摘要:

This article documents the process of an outreach program for locating disadvantaged women who, as a group, do not receive prenatal care early and have adverse pregnancy outcomes. Three full-time community residents searched for pregnant women for a year, being paid a commission for each woman that they found who enrolled for antenatal care. Outreach workers spent more than half of their time in the field, contacted 20 to 25 people per day, and used a variety of strategies to locate women. Fifty-two women entered the Harlem Hospital Medical Center health care system through the outreach process, with 104 pregnant women not already receiving antenatal care being identified by the outreach workers. Their effort, conversion rate, and yield were comparable to private sector salespeople. The cost per enrollee was high (although not higher than the cost of additional low-birthweight births). Alternatives for locating pregnant women are suggested.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

One mechanism proposed for encouraging use of prenatal services in lowincome communities involves the employment of community residents to encourage and support individuals in the use of available medical care. This study examines the effect of such workers on the start of prenatal care among a cohort of women receiving prenatal services at clinics affiliated with Harlem Hospital. Of the 599 women enrolling for prenatal care during the intake period for the study, only 52 had had an outreach contact before the start of prenatal care despite extensive field activity. No difference in the week of gestation at the start of prenatal care was noted between those with and without outreach contacts. Controlling for factors associated both with trimester of initiation of prenatal care in this population and with outreach contact did not account for this lack of difference. This type of outreach, known as case-finding, proved to be very labor intensive. Other less costly techniques for encouraging use of services in mobile, urban populations should be sought.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

This study's purpose was to develop a tool that detects, quantifies, and assigns causes for medically unnecessary hospital delays and use it to describe the epidemiology of delays at a teaching tertiary care hospital. Based on observational data, a taxonomy of delays was constructed that included nine major categories and 166 subcategories. This formed the basis for an instrument for detecting inefficiency in hospital care: the Delay Tool. Initially designed for real-time concurrent assessment, in retrospective use it was also reliable, requiring about 6 minutes per medical record. In using the Delay Tool over a 6-month period on general internal medical and gastrointestinal services, it was discovered that 30% of 960 patients experienced delays, the average length of which was 2.9 days. This represented 17% of all hospital days. The most frequent causes of delays were scheduling of tests (31%), unavailability of post-discharge facilities (18%), physician decision-making (13%), discharge planning (12%), and scheduling of surgery (12%). Because of the longer lengths of the delays involved with awaiting postdischarge facilities (primarily nursing home beds), this was the most important cause of delays and represented 41% of all delay days. The general medicine and gastrointestinal services had significantly different distributions of delay types related to their different kinds of patients and care. The Delay Tool should be helpful in addressing hospital, and hospital-related, inefficiencies in health care delivery.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The purpose of the study was to determine the extent to which the existence of inpatient psychiatric units (IPU) in general hospitals is related to patient service “needs,” to certain economic and organizational characteristics of general hospitals, or to both. Area and institutional characteristics of general hospitals in Massachusetts were analyzed with multivariate techniques. Interviews were also conducted with representatives from hospitals and the Massachusetts Department of Mental Health in three mental health catchment areas. Most of the teaching hospitals in the state have IPUs. The study indicated that a statistical difference exists between characteristics of IPU and non-IPU nonteaching general hospitals. The probability that a nonteaching general hospital will have an IPU is related to both market conditions and institutional characteristics of the hospital. Nonteaching general hospitals with IPUs were more likely to be located in areas with higher incomes but fewer office-based psychiatrists per capita. IPU hospitals were also more likely to be larger and to receive a higher percent of their revenues from Medicaid than their non-IPU counterparts. The study did not provide evidence that “need” as defined by traditional indicators was an influential factor in IPU existence.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Little research exists linking social support, stressors, and related nutritional strain (loss of appetite) with the risk of poor nutritional health. Relationships among these concepts were investigated using a sample of elderly Virginians. It was hypothesized that the risk of poor nutritional health (dietary inadequacy) is reduced among elderly with high levels of social support and exacerbated among those experiencing stressful events and strain. Moreover, it was hypothesized that the negative effects of stressful events and strain on the diet are mitigated by high levels of social support. Using multiple regression models, these hypotheses were tested, controlling for age, sex, race, and socioeconomic status. The results indicated that elderly with 1) an extensive friendship network have more adequate diets; 2) greater financial stress experience greater nutritional stress (poorer appetite); and 3) greater nutritional stress have less adequate diets. Moreover, companionship serves as a buffer against the negative effects of poor appetite on dietary intake.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Data Envelopment Analysis (DEA) was used to estimate the relative efficiencies of nursing homes in Maine for 2 years before the introduction of a prospective payment system and for 2 years afterward. A multiple regression was performed in which the DEA-estimated efficiency was the dependent variable and a number of facility characteristics and study year were the independent variables. Study findings indicate that nursing home efficiency scores fell after the introduction of prospective reimbursement; that is, generally speaking, more inputs were being used per unit of output in the period after the introduction of prospective reimbursement than in the period preceding it. This may be the result of poor management, degraded quality of inputs, improved quality of outputs, or some other unobserved trend during this same period. The study also concludes that higher occupancy rates are associated with lower efficiencies and that patients in restraints produce severe negative effects on efficiency. In addition, it appears that a sudden increase in administrative hours in the final study year played a role in that year's lower average efficiency scores, but also that all input levels generally rose while output levels remained virtually constant.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Along with many other states, Wisconsin is considering a case mix approach to Medicaid nursing home reimbursement. To support this effort, a nursing home case mix model was developed from a representative sample of 410 Medicaid nursing home residents from 56 facilities in Wisconsin. The model classified residents into mutually exclusive groups that were homogeneous in their use of direct care resources, i.e., minutes of direct care time (weighted for nurse skill level) over a 7-day period. Groups were defined initially by intense, Special, or Routine nursing requirements. Within these nursing requirement categories, subgroups were formed by the presence/absence of behavioral problems and dependency in activities of daily living (ADL). Wisconsin's current Skilled/Intermediate Care (SNF/ICF) classification system was analyzed in light of the case mix model and found to be less effective in distinguishing residents by resource use. The case mix model accounted for 48% of the variance in resource use, whereas the SNF/ICF classification system explained 22%. Comparisons were drawn with nursing home case mix models in New York State (RUG-II) and Minnesota. Despite progress in the study of nursing home case mix and its application to reimbursement reform, methodologic and policy issues remain. These include the differing operational definitions for nursing requirements and ADL dependency, the inconsistency in findings concerning psychobehavioral problems, and the problem of promoting positive health and functional outcomes based on models that may be insensitive to change in resident conditions over time.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Long-term care is now the most common cause of catastrophic illness costs for the elderly. Although acute care health insurance represents a mature market, private long-term care insurance is in its infancy and poised for development. This study presents a comparative analysis of simulation data, generated from the Brookings-ICF Long-Term Care Financing Model, for five alternative private long-term care insurance models. The simulation results indicate 1) the potential market for private long-term care insurance is substantial, 2) moderately comprehensive long-term care policies are affordable by a significant minority of the elderly, 3) policies are considerably more affordable to those under age 65, and 4) long-term care insurance has somewhat less potential to pay for nursing home costs for high risk groups than for other elderly.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Increased use of antibiotics in any community increases the risks that future bacterial strains will resist the effects of current antibiotics. The consequences of a resistant bacterial strain include costs for more expensive and powerful drugs, additional hospital days, and on rare occasion, death. A key to understanding the importance of this problem is better knowledge about the rate that resistance increases and persists as antibiotic use rates increase. Using the scant evidence available in the literature, this study conducts a sensitivity analysis to calculate the unrecognized costs of antibiotic use annually in the United States under various possible circumstances. For the estimated 150 million annual antibiotic prescriptions, the unrecognized costs appears to be at least $.1 billion, and they may exceed $30 billion in the worst case. The estimates of the burden caused by bacterial resistance to antibiotics depend heavily on unknown parameters, including the rate that resistance occurs, the dose-resistance patterns through time, the frequency of inappropriate use of antibiotics, and the frequency with which death occurs due to a resistant bacterial infection. New studies in each of these areas are needed to improve our understanding of the extent of the resistance problem.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Decision analysis was used to examine the interrelationship of cost and success for an intervention program designed to prevent unexpected readmissions to an acute care hospital. Three separate strategies were considered: 1) intervention for patients who are at high risk for unexpected readmission; 2) intervention for all patients who are admitted to the medical service; and 3) no intervention. Risk and cost data were derived from an analysis of 4,769 patients discharged from Boston's Beth Israel Hospital medical service during a 1-year period. It was found that interventions that cost $250.00 per patient could be cost saving given reasonable expectations of success. If an intervention for high risk patients costs $250.00 per patient, overall costs would be reduced if the success rate of the intervention was 9% or greater. If the success rate exceeded 17%, offering the intervention to all patients would reduce costs. If the cost of an intervention increases by a factor of two, it must be twice as likely to succeed to achieve the same economic benefit. Decision analysis provides a useful framework for evaluation of the economic implications of intervention strategies, and it is recommended that these methods be used in the planning and implementing of medical interventions.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID