Health Services Research Commons^™

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.

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.

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.

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 …

Self-Reported Memory Symptoms With Coronary Artery Disease: A Prospective Of Cabg Patients And Nonsurgical Controls, Ola A. Selnes, Maura A. Grega, Louis M. Borowicz, Jr., Sarah Barry, Scott L. Zeger, Guy M. Mckhann

Johns Hopkins University, Dept. of Biostatistics Working Papers

Background. Subjective memory complaints are common after coronary artery bypass grafting (CABG), but previous studies have concluded that such symptoms are more closely associated with depressed mood than objective cognitive dysfunction. We compared the incidence of self-reported memory symptoms at 3 and 12 months after CABG with that of a control group of patients with comparable risk factors for coronary artery disease but without surgery.

Methods. Patients undergoing CABG (n = 140) and a demographically similar nonsurgical control group with coronary artery disease (n = 92) were followed prospectively at 3 and 12 months. At each follow-up time, participants were …

Impact Of Appropriate Pharmaceutical Therapy For Chronic Conditions On Direct Medical Costs And Workplace Productivity: A Review Of The Literature, Neil Goldfarb, Christine Weston, Christine W. Hartmann, Mirko Sikirica, Albert Crawford, Hope He, Jamie Howell, Vittorio Maio, Janice Clarke, Bhaskar Nuthulaganti, Nicole Cobb

College of Population Health Faculty Papers

This paper presents the findings of a literature review investigating the economic impact of appropriate pharmaceutical therapy in treating four prevalent chronic conditions - asthma, diabetes, heart failure, and migraine. The goal of the review was to identify high-quality studies examining the extent to which appropriate pharmaceutical therapy impacts overall medical expenditure (direct costs) and workplace productivity (indirect costs). The working hypothesis in conducting the review was that the costs of pharmaceuticals for the selected chronic conditions are offset by savings in direct and indirect costs in other areas. The literature provides evidence that appropriate drug therapy improves the health …

The Health Care Safety Net In South Carolina: A Test Of Tenacity, Jennifer Ryan, Randy Desonia

National Health Policy Forum

This site visit to the state of South Carolina provided an opportunity to experience and understand the unique makeup of the health care safety net in a southern state. Site visitors had the opportunity to interact with health care providers, state officials, faith-based organizations and leaders of provider-driven volunteer initiatives. They also learned about the challenges of access to care in rural areas and among diverse population groups. The group visited the Sea Island Medical Center and Our Lady of Mercy Community Outreach and Wellness House; a migrant farm worker camp on Johns Island; and a “medical home” site, Medical …

Single-Payer National Health Insurance: Physicians' Views, Danny Mccormick, David U. Himmelstein, Stephanie Woolhandler, David H. Bor

Publications and Research

Background
Forty-one million Americans have no health insurance and, despite the growth of managed care, medical costs are again increasing rapidly. One proposed solution is a single-payer health care financing system with universal coverage. Yet, physicians' views of such a system have not been well studied.

Methods
We surveyed a random sample of physicians (from the American Medical Association Masterfile) in Massachusetts, regarding their views on a single-payer health care financing system and other financing and physician work-life issues that such a system might affect.

Results
Of 1787 physicians, 904 (50.6%) responded to our survey. When asked which structure would …

The Frank J. Manning Certificate In Gerontology Alumni Survey: 21 Years Of Service To Elders, Nina M. Silverstein, Jenai Murtha, Donna Sullivan, May Jawad

Gerontology Institute Publications

The Certificate Program in Gerontology at the University of Massachusetts Boston, a large urban university, was established in 1979 as part of an Administration on Aging (AoA) grant to develop and expand services to the elderly citizens of the Commonwealth of Massachusetts. In 1984, a line item was added to the state budget by the legislature and governor establishing the Gerontology Institute at the University of Massachusetts Boston and ensuring the continuation of training, research, and policy and advocacy work on behalf of and with Massachusetts’ elders (O’Brien, 1996). Upon Frank J. Manning’s death in 1986, the program was renamed …

Incorporating Death Into Health-Related Variables In Longitudinal Studies, Paula Diehr, Laura Lee Johnson, Donald L. Patrick, Bruce Psaty

UW Biostatistics Working Paper Series

Background: The aging process can be described as the change in health-related variables over time. Unfortunately, simple graphs of available data may be misleading if some people die, since they may confuse patterns of mortality with patterns of change in health. Methods have been proposed to incorporate death into self-rated health (excellent to poor) and the SF-36 profile scores, but not for other variables.

Objectives: (1) To incorporate death into the following variables: ADLs, IADLs, mini-mental state examination, depressive symptoms, body mass index (BMI), blocks walked per week, bed days, hospitalization, systolic blood pressure, and the timed walk. (2) To …

Democratic Ideas To Address The Problem Of Americans Without Health Insurance, Jeanne Lambrew

Health Policy and Management Congressional Testimonies

No abstract provided.

Lack Of Chart Reminder Effectiveness On Family Medicine Resident Jnc-Vi And Ncep Iii Guideline Knowledge And Attitudes, Paul S. Echlin, Ross Eg Upshur, Tsveti P. Markova

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

The literature demonstrates that medical residents and practicing physicians have an attitudinal-behavioral discordance concerning their positive attitudes towards clinical practice guidelines (CPG), and the implementation of these guidelines into clinical practice patterns.

Methods

A pilot study was performed to determine if change in a previously identified CPG compliance factor (accessibility) would produce a significant increase in family medicine resident knowledge and attitude toward the guidelines. The primary study intervention involved placing a summary of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) and the National Cholesterol …

Effects And Cost Of Implementing A Gender-Sensitive Reproductive Health Program In Bolivia, Erica Palenque, Lizzy Montano, Ricardo Vernon, Fernando Gonzales Salguero, Patricia Riveros, John H. Bratt

Reproductive Health

The Integral Health Coordination Program (Programa de Coordinación en Salud Integral or PROCOSI), a network of 24 Bolivian NGOs, and the Population Council’s Frontiers in Reproductive Health (FRONTIERS) program evaluated the effects of interventions on clinic clients and their partners, and estimated the costs of incorporating a gender perspective into service delivery. Results show that sexual and reproductive health service organizations can implement action plans to change organizational policies and service delivery practices and to improve their infrastructure and equipment to make them more convenient for clients. The results further show that the intervention made modest but important changes in …

Introduction Of Emergency Contraception In Bangladesh: Using Operations Research For Policy Decisions, M.E. Khan, Sharif M.I. Hossain, Md. Moshiur Rahman

Reproductive Health

The Directorate of Family Planning, Bangladesh, the Population Council, Pathfinder International, and John Snow Incorporated collaborated to conduct this operations research study to assess the acceptability and feasibility of providing emergency contraception pills (ECP) as a backup support to existing family planning methods. The study demonstrated that all categories of health providers, including NGO outreach workers, could be effectively trained to provide ECP services. The study also demonstrated high acceptability of ECP and revealed that if used correctly, the success rate in avoiding unwanted pregnancy was extremely high. The positive findings of the study have helped the Ministry of Health …

Improving Adolescent Reproductive Health In Bangladesh, Ismat Bhuiya, Ubaidur Rob, Asiful Haider Chowdhury, Laila Rahman, Nazmul Haque, Susan E. Adamchak, Rick Homan, M.E. Khan

Reproductive Health

An operations research project was launched in northwestern Bangladesh with the objective of preventing adverse outcomes and promoting healthy lifestyles among adolescents by providing reproductive health education and services. The Population Council, in collaboration with the Urban Family Health Partnership and its three nongovernmental service delivery partners, worked in three urban areas of the country. On the basis of its findings, the study first recommends implementation of a combination of reproductive health interventions at the school, community, and health-facility levels, accompanied by community sensitization, to effectively respond to adolescent reproductive health needs. Second, information providers such as teachers and facilitators …

Evaluation Of Community Education Interventions In Sexual And Reproductive Health Services In Urban-Marginal Areas Of La Paz, Bolivia, Maria Dolores Castro Mantilla, Mariel Loayza Antezana

Reproductive Health

The purpose of this study was to strengthen community strategies to improve quality-of-care services first implemented as part of a Bolivian Ministry of Health and Prevention and World Health Organization (WHO) project in 1997–98. To reach groups that do not regularly attend health facilities and improve community demand for services, the Centro de Información y Desarrollo de la Mujer (Center for Information and Development of Women) implemented a community education intervention focusing on sexual and reproductive health and rights targeting adolescents, men, and women with older or no children. Results showed that the interventions improved access to and utilization of …

Impact Of Improved Client-Provider Interaction On Women's Achievement Of Fertility Goals In Egypt, Laila Nawar, Ibrahim Kharboush, Magdi A. Ibrahim, Hesham Makhlouf, Susan E. Adamchak

Reproductive Health

A two-phase operations research study was launched in Egypt in early 2000 with the goal of demonstrating how improving the quality of client–provider interaction (CPI) could be achieved in large healthcare systems, specifically in relation to family planning. The study was designed to explore how CPI improvements could enhance family planning knowledge, method continuation rates, client satisfaction, and achievement of fertility goals. Client outcome variables were expected to improve as a result of improving client–provider interaction. The study recommends continued development and testing of innovative, attractive, and well-designed IEC messages that influence woman's fertility preferences; continuous training of health providers; …

Mental Health Of Incarcerated Juveniles In Nevada: Final Report, Nevada Institute For Children's Rerearch And Policy, University Of Nevada, Las Vegas, Jennifer Petsonius, Denise Tanata, Michelle Chino Dr

Nevada Institute for Children's Research and Policy Reports

The prevalence of mental health problems in the juvenile offender population is substantially higher than that of the general population (Cocozza & Skowyra, 2000). Studies estimate that one in five juvenile offenders has serious mental health problems, which is nearly twice the rate of occurrence of mental illness in children and adults in the general population (NMHA Fact Sheet #l). However, there have been several methodological problems encountered in previous research. These include the use of inconsistent definitions and measurements of mental illness; the use of biased, nonrandom samples, a reliance on retrospective case report data, and the use of …

Optimization Of Breast Cancer Screening Modalities, Yu Shen, Giovanni Parmigiani

Johns Hopkins University, Dept. of Biostatistics Working Papers

Mathematical models and decision analyses based on microsimulations have been shown to be useful in evaluating relative merits of various screening strategies in terms of cost and mortality reduction. Most investigations regarding the balance between mortality reduction and costs have focused on a single modality, mammography. A systematic evaluation of the relative expenses and projected benefit of combining clinical breast examination and mammography is not at present available. The purpose of this report is to provide methodologic details including assumptions and data used in the process of modeling for complex decision analyses, when searching for optimal breast cancer screening strategies …

Maine Employer Experience And Perceptions Related To Providing Health Insurance: 2003 Summary Report, Gino Nalli, Elizabeth Kilbreth

Disability & Aging

No abstract provided.

Inadequate Physician Knowledge Of The Effects Of Diet On Blood Lipids And Lipoproteins., Mary M. Flynn, Chris N. Sciamanna, Kevin C. Vigilante

College of Population Health Faculty Papers

BACKGROUND:To assess the nutrition knowledge of physicians on the basic effects of diet on blood lipids and lipoproteins.

METHODS:Anonymous mailed dietary knowledge surveys to 6000 randomly selected physicians in the United States licensed in either Internal Medicine or Cardiology.RESULTS:Response rate: 16% (n = 639). Half of the physicians did not know that canola oil and 26% did not know olive oil were good sources of monounsaturated fat. Ninety-three percent (84% of cardiologists vs. 96% of internists; p < 0.001) did not know that a low-fat diet, in general, would increase blood triglycerides. Approximately three-quarters (70% of cardiologists vs. 77% of internists; p < 0.01) did not know a low-fat diet would decrease HDL-c and almost half (45%) thought that a low-fat diet would not change HDL-c.

CONCLUSIONS:If physicians are to implement dietary and cholesterol management guidelines, they will likely need to become more knowledgeable about nutrition.

Smooth Quantile Ratio Estimation With Regression: Estimating Medical Expenditures For Smoking Attributable Diseases, Francesca Dominici, Scott L. Zeger

Johns Hopkins University, Dept. of Biostatistics Working Papers

In this paper we introduce a semi-parametric regression model for estimating the difference in the expected value of two positive and highly skewed random variables as a function of covariates. Our method extends Smooth Quantile Ratio Estimation (SQUARE), a novel estimator of the mean difference of two positive random variables, to a regression model.

The methodological development of this paper is motivated by a common problem in econometrics where we are interested in estimating the difference in the average expenditures between two populations, say with and without a disease, taking covariates into account. Let Y1 and Y2 be two positive …

Bridging Silos, Part Ii: Di, Ssi, Medicare, And Medicaid Issues And Initiatives, Karen Matherlee

National Health Policy Forum

The second of two papers on the general topic of public disability and health benefits, this background paper lays out some key issues confronting the Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid programs. It also discusses major initiatives to address those issues, in light of growing administrative, fiscal, and other problems.

Bridging Silos, Part I: Linkages Among The Di, Ssi, Medicare, And Medicaid Programs, Karen Matherlee

National Health Policy Forum

This paper, the first of two on the general topic of public disability and health benefits, centers on the fundamentals of the Disability Insurance and Supplemental Security Income programs and their relationships with Medicare and Medicaid. In addition to looking at the programs’ definitions, distinctions, and overlaps, it reviews the effects on them of the Ticket to Work and Work Incentives Improvement Act of 1999 and, to a lesser extent, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

Sailing Schip Through Troubled Waters, Jennifer Ryan

National Health Policy Forum

As the State Children’s Health Insurance Program (SCHIP) enters its sixth year of operation, states have continued their commitment to children’s coverage and to reaching out to the uninsured. This issue brief explores the current status of SCHIP in light of fiscal pressures that have been created by the state budget crisis. It highlights some of the key successes in the program thus far and notes several examples of state initiatives to serve particularly vulnerable populations and collect outcomes data and information about access to care.

Rural Health Care In The Electronic Age (Danville, Pa), Lisa Sprague, Nora Super

National Health Policy Forum

This site visit to the Geisinger Health System in central Pennsylvania explored the use of technology in providing health care to an aging, rural population with a high index of chronic-care needs. The agenda included an in-depth examination of Geisinger’s electronic medical record and its use in various domains of care, including outpatient clinics, disease management, and non-Geisinger medical practices and community hospitals. The program also highlighted specific care management initiatives in the areas of radiology, stroke, and obesity. Geisinger’s advantages as an integrated system dominant in its market, with the resources to invest in technology were weighed in considering …

Decreasing Barriers For Teens: Evaluation Of A New Teenage Pregnancy Prevention Strategy In School-Based Clinics, Abbey C. Sidebottom, Amanda Birnbaum, Sarah S. Nafstad

Department of Public Health Scholarship and Creative Works

Sidebottom et al seek to evaluate the effects of the change in distribution systems on students' receipt of requested contraceptives and demand for contraceptive school-based clinics (SBC). The result of the study reveals that the average number of requests per student was higher under the voucher system, possibly as a consequence of expires vouchers resulting in repeated requests. The findings also suggest that SBCs could go a step further in reducing adolescents' barriers to accessing contraceptives by adopting an on-site direct delivery system..

Overview, David B. Nash

College of Population Health Faculty Papers

No abstract available.

Smooth Quantile Ratio Estimation, Francesca Dominici, Leslie Cope, Daniel Q. Naiman, Scott L. Zeger

Johns Hopkins University, Dept. of Biostatistics Working Papers

In a study of health care expenditures attributable to smoking, we seek to compare the distribution of medical costs for persons with lung cancer or chronic obstructive pulmonary disease (cases) to those without (controls) using a national survey which includes hundreds of cases and thousands of controls. The distribution of costs is highly skewed toward larger values, making estimates of the mean from the smaller sample dependent on a small fraction of the biggest values. One approach to deal with the smaller sample is to rely on a simple parametric model such as the log-normal, but this makes the undesirable …

Dually Eligible For Medicare And Medicaid: Two For One Or Double Jeopardy?, Jennifer Ryan, Nora Super

National Health Policy Forum

This issue brief describes the characteristics of the population of individuals known as “dual eligibles,” who are eligible for health insurance coverage through both Medicare and Medicaid. It also looks at the differences between “full Medicaid” and “supplemental Medicaid” dual eligibles and the ongoing challenges associated with enrollment and eligibility, integration and coordination, and managed care. The paper presents several examples of integrated care programs designed to better serve the dual-eligible population, including the Program of All-Inclusive Care for the Elderly, Evercare, social health maintenance organizations, and state/federal initiatives such as the Wisconsin Partnership Program, Texas STAR+PLUS, and others. Finally, …