Digital Commons Network^™

The Economics Of Quality: Changing Incentives In Cincinnati, Lisa Sprague, Nora Super

National Health Policy Forum

This site visit focused on private market dynamics and quality improvement initiatives. Cincinnati is characterized by strong players in all sectors of the market: employers such as Procter and Gamble and General Electric, hospital systems, health plans, and physician groups with the power to “push back” in contract negotiations. The city is a pilot site for Bridges to Excellence, a pay-for-performance initiative spearheaded by GE. Cincinnati Children’s Hospital Medical Center is a grantee under the Robert Wood Johnson Foundation’s Pursuing Perfection program. Among the issues explored were physician supply, incentive structures, specialty hospitals, and information technology.

Model Checking Techniques For Regression Models In Cancer Screening, Debashis Ghosh

The University of Michigan Department of Biostatistics Working Paper Series

There has been much work on developing statistical procedures for associating tumor size with the probability of detecting a metastasis. Recently, Ghosh (2004) developed a unified statistical framework in which equivalences with censored data structures and models for tumor size and metastasis were examined. Based on this framework, we consider model checking techniques for semiparametric regression models in this paper. The procedures are for checking the additive hazards model. Goodness of fit methods are described for assessing functional form of covariates as well as the additive hazards assumption. The finite-sample properties of the methods are assessed using simulation studies.

Binary Isotonic Regression Procedures, With Application To Cancer Biomarkers, Debashis Ghosh, Moulinath Banerjee, Pinaki Biswas

The University of Michigan Department of Biostatistics Working Paper Series

There is a lot of interest in the development and characterization of new biomarkers for screening large populations for disease. In much of the literature on diagnostic testing, increased levels of a biomarker correlate with increased disease risk. However, parametric forms are typically used to associate these quantities. In this article, we specify a monotonic relationship between biomarker levels with disease risk. This leads to consideration of a nonparametric regression model for a single biomarker. Estimation results using isotonic regression-type estimators and asymptotic results are given. We also discuss confidence set estimation in this setting and propose three procedures for …

Semiparametic Models And Estimation Procedures For Binormal Roc Curves With Multiple Biomarkers, Debashis Ghosh

The University of Michigan Department of Biostatistics Working Paper Series

In diagnostic medicine, there is great interest in developing strategies for combining biomarkers in order to optimize classification accuracy. A popular model that has been used for receiver operating characteristic (ROC) curve modelling when one biomarker is available is the binormal model. Extension of the model to accommodate multiple biomarkers has not been considered in this literature. Here, we consider a multivariate binormal framework for combining biomarkers using copula functions that leads to a natural multivariate extension of the binormal model. Estimation in this model will be done using rank-based procedures. We show that the Van der Waerden rank score …

Consumer Cost Sharing In Private Health Insurance: On The Threshold Of Change, Veronica V. Goff

National Health Policy Forum

Employers are asking employees to pay more for health care through higher premium contributions, share of contribution, and out-of-pocket maximums, along with variations in deductibles, copays, and coinsurance based on choice of providers, networks, drugs, and other services. This issue brief examines consumer cost-sharing trends in private insurance, discusses the outlook for cost sharing in employment-based benefits, and considers public policies to support health care markets for consumers.

Medicare's Chronic Care Improvement Pilot Program: What Is Its Potential?, Nora Super

National Health Policy Forum

This paper describes the voluntary chronic care improvement program under traditional fee-for-service Medicare as authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173; section 721). This brief analyzes the emerging issues raised by this new program, including which chronic conditions and regional areas will be targeted, the types of entities that may participate, the physician’s role in care management, and the adoption and use of health information technology and evidence-based clinical guidelines.

On Corrected Score Approach For Proportional Hazards Model With Covariate Measurement Error, Xiao Song, Yijian Huang

UW Biostatistics Working Paper Series

In the presence of covariate measurement error with the proportional hazards model, several functional modeling methods have been proposed. These include the conditional score estimator (Tsiatis and Davidian, 2001), the parametric correction estimator (Nakamura, 1992) and the nonparametric correction estimator (Huang and Wang, 2000, 2003) in the order of weaker assumptions on the error. Although they are all consistent, each suffers from potential difficulties with small samples and substantial measurement error. In this article, upon noting that the conditional score and parametric correction estimators are asymptotically equivalent in the case of normal error, we investigate their relative finite sample performance …

Religion And Crime: A Study Of Inmates In State And Federal Prisons In The United States., Dhanalakshmi Thirumalai

Electronic Theses and Dissertations

Persistent high levels of crime in this country have provided support for the need for public programs that help in reducing crime rates through effective interventions. Spirituality and religion are considered to play a major part in determining an individual's attitude towards committing a crime. This study analyzed if inmates in State and Federal prisons in the US are involved in prison religious activities and personal prayers in order to determine if criminality (measured by offense type) of inmates affects their participation in religious activities. Based on logistic regression analysis, gender, race, and marital status of inmates were found to …

International Art Therapy Program Development: An Exploratory Cultural Encounter In Ayacucho, Peru, Haley Johnstone

EVMS School of Health Professions Theses & Dissertations

Humanitarian aid organizations, both domestic and international, provide health care, mental health services, education, and community development for traumatized children worldwide living in regions affected by political violence. Sparse information exists regarding the role of an art therapist within these organizations. The profession of art therapy lacks research specific to the benefits of intervention and program development within the context of an international humanitarian aid team. This thesis reviews the ethnographic research of an art therapy graduate student who explored the opportunities for art therapy within such a team.

Cultural competency was an essential component of the researcher’s success while …

Investigation And Calculation Of Dose Coefficients For Radionuclides Produced In A Spallation Neutron Source Using The Ensdf And Nubase Nuclear Databases, Yayun Song

UNLV Theses, Dissertations, Professional Papers, and Capstones

Dose coefficients are useful for risk assessment during the design and siting of accelerator-driven nuclear facilities including the Spallation Neutron Source. There are seventy-two radionuclides with half-lives equal to or greater than one minute that will be produced by the spallation of a mercury target for which no published dose coefficients exist. Out of these seventy-two, twenty-four currently have conflicting published nuclear data in the Evaluated Nuclear Structure Data Files (ENSDF) and the NUBASE data files. In this research these twenty-four radionuclides have been studied. Because of missing ENSDF records, internal and external dose coefficients were determined for only six …

Santé Respiratoire Des Travailleurs Et Qualité De L’Air Des Tourbières Du Québec Possédant Des Systèmes De Dépoussiérage, Caroline Duchaine, Yvon Cormier, Anne Mériaux, Pascal Pageau, Madeleine Chabot, Évelyne Israël-Assayag, Nicole Goyer, Yves Cloutier, Louis Lazure

Rapports de recherche scientifique

Certains problèmes de santé reliés à la manipulation de la tourbe sont bien connus. On parle de maladie reliée à la présence de Sporothrix schenckii. La présence de Mycobacterium xenopi et M. fortuitum pourrait conduire à des infections aux reins et M.chelonae et M. gordonae pourraient être associées à l’alvéolite allergique. Si ces problèmes inhérents à la manipulation de la tourbe sont connus, aucune étude ne fait état de la microflore de l’air des tourbières et de l’exposition des travailleurs aux différents contaminants aériens comme les poussières organiques, les moisissures, bactéries, et autres produits pouvant causer des …

Influenza Vaccination Coverage Among Adults With Asthma: Findings From The 2000 Behavioral Risk Factor Surveillance System, Earl S. Ford, Seymour G. Williams, David M. Mannino, Stephen C. Redd

United States Public Health Resources

The prevalence of asthma has increased substantially in the United States since 1980 (1). The primary clinical and public health strategy to reduce the burden of asthma is to prevent exacerbation of the disease, of which upper and lower respiratory tract infections are a major cause (2–5). One such infection—influenza— and its complications are potentially preventable with annual vaccination, which is a safe and effective method (6,7), including among persons with asthma (8). Because persons with asthma are at increased risk of complications from influenza, they are advised to receive annual influenza vaccinations (9), unless there are contraindications.
Little is …

Evaluating Markers For Selecting A Patient's Treatment, Xiao Song, Margaret S. Pepe

UW Biostatistics Working Paper Series

Selecting the best treatment for a patient's disease may be facilitated by evaluating clinical characteristics or biomarker measurements at diagnosis. We consider how to evaluate the potential of such measurements to impact on treatment selection algorithms. For example, magnetic resonance neurographic imaging is potentially useful for deciding whether a patient should be treated surgically for carpal tunnel syndrome or if he/she should receive less invasive conservative therapy. We propose a graphical display, the selection impact (SI) curve, that shows the population response rate as a function of treatment selection criteria based on the marker. The curve can be useful for …

Veterans' Health Care: Balancing Resources And Responsibilities, Lisa Sprague

National Health Policy Forum

This paper looks at the health care benefits and services administered by the U.S. Department of Veterans Affairs. It examines management strategies adopted within the department to allocate resources, structure benefits, and improve quality. Some recommendations made by the General Accounting Office and the President’s Task Force to Improve Health Care Delivery for Our Nation’s Veterans are reviewed, in particular the emphasis of the latter on increased collaboration with the Department of Defense. Long-term proposals to balance service commitments and financing also are considered.

Three Steps Forward, Two Steps Back: Tobacco Policy Making In Nebraska, Andrew Wessel, Jennifer Ibrahim, Stanton Glantz

United States Public Health Resources

EXECUTIVE SUMMARY

• In 2002, 22.7% of Nebraskans over the age of 18 were current smokers, accounting for

approximately 389,000 smokers.

• Since 1995, the prevalence of adult tobacco use in Nebraska has remained about 1 percentage

point below the national average, but per capita tobacco consumption in Nebraska has been falling

more slowly than the Unites States as whole.

• The tobacco industry has directly been a major political force in Nebraska through lobbying and

campaign contributions. The tobacco industry spent over $1,027,000 on lobbying from 1997-2002.

The tobacco industry made direct campaign contributions to the members of the …

Cost Analysis Of The Built Environment: The Case Of Bike And Pedestrian Trials In Lincoln, Neb, Guijing Wang, Caroline A. Macera, Barbara Scudder-Soucie, Tom Schmid, Michael Pratt, David Buchner, Gregory Heath

United States Public Health Resources

We estimated the annual cost of bike and pedestrian trails in Lincoln, Neb, using construction and maintenance costs provided by the Department of Parks and Recreation of Nebraska. We obtained the number of users of 5 trails from a 1998 census report. The annual construction cost of each trail was calculated by using 3%, 5%, and 10% discount rates for a period of useful life of 10, 30, and 50 years. The average cost per mile and per user was calculated.
Trail length averaged 3.6 miles (range=1.6–4.6 miles). Annual cost in 2002 dollars ranged from $25 762 to $248479 (mean=$124927; …

Monitoring Physical Activity: Uses And Measurement Issues With Automated Counters, Michelle L. Granner, Patricia A. Sharpe

Faculty Publications

Background: Promotion of physical activity is a public health priority, and environmental factors influence physical activity behavior. Valid and reliable automated measurement tools of physical activity for assessment and evaluation within public settings are needed. Methods: Searches of the research literature and governmental reports from physical activity, transportation, and recreation fields were conducted to identify methods of automated counting and validation studies. The article provides a summary of (a) current methods and uses of automated counters, (b) information about validity and reliability where available, (c) strengths and limitations of each methods, and (d) measurement issues. Results: Existing automated counting technology …

State Efforts To Expand Health Coverage: One Bite At A Time, Christopher Stream

Public Policy and Leadership Faculty Research

For more than twenty years, health scholars and advocates have warned us about the lack of adequate health coverage among a growing number of Americans. Health insurance premiums are rising. Many employers, especially small employers who employ over half of the country’s workforce, and individuals are seeing premium increases of 30, 40, and even 50 percent. Not surprisingly, America’s uninsured population is rising— to more than 41 million people. States are feeling the budget crunch as the economy sags and more and more people turn to state Medicaid and other public health care systems. This all means that state policy …

The Florida Legislature’S Physical Activity And Nutrition Bills And Florida’S Youth: A Health Professional’S Call To Action

Florida Public Health Review

No abstract provided.

A Brief Interview With Vice Admiral Richard H. Carmona, Md, Mph, Facs Surgeon General Of The United States

Florida Public Health Review

No abstract provided.

Examination Of Impact Of Polk County Florida’S Safe And Drug Free Schools Program

Florida Public Health Review

No abstract provided.

Minority Youth: “Big Tobacco’S” 21st Century Marketing Targets

Florida Public Health Review

No abstract provided.

Perceptions Of Access To U.S. Health Care Of Haitian Immigrants In South Florida

Florida Public Health Review

No abstract provided.

School Health Is Public Health

Florida Public Health Review

No abstract provided.

An Overview And Evaluation Of Cultural Competence Training For Public Health Professionals

Florida Public Health Review

No abstract provided.

Use Of Hospitals, Physician Visits, And Hospice Care During Last Six Months Of Life Among Cohorts Loyal To Highly Respected Hospitals In The United States, J. E. Wennberg, Elliot S. Fisher, Therese A. Stukel, Jonathan S. Skinner

Dartmouth Scholarship

Objective: To evaluate the use of healthcare resources during the last six months of life among patients of US hospitals with strong reputations for high quality care in managing chronic illness.

Causal Inference In Hybrid Intervention Trials Involving Treatment Choice, Qi Long, Rod Little, Xihong Lin

The University of Michigan Department of Biostatistics Working Paper Series

Randomized allocation of treatments is a cornerstone of experimental design, but has drawbacks when a limited set of individuals are willing to be randomized, or the act of randomization undermines the success of the treatment. Choice-based experimental designs allow a subset of the participants to choose their treatments. We discuss here causal inferences for experimental designs where some participants are randomly allocated to treatments and others receive their treatment preference. This paper was motivated by the “Women Take Pride” (WTP) study (Janevic et al., 2001), a doubly randomized preference trail (DRPT) to assess behavioral interventions for women with heart disease. …

Necessary But Not Sufficient? Physician Volunteerism And The Health Care Safety Net, Eileen Salinsky

National Health Policy Forum

This paper examines the role of physician-sponsored charity care in meeting the health care needs of the uninsured. The paper provides an overview of current charity care levels by medical specialties and geographic regions, discusses limitations in available data, and describes the settings in which charity care is provided. The paper also summarizes the factors that motivate physicians to provide volunteer services, as well as the barriers that hinder volunteer activities, including malpractice insurance concerns. Also discussed are a range of public policies, both existing and considered, that support volunteer activities, with a particular emphasis on the expansion of Federal …

Health Educators In Florida’S County Public Health Departments: Frequency Of And Perceived Confidence In Performing Entry-Level Competencies, Michele Johnson Moore

Florida Public Health Review

No abstract provided.

A Bayesian Hierarchical Approach To Multirater Correlated Roc Analysis, Tim Johnson, Valen Johnson

The University of Michigan Department of Biostatistics Working Paper Series

In a common ROC study design, several readers are asked to rate diagnostics of the same cases processed under different modalities. We describe a Bayesian hierarchical model that facilitates the analysis of this study design by explicitly modeling the three sources of variation inherent to it. In so doing, we achieve substantial reductions in the posterior uncertainty associated with estimates of the differences in areas under the estimated ROC curves and corresponding reductions in the mean squared error (MSE) of these estimates. Based on simulation studies, both the widths of confidence intervals and MSE of estimates of differences in the …