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At least 19 recordsLinked to original sources
PubMed2003

Improving adequacy of peritoneal dialysis in ESRD Network 5 (Maryland; Washington, DC; Virginia; West Virginia).

The goal of the quality improvement project reported here was to increase the proportion of peritoneal dialysis (PD) patients receiving adequate dialysis as defined by the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) guidelines. Our approach was to increase the frequency with which we measured PD adequacy and changed prescriptions in response to low adequacy values. We developed 3 indicators, each one subdivided to reflect differences by type of PD and time on PD. Our improvement goal was to achieve the midpoint between baseline performance on those indicators and 100%, equating to a 50% reduction in failure rate (RFR). At baseline, the project included 122 facilities with 1,517 patients (data from October 1999 to March 2000). At re-measurement, we had 117 facilities with 1,372 patients (data from January 2001 to June 2001). In addition to obtaining facility-specific feedback reports, we conducted educational intervention workshops to which all PD providers were invited. After the workshops, "mandatory intervention" facilities submitted improvement plans that were reviewed by the PD Adequacy Work Group to determine if improvement actions were appropriately focused on identified root causes. Not all intervention facilities attended the workshops, and some facilities attended voluntarily. Overall, the Network 5 results showed a statistically significant improvement in measuring PD adequacy (84% baseline to 92% re-measurement), with a corresponding 51% RFR. Improvement in desired levels of adequacy was also statistically significant (55% baseline to 64% re-measurement), with a 21% RFR. Analysis by the intervention group showed that "mandatory intervention" facilities improved more than did "voluntary" facilities in measuring adequacy and in reaching desired levels, and that the differences were statistically significant. Quality improvement efforts that focused on improving the adequacy of PD in Network 5 were accomplished.

District of Columbia↗
PubMed1991

Family physicians' perceptions of health manpower needs in West Virginia.

West Virginia family physicians feel that they are able to assess the health care needs of their communities. There is a need for more physicians in all of the major specialties in West Virginia, but the largest numbers of physicians are needed in family practice and obstetrics. More registered nurses and licensed practical nurses are needed than any other health care professionals. Twenty-five percent of the respondents are actively recruiting associates, and 48 percent have seriously considered leaving, or are leaving West Virginia. The most commonly cited reasons for leaving are inadequate reimbursement, the state's economy, SB-576, lack of tort reform, and state government in general. The greatest advantage given to practicing in the state are its people, the quality of life, and home and family. In addition, the greatest problems are reimbursement, state government, the malpractice climate and the state economy. The survey shows that state government needs to show a good faith effort to enact tort reform to improve relations with physicians. The threat of losing more physicians is real and must be addressed. Improving the climate for the practice of medicine is a viable solution to West Virginia's manpower problems. There is also a need to continue all present health care professional training programs. More emphasis should be placed on recruitment and retention of nursing students. There is expressed support for nurse midwives, nurse practitioners, and physicians' assistants all working under the supervision of physicians. The finding that home and family are frequently listed as advantages to practicing here indicates recruitment and nurturing of students from underserved areas should be increased.(ABSTRACT TRUNCATED AT 250 WORDS)

Allied Health Personnel↗
PubMed1994

The challenge of managed care in rural West Virginia.

West Virginia faces a particularly difficult challenge in organizing its health care system for managed care. The rural nature of the state, the shortage of primary care practitioners, few large employers, and the predominant role played by federal and state health care purchasers have hindered managed care development in the state. The crisis in the cost of health care and discussions of health care reform have now created interest in developing prepaid managed care by both payers and providers. In the last three years, several initiatives have paved the way for a more organized approach to the delivery of health care. This article describes the current health care environment in West Virginia and the efforts underway to prepare for system change.

Demography↗
PubMedDate not supplied

Malaria in West Virginia: forty cases seen at West Virginia University Hospital.

In the U.S., malaria predominately occurs in travelers and immigrants. We report a series of 40 cases at West Virginia University Hospital, and 24 of whom were students who had visited areas of East Africa, West Africa and Asia usually in either December, January, August or September. Most patients (79%) reported a previous episode of malaria, and P. falciparum was identified in 60%. Fever, chills and rigors were the most common symptoms. Correct use of malaria prophylaxis was recorded in five patients, and only two of these were students. Successful outcomes were recorded in all but one patient. Our series suggests that international students would benefit from the proper use of chemoprophylaxis, thus decreasing the number of cases of malaria seen in university settings.

Adolescent↗
PubMedDate not supplied

West Virginia Medical Institute: the Quality Improvement Organization for West Virginia.

The Federal Quality Improvement program, (QIO), charged with quality improvement and some case review activities is conducted under a contract with the Centers for Medicare and Medicaid Services (formerly HCFA), now CMS. Every state has one organization which handles this program and in West Virginia, the West Virginia Medical Institute has been responsible for this work for over 30 years. When case review is involved, the conclusions are communicated to individual physicians and hospitals. Occasionally, serious quality of care concerns are encountered. This article explains the case review process and why cases are selected, and also makes suggestions about how individual physicians may appeal or respond. It is designed to help enhance understanding of the program and its goals.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1990

Lipid screening in a rural West Virginia clinic.

West Virginia leads the nation in mortality from coronary heart disease among both men and women aged 35 to 74. Although there has been some research with respect to behavioral risk factors, little is known about the prevalence of high serum cholesterol among West Virginia residents. The present paper begins this examination by reporting the results of a medical chart audit conducted recently in a rural medicine clinic in Matewan, West Virginia. Results revealed that only 17 per cent of the 501 charts reviewed reported serum cholesterol. Significant differences were noted between the local sample and a national comparison for two groups. The implications of these findings are discussed.

Adult↗
PubMed1993

How the Health Care Surrogate Act of 1993 will simplify medical care in West Virginia.

The West Virginia Health Care Surrogate Act of 1993 became effective July 1, 1993. This law establishes a process for making health care decisions for adults who lack decision-making capacity and who have not completed a medical power of attorney that does not require judicial involvement. The law describes how a health care surrogate is to be selected by the physician, and it provides immunity to the physician and surrogate who make health care decisions according to its provisions. This article presents a case in which the application of the new law is demonstrated.

Advance Directives↗
PubMed1981

Malignant melanoma in West Virginia.

In West Virginia from 1959 to 1975 there were 279 deaths caused by malignant melanoma. From 1959 to 1967 there were 8.4 such deaths per year and from 1968 to 1975, 25.4 per year (2P < .0005). This trend was observed throughout the state. The population-adjusted melanoma mortality of 1.45 per 100,000 from 1968 to 1975 contrasts with a rate of only 0.48 per 100,000 during the earlier period from 1959 to 1967. The rate of increase was greater in the southern portion of the state. The highest melanoma mortality was seen in the state's major agricultural area, while the lowest rate was seen in its most densely populated urban region. In our community, 102 new melanoma cases were diagnosed from 1969 to 1978. From 1969 to 1973, there were 33 new cases, 6.6 per year, and from 1974 to 1978, 13.8 per year (2P < .01). Men tended to be older at the time of diagnosis. The most common locations of the primary tumors were the lower extremity in women and the trunk and head and neck in men.

Adolescent↗
PubMedDate not supplied

Adolescent all-terrain vehicle deaths in West Virginia, 1990-1998.

West Virginia had the third highest number of ATV-related deaths and the highest death rate among all states from 1990-98. Adolescents were identified as a particularly high-risk ATV user group. Fatality data from the U.S. Consumer Product Safety Commission indicated that one-quarter (25 of 101) of the state's ATV-related deaths occurred among children 16 and younger. Only one victim was wearing a helmet at the time of their fatal crash and nearly 70% of the victims were males. The average years of potential life lost was 64.2. WV's adolescent death rate of 0.67 per 100,000 was 5 times higher than the national rate. Young ATV drivers exacerbate the inherent dangers associated with ATVs through poor judgment and risk-taking. Health care providers should utilize "teachable moments" to emphasize ATV safety to their young patients and their parents, but more importantly, adults must become role models by embracing and teaching practical preventive measures.

Accidents, Traffic↗
PubMedDate not supplied

ATV-related deaths in West Virginia: 1990-2003.

During the 14-year period from 1990-2003, West Virginia experienced 220 deaths related to All Terrain Vehicles (ATVs). Death rates in West Virginia however, were significantly higher than the national rate or those of any of the its five surrounding states. About 25% of the West Virginia deaths occurred in children less than 18 years of age. Ninety-five percent of the victims were not wearing helmets and 15% were passengers. Nearly one-third of the ATV crashes occurred on public roads, streets, and highways--surfaces on which ATVs are not designed nor recommended to be used. The cost of ATV-related deaths is estimated to be over dollar 100 million annually. The number of non-fatal injuries resulting from ATV crashes is difficult to ascertain because of a lack of a centralized and standardized state-based surveillance mechanism. The 44 states that have some level of ATV safety requirements have a collective death rate half that of states, like West Virginia, who do not have ATV safety requirements. Due to the continuing public health burden caused by ATV deaths and injuries, as well as their associated costs, it is important that West Virginia policymakers pass strong ATV safety legislation during the current session.

Accidents, Traffic↗
PubMedDate not supplied

A study of the future practice location intent of family medicine residents in West Virginia.

Recruitment of graduating family medicine residents into practice in rural West Virginia has been hampered by many factors. A cross-sectional survey was done to obtain the opinions of family medicine residents in West Virginia in 1996 in order to characterize their perceptions regarding certain aspects of their rural training and the relative importance of various factors influencing their future practice location intent. There was a positive association between cumulative resident experience and intent to practice in West Virginia and in rural areas. Perceived preparation for rural practice varied with educational area. There was significant variation in the relative importance of recruiting factors for likelihood of practice in West Virginia and in rural areas. Some recruiting factors tended to be positive or negative discriminators for intent to practice in West Virginia and in rural areas. Enhanced recruitment may be aided by an active community involvement which addresses the identified relevant factors.

Choice Behavior↗
PubMed2000

Assessment of school-based health centers in a rural state: the West Virginia experience.

PURPOSE: To assess the capability of school-based health centers (SBHCs) to provide access to health care for rural youth. METHODS: Review of annual patient records from SBHCs in West Virginia. Ten of 24 SBHCs in West Virginia in operation from July 1994 to June 1997 were selected for the study. Enrollment and utilization rates were generated for each site. A comparison was made between rates of enrollment, utilization, and annual visits among youth with private insurance, those covered by Medicaid, and youth without insurance. Rural and urban SBHCs within West Virginia were compared based on enrollment, utilization, and visit rates. The diagnostic categories were analyzed. Finally, enrollment rates, utilization rates, and insurance status for the West Virginia SBHCs were compared with national norms. RESULTS: Enrollment rates rose steadily during the study period from 27% in Year 1 to 64% by the end of Year 3. The utilization rate was 67% in Year 3. The youth with either Medicaid or no insurance comprised 52% of enrollees, but they accounted for 63% of all visits. West Virginia SBHCs have a higher rate of Medicaid users than the national average for SBHCs, and the annual visit rate for West Virginia youth is higher than the national average for nonmetropolitan adolescents. The enrollment rate of 64% is slightly higher than the national average for SBHCs. Within West Virginia, the enrollment rate in rural schools was significantly higher, 86% compared to 46% (p < .001), and the utilization rate was 70% in rural centers compared to 63% in the urban centers (p < .001). CONCLUSION: When SBHCs are available in rural areas, students use them. In West Virginia, SBHCs have contributed to providing access to health care for rural youth.

Adolescent↗
PubMedDate not supplied

Fatal traumatic brain injury, West Virginia, 1989-1998.

OBJECTIVE: The objective of this study was to describe fatal cases of traumatic brain injury (TBI) among West Virginia residents. METHODS: The authors analyzed data from the National Center for Health Statistics Multiple Cause of Death tapes for the period 1989-1998. They compared West Virginia's annualized average TBI death rate with the rates of other states and with the rate among U.S. residents for the same period. U.S. Bureau of Census population estimates were used as denominators. RESULTS: A total of 4,416 TBI deaths occurred in West Virginia in 1989-1998, for an annual average death rate of 23.6 per 100,000 population. From 1989 to 1998, TBI death rates declined 5% (p=0.4042). Seventy-five percent (n=3,315) of fatalities occurred among men. Adults > or =65 years of age accounted for the highest percentage of fatal injuries (n=1,135). The leading external causes of fatal TBI were: firearm-related (39% of reported fatalities), motor vehicles-related (34%), and fall-related (10%). Firearm-related TBI became the leading cause of TBI fatalities in 1991, surpassing motor vehicle-related TBI. Seventy-five percent of firearm-related TBI deaths were suicides (n=1,302). West Virginia's TBI death rate (23.6 per 100,000) was higher than the national rate (20.6 per 100,000). In 23 states, the average TBI death rates over the 10-year period were higher than West Virginia's. Whereas modest declines in TBI death rates occurred for motor vehicle-related and firearm-related causes in West Virginia, a concomitant 38% increase occurred in the fall-related TBI death rate during the decade. CONCLUSION: Data presented in this report can be used to develop targeted prevention programs in West Virginia.

Accidental Falls↗