Digital Commons Network^™

The Medicare And Medicaid Intersection: Caring For Arizona's Seniors, Nora Super, Lisa Sprague, Judith D. Moore

National Health Policy Forum

This site visit to Phoenix examined the interplay between Medicare and Medicaid and how payment streams and regulatory requirements affect the delivery of health and long-term care services. The visit explored trends related to Medicare+Choice plan participation, physician acceptance of Medicare patients, and care management for individuals with chronic illnesses, such as Alzheimer’s disease. It also considered Arizona’s capitated Medicaid long-term care program, which recently implemented competitive bidding among plans in Maricopa County.

Prescription Drugs In Nursing Homes: Managing Costs And Quality In A Complex Environment, Dan Mendelson, Rajeev Ramchand, Richard Abramson, Anne Tumlinson

National Health Policy Forum

This issue brief provides a description of prescription drug use in nursing homes and a summary of policy issues in this area. It first profiles the nursing home pharmaceutical market, outlining the major trends in demographics and drug utilization, the supply chain by which drugs go from manufacturers to pharmacies to nursing home residents, and the alternative arrangements by which prescription drugs in nursing homes are financed. The paper then provides a synopsis of current policy issues, focusing in turn on cost containment and quality improvement initiatives.

U.S. Childhood Vaccine Availability: Legal, Regulatory, And Economic Complexities, Robin J. Strongin

National Health Policy Forum

Despite the vital role they play in public health, childhood vaccines travel a complicated road from laboratory to provider and patient. From the fall of 2000 until well into 2002, a combination of factors, including market dynamics, legal challenges, and regulatory hurdles, led to a shortage of some childhood vaccines. This paper examines each of these factors, focusing on the important roles of both the public and the private sectors.

Assessing Workplace Tobacco Policies: A Community-Academic Partnership, Ellen J. Hahn, Mary Kay Rayens, Chizimuzo T.C. Okoli

Nursing Presentations

Purpose

• Describe the number and type of tobacco policies in manufacturing facilities

• Assess the resources for tobacco education and cessation

• Identify factors related to tobacco policies and practices within manufacturing facilities

A Survey Of Health Services And Identification Of Needs For Asian American Elderly Women In The Greater Boston Area, Connie S. Chan, Lin Zhan

Institute for Asian American Studies Publications

Over one hundred Asian American and mainstream health care providers in the greater Boston area were surveyed for this study. The authors have identified critical gaps in services for elderly Asian American women.

Activity Patterns And Correlates Among Youth: Differences By Weight Status, Wendell C. Taylor, James F. Sallis, Marsha Dowda, Patty S. Freedson, Karen Eason, Russell R. Pate

Faculty Publications

The purposes of the study were to assess differences in physical activity levels and correlates of physical activity among overweight (‡ 85th percentile of body mass index for their sex and age) and non-overweight (< 85th percentile) youth. The sample included 509 seventh through twelfth graders. Activity was measured by a 7-day, 46-item activity checklist. Overweight girls were more sedentary than non-overweight girls (p<.03), and non-overweight girls engaged in more vigorous physical activity than overweight girls (p<.03). For boys, there were no significant differences in activity. The regression analyses for vigorous activity yielded the largest total R²'s (R²=.049 for overweight and R²=.27 for non-overweight.) The significant factor for overweight youth was greater athletic coordination (p<.01). For non-overweight youth, the significant factors were greater family support (p<.05), greater peer support (p<.001), fewer barriers (p<.03), and greater athletic coordination (p<.01). Correlates of physical activity vary by weight status of young people.

Associations Between Cardiorespiratory Fitness And C-Reactive Protein In Men, Timothy S. Church, Carolyn E. Barlow, Conrad P. Earnest, James B. Kampert, Elisa L. Priest, Steven N. Blair

Faculty Publications

Objective - This study examined the association between cardiorespiratory fitness and C-reactive protein (CRP), with adjustment for weight and within weight categories.

Methods and Results - We calculated median and adjusted geometric mean CRP levels, percentages of individuals with an elevated CRP (≥2.00 mg/L), and odds ratios of elevated CRP across 5 levels of cardiorespiratory fitness for 722 men. CRP values were adjusted for age, body mass index, vitamin use, statin medication use, aspirin use, the presence of inflammatory disease, cardiovascular disease, and diabetes, and smoking habit. We found an inverse association of CRP across fitness levels (P for …

Asphalt Compactor Operator Dies When Machine Slides And Falls 17 Feet, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

A 32-year-old woman (the decedent) was killed when the asphalt compactor she was operating slid over an embankment and dropped 17 feet to a roadway below. At the time she was pressing an asphalt joint joining a roadway and a shoulder/emergency lane. She was two miles behind the asphalt truck and 1000 feet in front of a flat bed truck. The location of the incident had been identified as a possible hazardous location and her supervisors had instructed her to use extra caution in that area. The decedent was trained and had several years of experience operating an asphalt compactor. …

An Empirical Study Of Marginal Structural Models For Time-Independent Treatment, Tanya A. Henneman, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

In non-randomized treatment studies a significant problem for statisticians is determining how best to adjust for confounders. Marginal structural models (MSMs) and inverse probability of treatment weighted (IPTW) estimators are useful in analyzing the causal effect of treatment in observational studies. Given an IPTW estimator a doubly robust augmented IPTW (AIPTW) estimator orthogonalizes it resulting in a more e±cient estimator than the IPTW estimator. One purpose of this paper is to make a practical comparison between the IPTW estimator and the doubly robust AIPTW estimator via a series of Monte- Carlo simulations. We also consider the selection of the optimal …

Trends. Fantasies, Death, And Violence, Ibpp Editor

International Bulletin of Political Psychology

This Trends article examines violence and death in the context of the goals of international health organizations.

Natural Experiment Examining Impact Of Aggressive Screening And Treatment On Prostate Cancer Mortality In Two Fixed Cohorts From Seattle Area And Connecticut, Grace Lu-Yao, Peter C. Albertsen, Janet L. Stanford, Therese A. Stukel

Dartmouth Scholarship

To determine whether the more intensive screening and treatment for prostate cancer in the Seattle≠Puget Sound area in 1987≠90 led to lower mortality from prostate cancer than in Connecticut.

Laboratory Response To Anthrax Bioterrorism, New York City, 2001, Michael B. Heller, Michel L. Bunning, Martin E.B. France, Debra M. Niemeyer, Leonard Peruski, Tim Naimi, Phillip M. Talboy, Patrick H. Murray, Harald W. Pietz, John Kornblum, William Oleszko, Sara T. Beatrice, Joint Microbiological Rapid Response Team, New York City Anthrax Investigation Working Group, Denis Nash

Publications and Research

In October 2001, the greater New York City Metropolitan Area was the scene of a bioterrorism attack. The scale of the public response to this attack was not foreseen and threatened to overwhelm the Bioterrorism Response Laboratory’s (BTRL) ability to process and test environmental samples. In a joint effort with the Centers for Disease Control and Prevention and the cooperation of the Department of Defense, a massive effort was launched to maintain and sustain the laboratory response and return test results in a timely fashion. This effort was largely successful. The development and expansion of the facility are described, as …

The Analysis Of Placement Values For Evaluating Discriminatory Measures, Margaret S. Pepe, Tianxi Cai

UW Biostatistics Working Paper Series

The idea of using measurements such as biomarkers, clinical data, or molecular biology assays for classification and prediction is popular in modern medicine. The scientific evaluation of such measures includes assessing the accuracy with which they predict the outcome of interest. Receiver operating characteristic curves are commonly used for evaluating the accuracy of diagnostic tests. They can be applied more broadly, indeed to any problem involving classification to two states or populations (D = 0 or D = 1). We show that the ROC curve can be interpreted as a cumulative distribution function for the discriminatory measure Y in the …

Running On Empty: The State Budget Crisis Worsens, Randy Desonia

National Health Policy Forum

This issue brief reviews the status of state budget shortfalls and their growing impact on the Medicaid program. It describes the magnitude of the shortfalls, the forces behind them, and how states have responded with spending cuts and tax increases. It also discusses how long the budget crisis is expected to continue and what budget balancing options remain for fiscal year 2003.

Relationship Between Low Quality-Of-Care Scores And Hmos' Subsequent Public Disclosure Of Quality-Of-Care Scores, Danny Mccormick, David U. Himmelstein, Steffie Woolhandler, Sidney M. Wolfe, David H. Bor

Publications and Research

Context Public disclosure of quality data on health maintenance organizations (HMOs) might improve public accountability, inform consumer decision making, and promote quality improvement. But, because disclosure is voluntary, some HMOs could subvert these objectives by refusing to release unfavorable data.

Objective To determine the association between HMO quality of care and withdrawal from public disclosure of quality-of-care data the subsequent year.

Design and Setting Retrospective cohort study of administrative and quality-of-care data on HMOs from the National Committee for Quality Assurance (NCQA) annual Quality Compass databases for 1997, 1998, and 1999, including Health Plan Employer Data and Information Set (HEDIS) …

Case-Control Current Status Data, Nicholas P. Jewell, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

Current status observation on survival times has recently been widely studied. An extreme form of interval censoring, this data structure refers to situations where the only available information on a survival random variable, T, is whether or not T exceeds a random independent monitoring time C, a binary random variable, Y. To date, nonparametric analyses of current status data have assumed the availability of i.i.d. random samples of the random variable (Y, C), or a similar random sample at each of a set of fixed monitoring times. In many situations, it is useful to consider a case-control sampling scheme. Here, …

Assault-Related Admissions To Hospital In Central Australia, Ged F. Williams, Wendy P. Chaboyer, Philip J. Schluter

Aboriginal Policy Research Consortium International (APRCi)

Objective: To determine the number of assault-related admissions to hospital in the Central Australia region of the Northern Territory over a six-year period. Design and setting: Retrospective analysis of all patients admitted to Alice Springs Hospital (ASH) and Tennant Creek Hospital (TCH) from July 1995 to June 2001, where the primary cause of injury was “assault”. Main outcome measures: Frequency of assault-related admission to hospital; demographic characteristics of the victims. Results: In the six years, there were 2449 assault-related admissions to ASH and 545 to TCH. Adults aged 25–34 years were most frequently hospitalised for assault, in a proportion greater …

Patient Attitudes Toward Using Computers To Improve Health Services Delivery, Chris N. Sciamanna, Joseph A. Diaz, Puja Myne

College of Population Health Faculty Papers

BACKGROUND:The aim of this study was to examine the acceptability of point of care computerized prompts to improve health services delivery among a sample of primary care patients.

METHODS:Primary data collection. Cross-sectional survey. Patients were surveyed after their visit with a primary care provider. Data were obtained from patients of ten community-based primary care practices in the spring of 2001.

RESULTS:Almost all patients reported that they would support using a computer before each visit to prompt their doctor to: "do health screening tests" (92%), "counsel about health behaviors (like diet and exercise)" (92%) and "change treatments for health conditions" (86%). …

Medigap: Prevalence, Premiums, And Opportunities For Reform, Nora Super

National Health Policy Forum

This issue brief provides an overview of Medicare's coverage gaps and the primary sources of supplemental coverage for Medicare beneficiaries. It focuses particularly on the Medigap market: the effects of standardization, recent premium trends and rating practices, and options for reform. It considers Medigap within the context of Medicare prescription drug proposals and efforts to reform the entire Medicare program.

Current Status Data: Review, Recent Developments And Open Problems, Nicholas P. Jewell, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

Researchers working with survival data are by now adept at handling issues associated with incomplete data, particular those associated with various forms of censoring. An extreme form of interval censoring, known as current status observation, refers to situations where the only available information on a survival random variable T is whether or not T exceeds a random independent monitoring time C. This article contains a brief review of the extensive literature on the analysis of current status data, discussing the implications of response-based sampling on these methods. The majority of the paper introduces some recent extensions of these ideas to …

Avoiding West Nile Virus While Working, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Other

No abstract provided.

Erisa Health Plans: Key Structural Variations And Their Effect On Liability, Phyllis Borzi

Health Policy and Management Faculty Publications

No abstract provided.

State Eligibility Rules Under Separate State Schip Programs--Implications For Children's Access To Health Care, Sara Rosenbaum, Anne Rossier Markus

Health Policy and Management Issue Briefs

This Policy Brief is the fourth in a series of reports1 issued by the George Washington University Center for Health Services Research and Policy that examine the design of separately-administered State Children’s Health Insurance Programs (SCHIP) that is, programs that operate directly under the authority of the federal SCHIP statute rather than expansions of state Medicaid programs.2 These Policy Briefs also consider the implications of states’ design choices for children’s access to health care.

Evitando La Infección Del Nilo Occidental, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Other

No abstract provided.

Clinical And Epidemiological Correlates Of Genotypes Within The Mycobacterium Avium Complex Defined By Restriction And Sequence Analysis Of Hsp65, Sandra C. Smole, Fionnuala Mcaleese, Jutamas Ngampasutadol, C. Fordham Von Reyn, Robert D. Arbeit

Dartmouth Scholarship

Species identification of isolates of the Mycobacterium avium complex (MAC) remains a difficult task. Although M. avium and Mycobacterium intracellulare can be identified with expensive, commercially available probes, many MAC isolates remain unresolved, including those representing Mycobacterium lentiflavum as well as other potentially undefined species. PCR restriction analysis (PRA) of the hsp65 gene has been proposed as a rapid and inexpensive approach. We applied PRA to 278 MAC isolates, including 126 from blood of human immunodeficiency virus (HIV)-infected patients, 59 from sputum of HIV-negative patients with chronic obstructive pulmonary disease, 88 from environmental sources, and 5 pulmonary isolates from …

Strong Partnerships Make Good Partners: Insights About Physician-Hospital Relationships From A Study Of Physician Executives, Marc A. Bard, Michael L. Buehler, Andrew L. Epstein, David B. Nash, John P. O'Connor

College of Population Health Faculty Papers

While physicians are likely to respond favorably in concept to hospital-based disease management and other clinical programs, they are less likely to accept their structural and functional characteristics. Because of their role at the hospital-physician interface, hospital physician executives are often tasked with implementing such programs. Given the challenges involved, a deeper understanding of the role of these executives in building the hospital-physician relationship will therefore be an important contribution. To this end, we surveyed senior physician executives at hospitals and health systems (n = 326), to assess their view of the hospital-physician relationship at their institutions, focusing especially on …

Economic And Health Outcomes Of Capsule Endoscopy: Opportunities For Improved Management Of The Diagnostic Process For Obscure Gastrointestinal Bleeding, Neil I. Goldfarb, Amy Phillips, Mitchell Conn, Blair S. Lewis, David B. Nash

College of Population Health Faculty Papers

The estimated annual incidence of gastrointestinal bleeding in the United States is approximately 100 episodes per 100,000 persons, resulting in 300,000 hospitalizations annually. Diagnostic tools such as radiologic studies and endoscopic examination often fail to identify a source of bleeding, resulting in a cycle of repetitive testing over months or even years. Costs associated with the diagnostic process, and with interim treatment for anemia and other symptoms, can be significant. The diagnostic process also takes a toll on the patient, in terms of worry, pain, and discomfort. Capsule endoscopy, a technology that received FDA clearance in August, 2001, consists of …

Expanding Health Coverage For The Uninsured: Fundamentals Of The Tax Credit Option, Beth Fuchs, Julie James

National Health Policy Forum

This paper seeks to provide the basics for understanding the current debate over tax credits as a vehicle for reducing the number of uninsured Americans and focuses attention on some of the associated issues: How is health insurance treated under current tax law? Why tax credits and not deductions? What are the major issues in designing tax credits? Who should be eligible and for what size credit? What changes, if any, would be needed to the insurance market to ensure that policies are available and affordable for people eligible for tax credits? What are the major issues related to administering …

Schip Turns Five: Taking Stock, Moving Ahead, Jennifer Ryan

National Health Policy Forum

This issue brief notes the five-year anniversary of the effective date of Title XXI of the Social Security Act, the State Children's Health Insurance Program (SCHIP). It looks at the successes of the program, as well as some of the obstacles SCHIP will face as it moves from childhood into adolescence and attempts to maintain its effectiveness in providing health coverage to uninsured children and families. The paper explores the critical funding impasse created by the downturns in the economy and the financing structure of the SCHIP statute. It also highlights the emerging issue of program retention and the need …

The Relationship Of Demographic Characteristics To Consumer Knowledge Of Diet And Health Relationships To Intake Of Soy Foods And Soy Supplements, Ashlyn K. Hosokawa

All-Inclusive List of Electronic Theses and Dissertations

In 1999, the FDA approved a health claim for a relationship between intake of 25 grams of soy protein per day and reduced risk of heart disease. Literature suggests that consumers are increasingly krtowledgeable about diet and disease risk factors. While gender, age, race, and family history cannot be altered, diet may be changed to decrease risks. This study explored the relationship of demographic characteristics to consumer knowledge and use of some of the more popular soy products and supplements. Surveys were completed by a random sample of 100 attendees at area festivals and 100 nutrition professionals at a national …