Management information techniques in federal health programs.
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Costs and Cost Analysis↗
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FIGO stage, histology, histologic grade, age and race as prognostic factors in determining survival for cancers of the female gynecological system: an analysis of 1973-87 SEER cases of cancers of the endometrium, cervix, ovary, vulva, and vagina.
The prognostic impact of FIGO stage, histology, histologic grade, age and race in survival for cancers of the female gynecological (cervix, endometrium, ovary, vulva, vagina) were examined using cases obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program that were diagnosed between 1973 and 1987. Utilizing Cox proportional hazards modeling and relative survival rates analysis of 17,119 cases of cervical cancer indicated that the International Federation of Gynecology and Obstetrics (FIGO) stage, histology, histological grade, lymph node status, and age at diagnosis were all independently prognostic. No evidence was found of survival differences between squamous cell carcinoma and adenocarcinoma. Younger women were not found to have a poorer prognosis, survival declined with increased age. Analysis of 41,120 cases of endometrial cancer indicated that FIGO stage, histology, histologic grade, lymph node status, age at diagnostic, and race were all prognostic factors. Clear cell adenocarcinoma, leiomyosarcoma, and mixed mullerian tumors were all found to have poorer prognosis. Analysis of 21,240 cases of ovarian cancer indicated that FIGO stage, histology, histologic grade, lymph node status, age at diagnosis, presence of ascites, and race were all prognostically significant. Analysis of 2,575 cases of vulvar cancer indicated that FIGO stage, histology, histologic grade, age, and race were all prognostically significant. Analysis of 916 cases of vaginal cancer indicated that FIGO stage, histologic grade, lymph node status, and age are all prognostically significant. Additional analysis of the data by combinations of independent prognostic factors indicates that the interaction of factors may be more predictive of outcome than any one factor separately.
Adenocarcinoma↗
Oregon versus Ashcroft: pain relief, physician-assisted suicide, and the Controlled Substances Act.
OBJECTIVE: Late in 2001, the State of Oregon filed suit against Attorney General John Ashcroft, seeking to halt his recent directive that physicians who comply with the Oregon Death with Dignity Act by writing a lethal prescription for a controlled substance should be prosecuted for violating the federal Controlled Substances Act (CSA). This special article reviews the history of the series of challenges to the Oregon Act since its initial adoption in 1994, with particular consideration of the arguments on both sides of Oregon v. Ashcroft and the disposition of the case by the district court. DESIGN: The article utilizes an historical review of the Oregon Act, including legal and political challenges to it, as well as discussion of the 3 years of data on the experience with legalized physician-assisted suicide in Oregon, and analysis of the legal issues in the current litigation. CONCLUSIONS: The federal district court concluded that the Attorney General's interpretation of certain provisions of the CSA so as to preclude the writing of a lethal prescription where otherwise permitted by state law as a legitimate medical practice was inconsistent with the CSA and, therefore, beyond the scope of his authority. The Oregon Act will continue in force while the Attorney General's appeal of the district court ruling is considered by the Ninth Circuit Court of Appeals.
Analgesics, Opioid↗
The "common sense" of the nonprofit hospital tax exemption: a policy analysis.
Although rarely discussed prior to the 1985 Utah Supreme Court ruling against Intermountain Health Care Inc., the question of whether to grant tax exemptions to nonprofit hospitals is currently being debated by federal, state, and local legislators, and by the courts. Changes to current policy seem likely. This policy analysis: (1) presents the historical and legal background; (2) examines the economic, political, and organizational implications of current tax-exemption policy; and (3) offers three alternatives to this current policy. The analysis indicates that the current policy provides little incentive for nonprofit hospitals to make contributions of charity care. Of the alternatives, eliminating the exemption is not politically feasible at this time; regulating hospital operations and outputs portends an implementation nightmare; and tying tax subsidy levels to output levels of charity care--perhaps the strongest and most efficient incentive--would require an unlikely political consensus on what constitute valid and reliable measures of charity care. If there is a movement toward subsidies, then linking subsidy amounts to levels of charity care will depend on whether policy analysts can design satisfactory empirical measures. With the advent of universal health coverage, the demand for charity care will decrease. The problem for tax-exempt hospitals will then become justifying the exemption by demonstrating the extent to which they generate community benefits at no or reduced cost to society.
History, 19th Century↗
[Mortality as a result of accidental and intentional injuries in the Federal District from 1970 to 1986].
This article presents the results of a retrospective analysis of unintentional and intentional injury mortality in México City for the period 1970-1986. The mortality rates and trends were obtained out of 73,197 registered deaths, (according to the 9th revision of the International Disease Classification). Deaths due to the earthquakes of 1985 were not included. The trend of mortality is undefined (r = -0.430). The most important causes of death were: traffic accidents, homicides, and others accidents. Males accounted 77 per cent of the deaths. The most affected age groups were 15-19 and 20-24 years. The potential years of life lost were analyzed. This study provides information for the prevention and control of injuries and for future research in this field.
Accidents↗
[Significance of longitudinal analysis for the evaluation of early detection studies in childhood].
In 1971, the first preventive examination programme for children up to 4 years of age was started in the Federal Republic of Germany; in 1977 followed a completely revised programme. However, even with this altered documentation a longitudinal analysis is not feasible. An effective evaluation should yield the following results: 1. Assessment of the success through differentiated recording of sufficiently early recognized health disorders and treatment effects. 2. Availability of reliable, regional and nation-wide statistics on incidence and prevalence. 3. An estimate of the number of health professionals required. - These aims can be achieved only by a longitudinal record linkage of the data on individuals of a sufficiently large random sample. For this purpose a revised data-sheet is presented. In addition, specific suggestions are made for longitudinal evaluations.
Child, Preschool↗
Canada's health system.
AIM: To examine the Canadian health system, in particular as it relates to health care, and to assess the functions of the provincial and federal governments in relation to health care, spending, funding, and reform. METHODS: Description and analysis of the Canadian health care system, including the overall structure, funding and spending, history, necessary reforms, and future of the system. RESULTS: Canada's health care system, through funding from both the federal and provincial/territorial governments, provides insured hospital and medical care services to all eligible Canadian residents. In order for the provinces to receive funding from the federal government, five criteria as stated in the Canada Health Act, must be met, namely: public administration, comprehensiveness, universality, accessibility, and portability. Funding is provided primarily through taxation, with some provinces also utilizing ancillary funding methods, such as health care premiums. In the latest review of Canada's health care system, the National Forum on Health reported in 1997 that the system must become more efficient, effective, and reflective of contemporary practices in health care delivery. CONCLUSIONS: The benefits of our system can be seen in the favorable health status of Canadians. Canada has been successful in its efforts to contain health expenditures and begin the process of reallocating resources. Health care is recognized as only one element of a larger health system, encompassing a broader range of services, providers, and delivery sites.
Canada↗
Impact of arterial blood gas analysis in disability evaluation of the bituminous coal miner with simple pneumoconiosis.
The Department of Labor has set guidelines for the use of resting arterial blood gas analysis in determination of total and permanent disability for coal workers' pneumoconiosis. To determine the prevalence with which bituminous coal miners fall below the arterial tensions of both oxygen and carbon dioxide published in the Federal Register, we studied 1012 miners who had both reproducible spirometry and arterial blood gas analysis as part of their disability evaluation. Eighty-seven percent of impaired miners could be identified by the spirometric criteria. Thirteen percent of impaired bituminous coal miners had acceptable pulmonary function but were eligible for black lung benefits by the blood gas guidelines. This population would have been missed if blood gas analysis were excluded from the evaluation process. On the other hand, approximately 25% of the blood gas analyses that were performed could be eliminated if a policy was adopted to do this test only on miners with spirometry that exceed the federal guidelines.
Carbon Dioxide↗
Social support, medication compliance and HIV/AIDS.
Social work practitioners and researchers have greatly understudied the idea of how social support correlates with combination therapy medication compliance, in people living with HIV disease. Meanwhile, such data could help health social workers better assist HIV-infected people who want to cope well, live long, and avoid drug resistance. Therefore, this article presents findings from a three-stage empirical secondary data analysis that examined seven specific types of social support, psychological history and stage of illness variables, and sociodemographics and their connection to medication compliance ratings. A sub-sample of 179 HIV-infected clinical trial study participants enrolled in a federally funded combination therapy treatment study and a nested compliance study were analyzed. Analysis of 14 bivariate hypotheses and 20 predictor variables at the multivariate level revealed that having emotional support and being employed seemed to be predictive of being a "Good Complier." Also, having higher levels of HIV symptoms appeared to be associated with being a "Poor Complier."
Acquired Immunodeficiency Syndrome↗
Environmental monitoring programs vs Good Laboratory Practice (GLP) programs: differences and similarities.
Environmental monitoring and Good Laboratory Practice programs are similar when looked at empirically. Both address quality issues, human or environmental safety, and have set procedures to assure the concomitant results. However, when compared at the operational level, they can be best described as very different. Good Laboratory Practice programs deal basically with two governmental agencies and their divisions- the Environmental Protection Agency and Food and Drug Administration. These are administered from the federal level involving no state resources. These programs are objective driven with the procedures being defined in study plans, protocols, and standard operating procedures. The environmental monitoring testing programs deal with a profusion of federal legislation including CERCLA (also known as CLP), RCRA, CWA, CAA, SDWA, NPDES and others. These acts require analysis by specific procedures mandated by the statutes. States operate many of these programs and have been given the authority by the federal government. Many of the states require separate certifications to conduct these analyses. Environmental monitoring testing laboratories often must acquire multiple state certifications to participate in multiple state programs. This is not cost effective and often leads to conflicting requirements. Much of the direction for having a national certification program comes from problems associated with these state-operated programs.
Accreditation↗
Adult immunization priorities in the United States.
Pneumonia and influenza (P&I) are the sixth leading cause of death in the United States. Despite universal coverage under Medicare, one-half to three-quarters of elderly adults fail to get vaccinated against P&I disease. Hepatitis B vaccine is also widely underutilized by adults. Although more than 100 times as many adults as children die from vaccine-preventable disease, the Centers for Disease Control and Prevention (CDC) currently allocates the vast majority of federal immunization funds to childhood programs. Top CDC officials say this is in accordance with the will of the Congress and the President. However, analysis of legislative documents shows that there is no legal bar or restriction to the use of federal funds to support adult immunization. CDC has the authority to use federal immunization funds to enhance adult immunization services, but the agency has yet to make adult immunization a priority. A commentary follows.
Adult↗
Age, resource consumption, and outcome for medical patients at an academic medical center.
At the national level debate is growing about the effects of the diagnosis related group (DRG) hospital payment system on patient access and quality of care. Recent changes to the DRG system have dropped any stratification by age and have delayed any other major change to improve payment equity. We characterized hospital resource consumption and outcome by age for all medical admissions (N = 31,838) to a large academic medical center (January 1, 1985, through December 31, 1987) using the DRG format. Mean hospital cost per patient, hospital length of stay, percentage of outliers, and mortality increased with age. The mean DRG case-mix index and the number of diagnostic codes per patient also rose with age. The DRG payment for all patients would have produced an aggregate profit of $34,426,951 ($1081 profit per patient); however, patients aged 71 years or older generated loses (the highest with patients aged 85 years or older--a $2177 loss per patient). As the financial position of American hospitals continues to deteriorate, these data suggest that the current DRG payment scheme may be inequitable for the medical patient aged 71 years or older, thus providing financial disincentives to treat the elderly medical patient and perhaps limiting their access and quality of care in the future.
Academic Medical Centers↗
Toward policies and decision-making for dam removal.
Dam removal has emerged as a critical issue in environmental management. Agencies responsible for dams face a drastic increase in the number of potential dam removals in the near future. Given limited resources, these agencies need to develop ways to decide which dams should be removed and in what order. The underlying science of dam removal is relatively undeveloped and most agencies faced with dam removal lack a coherent purpose for removing dams. These shortcomings can be overcome by the implementation of two policies by agencies faced with dam removal: (1) the development and adoption of a prioritization scheme for what constitutes an important dam removal, and (2) the establishment of minimum levels of analysis prior to decision-making about a dam removal. Federal and state agencies and the scientific community must encourage an initial experimental phase of dam removal during which only a few dams are removed, and these are studied intensively. This will allow for the development of the fundamental scientific understanding needed to support effective decision-making in the future and minimize the risk of disasters arising from poorly thought out dam removal decisions.
Conservation of Natural Resources↗
The competitive effects of horizontal mergers in the hospital industry.
Past empirical research has associated higher prices (and potentially profits) with less concentrated hospital markets. This has led to consternation among policymakers who must decide whether or not to apply traditional antitrust guidelines to hospital mergers. Due to the inherent flaws of accounting data, an 'event study' methodology is used to examine the effects of merger related announcements on the competitors' stock price returns. The results provide evidence that events which promote mergers increase the profits of competitors, while events which deter mergers decrease them. Furthermore, the greater the merger impact on local hospital markets, the stronger the effect.
Catchment Area, Health↗
A comparison of behavioral interventions reported in treatment studies and programs for adults with developmental disabilities.
This study examined the frequency with which behavioral interventions reported in the research literature were being incorporated into residential treatment programs addressing identical skill deficits. A sample of 113 research articles involving 299 subjects and a corresponding sample of 299 adaptive skill programs implemented in state-funded facilities were reviewed. Information was collected about subject attributes, target behaviors, types of intervention, and alternative instructional techniques. Chi-square analyses revealed significant differences between researchers and clinicians in the categories of adaptive and maladaptive behavior targeted as well as the behavioral interventions reported. Disparities were also found in treatment implementation practices including the use of task analysis, instruction in the natural environment, teaching of replacement skills, and the functional analysis of behavior. These differences are discussed in light of federal regulations governing practices in state-funded facilities as well as current research trends.
Adult↗
Effects of design flow and treatment level on construction and operation costs of municipal wastewater treatment plants and their implications on policy making.
Construction costs of 55 municipal wastewater treatment plants in Israel (secondary, advanced secondary, and advanced treatment) were analysed in order to derive cost functions expressing the effects of design flow and treatment level on construction costs. Three equations were derived (statistically significant, p<0.01), one for each treatment level. These indicate that economy of scale may become weaker as treatment level rises. Analysis of the distribution of construction costs revealed negative correlation (p<0.05) between the proportional cost of civil engineering and design flow, positive correlation (p<0.05) between the proportional cost of elecromechanical equipment and design flow, and no correlation between the proportional cost of electricity and control and design flow. Operation costs were found to be 20-70% more sensitive than construction costs to treatment level. The share of operation costs as part of the total annual costs was found to increase both with design flow and treatment level, whereas the share of construction costs concurrently decreased. The implication of the findings on policy, and consequently on treatment plants performance is discussed in the last part of the paper.
Costs and Cost Analysis↗
Women's health care utilization and expenditures.
This study examines women's use and expenditures for medical care in the US. In 2000, 91% of women aged 18 years and older used any form of health care services. Overall, 82% of adult women reported an ambulatory care visit, and 11% had an inpatient hospital stay. Mean expense per person with expenses was 3219 dollars for that year. We examined use and expenditures by sociodemographic characteristics. The most notable findings indicate that women with private insurance and those on Medicaid are more likely to use health services than uninsured women. White women, compared to black and Hispanic women, are more likely to have an ambulatory care visit, buy prescription drugs, and use preventive health care services. In addition, white and Hispanic women pay a higher proportion of medical care expenses out-of-pocket than do black women. Finally, nearly 30% of older women in fair or poor health spent 10% or more of their income on medical care. Preventable disparities in access to and receipt of care are unacceptable. To improve the quality of health care for all women, it is important for policymakers to understand the factors that influence their utilization and expenditures for medical care. Data collection, analysis, and reporting by race, ethnicity, and primary language across federally supported health programs are essential to help identify, understand the causes of, monitor, and eventually eliminate disparities.
Adult↗
Adjustment of benthic fauna following sediment disposal at a site with multiple stressors in Port Valdez, Alaska.
The shallow subtidal macrobenthos at Port Valdez, Alaska, was examined to assess faunal adjustment following disposal of dredged sediments over a three-year period. Prior to sediment disposal, the infauna consisted of a relatively species-rich assemblage dominated by sessile polychaetes and bivalves. Six months after disposal, virtually all taxa present prior to dredging and disposal were rare or absent with opportunistic taxa dominant. Surveys performed 1.5 years after sediment disposal indicated faunal adjustment was in progress; large, sessile polychaetes and bivalves were still present in low numbers after 2.5 years. At one station, increasing organic enrichment by fish-wastes from adjacent processing plants resulted in a shift to a highly disturbed benthic assemblage. The trends in the faunal assemblage suggest that environmental conditions were still in a state of flux 2.5 years after the dredging event.
Alaska↗