method is a viable way for a small Poison Center to cover the night shift with certified, reliable, capable staff. This method of call answering has solved our major problem of hiring night staff who would satisfy requirements and provide excellent service.

Hotlines↗
PubMedDate not supplied

The vascular access coordinator role: an interview with Donna Carlton by Betsy King.

In summary, the access coordinator is at the center of our access program at UAB. The coordinators can make decisions based on the calls we receive from the nursing staff and reports obtained from procedures. The ability to relay information to the entire team rather than simply data entry staff, makes us a central focal area for our access team. This type of model is working to help us achieve better patient outcomes. We provide many services but the most important is follow-up. As a result, we are able to achieve optimal outcomes for our patients.

Aftercare↗
PubMed2006

Web-based primary care referral program associated with reduced emergency department utilization.

BACKGROUND AND OBJECTIVES: Uninsured patients without a primary care home tend to use the emergency department (ED) for primary care. We examined whether an enhanced scheduling system for follow-up care from the University of New Mexico Hospital Emergency Department (UNMH-ED) that assigns patients to a family medicine home can decrease ED utilization. METHODS: The Community Access Program for Central New Mexico (CAP-NM) is a consortium of primary care safety net provider organizations. CAP-NM developed a HIPAA-compliant (Health Insurance Portability and Accountability Act), Web-based information system used by the UNMH-ED to refer uninsured, unassigned patients to family medicine practices ("homes") within the consortium. The Web site referral system operated 24 hours a day, 7 days a week; printed maps to clinic sites; and listed services offered. Analysis of quality assurance data compared (1) ED utilization outcomes of eligible patients referred by the CAP-NM Web site to a family medicine home to (2) outcomes of controls discharged from the ED in the usual manner. RESULTS: The 756 patients referred to family medicine homes through the CAP-NM Web site demonstrated a significant 31% reduction in subsequent ED visits compared to controls. This reduction was most evident among those who had infrequent ED use before institution of the program. CONCLUSIONS: Implementing an enhanced referral system to family medicine homes from the ED is associated with decreased subsequent ED utilization by uninsured patients.

Appointments and Schedules↗
PubMedDate not supplied

Barriers and facilitators to primary care or human immunodeficiency virus clinics providing methadone or buprenorphine for the management of opioid dependence.

BACKGROUND: Federal initiatives aim to increase office-based treatment of opioid dependence, but, to our knowledge, factors associated with willingness to deliver this care have not been defined. The objective of this study was to describe clinics' willingness to provide methadone hydrochloride or buprenorphine hydrochloride for opioid dependence. METHODS: The design of the study was a survey conducted in New York State. Two hundred sixty-one directors of primary care and/or human immunodeficiency virus specialty clinics (response rate, 61.1%) that serve Medicaid enrollees were questioned. Outcomes were willingness to provide methadone and buprenorphine. Predictors included clinic characteristics, attitudes about drug users and their treatment, and reported barriers and facilitators to treatment. RESULTS: Clinics were more willing to provide buprenorphine than methadone treatment (59.8% vs 32.6%; P < .001). Clinics offering human immunodeficiency virus specialty care (adjusted odds ratio [AOR], 2.16; 95% confidence interval [CI], 1.18-3.95) or a safe location to store narcotics (AOR, 2.99; 95% CI, 1.57-5.70) were more willing to prescribe buprenorphine and more willing to provide methadone. Willingness was positively associated with continuing medical education credits for training, but negatively associated with greater concern about medication abuse. Immediate telephone access to an addiction expert was associated with willingness to provide buprenorphine (AOR, 2.08; 95% CI, 1.15-3.76). Greater willingness to provide methadone was associated with a belief that methadone-treated patients should be seen along with other patients (AOR, 6.20; 95% CI, 1.78-21.64), methadone program affiliation (AOR, 4.76; 95% CI, 1.64-13.82), and having more patients with chronic pain in the clinic (AOR, 2.80; 95% CI, 1.44-5.44). CONCLUSIONS: These clinics serving Medicaid enrollees were more receptive to buprenorphine than methadone treatment. Willingness to provide this care was greater in clinics offering human immunodeficiency virus services, treating more chronic pain, or affiliated with methadone programs. Accessible addiction experts and continuing medical education for training may facilitate adoption of this care.

Buprenorphine↗
PubMed2000

Comparing consumer and nonconsumer provided case management services for homeless persons with serious mental illness.

This study compared the outcomes of services provided by case managers who are mental health system consumers and case managers who were not consumers. The study focused on the first two cohorts that entered the ACCESS program, a 5-year demonstration program funded by the Center for Mental Health Services between 1994 and 1996. We tested the associations between the type of case manager and clinical outcomes at three time points (baseline, 3 months, and 12 months). A series of one-way repeated measures of analyses of variance were conducted on clients from ACCESS sites that hired consumer providers. Although there were significant effects of Time for almost every outcome measure (clients improved over time), there were no significant Time x Case Manager Type interactions. Staff age, race, or gender did not significantly alter the pattern of these results. Given that services provided by consumers and nonconsumers were associated with equivalent client outcomes, the present study shows, using a large sample, the ability of consumers to provide mental health services as members of a case management team.

Adult↗
PubMed1993

Transportation needs of the elderly population.

All evidence suggests that the elderly population of today and tomorrow will continue to depend on the private car to give them freedom, independence, and choice--as do younger travellers. Given the demographic changes in the United States, it seems very unlikely that other modes or options can provide anywhere near the level of mobility that the elderly want or need. Almost three fourths of those over age 65 will live in suburban or rural places after the turn of the century, places where transit and para-transit options are inherently impractical or costly. These elderly individuals will have made choices about doctors, hospitals, friends, and social and recreational options based on their lifelong access to the car. When they can no longer drive or receive rides, their mobility will drop and they may have to make drastic changes in their whole life network to be able to access just a few necessary services. Those concerned with the use of medical services by the elderly population must focus not only on transportation but on the other variables that create the need for a car. Transportation needs are clearly linked to where and how medical and social services are made available, so medical agencies must recognize the changing demographics of the elderly population by locating and programming their services accordingly. Medical and human service agencies will have to make an effort to make their programs accessible to the elderly population rather than simply locating their facilities where they please and assuming that elderly persons or transportation planners will somehow deal with the resulting loss of mobility.

Adult↗
PubMed2026

VIJB: a companion of the JBROWSE genome browser for the visually impaired people.

MOTIVATION: The availability of touch-sensitive and haptic devices has been a keystone development for the inclusion of visually impaired people (VIPs) in modern, highly digitized work environments. Braille displays have proven efficient and versatile enough to parse large and complex text files, making bioinformatics and text-heavy programming accessible to VIPs. However, the complex graphical objects -combining numerous datasets- typically generated during data integration remain challenging, even with the aid of descriptive AI. This is particularly true in functional genomics. Here, we present VIJB, a simple application that displays the multilayered output of the JBROWSE genome browser on a Braille reader, enabling VIPs to fully participate in data integration in functional genomics. AVAILABILITY AND IMPLEMENTATION: VIJB is programmed in Python and relies on the scientific library NumPy, the braillegraph and pyBigWig libraries, and the TABIX software. The architecture is summarized in Supplementary Material 1, available as supplementary data at Bioinformatics online. VIJB is available for download at the GitHub repository https://GitHub.com/NiBuMNHN/VIJB and is licenced under the GPL 3.0.

Persons with Visual Disabilities↗
PubMed1979

A computer assisted test assembly system for medical technology examinations.

A descriptive report on the establishment and implementation of a computer assisted test assembly (CATA) system at the University of Iowa Medical Technology Program is presented. This system is an alternative approach to the production of paper and pencil examinations that may be considered for use in other medical technology programs. Access to the system is designed, through coding, to correlate with specific instructional objectives in a variety of subject areas. The CATA system has capabilities for mass production of examinations, correction of examinations, and production of accumulative item analyses. Use of this computerized system has produced savings in terms of money, faculty time, and clerical assistance. Primarily, however, it has served to effectively relate instructional objectives in an educational program to the evaluation process.

Computers↗
PubMed2001

Simulating the spread of membrane potential changes in arteriolar networks.

OBJECTIVE: Our aim was to simulate the spread of membrane potential changes in microvascular trees and then make the simulation programs accessible to other researchers. We have applied our simulations to demonstrate the implications of electrical coupling between arteriolar smooth muscle and endothelium. METHODS: A two-layered, cable-like model of an arteriole was used, and the assumptions involved in the approach explicitly stated. Several common experimental situations that involve the passive spread of membrane potential changes in microvascular trees were simulated. The calculations were performed using NEURON, a well-established computer simulation program that we have modified for use with vascular trees. RESULTS: Simulated results show that membrane potential changes would probably not spread as far in the endothelium as they would in the smooth muscle of arterioles. Where feed arteries are connected to larger distributing arteries, passive spread alone may not explain the physiologically observed spread of diameter changes. CONCLUSIONS: Simulated results suggest that the morphology of an arteriole, in which the muscle layer is much thicker than the endothelium, favors electrical conduction along smooth muscle rather than the endothelium. However, it seems that passive electrical spread is insufficient to explain the apparent spread of membrane potential changes in experimental situations. Active responses involving voltage-dependent conductances may be involved, and these can also be included in our simulation.

Animals↗
PubMed2005

Medicare-approved drug discount cards and renal transplant patients: how much can these cards reduce prescription costs?

BACKGROUND: Post-transplant prescription medications are expensive, often costing over 12,000 dollars annually. Many solid-organ transplant patients have Medicare coverage and patients enrolled in Medicare-approved drug discount card (MADDC) programs may be able to receive prescription medications at a reduced price. However, many transplant healthcare practitioners are unaware of the utility of MADDCs. The purpose of this study was to determine whether enrolling renal transplant patients (RTPs) into a MADDC produces significant savings in prescription costs. METHODS: Two Medicare RTPs, with prescription medication profiles representative of an RTP within 3 months post-transplant and an RTP greater than 5 yr post-transplant, were randomly selected from the Medication Access Program's database. Cost benefit analyses were from the patients' perspective and were performed using the: (i) prescription cost from the Medicare website of MADDCs that listed the greatest and least prescription costs compared with the retail cash price of the same prescription without using the MADDCs; and (ii) MADDCs' annual enrollment fee. The potential cost difference of using MADDCs and not using MADDCs to purchase the prescription medications were calculated. RESULTS: RTPs' monthly out-of-pocket cost for prescription medications ranged from 162 dollars to 340 dollars, and MADDCs offered discounts of 20-37% from retail prices; thus outweighing the MADDC enrollment cost. CONCLUSION: MADDCs, when selected and used appropriately, can reduce prescription medication cost for RTPs. Card selection is of great importance as discount rates vary greatly among cards, and only under restricted circumstances is a patient allowed to switch to another card. It is imperative that practitioners are aware of these programs and utilize cost-effective prescribing practices.

Cost Savings↗
PubMed2004

Educational research at Johns Hopkins University School of Medicine: a grassroots development.

The Divisions of General Internal Medicine at Johns Hopkins University School of Medicine have been a rich source of educational research. To better understand the facilitators and barriers to educational research within the divisions, the authors reviewed published educational research from the divisions published between 1995-2004 and examined the history, leadership decisions, and sentinel events that have allowed educational scholarship within the divisions to grow. The authors' analysis suggests a grassroots model of programmatic growth that includes a growing cadre of clinician-educator scholars, effective mentorship, a faculty development program, access to learners, access to research expertise, protected time for scholarship, some funding, and an institutional culture that stimulates scholarship. A medical education fellowship was integral to the model; fellows were first authors for 47% of reviewed manuscripts. Extramural funding has helped build an infrastructure that supports educational scholarship; however, only 12% of the publications have had extramural funding. Protected time for faculty is the characteristic of this model most at risk. While there has been a move toward more institutional support of educational research, it is clear that further growth in the educational research program will require noninstitutional resources.

Baltimore↗
PubMed2004

The urban safety net: can it keep people healthy and out of the hospital?

There is much discussion and debate over the relative vulnerability and capacity of the health care safety net to care for the growing numbers of uninsured and disenfranchised persons in urban poor communities. In this study, we present findings from a community-based survey of 248 adults identified at eight safety net provider sites in Baltimore, Maryland, to contextualize recent findings that described Baltimore's safety net capacity as having more hospital- and intensive service-based interventions, with higher proportions of the population reportedly unable to get care when needed compared with other cities. The average age of respondents was 41.2 years, most (87.3%) were African American, unemployed (75.8%), homeless (57.0%), and with at least one chronic medical problem (77.8%). Almost one half (47.6%) also reported a chronic mental health condition, and 51.2% reported having difficulty accessing health care services in the past. Overall, 76.9% reported accessing additional community sites for daily sustenance needs, with most of these sites community non-profit or faith-based organizations. In the multiple logistic regression model, only individuals with chronic mental health conditions were significantly more likely to report difficulties accessing health care. The lack of a Community Access Program or other structured efforts to facilitate integration of services among providers in Baltimore and an "all-payer" system that reimburses uncompensated care only for hospital admissions are postulated as two structural elements that may contribute to these findings.

Adult↗
PubMedDate not supplied

Indigenous health: chronically inadequate responses to damning statistics.

In the 10 years 1990-2000, despite improvements in some conditions, there has been little or no overall progress in the health of the Aboriginal and Torres Strait Islander populations of Australia. This is in stark contrast to the gains made in Indigenous health in other countries. The issue is one of lack of commitment to and implementation of already existing policies. We need to (i) fully and adequately fund the Primary Health Care Access Program to provide the out-of-hospital services for prevention and early treatment required to break the cycle of ill-health; (ii) implement a National Training Plan to train the necessary health workforce; and (iii) introduce a National Infrastructure Plan to rectify the continuing deficiencies in water supply, sanitation, education and other basic services.

Australia↗
PubMed2002

A model for managed behavioral health care in an academic department of psychiatry.

In response to the effects of the managed care environment on patient flow and care, the department of psychiatry and behavioral sciences of the Johns Hopkins School of Medicine developed and has been managing a capitated behavioral health care program. The program is responsible for providing mental health and substance abuse services for 22,000 members of the TRICARE Uniformed Services Family Health Plan (USFHP), directed by the U.S. Department of Defense. The integration of primary care and behavioral health care is a major feature of the USFHP/TRICARE program. The authors describe the transition from a carve-out for-profit managed care organization to the integrated program managed by the department. During the first two years of the program, access to services increased and use of inpatient services decreased without the need to deny service use. To supplement previous reports of the involvement of academic psychiatry departments in behavioral health care, the authors supply utilization and financial data that may serve as benchmarks for similar efforts by other departments.

Academic Medical Centers↗
PubMed2000

The Employee Stress and Alcohol Project: the development of a computer-based alcohol abuse prevention program for employees.

The Employee Stress and Alcohol Project (ESAP) developed an interactive computer-based alcohol abuse prevention and early intervention program accessible to employees over the Internet. Behavioral health research recommends that specialists develop and provide comprehensive yet cost-effective approaches to alcohol abuse prevention, early intervention, and treatment within the context of workplace managed care. ESAP is implementing this web site for a diverse 8,567-employee work site. ESAP's web site enables employees to self-assess their stress levels, coping styles, and risk for alcohol-related problems. It provides personalized feedback, recommendations, mini-workshops, a drinking journal, links to other online resources, and an interactive forum for direct participant-to-participant communication. ESAP's web site provides resources for employees who are concerned about another individual's drinking as well as information about adolescent alcohol use. This article discusses the implications of incorporating the ESAP web site into worksite alcohol abuse prevention and early intervention programming.

Alcoholism↗
PubMedDate not supplied

Locations of cardiac arrest: affirmation for community Public Access Defibrillation (PAD) Program.

BACKGROUND: The purpose of this study was to describe the regional locations of cardiac arrest, and to identify public locations and the annual incidence of arrests within the identified locations, in order to help to determine optimal placement of Automatic External Defibrillators (AEDs) under the regional Public Access Defibrillation (PAD) Program. This is a retrospective study. METHODS: The locations of cardiac arrest were abstracted from Ambulance Call Reports (ACRs) collected by the Essex-Kent Base Hospital Centre from regional ambulance services throughout the City of Windsor, and the Counties of Essex and Kent, Ontario, Canada, from 01 January 1994 through 31 December 2000. Arrest locations were grouped into five categories, and then the number of public venues was determined. Public Sites were grouped into 28 Public Locations. Also included in the Public Sites were both General Industry and Outdoors categories. Categories identified but excluded from Public Sites were Institutions and Private Residences. RESULTS: During the study, 2,295 arrests occurred, 152 cases were excluded, 2,142 arrests were categorized, (average annual incidence of 306 +/- 50.4 cardiac arrests), 329 (15.4%) of which were in Public Sites. Nineteen public venues had an average of > 1 arrest/year, and nine public venues had an average of < or = 1 arrest/year during the study, period. Calculations of the annual incidence of arrests for each public location were completed. CONCLUSIONS: These findings have significant prehospital emergency cardiac care implications for communities that wish to strengthen/improve their responses to out-of-hospital cardiac arrests. Public Access Defibrillation Programs should identify the site-specific incidence of arrest within their communities in order to provide legitimacy for funding and planning of programs. Training and availability of AEDs will reduce the time to first shock, thus strengthening the chain-of-survival and will save more lives.

Ambulances↗